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Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men's Health Study
Abstract
The prevalence and characteristics of childhood sexual abuse (CSA) among men who have sex with men (MSM), and links with sexual risk are explored. A model linking CSA and sexual risk among MSM is proposed.
A telephone probability sample of urban MSM (n = 2881) was recruited and interviewed between November 1996 and February 1998. The interview covered numerous health issues, including history of sexual victimization.
One-fifth reported CSA, primarily by non-family perpetrators. Initial CSA experiences are characterized by high levels of force (43% involved physical force/weapons), and penetrative sex (78%; 46% reported attempted or actual anal intercourse). Such men are more likely than nevercoerced men to engage in high risk sex (unprotected anal intercourse with a non-primary partner or with a serodiscordant male). In multivariate analyses, the effect of childhood sexual coercion on sexual risk is mediated by substance use, patterns of sexual contacts, and partner violence, but not by adult sexual revictimization or by depression.
Findings are interpreted within the context of social learning theory and prior research on sexual risk-taking. The high risk for CSA among MSM, which can predispose such men to patterns of HIV sexual risk, warrants new approaches in HIV prevention.
... Welles (2007) also included "forced" sexual activity as part of their definition of CSA. Despite the lack of consensus about the definition of CSA, all agree that experiencing CSA is a traumatic experience that should be given considerable clinical and research attention (e.g., Arreola et al., 2009;Bradford, Ryan, and Rothblum, 1994;Doll et al., 1992;Jinich et al., 1998;Loulan, 1988;Morris & Balsam, 2003;Paul et al., 2001;Roberts & Sorenson, 1999;Saewyc, Skay, Pettingell, et al., 2006;Simari & Baskin, 1982;Tomeo, Templer, Anderson and Kotler, 2001). Scholars and clinicians have described the psychological impact on survivors, risk factors that make one more susceptible to being victimized, and the association with later developing a healthy and positive lesbian, gay, bisexual, or queer (LGBQ) sexual or affectional identity which is the focus of our article. ...
... Most research examining the prevalence of CSA in non-heterosexual individuals has reported that there is a higher prevalence rate when compared to heterosexual individuals (Arreola et al., 2009;Bradford, Ryan, and Rothblum, Child Sexual Abuse and Sexual Identity Formation 387 1994;Doll et al., 1992;Jinich et al., 1998;Loulan, 1988;Morris & Balsam, 2003;Paul et al., 2001;Roberts & Sorenson, 1999;Saewyc, Skay, Pettingell, et al., 2006;Simari & Baskin, 1982;Tomeo, Templer, Anderson and Kotler, 2001). Although, prior studies highlight the prevalence of CSA in the LGBQ community and reported disparities regarding gender, race, and ethnicity, they have not specifically examined associations between experiencing CSA and later sexual or affectional identity formation through the intersection of gender, ethnicity, and race. ...
... Several studies have described the potential consequences of having a history of CSA and how it can affect LGBQ individuals intrapersonally and interpersonally. These consequences of CSA include the manifestation of alcoholism and drug addiction (Baker, 2003;Paul et al., 2001), developing mental health disorders (depression, PTSD, suicide), eating disorders (Aaron & Hughes, 2007;Feldman & Meyers, 2007), and engaging in highrisk behaviors including sexual addiction, unprotected sex, high numbers of sexual partners, and other HIV-risk behaviors (Brennan et al., 2007;Saewyc, Skay, Richens, et al., 2006). Arreola et al. (2009) stated that several studies have shown that CSA "significantly predicts negative health outcomes including HIV-risk and mental health issues such as depression, suicidal ideation, and substance abuse among adults" (p. ...
There is a significantly higher rate of childhood sexual abuse among individuals who identify as lesbian, gay, bisexual, or queer. We describe how being a survivor of childhood sexual abuse can later affect adult sexual identity formation by examining it through the intersection of gender, race, and sexual orientation. Adult lesbian, gay, bisexual, and queer abuse survivors may experience unique clinical challenges while healing from this type of traumatic experience and developing a healthy lesbian, gay, bisexual, or queer identity. We recommend a multicultural clinical approach for family therapists in order to best treat this vulnerable population.
... Of the 17 included studies, one article presented information about CSA perpetrator gender identity (Paul et al., 2001). Paul et al. (2001) found that 92.3% of the CSA survivors were targeted by male perpetrators. ...
