The association between childhood sexual abuse and prevalence of HIV-related risk behaviors

Gender differences in the association between childhood sexual abuse and risky sexual behaviours: A systematic review and meta-analysis

This meta-analytic review examines the association between childhood sexual abuse and risky sexual behaviours with sub-group analyses by gender. Systematic searches of electronic databases including MEDLINE, PubMed, EMBASE, and PsycINFO were performed using key terms. We used a priori criteria to include high quality studies and control for heterogeneities across eligible studies. The review was registered with PROSPERO and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final meta-analysis applied fixed-effects model to generate pooled odds ratio (OR). Subgroup analyses were conducted to identify potential methodological moderators. The meta-analysis included 8 eligible studies (N=38,989, females=53.1%). The overall syndemic of risky sexual behaviors at adulthood was 1.59 times more common in childhood sexual abuse victims. There was a similar association between childhood sexual abuse in general and subsequent risky sexual behaviors in both females and males. However, in cases of substantiated childhood sexual abuse, there was a greater odds of risky sexual behaviors in females (OR=2.72) than males (OR=1.69). The magnitude of association of childhood sexual abuse and risky sexual behaviors was similar for males and females regardless of study time, study quality score and method of childhood sexual abuse measurement. There were nonsignificant overall and subgroup differences between males and females. Childhood sexual abuse is a significant risk factor for a syndemic of risky sexual behaviors and the magnitude is similar both in females and males. More research is needed to explore possible mechanisms of association.

Correlates of Sexual Abuse and Subsequent Risk Taking

Correlates of sexual abuse among female participants in the California Latino Couples Study were examined in two sets of comparisons: (a) nonabused women versus women reporting any sexual abuse and (b) among sexually abused women, those reporting forced intercourse versus those with no forced intercourse. Women who reported any sexual abuse (n = 208) differed from women who reported no abuse (n = 363) in their age at first voluntary sexual intercourse, risk-taking scores, and sexually transmitted infection (STI) history. Among the abused women, those who experienced forced intercourse (n = 101) were more likely to report sexual intercourse with an injection drug user, a history of STIs, unhappy intimate relationships, depression, and elevated stress scores compared wth women who had been touched inappropriately but not forced to have sexual intercourse.

Puerto Rican Drug Users' Experiences of Physical and Sexual Abuse

This study examines gender and developmental stage differences in physical and sexual abuse among Puerto Rican drug users. A structured questionnaire was administered to 799 participants in New York and 382 in Puerto Rico. Qualitative data were collected through in-depth life histories with 21 participants. Study participants included 297 female and 884 male Puerto Rican drug injectors and crack smokers. Females were significantly more likely than males to report physical abuse by a family member in childhood and unwanted sex in childhood, adolescence, and adulthood. Qualitative findings describe abuse in the contexts of family, drug dealing, drug paraphernalia possession, and sex work.

HIV and gender-based violence: welcome policies and programmes, but is the research keeping up?

The global HIV policy arena has seen a surge of interest in gender-related dimensions of vulnerability to HIV and violence. UNAIDS and other prominent actors have named gender-based violence a key priority, and there seems to be genuine understanding and commitment to addressing gender inequalities as they impact key populations in the AIDS response. In the quest for evidence-informed interventions, there is usually a strong connection between the research conducted and the policies and programmes that follow. Regarding gender, HIV and violence, is this the case? This discussion paper asks whether the relevant peer-reviewed literature is suitably representative of all affected populations--including heterosexual men, transgender men and women, women who have sex with women, and men who have sex with men--as well as whether the literature sufficiently considers gender norms and dynamics in how research is framed. Conclusions about violence in the context of heterosexual relationships, and with specific attention to heterosexual women, should not be presented as insights about gender-based violence more generally, with little attention to gender dynamics. Research framed by a more comprehensive understanding of what is meant by gender-based violence as it relates to all of the diverse populations affected by HIV would potentially guide policies and programmes more effectively.

Childhood Sexual Abuse and Syringe Sharing Among People Who Inject Drugs

Childhood sexual abuse is associated with adverse health outcomes. However, the impact of sexual abuse on HIV risk behaviors among people who inject drugs (IDU) has not been thoroughly characterized. We therefore sought to identify whether childhood sexual abuse was associated with syringe sharing among a sample of IDU in Vancouver, Canada. We assessed sexual abuse among two cohorts of IDUs via the Childhood Trauma Questionnaire. Multivariate logistic regression was used to estimate the relationship between childhood sexual abuse and syringe sharing. In total, 1380 IDU were included in the study, and 426 (30.9 %) IDU reported childhood sexual abuse. Syringe sharing (Adjusted Odds Ratio = 1.83, 95 % Confidence Interval 1.28-2.60) remained independently associated with childhood sexual abuse after adjustment for potential confounders. Given that a history of childhood sexual abuse appears to be elevated among IDU who engage in HIV risk behaviors (i.e., syringe sharing), HIV prevention efforts should include efforts to address historical trauma in this population.

