UCSF study finds gay/bisexual men who were sexually abused as children are more likely to engage in unsafe sex

Men who have sex with men (MSM) who are victims of childhood sexual abuse are more likely to engage in risky sexual behavior than other MSMs, say researchers from UCSF's Center for AIDS Prevention (CAPS).

The study, published in the April issue of Child Abuse & Neglect, found that about one fifth (20.6%) of all MSMs experienced childhood sexual abuse--a rate that is higher than prevalence estimates for the general male population. These men's early sexual victimization experiences typically involved physical force, penetrative sex, and were highly distressing. Researchers found that greater severity of childhood abuse (more incidents) was associated with higher rates of risky sexual behavior. Findings were similar using two different definitions of risky sexual behavior (unprotected anal intercourse with a non-primary partner; unprotected anal intercourse with a male whose HIV status was different from their own). As further evidence of their greater sexual risk-taking, those reporting childhood sexual abuse were more likely to be HIV-positive (24% vs. 14%).

To understand better the linkages between childhood sexual abuse and current sexual risk, the researchers examined other behaviors that are both associated with sexual risk taking and with childhood sexual abuse. The study found that the men who had been victimized had higher rates of sex under the influence of alcohol/drugs, "one-night stands," and intimate partner violence, the researchers said. The current risk behavior of sexually abused men could be related to these variables, which were also linked to other measures of disturbed family functioning (e.g., childhood physical abuse, parental substance abuse).

"These findings clearly indicate that there is a need to consider childhood sexual abuse in developing and delivering HIV prevention interventions. Messages that emphasize the avoidance of 'sex under the influence' may not be effective for those men whose use of substances may be a form of coping with the disturbing aftermath of early sexual traumatization. Work can be done to identify prevention strategies that consider the after-effects of childhood sexual abuse," said lead author, Jay Paul, PhD, a specialist in the division of medicine at UCSF's Center for AIDS Prevention Studies.

"In addition, given the extent to which this is a problem among MSM, community services should be reviewed to ensure that appropriate referrals are offered at points where these men may contact mental health, substance abuse, social services and medical services. The multiple health-related negative consequences of childhood sexual abuse emphasize the need to give this issue appropriate attention," said Paul.

The study analyzed data collected in the Urban Men's Health Study, a telephone sample of MSMs in San Francisco, New York, Chicago, and Los Angeles. These four cities were selected due to their importance as regional centers, being the source of two thirds of U.S. MSM AIDS cases, and the estimated size and concentration of their MSM population. This sample, conducted between November 1996 and February 1998, interviewed 2881 MSMs. The interviews covered numerous health issues; other findings (such as overall levels of risk behavior) have been reported elsewhere.

Study co-investigators are Joseph Catania, PhD, assistant professor of medicine with UCSF CAPS, Lance Pollack, PhD, specialist at UCSF CAPS, and Ron Stall, PhD, MPH, Chief of the Behavioral Interventions Research Branch at the Division of HIV/AIDS Prevention at the Centers for Disease Control.

The research was supported by grants from the National Institute of Mental Health, the National Institute of Alcohol Abuse and Alcoholism, and the Centers for Disease Control and Prevention's Division of HIV/AIDS Prevention. Further research to gain a clearer understanding of these issues has been funded by the National Institute of Mental Health.