... Of the 17 included studies, one article presented information about CSA perpetrator gender identity (Paul et al., 2001). Paul et al. (2001) found that 92.3% of the CSA survivors were targeted by male perpetrators. Morris and Balsam (2003) did not present gender identity information about all CSA perpetrators, but did present the percentage of perpetrators that were male relatives (i.e., father, grandfather, uncle, brother, stepfather, foster father, or male cousin). ...
... The authors provided the gender or sex designation and sexual orientation designation that reflects the description. The following articles provided information about participant gender identity: (Balsam et al., 2011;Canan et al., 2019;Heidt et al., 2005;McConnell & Messman-Moore, 2019;Paul et al., 2001). The following articles did not clearly state whether their sample was asked to provide their gender or sex or if the sample inclusion criteria was sex or gender based: (Hequembourg et al., 2013;Hughes et al., 2010;Kalichman et al., 2001;Martin et al., 2011;Morris & Balsam, 2003;Pantalone et al., 2015). ...
Objective: Sexual minority people are at risk for sexual violence across the life span, but a comprehensive review of revictimization has not been conducted. The aim of the present study was to conduct a meta-analysis on the prevalence of adult sexual assault revictimization among sexual minority survivors of childhood sexual abuse, as well as to review risk factors and outcomes of revictimization. Method: Articles were downloaded from APA PsycInfo, PubMed, and Open Access Theses and Dissertations. Once duplicates were removed, 864 abstracts and titles were reviewed. Articles were included if they presented prevalence data on revictimization experiences for sexual minorities. Of the 864 abstracts and titles reviewed, 17 were included in our meta-analysis (k = 17, n = 26,280, n sexual minority = 12,220). Of these 17, 13 studies presenting data specifically on revictimization risk factors, consequences, and information on perpetrators were included for a qualitative review. Results: Rates of revictimization among sexual minority individuals were high, with a meta-analysis finding a pooled rate of 49.4% (95% Confidence Interval [.396, .593]). Risk factors for revictimization included alcohol use severity and experiences with prejudice. Revictimized people were at increased risk for posttraumatic stress disorder, problematic alcohol use, and substance use. Conclusion: Sexual assault revictimization was prevalent among sexual minority individuals, and greater attention to sexual minority populations is necessary for implementing sexual violence resources and sexual violence prevention efforts.
... It may include sexual behaviors which are painful and fear-arousing, such that the sexual experience itself encompasses both physical and psychological trauma [12,17,[19][20][21][22]. Moreover, CST may co-occur with other non-sexual forms of psychological and physical abuse [23][24][25][26][27]. ...
... Because CST may involve traumatic experiences at multiple levels, it may have broad-reaching effects which disrupt core developmental competencies during childhood and adolescence. These developmental challenges, in turn, produce a wide range of AAOs (i.e., physical and mental health, social relationships, and achievement domains) [2,[4][5][6]12,18,25,[35][36][37]. We examined the impact of CST across four major life domains. ...
... Participants in the current analyses include those aged 18-70 years (N = 6537; sample exclusions described in Table 1 notes; demographic characteristics reported in Table 2). Numerous studies have used RDD interview methods to assess CST, including the National Violence Against Women Survey [57], the National Alcohol Survey [24], and the Urban Men's Health Study [25,37], and produced similar CST estimates. Telephone interviews have been found to generate high quality data on sensitive topics [58,59]. ...
Research has linked childhood sexual trauma (CST) with adverse adult outcomes (AAOs) that span physical, psychological, and social domains of functioning. Differences in conceptualizing and measuring CST, however, have inhibited the examination of trauma-related variables hypothesized to impact adult outcomes. We used National Sexual Health Survey (NSHS; 1995–1996) data to examine trauma chronicity (i.e., duration) and AAOs (domains: physical and mental health, close relationships, and achievement). The NSHS (N = 6537, 18–70 years) assessed duration using perpetrator-specific CST reports. Adjusting for background characteristics, we examined CST duration in relation to AAOs and CST-related help-seeking. Approximately 8% of participants reported CST. Chronic (vs. single-exposure) CST survivors were at substantially higher risk of experiencing AAOs [i.e., mean AAOs and specific AAOs (e.g., physical and emotional health problems, divorce/separation, and poverty)]. CST had direct effects on sexual dysfunction and satisfaction, and on relationship stressors which may impact sexual relationship quality. Although 62% of CST survivors did not seek help, those with more chronic CST histories reported a higher prevalence of trauma-related help-seeking. Our work underscores the importance of examining CST chronicity in relation to long-term developmental outcomes. Chronicity assessment may be an important screening tool in the therapeutic context and in broader community screening efforts.
