Dataset Information

Childhood sexual abuse among Black men who have sex with men: A cornerstone of a syndemic?

ABSTRACT:

Background

The sequelae of childhood sexual abuse (CSA) includes HIV infection, engagement in HIV risk behaviors, substance misuse, and intimate partner violence (IPV). Although Black men who have sex with men (MSM) are disproportionately infected with HIV in the U.S.-especially in urban locations such as New York City-there is limited research with larger samples of Black MSM of varied HIV status regarding the prevalence of CSA and the potential negative consequence with respect to a "syndemic," i.e., the co-occurrence of adverse conditions such as HIVrisk, substance misuse, and IPV.

Methods

Black MSM (N = 1,002) recruited in New York City from 2009-2015 completed a screening assessment eliciting self-reported data on age, CSA, self-reported HIV status, number of male sexual partners, number of acts of condomless anal intercourse (CAI), substance misuse, and IPV. Hypothesis testing utilized logistic and linear regression models with self-reported data on CSA (independent variable) and indicators of the following syndemic factors: HIV risk, substance misuse, and IPV.

Results

More than one-fourth (28.1%) met criteria for experiencing CSA. CSA was associated with significantly greater odds of being HIV-positive (AOR = 1.5; 95% CI = 1.1-2.0); number of male sexual partners (b = 2.0, SE = 0.5, p = .002) and condomless acts of anal intercourse (b = 4.3, SE = 1.6, p = .007); odds of binge drinking (AOR = 1.5; 95% CI = 1.1-2.0) and illicit substance use (AOR = 1.5; 95% CI = 1.1-2.0); and odds of experiencing current IPV (AOR = 1.7; 95% CI = 1.2-2.3). CSA was associated with significantly greater odds of concurrently experiencing 2 or more syndemic factors (AOR = 2.0, 95% CI = 1.4-2.9, p < .001); concurrently experiencing 2 or more syndemic factors was significantly associated with having a riskier HIV status (for being HIV-positive: AOR = 1.5, 95% CI = 1.1-2.1, p = .02; for having an unknown HIV status: AOR = 3.7, 95% CI = 1.9-12.9, p = .04).

Conclusions

Among Black MSM, CSA is a prevalent problem and is a significant antecedent to HIV, substance misuse, and IPV indicators and risk. Addressing CSA may be a valuable approach to remedy the syndemic of HIV, substance misuse, and violence that has burdened MSM, especially Black MSM, in the U.S.

SUBMITTER: Wu E

PROVIDER: S-EPMC6211721 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Childhood sexual abuse among Black men who have sex with men: A cornerstone of a syndemic?

Wu Elwin E

PloS one 20181101 11

<h4>Background</h4>The sequelae of childhood sexual abuse (CSA) includes HIV infection, engagement in HIV risk behaviors, substance misuse, and intimate partner violence (IPV). Although Black men who have sex with men (MSM) are disproportionately infected with HIV in the U.S.-especially in urban locations such as New York City-there is limited research with larger samples of Black MSM of varied HIV status regarding the prevalence of CSA and the potential negative consequence with respect to a "s ...[more]

PMID: 30383859

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Project description:BackgroundChildhood sexual abuse (CSA) is a significant global public health problem, which is associated with negative psychosocial outcomes and high-risk sexual behaviors in adults. Men who have sex with men (MSM) often report higher prevalence of CSA history than the general population, and CSA may play a key role in MSM's greater vulnerability to HIV.MethodsThis study examined the prevalence of CSA history and its impact on the number of recent HIV-related risk behaviors (unprotected anal intercourse, high number of male and female sexual partners, alcohol use, drug use, and sex work in prior 6 months) and lifetime risk behaviors and experiences (high number of lifetime male and female sexual partners, early sexual debut, injection drug use, sex work, and intimate partner violence) among 11,788 adult MSM recruited via respondent driven sampling across 12 sites in India, with additional insights from thematic analysis of qualitative research with 363 MSM from 15 sites.ResultsNearly a quarter (22.4 %) of participants experienced CSA, with substantially higher prevalence of CSA in the South and among kothis (feminine sexual identity). Qualitative findings revealed that older, trusted men may target young and, especially, gender nonconforming boys, and perpetrators' social position facilitates nondisclosure. CSA may also initiate further same-sex encounters, including sex work. In multivariable analysis, MSM who experienced CSA had 21 % higher rate of recent (adjusted rate ratio [aRR = 1.21], 95 % confidence interval [CI]: 1.14-1.28), and 2.0 times higher lifetime (aRR = 2.04, 95 % CI: 1.75-2.38) HIV-related behaviors/experiences compared with those who did not.ConclusionThis large, mixed-methods study found high overall prevalence of CSA among MSM (22.4 %), with substantially higher prevalence among MSM residing in the South and among more feminine sexual identities. Qualitative findings highlighted boys' vulnerabilities to CSA, especially gender nonconformity, and CSA's role in further sexual encounters, including sex work. Additionally, CSA was associated with an elevated rate of recent, and an even higher rate of lifetime HIV-related risk factors. Our results suggest an acute need for the development of CSA prevention interventions and the integration of mental health services for MSM with histories of CSA as part of HIV-prevention efforts.

