Relation of Childhood Sexual Abuse, Intimate Partner Violence, and Depression to Risk Factors for HIV Among Black Men Who Have Sex With Men in 6 US Cities

摘要

Objectives. We assessed the relation of childhood sexual abuse (CSA), intimate partner violence (IPV), and depression to HIV sexual risk behaviors among Black men who have sex with men (MSM). Methods. Participants were 1522 Black MSM recruited from 6 US cities between July 2009 and December 2011. Univariate and multivariable logistic regression models were used. Results. Participants reported sex before age 12 years with someone at least 5 years older (31.1%), unwanted sex when aged 12 to 16 years (30%), IPV (51.8%), and depression (43.8%). Experiencing CSA when aged 12 to 16 years was inversely associated with any receptive condomless anal sex with a male partner (adjusted odds ratio [AOR]?=?0.50; 95% confidence interval [CI]?=?0.29, 0.86). Pressured or forced sex was positively associated with any receptive anal sex (AOR?=?2.24; 95% CI?=?1.57, 3.20). Experiencing CSA when younger than 12 years, physical abuse, emotional abuse, having been stalked, and pressured or forced sex were positively associated with having more than 3 male partners in the past 6 months. Among HIV-positive MSM (n?=?337), CSA between ages 12 and 16 years was positively associated with having more than 3 male partners in the past 6 months. Conclusions. Rates of CSA, IPV, and depression were high, but associations with HIV sexual risk outcomes were modest. Despite significant medical advances, the HIV epidemic remains a health crisis in Black communities. The Black population represents only 14% of the total US population but accounted for 44% of all new HIV infection (68.9 of 100?000) in 2010. 1 Black men who have sex with men (MSM) are disproportionately impacted by HIV compared with other racial/ethnic groups of MSM. 1,2 Male-to-male sexual contact accounted for 72% of new infections among all Black men. 1 Young Black MSM (aged 13–24 years) have a greater number of new infections than any other age or racial group among MSM. 1 Researchers have been challenged with developing HIV prevention strategies for Black MSM. 3–7 Higher frequencies of sexual risk behaviors, substance use, and nondisclosure of sexual identities do not adequately explain this disparity. 8,9 High rates of sexually transmitted infections (STIs), which facilitate HIV transmission, and undetected or late diagnosis of HIV infection only partially explain disproportionate HIV rates. 8 Researchers have begun to examine a constellation of health factors that may contribute to HIV among MSM. For example, syndemic theory or the interaction of epidemics synergistically, such as intimate partner violence (IPV) and depression, may help explain HIV-related sexual risk behaviors among Black MSM. 9 Childhood sexual abuse (CSA), IPV, and mental health disorders including depression may comprise such a constellation and warrant further exploration. Experiences of CSA have been identified as being associated with negative sexual health outcomes, with MSM reporting higher CSA rates than the general male population. 10–12 Men with CSA experiences are more likely than men without CSA experiences to engage in high-risk sexual behaviors, 13–21 have more lifetime sexual partners, 13–16 use condoms less frequently, 13,14,16 and have higher rates of STIs, 13,14,17 exchanging sex for drugs or money, 13,14,17 HIV, 13,14 alcohol and substance use, 13–21 and depression. 13–15,18,21 Such findings suggest that sexual risk reduction counseling may need to be tailored for MSM with CSA experiences. 15 Childhood sexual abuse histories have also been correlated with sexual revictimization, including IPV. 22–24 One study with population-based estimates of CSA found that gay and bisexually identified men had higher odds of reporting CSA (9.5 and 12.8, respectively) compared with heterosexual men. 25 For sexual minority men, CSA histories were associated with higher HIV and STI incidence. 25 However, research examining CSA, revictimization, and sexual risk behaviors is lacking among Black MSM. In one existing study, Black and Latino MSM with CSA histories identified their trauma experiences as influencing their adult sexual decision-making. 26 Among Black MSM in 2 additional studies, emotional distress and substance use were attributed to having CSA experiences (Leo Wilton, PhD, written communication, October 2, 2013). 27 In an ethnically diverse sample of 456 HIV-positive MSM, CSA was associated with insertive and receptive condomless anal sex. 19 Similar to CSA, IPV has not been extensively examined among MSM or Black MSM, 28 but may be associated with sexual risk behaviors. Intimate partner violence is defined as a pattern of controlling, abusive behavior within an intimate relationship that may include physical, psychological or emotional, verbal, or sexual abuse. 29 Little research exists on IPV among same-sex couples despite incidence rates being comparable to or greater than that of heterosexual women. 28,30–34 Important IPV information comes from the National Intimate Partner and Sexual Violen