... Of the 17 included studies, one article presented information about CSA perpetrator gender identity (Paul et al., 2001). Paul et al. (2001) found that 92.3% of the CSA survivors were targeted by male perpetrators. ...
... Of the 17 included studies, one article presented information about CSA perpetrator gender identity (Paul et al., 2001). Paul et al. (2001) found that 92.3% of the CSA survivors were targeted by male perpetrators. Morris and Balsam (2003) did not present gender identity information about all CSA perpetrators, but did present the percentage of perpetrators that were male relatives (i.e., father, grandfather, uncle, brother, stepfather, foster father, or male cousin). ...
... The authors provided the gender or sex designation and sexual orientation designation that reflects the description. The following articles provided information about participant gender identity: (Balsam et al., 2011;Canan et al., 2019;Heidt et al., 2005;McConnell & Messman-Moore, 2019;Paul et al., 2001). The following articles did not clearly state whether their sample was asked to provide their gender or sex or if the sample inclusion criteria was sex or gender based: (Hequembourg et al., 2013;Hughes et al., 2010;Kalichman et al., 2001;Martin et al., 2011;Morris & Balsam, 2003;Pantalone et al., 2015). ...
Presented at the ABCT special interest group (SIG) exposition with the Sexual and Gender Minority (SGM) SIG.
... 2017; Boroughs et al., 2015;Mimiaga et al., 2009;Paul et al., 2001). Studies that sampled gay and bisexual men have reported CSA prevalence that is five times higher than men within the general population (Mimiaga et al., 2009(Mimiaga et al., , 2015O'Cleirigh et al., 2019;Paul et al., 2001). ...
... 2017; Boroughs et al., 2015;Mimiaga et al., 2009;Paul et al., 2001). Studies that sampled gay and bisexual men have reported CSA prevalence that is five times higher than men within the general population (Mimiaga et al., 2009(Mimiaga et al., , 2015O'Cleirigh et al., 2019;Paul et al., 2001). ...
... Abundant research has suggested an association between CSA and high-risk sexual behavior (Abajobir et al., 2017;Arriola et al., 2005;Kalichman et al., 2004;Levine et al., 2018;Merrill et al., 2003;Mimiaga et al., 2009;Paul et al., 2001). Several studies have reported a greater likelihood of HIV infection among YMSM CSA survivors (Boroughs et al., 2015;Kalichman et al., 2004;Mimiaga et al., 2009;Paul et al., 2001), which suggests that the experiences of CSA among YMSM correlate with high-risk sexual behavior (Mimiaga et al., 2009;Paul et al., 2001). ...
Young men who have sex with men (YMSM) have the highest burden of sexually transmitted infections (STIs), including HIV. Childhood sexual abuse (CSA) is a risk factor for high-risk sexual behavior and STI acquisition. Studies that have explored sexual behavior based on the type of reported sexual abuse are limited. This study aimed to further understand current sexual behaviors and perceptions among YMSM that have experienced different types of CSA. Sixteen YMSM who were survivors of CSA were interviewed utilizing a phenomenological conceptual framework and methodology. Thematic findings were divided into two parts. Part I gave an overview of the entire sample, and themes were as follows: unprotected oral sex used to evaluate penile abnormalities, trust promoting unprotected sex, and alcohol and other drugs not cited as the reason for casual sex. Part II demonstrated the differences among those with a history of CSA involving non-penile–anal intercourse and those with a history of CSA involving penile–anal intercourse. The major themes in Part II were that victims of CSA involving penile–anal intercourse reported the following: a hypersexual self-definition, an STI diagnosis and noncondom use history, and a third sexual partner during sexual activity. Based on the findings, early life experiences such as CSA should be considered when developing preventative sexual health strategies and individuals who experienced penetrative sexual abuse may have different needs which should be further explored.