The relationship between sexual abuse and risky sexual behavior among adolescent boys: a meta-analysis

PURPOSE

Childhood and adolescent sexual abuse has been shown to lead to increased odds of sexual behaviors that lead to sexually transmitted infections and early pregnancy involvement. Research, meta-analyses, and interventions, however, have focused primarily on girls and young women who have experienced abuse, yet some adolescent boys are also sexually abused. We performed a meta-analysis of the existing studies to assess the magnitudes of the link between a history of sexual abuse and each of the three risky sexual behaviors among adolescent boys in North America.

METHODS

The three outcomes were (a) unprotected sexual intercourse, (b) multiple sexual partners, and (c) pregnancy involvement. Weighted mean effect sizes were computed from ten independent samples, from nine studies published between 1990 and 2011.

RESULTS

Sexually abused boys were significantly more likely than nonabused boys to report all three risky sexual behaviors. Weighted mean odds ratios were 1.91 for unprotected intercourse, 2.91 for multiple sexual partners, and 4.81 for pregnancy involvement.

CONCLUSIONS

Our results indicate that childhood and adolescent sexual abuse can substantially influence sexual behavior in adolescence among male survivors. To improve sexual health for all adolescents, even young men, we should strengthen sexual abuse prevention initiatives, raise awareness about male sexual abuse survivors' existence and sexual health issues, improve sexual health promotion for abused young men, and screen all people, regardless of gender, for a history of sexual abuse.

Psychiatric symptom typology in a sample of youth receiving substance abuse treatment services: associations with self-reported child maltreatment and sexual risk behaviors

Latent profile analysis (LPA) was used to classify 394 adolescents undergoing substance use treatment, based on past year psychiatric symptoms. Relations between profile membership and (a) self-reported childhood maltreatment experiences and (b) current sexual risk behavior were examined. LPA generated three psychiatric symptom profiles: Low-, High- Alcohol-, and High- Internalizing Symptoms profiles. Analyses identified significant associations between profile membership and childhood sexual abuse and emotional neglect ratings, as well as co-occurring sex with substance use and unprotected intercourse. Profiles with elevated psychiatric symptom scores (e.g., internalizing problems, alcohol abuse and dependence symptoms) and more severe maltreatment histories reported higher scores for behavioral risk factors for HIV/STI exposure. Heterogeneity in psychiatric symptom patterns among youth receiving substance use treatment services, and prior histories of childhood maltreatment, have significant implications for the design and delivery of HIV/STI prevention programs to this population.

Impact of childhood trauma on functionality and quality of life in HIV-infected women

BACKGROUND

While there are many published studies on HIV and functional limitations, there are few in the context of early abuse and its impact on functionality and Quality of Life (QoL) in HIV.

METHODS

The present study focused on HIV in the context of childhood trauma and its impact on functionality and Quality of Life (QoL) by evaluating 85 HIV-positive (48 with childhood trauma and 37 without) and 52 HIV-negative (21 with childhood trauma and 31 without) South African women infected with Clade C HIV. QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the Patient's Assessment of Own Functioning Inventory (PAOFI), the Activities of Daily Living (ADL) scale and the Sheehan Disability Scale (SDS). Furthermore, participants were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Childhood Trauma Questionnaire (CTQ).

RESULTS

Subjects had a mean age of 30.1 years. After controlling for age, level of education and CES-D scores, analysis of covariance (ANCOVA) demonstrated significant individual effects of HIV status and childhood trauma on self-reported QoL. No significant interactional effects were evident. Functional limitation was, however, negatively correlated with CD4 lymphocyte count.

CONCLUSIONS

In assessing QoL in HIV-infected women, we were able to demonstrate the impact of childhood trauma on functional limitations in HIV.

Associations between nonverbal behaviors and subsequent sexual attitudes and behaviors of sexually abused and comparison girls

This prospective, longitudinal study examined a sample of sexually abused and comparison girls to determine (a) whether there were patterns of behavior that differed between the groups and (b) whether nonverbal behaviors assessed at the initial visit (n = 147; M = 11.11 years; SD = 3.02) might predict sexual attitudes and behaviors at a later point in development (n = 144; M = 18.52 years; SD = 3.52). At the initial assessment, nonverbal behaviors during an interaction with an unknown male interviewer were factor analyzed revealing 3 factors: wary (e.g., pouting), affiliative (e.g., chin resting on hand), and coy (e.g., tongue show). Abused girls scored higher on the coy factor that was related to earlier age at first voluntary intercourse later in development (approximately 7 years later). High scores on the affiliative factor were related to higher sexual permissiveness and less negative attitudes toward sex. Results indicate that sexually abused girls showed early maladaptive patterns in interpersonal interactions, which were subsequently related to risky sexual attitudes and behaviors.

The Role of Youth Problem Behaviors in the Path From Child Abuse and Neglect to Prostitution: A Prospective Examination

Behaviors beginning in childhood or adolescence may mediate the relationship between childhood maltreatment and involvement in prostitution. This paper examines five potential mediators: early sexual initiation, running away, juvenile crime, school problems, and early drug use. Using a prospective cohort design, abused and neglected children (ages 0-11) with cases processed during 1967-1971 were matched with non-abused, non-neglected children and followed into young adulthood. Data are from in-person interviews at approximate age 29 and arrest records through 1994. Structural Equation Modeling tested path models. Results indicated that victims of child abuse and neglect were at increased risk for all problem behaviors, except drug use. In the full model, only early sexual initiation remained significant as a mediator in the pathway from child abuse and neglect to prostitution. Findings were generally consistent for physical and sexual abuse and neglect. These findings suggest that interventions to reduce problem behaviors among maltreated children may also reduce their risk for prostitution later in life.

