Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE study

Matthew J. Mimiaga, Elizabeth Noonan, Deborah Donnell, Steven Safren, Karestan C. Koenen, Steven Gortmaker, Conall O'Cleirigh, Margaret A. Chesney, Thomas J. Coates, Beryl A. Koblin, Kenneth H. Mayer

Research output: Contribution to journalArticle

162 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)340-348
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume51
Issue number3
DOIs
StatePublished - Jul 2009
Externally publishedYes

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Sex Offenses
Risk-Taking
HIV
Infection
HIV Infections
Unsafe Sex
Sexual Behavior
Confidence Intervals
Odds Ratio
Nonprescription Drugs
Random Allocation
Mental Health
History
Depression
Education

Keywords

  • Child sexual abuse
  • EXPLORE
  • HIV
  • MSM
  • Sexual risk taking

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE study. / Mimiaga, Matthew J.; Noonan, Elizabeth; Donnell, Deborah; Safren, Steven; Koenen, Karestan C.; Gortmaker, Steven; O'Cleirigh, Conall; Chesney, Margaret A.; Coates, Thomas J.; Koblin, Beryl A.; Mayer, Kenneth H.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 51, No. 3, 07.2009, p. 340-348.

Research output: Contribution to journalArticle

Mimiaga, MJ, Noonan, E, Donnell, D, Safren, S, Koenen, KC, Gortmaker, S, O'Cleirigh, C, Chesney, MA, Coates, TJ, Koblin, BA & Mayer, KH 2009, 'Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE study', Journal of Acquired Immune Deficiency Syndromes, vol. 51, no. 3, pp. 340-348. https://doi.org/10.1097/QAI.0b013e3181a24b38
Mimiaga, Matthew J. ; Noonan, Elizabeth ; Donnell, Deborah ; Safren, Steven ; Koenen, Karestan C. ; Gortmaker, Steven ; O'Cleirigh, Conall ; Chesney, Margaret A. ; Coates, Thomas J. ; Koblin, Beryl A. ; Mayer, Kenneth H. / Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE study. In: Journal of Acquired Immune Deficiency Syndromes. 2009 ; Vol. 51, No. 3. pp. 340-348.
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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.",
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AU - Mimiaga, Matthew J.

AU - Noonan, Elizabeth

AU - Donnell, Deborah

AU - Safren, Steven

AU - Koenen, Karestan C.

AU - Gortmaker, Steven

AU - O'Cleirigh, Conall

AU - Chesney, Margaret A.

AU - Coates, Thomas J.

AU - Koblin, Beryl A.

AU - Mayer, Kenneth H.

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N2 - 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.

AB - 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.

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