Dataset Information

Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial.

ABSTRACT: To address childhood sexual abuse (CSA) related distress and HIV risk in men who have sex with men (MSM) using cognitive-behavioral therapy for trauma and self-care (CBT-TSC), which is a novel intervention integrating HIV risk reduction with modified cognitive and behavioral therapy strategies for post-traumatic stress. We compared CBT-TSC to HIV voluntary counseling and testing (VCT)-only in an initial 2-arm RCT in 43 HIV-negative MSM at with a history of CSA and HIV risk. Serodiscordant condomless anal/vaginal sex (CAS; CAS with HIV-postive or HIV unknown status partners) and posttraumatic stress disorder (PTSD) symptoms (Davidson Trauma Scale: total score and avoidance, intrusions, hyperarousal subscales) were outcomes immediately post-treatment, and at 6- and 9-month follow-up. At post-treatment, CBT-TSC had decreased odds (approximately 60%) of any CAS and greater reductions in CAS compared to VCT-only. Additionally, the CBT-TSC condition experienced greater reductions in total PTSD and avoidance symptoms. At the follow-up visits, CBT-TSC condition had significant reductions in the odds of any CAS and reductions in CAS. However, for PTSD symptoms, only the avoidance subscale remained significantly different compared to VCT-only. CBT-TSC is a potentially efficacious approach to address HIV risk in MSM with a CSA history, with replication and extension in a larger trial needed. This proof-of-concept trial is the first to integrate the treatment of a commonly occurring mental-health syndemic problem in MSM with a health psychology approach to self-care in MSM.Trial Registration Clinicaltrials.gov NCT01266122.

SUBMITTER: O'Cleirigh C

PROVIDER: S-EPMC7271561 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial.

O'Cleirigh Conall C Safren Steven A SA Taylor S Wade SW Goshe Brett M BM Bedoya C Andres CA Marquez Samantha M SM Boroughs Michael S MS Shipherd Jillian C JC

AIDS and behavior 20190901 9

To address childhood sexual abuse (CSA) related distress and HIV risk in men who have sex with men (MSM) using cognitive-behavioral therapy for trauma and self-care (CBT-TSC), which is a novel intervention integrating HIV risk reduction with modified cognitive and behavioral therapy strategies for post-traumatic stress. We compared CBT-TSC to HIV voluntary counseling and testing (VCT)-only in an initial 2-arm RCT in 43 HIV-negative MSM at with a history of CSA and HIV risk. Serodiscordant condom ...[more]

PMID: 30993478

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Project description:BackgroundThe 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.MethodsBlack 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.ResultsMore 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).ConclusionsAmong 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.

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:As they age, people living with HIV (PLWH) experience greater rates of inflammation-related health conditions compared to their HIV-negative peers. Because early life adversity can exaggerate proinflammatory effects of later physiological challenges, inflammation may be higher among PLWH with these combined risks, which could inform intervention approaches to mitigate multimorbidity. In this cross-sectional analysis, we investigated individual and combined effects of childhood sexual abuse (CSA) history and physiological burden (Veterans Aging Cohort Study Index scores) on serum cytokine and C-reactive protein (CRP) levels among PLWH. Participants (n = 131; age 54 and older) were patients at an outpatient HIV clinic who completed a psychosocial survey and biomedical research visit as part of a larger study. 93% were virally suppressed, and 40% reported experiencing sexual abuse in childhood. Composite cytokine levels (summarizing IL-6, TNF-α, IFN-γ), CRP, and disease burden did not differ significantly between those who had a history of CSA and those who did not. Participants with greater disease burden had higher composite cytokine levels (r = 0.29, p = 0.001). The disease burden by CSA interaction effect was a significant predictor of composite cytokine levels (but not CRP), and remained significant after controlling for age, sex, race, BMI, anti-inflammatory medication use, selective serotonin reuptake inhibitor use, depressive symptoms, and smoking status (F(1, 114) = 5.68, p = 0.02). In follow-up simple slopes analysis, greater disease burden was associated with higher cytokine levels among those with CSA history (b = 0.03, SE = 0.008, p<0.001), but not among those without CSA history. Further, in the context of greater disease burden, individuals with a CSA history tended to have higher cytokine levels than those without a CSA history (b = 0.38, SE = 0.21, p = 0.07). These data suggest that the physiological sequelae of childhood trauma may persist into older age among those with HIV. Specifically, links between physiological burden and inflammation were stronger among survivors of CSA in this study. The combined presence of CSA history and higher disease burden may signal a greater need for and potential benefit from interventions to reduce inflammation, an area for future work.

Dataset Information

Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial.

Publications

Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial.

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