The Role of Youth Problem Behaviors in the Path From Child Abuse and Neglect to Prostitution: A Prospective Examination

Behaviors beginning in childhood or adolescence may mediate the relationship between childhood maltreatment and involvement in prostitution. This paper examines five potential mediators: early sexual initiation, running away, juvenile crime, school problems, and early drug use. Using a prospective cohort design, abused and neglected children (ages 0-11) with cases processed during 1967-1971 were matched with non-abused, non-neglected children and followed into young adulthood. Data are from in-person interviews at approximate age 29 and arrest records through 1994. Structural Equation Modeling tested path models. Results indicated that victims of child abuse and neglect were at increased risk for all problem behaviors, except drug use. In the full model, only early sexual initiation remained significant as a mediator in the pathway from child abuse and neglect to prostitution. Findings were generally consistent for physical and sexual abuse and neglect. These findings suggest that interventions to reduce problem behaviors among maltreated children may also reduce their risk for prostitution later in life.

Sexually transmitted diseases among adults who had been abused and neglected as children: a 30-year prospective study

OBJECTIVES

We examined associations between childhood abuse and neglect and the risk in adulthood for sexually transmitted diseases.

METHODS

In a prospective cohort design, we matched children aged 0 to 11 years with documented cases of abuse or neglect during 1967 to 1971 with a control group of children who had not been maltreated (754 participants in all) and followed them into adulthood. Information about lifetime history of sexually transmitted diseases was collected as part of a medical status examination when participants were approximately 41 years old.

RESULTS

Childhood sexual abuse increased risk for any sexually transmitted disease (odds ratio [OR] = 1.94; 95% confidence interval [CI] = 1.00, 3.77; P = .05) and more than 1 type of sexually transmitted disease (OR = 3.33; 95% CI = 1.33, 8.22; P = .01). Physical abuse increased risk for more than 1 type of sexually transmitted disease (OR = 3.61; 95% CI = 1.39, 9.38; P = .009).

CONCLUSIONS

Our results provided the first prospective evidence that child physical and sexual abuse increases risk for sexually transmitted diseases. Early screening and interventions are needed to identify and prevent sexually transmitted diseases among child abuse victims.

The effect of intimate partner violence on receptive syringe sharing among young female injection drug users: an analysis of mediation effects

This study sought to explore the relationship between intimate partner violence (IPV) and receptive syringe sharing (RSS) among young female injection drug users (IDUs) and to examine mediating variables. Cross-sectional behavioral assessments were completed by 797 female IDUs in five U.S. cities who reported having at least one main sexual partner in the past three months. Linear regression was used to estimate direct and mediated effects. The product of coefficients method was used to statistically evaluate mediation. Respondents were predominantly white (70%) and mean age was 23 years. Sixty percent reported RSS in the past three months and 33% reported IPV in the past year. The association between IPV and RSS was independently mediated by self-esteem and depression, but not by self-efficacy for safer drug injection. Findings suggest that interventions focused on improving victimized women's self-esteem and depression may help mitigate some of the negative health effects of IPV.

The potential for PTSD, substance use, and HIV risk behavior among adolescents exposed to Hurricane Katrina

Adverse psychosocial outcomes can be anticipated among youth exposed to Hurricane Katrina. Adolescents are particularly vulnerable to the consequences of this natural disaster and may suffer lasting consequences in the form of psychological morbidity and the development of negative health behaviors due to their exposure. We review existing literature on the effects of exposure to natural disasters and similar traumas on youth and, where data on youth are unavailable, on adults. The effect of natural disasters is discussed in terms of risk for three negative health outcomes that are of particular concern due to their potential to cause long-term morbidity: post-traumatic stress disorder, substance use disorder, and HIV-risk behavior. Where available, data from studies of the effects of Hurricane Katrina are included.

Childhood and adolescent sexual abuse and subsequent sexual risk behavior: evidence from controlled studies, methodological critique, and suggestions for research

Childhood and adolescent sexual abuse (CSA) is associated with a wide variety of adverse psychological and health outcomes, including negative sexual health outcomes. In this paper, we review the literature investigating the relation between CSA and subsequent sexual risk behaviors among men and women. Previous research has found a relatively consistent association between CSA and higher rates of sexual risk behaviors, particularly sex trading, more sexual partners, and an earlier age of first intercourse. However, there are a number of limitations to this research, including lack of a consistent definition of CSA, failure to investigate gender as a moderator, and possible confounding of the CSA experience with some of the sexual behavior outcome variables. Further, although there appears to be an association between CSA and later sexual risk behavior, researchers have not established whether this association is causal. Suggestions for future research and implications for clinical practice are discussed.