Project description:BackgroundThe prevalence of childhood sexual abuse (CSA) is high among Western men who have sex with men (MSM), and CSA is associated with certain socio-demographic variables and with human immunodeficiency virus (HIV) status. Little is known about CSA among Chinese MSM; therefore, we explored the prevalence and frequency of non-contact (e.g., sexual invitations, exhibitionism) and contact (e.g., intercourse, genital contact) forms of CSA in an Internet-based sample of MSM in China. We also examined the associations between the participants' socio-demographic characteristics and HIV status, and their histories of CSA.MethodsWe surveyed MSM from 30 Chinese provinces in 2014-2015; 1,030 (mean age = 25.15 years, SD = 6.32) and 1,020 (mean age = 25.05 years, SD = 5.95) respondents were eligible for inclusion in the non-contact and contact CSA groups, respectively.ResultsPrevalence of non-contact and contact CSA was 36.2% and 29.8%, respectively; 20.4% and 15.0% had experienced non-contact and contact CSA ≥ 3 times, respectively. Most respondents were young adults, well educated, single, had never "come out," and self-identified as gay or bisexual men. Univariate analyses showed that respondents who had experienced contact CSA were more likely to be HIV-positive than those who had never experienced contact CSA. Multivariate analyses showed that non-contact CSA was associated with less education, being in a relationship with a woman or a man, and having "come out." Contact CSA was associated with less education, higher income, and being in a relationship with a man. Respondents who had experienced non-contact CSA ≥ 3 times were more likely to be less educated, "out," and to be in a relationship with a woman or a man. Respondents who had experienced contact CSA ≥ 3 times were more likely to be less educated and to be in a relationship with a man.ConclusionsIt is necessary to pay closer attention to CSA among MSM and other sexual minorities in China.

Project description:Sexual networks may place U.S. Black men who have sex with men (MSM) at increased HIV risk.Self-reported egocentric sexual network data from the prior six months were collected from 1,349 community-recruited Black MSM in HPTN 061, a multi-component HIV prevention intervention feasibility study. Sexual network composition, size, and density (extent to which members are having sex with one another) were compared by self-reported HIV serostatus and age of the men. GEE models assessed network and other factors associated with having a Black sex partner, having a partner with at least two age category difference (age difference between participant and partner of at least two age group categories), and having serodiscordant/serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last six months.Over half had exclusively Black partners in the last six months, 46% had a partner of at least two age category difference, 87% had ≤5 partners. Nearly 90% had sex partners who were also part of their social networks. Among HIV-negative men, not having anonymous/exchange/ trade partners and lower density were associated with having a Black partner; larger sexual network size and having non-primary partners were associated with having a partner with at least two age category difference; and having anonymous/exchange/ trade partners was associated with SDUI. Among HIV-positive men, not having non-primary partners was associated with having a Black partner; no sexual network characteristics were associated with having a partner with at least two age category difference and SDUI.Black MSM sexual networks were relatively small and often overlapped with the social networks. Sexual risk was associated with having non-primary partners and larger network size. Network interventions that engage the social networks of Black MSM, such as interventions utilizing peer influence, should be developed to address stable partnerships, number of partners, and serostatus disclosure.

Dataset Information

Childhood sexual abuse among Black men who have sex with men: A cornerstone of a syndemic?

Background

Methods

Results

Conclusions

Publications

Childhood sexual abuse among Black men who have sex with men: A cornerstone of a syndemic?

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