... Male survivors of childhood sexual abuse (CSA), often overlooked as health care consumers, have unique clinical and psychological needs (Gallo-Silver et al., 2014). Negative mental and physical health consequences associated with CSA include substance use (Arreola et al., 2008;Kalichman et al., 2004;Wang et al., 2017), poor mental health (Rosario et al., 2006;Sauceda et al., 2016), sexual behavior that increases HIV transmission risk (Kalichman et al., 2004;Paul et al., 2001;Rosario et al., 2006), and revictimization (Pantalone et al., 2015;Paul et al., 2001;Phillips et al., 2014). Substance abuse and allied health professionals who address these consequences should be able to skillfully and safely assess CSA as a potential contributing factor to provide clients with the most effective care. ...
... Male survivors of childhood sexual abuse (CSA), often overlooked as health care consumers, have unique clinical and psychological needs (Gallo-Silver et al., 2014). Negative mental and physical health consequences associated with CSA include substance use (Arreola et al., 2008;Kalichman et al., 2004;Wang et al., 2017), poor mental health (Rosario et al., 2006;Sauceda et al., 2016), sexual behavior that increases HIV transmission risk (Kalichman et al., 2004;Paul et al., 2001;Rosario et al., 2006), and revictimization (Pantalone et al., 2015;Paul et al., 2001;Phillips et al., 2014). Substance abuse and allied health professionals who address these consequences should be able to skillfully and safely assess CSA as a potential contributing factor to provide clients with the most effective care. ...
In this study, we report findings from a directed content analysis of service provider (SP) interpretations of early sexual experiences depicted in vignettes created from retrospective interviews with Black sexual minority men. Specifically, we explore whether SP recognize circumstances of abuse in the vignette narrators’ sexual histories. Data for this analysis come from in-person qualitative interviews conducted with 35 providers working in substance abuse treatment and allied health service settings (e.g., mental health, HIV prevention and outreach) across the New York City area. The interviewees were asked to evaluate each of five vignettes depicting a range of early sexual experiences as described by the narrators [e.g., unwanted experiences with a male or female consistent with definitions of childhood sexual abuse (CSA), consensual sex with an older male or female]. Based on analysis of provider responses to the vignettes, we found that most recognized differences in age and authority as abuse indicators. Many of the providers struggled with assertions by vignette narrators that they had consented to the encounters—specifically those that could be considered abusive. Findings highlight areas to focus on in developing additional provider training, including the challenges of defining CSA, age and other factors that influence consent, and how cultural background and sexual minority status may shape men’s appraisals of their experiences.
... There is substantial evidence for an association between symptoms of depression and increased engagement in condomless sex (CLS), including CLS with multiple partners and partners of an unknown/sero-different HIV status [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21], and HIV acquisition [22] in studies of GBMSM. Most of these studies have been conducted in the U.S. To date, two UK cross-sectional studies have investigated the relationship between symptoms of depression and CLS. ...
... Compared to traditional regression analysis, SEM allows investigation of (complex) mediation chains and examination of the validity of the entire hypothesized conceptual model. This paper extends previous findings of a direct link between clinically significant depressive symptoms and CLS among GBMSM in the AURAH study [21], as well as in a number of other studies [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. There may be numerous complex mechanisms of association between depression and sexual risk taking. ...
The aim of this study is to investigate five hypothesized mechanisms of causation between depression and condomless sex with ≥ 2 partners (CLS2+) among gay, bisexual, and other men who have sex with men (GBMSM), involving alternative roles of self-efficacy for sexual safety and recreational drug use. Data were from the AURAH cross-sectional study of 1340 GBMSM attending genitourinary medicine clinics in England (2013–2014). Structural equation modelling (SEM) was used to investigate which conceptual model was more consistent with the data. Twelve percent of men reported depression (PHQ-9 ≥ 10) and 32% reported CLS2+ in the past 3 months. AURAH data were more consistent with the model in which depression was considered to lead to CLS2+ indirectly via low self-efficacy for sexual safety (indirect Beta = 0.158; p < 0.001) as well as indirectly via higher levels of recreational drug use (indirect Beta = 0.158; p < 0.001). SEM assists in understanding the relationship between depression and CLS among GBMSM.
... De nombreuses études établissent un lien entre les violences sexuelles subies dans l'enfance par les minorités sexuelles masculines et les comportements sexuels à risque (Paul et al., 2001 ;Relf et al., 2004 ;Brennan et al., 2007 ;Mimiaga et al., 2009 ;Schilder et al., 2014 ;Phillips et al., 2014 ;Williams et al., 2015). Dans leur méta-analyse, Loyd et Operario (2012) concluent à une surexposition aux violences sexuelles subies dans l'enfance chez les hommes séropositifs qui ont des rapports sexuels avec des hommes ainsi que chez ceux qui ont des rapports sexuels non protégés. ...