HIV in adolescents: what we know and what we need to know

HIV, the cause of AIDS, has infected more than 65 million people worldwide, including 1 million children. An estimated 39.5 million people are living with HIV. As of 2006, 4.3 million were newly infected, with 2.8 million occurring in sub-Saharan Africa. Rates of infection have risen more than 50% in Eastern Europe and Central Asia. Mother-to-child transmission occurs rarely with antiretroviral treatments in the United States, and congenitally infected children are living to adulthood. HIV is now a "youth-driven disease" worldwide. In the United States, 40% of new HIV infections occur in individuals less than 25 years old, and HIV is the sixth-leading cause of death among adolescents. Young people with HIV/AIDS live with this chronic condition and its associated medical and psychological morbidities while coping with identity and maturation issues. In this paper, we review what we know about HIV and psychiatric disorders among adolescents.

Sexual and physical abuse history and adult sexual risk behaviors: relationships among women and potential mediators

OBJECTIVE

While research has supported associations between experiencing abuse and engaging in risky sexual behaviors during adolescence, research regarding these associations among adult women is much more equivocal. In addition, few studies have attempted to identify potential pathways from abuse experiences to sexual risk behaviors. The current study examined the associations between a history of physical or sexual abuse and recent sexual risk behaviors among adult women. Additionally, this study evaluated binge drinking and depressive symptomatology as potential mediators of any relationships between abuse history and sexual risk behaviors.

METHODS

A total of 1,428 women between 18 and 40 years of age attending family planning clinic appointments completed a self-report survey regarding their recent sexual behaviors and sexual and physical abuse history. Logistic regressions using backward elimination were conducted to identify factors associated with sexual risk behavior.

RESULTS

A history of physical abuse by a romantic partner was associated with several sexual risk behaviors. Few significant associations between intrafamilial physical or sexual abuse and recent sexual risk behaviors were found. Additionally, there was no evidence that these relationships were mediated by binge drinking or depressive symptomatology.

CONCLUSIONS

Familial abuse experiences are not necessarily associated with recent sexual risk behaviors among adults. In contrast, physical abuse experiences, particularly those perpetrated by a romantic partner, are associated with engaging in adult sexual risk behaviors among women. However, these associations are not mediated by alcohol use or depressive symptomatology.

Sexual violence among two populations of men at high risk of HIV infection

This study sought to compare the prevalence of, and relationship between, age at first experience of sexual violence and HIV and other health risk behaviors in two populations of men at high risk of HIV infection. Data were drawn from two cohorts: Vanguard, a prospective study of young men who have sex with men (MSM), and VIDUS, the Vancouver Injection Drug Users Study. Controlling for fixed sociodemographics, multivariate logistic regression was used to assess the relationship between age at first sexual violence (vs. never experiencing it) and several health risk behaviors. There were 140/498 (28%) MSM from Vanguard and 173/932 (19%) injection drug users (IDU) from VIDUS who reported having experienced sexual violence. Among VIDUS men, 130/852 (15%) IDU-only and 43/80 (54%) who were both IDU and MSM reported a history of sexual violence. The prevalence of child sexual abuse was 13% in Vanguard MSM, and 11% among VIDUS IDU-only, but 26% among VIDUS MSM/IDU. The median age of onset was significantly lower among VIDUS IDU-only compared to the two other groups. Experiencing sexual violence first in childhood was strongly related to ever being in the sex trade in both IDU and MSM. MSM in Vanguard who experienced sexual violence in childhood were more likely to have attempted suicide, and have a diagnosed mood disorder. Non-MSM IDU in VIDUS who experienced sexual violence in childhood were more likely to have a diagnosed mental illness, to binge on alcohol, and to have ever accidentally overdosed. In conclusion, men who have ever had sex with men appear to have a higher lifetime prevalence of sexual violence, compared to non-MSM injection drug users. Sexual violence is differentially associated with different health risk behaviors, depending on the age at first occurrence and the primary HIV risk factor (i.e. MSM vs. IDU).

Child abuse and AIDS-related knowledge, attitudes and behavior among adolescents in Zambia

OBJECTIVE

To research the correlation between physical and sexual abuse by family members and AIDS-related knowledge, attitudes, self-efficacy and behavior among urban and rural adolescents in Zambia.

SAMPLE

The sample comprises 3,360 adolescents, aged 10-19, from urban and rural Zambia; 2,160 of them attended school, while 1,200 of them did not.

MEASURES

Standardized scales were utilized to assess AIDS-related knowledge, attitudes, and self-efficacy. In addition, the adolescents reported the extent of their engagement in various high-risk behaviors and their lifetime experience of being sexually or physically abused.

RESULTS

As the level of abuse experienced by the adolescents increased, their level of knowledge about HIV/AIDS, tendency to hold positive attitudes toward prevention, and level of self-efficacy regarding HIV/AIDS prevention decreased. Most importantly, when controlling for socio-demographic variables, findings indicate that past abuse was a key factor predicting participation in high-risk behaviors associated with HIV infection.

CONCLUSION

Physical and sexual abuse of adolescents in Zambia is significantly related to HIV risk behaviors. Future studies should investigate which factors mediate between the experience of abuse and the tendency to engage in risky behaviors.

