JAIDS Journal of Acquired Immune Deficiency Syndromes
Epidemiology and Social Science
Childhood Sexual Abuse Is Highly Associated With HIV Risk-Taking Behavior and Infection Among MSM in the EXPLORE Study
Mimiaga, Matthew J ScD, MPH*†; Noonan, Elizabeth MS‡; Donnell, Deborah PhD‡; Safren, Steven A PhD*†; Koenen, Karestan C PhD§; Gortmaker, Steven PhD§; O'Cleirigh, Conall PhD*†; Chesney, Margaret A PhD‖; Coates, Thomas J PhD¶; Koblin, Beryl A PhD#; Mayer, Kenneth H MD†**
From the *Departments of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA; †Epidemiology Unit, The Fenway Institute, Fenway Community Health, Boston, MA; ‡Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA; §Departments of Society, Human Development and Health, and Epidemiology, Harvard School of Public Health, Boston, MA; ‖Center for AIDS Prevention Studies, The University of California at San Francisco, San Francisco, CA; ¶The University of California Los Angeles School of Medicine, Los Angeles, CA; #New York Blood Center, New York, NY; and **Departments of Infectious Diseases and Community Health, Miriam Hospital, Brown Medical School, Providence, RI.
Received for publication October 6, 2008; accepted February 5, 2009.
Supported by the HIV Network for Prevention Trials and sponsored by the US National Institute of Allergy and Infectious Diseases and the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health-Department of Health and Human Services, through contract N01 AI35176 with Abt Associates, Inc; contract N01 AI45200 with the Fred Hutchinson Cancer Research Center; and subcontracts with the Denver Public Health, the Fenway Community Health Center, the Howard Brown Health Center, the New York Blood Center, the Public Health Foundation, Inc, and the University of Washington. In addition, this work was supported by the HIV Prevention Trials Network and sponsored by the National Institute of Allergy and Infectious Diseases, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, the National Institute of Mental Health, and the Office of AIDS Research of the National Institutes of Health-US Department of Health and Human Services, through a cooperative agreement with Family Health International (cooperative agreement 5 U01 AI46749) with a subsequent subcontract to Abt Associates, Inc, with subcontracts to the Howard Brown Health Center and Denver Public Health; cooperative agreement U01 AI48040 to the Fenway Community Health Center; cooperative agreement U01 AI48016 to Columbia University (including a subagreement with the New York Blood Center); cooperative agreement U01 AI47981 to the University of Washington; and cooperative agreement U01 AI47995 to the University of California, San Francisco.
Correspondence to: Dr. Matthew J. Mimiaga, ScD, MPH, The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215 (e-mail: [email protected]).
JAIDS Journal of Acquired Immune Deficiency Syndromes 51(3):p 340-348, July 2009. | DOI: 10.1097/QAI.0b013e3181a24b38
Abstract
Background:
Previous studies have found high rates of childhood sexual abuse (CSA) among US men who have sex with men (MSM). CSA history has been associated with a variety of negative effects later in life including behaviors that place MSM at greater risk for HIV acquisition and transmission. The present analysis is the first to examine the longitudinal association between CSA and HIV infection, unprotected anal sex, and serodiscordant unprotected anal sex, as well as mediators of these relationships among a large sample of HIV-uninfected MSM.
Methods:
The EXPLORE Study was a behavioral intervention trial conducted in 6 US cities over 48 months with HIV infection as the primary efficacy outcome. Behavioral assessments were done every 6 months via confidential computerized assessments. Longitudinal regression models were constructed, adjusting for randomization arm, geographical location of study site, age at enrollment, education, and race/ethnicity.
Results:
Of the 4295 participants enrolled, 39.7% had a history of CSA. Participants with a history of CSA [adjusted hazards ratio = 1.30, 95% confidence interval (CI): 1.02 to 1.69] were at increased risk for HIV infection over study follow-up. A significant association was seen between history of CSA and unprotected anal sex (adjusted odds ratio = 1.24, 95% CI: 1.12 to 1.36) and serodiscordant unprotected anal sex (adjusted odds ratio = 1.30, 95% CI: 1.18 to 1.43). Among participants reporting CSA, the EXPLORE intervention had no effect in reducing HIV infection rates. Participants reporting CSA were significantly more likely to have symptoms of depression and use nonprescription drugs.
Conclusions:
A predictive relationship between a history of CSA and subsequent HIV infection was observed among this large sample of HIV-uninfected MSM. Findings indicate that HIV-uninfected MSM with CSA histories are at greater risk for HIV infection, report higher rates of HIV sexual risk behavior, and may derive less benefit from prevention programs. Future HIV prevention interventions should address the specific mental health concerns of MSM with a history of CSA.