Les violences sexuelles subies par les minorités sexuelles masculines ont fait l’objet de travaux qui se sont largement focalisés sur les abus sexuels subis dans l’enfance, occultant les violences à l’âge adulte. Les études prennent peu en compte les spécificités et la diversité des modes de vie de ces populations et les différentes manières de vivre les violences subies. À partir d'un échantillon d'hommes s'identifiant comme homosexuels et bisexuels issu de l’enquête de l’Ined Virage-LGBT sur les violences de genre menée en France en 2015-2016, cet article montre qu’il existe une diversité de situations au sein de cette population. En prenant en compte l’ensemble des violences sexuelles ayant eu lieu dans l’enfance ou à l’âge adulte, ainsi que plusieurs dimensions de la sexualité – identification, pratiques, sociabilité –, cinq configurations sexuelles se dessinent et se différencient par la place qu’y tiennent la sexualité, l’exposition aux violences et le rapport aux sociabilités homosexuelles. Cette approche permet d’identifier différents modes de vie au sein des minorités sexuelles masculines, dont certains sont sans doute propres à certaines générations, et de cerner des individus ayant subi des violences sexuelles tout au long de leur vie, y compris exercées par d’autres homosexuels, et qui semblent se disséminer dans leur existence. L’appartenance à une minorité sexuelle et les évolutions de son acceptation ne sont pas les seuls éléments permettant de saisir les logiques des violences sexuelles subies par cette population : l’organisation genrée de l’homosexualité masculine, les manières dont les vies des homo-bisexuels s’inscrivent dans des rapports de classe et d’âge incitent à proposer une approche intersectionnelle de ces violences.
... MSM with HIV also experience disproportionate rates of physical and sexual abuse, including childhood sexual abuse (CSA; O'Leary et al., 2003). For example, studies have found that between 25-47% of gay and bisexual men report CSA (Arreola et al., 2008;Boroughs et al., 2015;Lenderking et al., 1997;Paul et al., 2001;Sweet & Welles, 2012), compared to 5-10% of heterosexual men (Finkelhor, 1994;Sweet & Welles, 2012). ...
... Second, our use of PTSD as a proxy for the experience of trauma is not ideal. Trauma history is associated with BPD symptoms, such as sexual behavior that confers risk for detrimental outcomes, [93][94][95] as well as the diagnosis of BPD. 66 Not all individuals who experience trauma will develop PTSD. ...
... Furthermore, male victims also commonly experience "secondary revictimization," in which their rape trauma is exacerbated due to negative social reactions from police, medical and legal personnel, and/or community members (Javaid, 2015b;Lowe & Rogers, 2017;Rumney et al., 2009). Sexual revictimization, whether primary or secondary, puts male rape victims at risk for several negative outcomes, including psychological symptomatology (e.g., depression, PTSD, anxiety; Heidt et al., 2005), interpersonal and adjustment difficulties (e.g., higher levels of distress; Aosved et al., 2011), and engagement in unsafe sex (Paul et al., 2001). ...
The crime of rape is ubiquitous in the United States and around the world. Due to the traditional conceptualization of rape being perpetrated by men against women (e.g., Tjaden & Thoennes, 2006), the experiences of men who have been raped have been relatively understudied. Nonetheless, male rape is stigmatized, likely attributable to myths about male rape (e.g., men cannot be raped by women; Turchik & Edwards, 2012). The stigma of male rape, and in turn perceptions of men who have been raped, likely relate to masculine honor beliefs (i.e., MHBs; beliefs that male aggression is justifiable in response to threat, provocation, and/or insult; Saucier et al., 2016). Across two studies, I examined how MHBs related to the acceptance of male rape myths (Study 1) and perceptions of men who have been raped (Study 2). Consistent with my hypotheses, in Study 1, higher levels of MHBs were uniquely associated with male rape myth acceptance above and beyond relevant correlates (e.g., female rape myth acceptance, adherence to traditional gender roles). Study 2 extended this by examining how MHBs related to perceptions of a hypothetical male rape scenario, dependent upon the sexual orientation of the victim (i.e., gay or heterosexual) and the gender of the perpetrator (i.e., man or woman). Consistent with my hypotheses, higher levels of MHBs were uniquely associated with more disparaging attitudes towards a male rape victim (e.g., higher levels of victim blaming, higher ratings that the victim should have been able to resist the assault). Several of these relationships were moderated by situational factors. Most notably, higher levels of MHBs were associated with more attitudes that trivialize the victim's experience (e.g., lower ratings that the assault should be conceptualized as rape) when the perpetrator was a woman, compared to a man. Overall, my research suggests adherence to masculine honor ideology relates to beliefs that trivialize male rape-particularly when rape is perpetrated by a woman.