Change trajectories in women's STD/HIV risk behaviors following intervention

Three 16-month sexual risk-taking trajectories were identified in 287 women in an STD/HIV intervention study. The Risk Eliminator group reported no sex risk following intervention while the Risk Reducer group reported continuous drops over time. The High Risk group reported higher initial risk than the other two and no subsequent changes. The trajectory groups showed no between- or within-group effects of intervention exposure. Trajectory groups were compared on baseline characteristics. No differences were seen in demographics or STD/HIV knowledge. Compared to one or both of the other groups, the High Risk women reported more lifetime partners, recent paying partners, adult rape, and recent substance use. Their steady partners were more likely to be abusive, intoxicated during sex (as were the women themselves), and believed to be non-monogamous. The Risk Eliminator group differed from the other two by being less likely to report a history of childhood sexual abuse.

Adolescent girls' offending and health-risking sexual behavior: the predictive role of trauma

Several studies have highlighted high levels of risk for girls who have been exposed to traumatic experiences, but little is known about the exact relationship between traumatic experiences and problems with delinquency and health-risking sexual behavior (e.g., precipitory and/or exacerbatory roles). However, numerous short- and long-term detrimental effects have been linked to trauma, delinquency, and health-risking sexual behavior. The utility of diagnostic and experiential trauma measures in predicting the greatest risk for poor outcomes for delinquent girls was examined in this study. Results indicate that the experiential measures of trauma (cumulative and composite trauma scores) significantly predicted adolescent offending and adolescent health-risking sexual behavior, whereas the diagnostic measures of trauma (full and partial diagnostic criteria) did not.

Childhood sexual abuse and sexual risk behavior among men and women attending a sexually transmitted disease clinic

Childhood sexual abuse (CSA) is associated with a wide range of negative outcomes. The authors investigated the relation between CSA and sexual risk behavior in 827 patients recruited from a sexually transmitted disease (STD) clinic. Overall, CSA was reported by 53% of women and 49% of men and was associated with greater sexual risk behavior, including more sexual partners, unprotected sex, and sex trading. Alcohol use for men and drug use for women mediated the relation between CSA and the number of sexual partners in the past 3 months; intimate partner violence mediated the relation between CSA and the number of episodes of unprotected sex in the past 3 months for women. These results document the prevalence of CSA among patients seeking care for an STD and can be used to tailor sexual risk reduction programs for individuals who were sexually abused.

Violence and abuse among HIV-infected women and their children in Zambia: a qualitative study

HIV and violence are two major public health problems increasingly shown to be connected and relevant to international mental health issues and HIV-related services. Qualitative research is important due to the dearth of literature on this association in developing countries, cultural influences on mental health syndromes and presentations, and the sensitive nature of the topic. The study presented in this paper sought to investigate the mental health issues of an HIV-affected population of women and children in Lusaka, Zambia, through a systematic qualitative study. Two qualitative methods resulted in the identification of three major problems for women: domestic violence (DV), depression-like syndrome, and alcohol abuse; and children: defilement, DV, and behavior problems. DV and sexual abuse were found to be closely linked to HIV and alcohol abuse. This study shows the local perspective of the overlap between violence and HIV. Results are discussed in relation to the need for violence and abuse to be addressed as HIV services are implemented in sub-Saharan Africa.

Substance abuse and medication adherence among HIV-positive women with histories of child sexual abuse

Substance abuse increases the risks for infections and impairs medication adherence among HIV/AIDS patients. However, little is known about the characteristics of substance abuse and its impact on medication adherence among HIV-positive women with a history of child sexual abuse (CSA). In the present study, 148 HIV-positive women with a history of CSA completed a structured interview assessing CSA severity, psychological status, substance abuse, medication adherence, and sexual decision-making. Severity of CSA was significantly associated with substance use but not with adherence. Participants who had used hard drugs and who had lower self-esteem and adherence self-efficacy reported significantly lower levels of adherence. Additional research on how CSA experiences impact health behaviors is needed to help develop culturally congruent interventions to reduce risk behaviors and facilitate better medication adherence for this vulnerable population.

Severity of child sexual abuse, post- traumatic stress and risky sexual behaviors among HIV-positive women

Child sexual abuse (CSA) has been shown to enhance risk for HIV infection and other adverse outcomes. However, most studies examine the effects of a single incident of CSA rather than the full burden of abuse over the life span in predicting these adverse outcomes. A multi-dimensional approach was used in this study to examine the severity of abuse as a predictor of post-traumatic stress, depression, sexual symptoms, and risky sexual behaviors in a multi-ethnic sample of 147 HIV-positive women. Multivariate models indicated that experiencing both intrafamilial and extrafamilial CSA, adult sexual abuse (ASA) and Latina ethnicity predicted PTSD symptoms. ASA also predicted sexual trauma symptoms. Also, CSA and adult re-victimization contributed independently to risk for PTSD and sexual trauma symptoms, but not for risky sexual behaviors. The results support the need for interventions for HIV-positive women that address the full burden of abuse experienced and its sequelae.

Predictors of early initiation of vaginal and oral sex among urban young adults in Baltimore, Maryland

Over the past three decades, most research on adolescent sexual behavior has focused on vaginal intercourse and related behaviors, including contraception and unintended pregnancy. In this study, we describe the prevalence and correlates of vaginal, oral, and anal sex in an epidemiologically defined population in Baltimore, Maryland. Young adults (ages 18-24), who had been enrolled in a behavioral intervention trial during elementary school, were interviewed by telephone between 1998 and 2002 to assess their sexual behavior. Of 1679 respondents interviewed, 70.8% were Black and 55% were women. Overall, 93% of the young adults reported vaginal intercourse, 78% reported receiving oral sex, 57% reported performing oral sex, and 10% reported receptive anal intercourse. Among men, 27% reported insertive anal intercourse. Blacks initiated vaginal intercourse at an earlier age than Whites; White women performed oral sex earlier than Black women. Significant interactions were observed between age of first vaginal partner and both gender and race/ethnicity. Blacks with older partners initiated sex at an earlier age than both Blacks with a partner the same age or younger and Whites. We also observed a relationship between older female sex partners and earlier vaginal sex initiation among men. We conclude that older sex partners play an important role in sexual initiation among young adults. In light of the rates of oral and anal sex, sexual education and intervention programs should address the risk for unintended consequences of these behaviors.

Abuse, HIV status and health-related quality of life among a sample of HIV positive and HIV negative low income women

The assessment of a person's quality of life as it relates to health, HIV status and intimate partner violence (IPV) among women has been limited in its scope of investigation. Consequently, little is known about the adjusted and combined effects of IPV and HIV on women's health status and QOL. 445 women (188 HIV + 257 HIV -) residing in an urban low income area were interviewed regarding current IPV experiences (no IPV, IPV more than 1 year ago, IPV in last year), HIV status (positive and negative), use of illicit drugs, and presence of instrumental social support. Health-related QOL (HRQOL) was measured using the MOS-HIV. Stratified bivariate analyses demonstrate that living with HIV or having experienced IPV in the past year was significantly associated with poorer levels of HRQOL. Multiple logistic regression models indicate a robust negative relationship between the experience of IPV in the past year, living with HIV, use of illicit drugs and a protective effect of social support on women's reported HRQOL. The results of the bivariate and multivariate analyses provide evidence that there are independent and adjusted detrimental associations of the experience of IPV and living with HIV with women's HRQOL. As HRQOL is a good indicator of physical and mental health, these findings should alert health care and other service providers to their responsibility to screen and treat women experiencing intimate partner violence and living with HIV.

Youths and HIV/AIDS: psychiatry's role in a changing epidemic

OBJECTIVE

To review the past 10 years of published research on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the United States, including psychosocial and psychiatric risk factors, epidemiology, biology, neurocognitive and psychiatric sequelae, disclosure issues, prevention strategies, and biological and behavioral treatments.

METHOD

Researchers reviewed the English-language literature with a focus on child and adolescent risk factors associated with HIV/AIDS, prevention, and treatment.

RESULTS

Substantial scientific advances have occurred over the past two decades leading to decreased morbidity and mortality in the United States from AIDS-related opportunistic infections. At the same time, rates of HIV infection are increasing in teenagers, young women, and minorities, and growing numbers of youths are living with an infected family member. Understanding HIV risk behavior requires a broad theoretical framework. Comprehensive HIV prevention programs have led to reduced risk behavior among HIV-affected youths and teens at risk of infection. Biological and behavioral treatments of HIV infection continue to evolve and have led to longer life span, improved quality of life, and fewer psychiatric problems.

CONCLUSIONS

HIV/AIDS has significant mental health implications, and psychiatry can play a critical role in curbing the epidemic. With minimal effort, mental health professionals can adapt and apply the strategies that they use to treat psychiatric symptoms to prevent HIV transmission behaviors.

Childhood sexual abuse and age at initiation of injection drug use

OBJECTIVES

We examined the relation between childhood sexual abuse and injection drug use initiation among young adult injection drug users.

METHODS

We used mixed effect linear models to compare age at first injection among 2143 young injection drug users by first sexual abuse age categories.

RESULTS

The participants were predominantly male (63.3%) and White (52.8%). Mean age and age at first injection were 23.7 and 19.6 years, respectively; 307 participants (14.3%) reported childhood sexual abuse. After adjustment for gender, race/ethnicity, noninjection drug use before first injection drug use, and recruitment site, childhood sexual abuse was independently associated with younger age at first injection.

CONCLUSIONS

Childhood sexual abuse was associated with earlier initiation of injection drug use. These data emphasize the need to integrate substance abuse prevention with postvictimization services for children and adolescents.

Understanding the interface of HIV, trauma, post-traumatic stress disorder, and substance use and its implications for health outcomes

Many individuals living with HIV have been exposed to some type of traumatic event during their lives and may be living with symptoms of post-traumatic stress disorder (PTSD). A substantial number of these individuals are also likely to show evidence of a co-morbid substance use disorder (SUD). There is reason to believe that the co-occurrence of HIV and PTSD or co-morbid PTSD and SUD (PTSD/SUD) may predict poorer health outcomes. There are several pathways through which PTSD or PTSD/SUD might adversely impact the health of individuals living with HIV, including participation in negative health behaviours, low levels of adherence to antiretroviral medications, and/or a direct, deleterious effect on immune function. Psychological interventions are needed to treat PTSD and PTSD/SUD in HIV-positive individuals, and reduce the negative impact of these conditions on health outcomes. This article will explore data on the prevalence of trauma exposure, PTSD, and PTSD/SUD among individuals living with HIV, the pathways through which these conditions might affect health, possible interventions for PTSD and PTSD/SUD for individuals living with HIV, and methods for integrating care for individuals with these disorders. Future directions for research related to HIV, PTSD, and PTSD/SUD will also be discussed.

HIV infection among female drug users in Northern Thailand

Reports on HIV infection and risk behaviors among female drug users in developing countries, particularly in Asia, are limited. In this study, we investigated HIV prevalence and risk factors for HIV infection among 200 women admitted for 21-day inpatient drug detoxification in Chiang Mai, Thailand. Volunteers completed a face-to-face interview using a structured interview, HIV pre-test counseling, specimen collection for HIV and STD tests, and were provided test results and HIV post-test counseling 1 week later. Two-third of participants (68%) were ethnic minorities with no formal education. Overall, 14 (7%) were HIV positive: 25% among 28 heroin injectors and 4.1% among 172 opium or methamphetamine smokers (p<0.001). History of drug injection and sexual abuse were associated with HIV infection. HIV prevention strategies for drug-using women in Thailand should consider both harm reduction strategies for drug use and promoting safer sex measures in a culturally appropriate context.

Child abuse in Chandigarh, India, and its implications

Few abuses of human rights are so universally condemned but at the same time so universally practiced as child abuse. Over the centuries, children have been subjected to physical, sexual and emotional abuse as well as neglect. By any objective measures, this issue should rank high on the global agenda but in practice it is surrounded by a wall of silence and perpetuated by ignorance. Child sexual abuse is a dark reality that routinely inflicts our daily lives but in a majority of cases it goes unnoticed and unreported on account of the innocence of the victim, stigma attached to the act, callousness and insensitivity of the investigating and the law enforcement agencies, etc. A child who has been sexually abused is traumatized for life but it is only much later in life when the emotional and psychological trauma aggravates that such people seek medical help. There is an urgent need to take up the problem as a larger social issue where the society has a responsibility to help the victims overcome their trauma and move on with life as normally as possible. We report a retrospective review of children (age<16 years) referred for medicolegal examination, an autopsy in Chandigarh, India, between 2000 and 2003.

The state of science: violence and HIV infection in women

Violence and human immunodeficiency virus (HIV) are two critical public health problems affecting the lives of millions of women today. The purpose of this article is to review the state of science that exists in linking the phenomena of violence and HIV infection in women. The history and scope of violence and HIV infection is presented. Theoretical models for the phenomena of violence and abuse against women and HIV risk behavior reduction are explored. The literature review consists of 44 research articles that examine risk factors for violence and HIV, violence associated with HIV/AIDS disclosure, history of violence and HIV/AIDS, forced or coercive sex and HIV/AIDS, and violence associated with HIV self-protection conduct. Implications for nursing practice and nursing research are presented.

Trauma symptoms, sexual behaviors, and substance abuse: correlates of childhood sexual abuse and HIV risks among men who have sex with men

Childhood sexual abuse is associated with high-risk sexual behavior in men who have sex with men. This study examined psychological and behavioral correlates of HIV risk behavior associated with childhood sexual abuse in a sample of men who have sex with men. Men attending a large gay pride event (N = 647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse history, symptoms of dissociation and trauma-related anxiety, borderline personality characteristics, substance use, and sexual risk behavior. Results indicated that men who have a history of childhood sexual abuse were more likely to: engage in high-risk sexual behavior (i.e., unprotected receptive anal intercourse), trade sex for money or drugs, report being HIV positive, and experience non-sexual relationship violence. Results of this study extend previous research to show that men who have sex with men and who have a history of child sexual abuse are more likely to be at high risk for HIV infection.

Does HIV status make a difference in the experience of lifetime abuse? Descriptions of lifetime abuse and its context among low-income urban women

Women living in poor urban communities are doubly disadvantaged with regard to increased risk for two major public health crises in the United States today--HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) and violence. This study moves beyond the comparison of rates of lifetime abuse among women to incorporate contextual information of the abusive situation and experiences of HIV-positive women and a sample of sociodemographically similar HIV-negative women. A total of 611 women, 310 of whom were diagnosed as HIV positive, provided interviews integrating quantitative data and qualitative text on their lifetime experience of abuse. Quantitative results yielded few statistically significant differences between the lifetime experiences of violence between HIV-positive women and their HIV-negative counterparts. Of the women, 62% reported intimate partner violence, and 38% reported experiencing nonpartner abuse as an adult. A majority of the abused women reported that their alcohol or drug use or their partner's alcohol or drug use was associated with the abuse experienced. Significant differences were found between HIV-positive women and HIV-negative women in the pattern of abuse experienced as a child, the frequency of abuse as an adult, and the involvement of women's drinking before or during a violent episode. Qualitative excerpts from the interviews were found to differ thematically and were integrated with the quantitative data to provide a more comprehensive understanding of the women's contextual situation in understanding interpersonal violence experienced by both HIV-positive and HIV-negative women.

Sexual at-risk behaviors of sexually abused adolescent girls

The present study investigated sexual at-risk behaviors of sexually abused adolescent girls. Variables of interest were presence of consensual sexual activity, age at first consensual intercourse, number of sexual partners, condom use, and pregnancies. Participants were 125 sexually abused adolescent girls aged 12 to 17 years. Results showed that severity of sexual abuse (e.g., penetration, multiple perpetrators, physical coercion, multiple incidents of abuse) was related to a greater number of sexual at-risk behaviors. For instance, adolescents with a history of sexual abuse involving penetration were 13 times as likely to have been pregnant. Although family characteristics were significantly associated with being sexually active, their effect proved non-significant in the final hierarchical regression. Regression analyses clearly showed that the likelihood of engaging in sexual at-risk behaviors increased as a function of the number of severity factors.

Abuse, Social Support, and Depression Among HIV-Positive Heterosexual, Bisexual, and Lesbian Women

SUMMARY A nonprobability sample of HIV-positive mostly African American and Puerto Rican women in New York City were surveyed regarding abusive experiences, social support, and depressive symptoms. Seventy-five percent reported experiencing physical or sexual abuse at some point in their lives. Multiple regression analyses controlling for relevant sociodemographic variables indicated that child physical and sexual abuse and adult sexual abuse were significantly associated with depressive symptomatology (i.e., CES-D scores). HIV-related social support had a significant negative correlation with CES-D scores but did not have a moderating impact on the effects of physical or sexual abuse. Lesbian/bisexual women reported higher rates of lifetime sexual and physical abuse than heterosexual women. However, there were no differences between the groups in total CES-D scores. Lesbian/bisexual women had significantly greater support from friends and groups/organizations than the heterosexual women. The implications of the findings for future research and the provision of services for HIV-positive women are considered.

Relationships between childhood abuse and neglect experience and HIV risk behaviors among methadone treatment drop-outs

OBJECTIVE

The purpose of this study was to examine the relationships between childhood abuse/neglect experiences (sexual abuse, physical abuse, emotional abuse, and child neglect) and adult life functioning among Methadone Maintenance Treatment Program (MMTP) drop-outs.

METHOD

432 subjects who dropped out of MMTP were recruited in New York City in 1997-1999. Adult life functioning was measured by HIV drug and sex risk behaviors, Addiction Severity Index (ASI) composite scores, and depression. The chi(2) tests, t tests, correlation, and multiple logistic regressions were performed to examine the relationships between abuse experiences and adult life functioning.

RESULTS

The prevalence of child abuse/neglect history was high among MMTP drop-outs: sexual abuse-36%; physical abuse-60%; emotional abuse-57%; child physical neglect-66%; all four experiences-25%. As assessed via ASI composite scores, those who had been abused in childhood had significantly more medical, legal, relationship, and psychological problems than those who had not. Overall, several significant associations were found between the abuse experiences and HIV risk behaviors. Those who had experienced child neglect were more likely to be HIV positive. In multivariate analyses, childhood physical abuse was a significant predictor of having multiple sex partners while depression was significantly related to injection drug use in adulthood (p<.05). There were trends for the relationships between childhood sexual abuse and HIV sex risk behavior (p<.10) and between gender and injection drug use (p<.10).

CONCLUSIONS

The findings support a need for drug treatment programs that include specialized therapies for those who suffered childhood abuse and neglect experiences.

Understanding the psychodynamics of non-adherence to medical treatment in persons with HIV infection

We present this medical-psychiatric case discussion to illustrate the psychodynamic aspects of nonadherence in a woman with AIDS. Our patient sustained severe, repeated abandonment and brutal emotional, physical and sexual trauma throughout her early and later childhood and adult life. Her care was considerably complicated by the sequelae of trauma including difficulty with trust and posttraumatic stress disorder. The additional problem of HIV dementia compounded the patient's nonadherence to treatment. We present a multidisciplinary biopsychosocial approach that enabled the patient to engage in both medical and psychiatric care.

The impact of perceived child physical and sexual abuse history on Native American women's psychological well-being and AIDS risk

The impact of perceived child abuse history on 160 adult, Native American women's emotional well-being (i.e., depressive mood and anger) and AIDS risk was examined. How sense of mastery and social support might lead to women's greater resiliency was also investigated. Child physical-emotional abuse was found to have greater impact on depressive mood and anger and AIDS risk than did child sexual abuse. This finding was independent of current stress in women's lives. Women who were physically-emotionally abused as children had 5.14 times greater odds of having a sexually transmitted disease in their lifetimes than did women who experienced only marginal or no physical-emotional abuse. Moreover, consistent with the communal culture of Native Americans, social support was found to contribute more to resilience than sense mastery did. Reasons for the greater predictive power of child physical-emotional abuse compared with child sexual abuse in a growing number of studies are discussed.

Childhood sexual abuse in men who have sex with men: the current state of the science

The experience of childhood sexual abuse (CSA) among men, particularly men who have sex with men (MSM), is poorly understood. Consequently, the long-term psychological and behavioral consequences of this phenomenon are unclear. This article provides a critique and synthesis of the existing literature on childhood sexual abuse in MSM. After an examination of prevalence estimates reported in the literature, the mental health and substance abuse behaviors in MSM that were the victims of CSA will be examined. In addition, the relationship between CSA and sexual identity development and HIV risk behaviors is critically evaluated. Finally, implications for nursing practice are explored.