... In addition, participants engaged in chemsex were well characterized, reporting in detail many drugs use-related variables. We believe that including a group of GBMSM non-engaged in chemsex as a comparison group allows us to better explore the associations of interest, since both the frequency of drug use (Abdulrahim et al., 2016) and sexual abuse in childhood (Paul et al., 2001) is higher in GBMSM than in the general population. Furthermore, we controlled covariates when exploring the associations we found, in order to improve the validity of our conclusions. ...
Background: Although evidence shows that engaging in chemsex can be associated with poor mental health, little is known about the relationship between psychological factors and this type of drug use. We aim to explore associations between engagement in chemsex and several psychological variables (adverse life events, attachment styles, emotional regulation skills, self-care patterns) in a sample of gay, bisexual, and other men who have sex with men (GBMSM) with drug-related problems. Methods: A group of GBMSM engaged in chemsex (n = 41) and a control group of GBMSM (n = 39) completed an online survey to assess drug-related problems and the abovementioned psychological variables, in which both groups were compared. All analyses were adjusted for covariates showing significant differences between groups. Results: Compared to the control group, participants engaged in chemsex showed significantly higher frequencies of an avoidant-insecure attachment style and early adverse life events, regardless of all covariates (HIV status, job situation, and place of birth). Poorer emotional regulation and self-care patterns and a higher frequency of sexual abuse were also found in participants engaged in chemsex, though we cannot rule out the influence of HIV status on this second group of variables. Conclusions: Some people with drug-related problems engaged in chemsex might have suffered early adverse events and might have an avoidant-insecure attachment style. Moreover, those who have been diagnosed with HIV might show higher emotional dysregulation and poorer self-care patterns. These variables should be routinely evaluated in this population.
... Childhood sexual abuse. CSA was operationalized using pre-established criteria derived through iterative field testing in a large-scale probability-based sample of sexual minority men (Paul et al., 2001). Criteria consisted of two questions asking if the participant: (a) had experienced sexual activity in which they felt forced or scared into having sex with someone who was older than them and (b) were age 16 or younger at the time. ...
Although sexual minority men experience elevated rates of childhood sexual abuse (CSA) and equal or greater rates of intimate partner violence (IPV) victimization compared to heterosexual individuals, little research has examined mechanisms linking these forms of victimization in this high-need population. We examined general (i.e., emotion regulation difficulties) and sexual minority specific (i.e., internalized homophobia) mediational pathways between CSA and IPV victimization in a longitudinal sample of 940 sexual minority men. Path analyses revealed significant associations between CSA and internalized homophobia, between internalized homophobia and emotion regulation difficulties, and between emotion regulation difficulties and IPV victimization. No indirect effects of CSA on IPV via general or minority specific pathways were observed. Findings suggest that minority stress specific (i.e., internalized homophobia) and general psychological risk factors (i.e., emotion regulation difficulties) co-occur and may function along independent pathways to link CSA to IPV revictimization. Future work is needed to investigate how mitigation of these modifiable pathways may be targeted to inform violence prevention interventions for sexual minority men.
... Our findings have several implications for clinical practice, including HIV prevention and treatment efforts for MSM. Consistent with prior literature, this sample of MSM had higher rates of lifetime PTSD symptoms (Roberts et al., 2010), a higher HIV acquisition risk profile (Brennan et al., 2007;Mimiaga et al., 2009;Paul et al., 2001), and reported more dissociative symptoms, relative to the general population. Trauma-related dissociation among MSM may impact the ability to accurately assess risk and sexual safety and interfere with negotiating for sexual health (discussing sexual histories, HIV status, or safer sexual practices) with sexual partners. ...
Posttraumatic stress disorder (PTSD) symptoms may interfere with gay, bisexual and other men who have sex with men's (MSM) ability to engage in safe sex practices. An indirect relationship with dissociation may help to elucidate the relationship between PTSD symptom severity and condomless sex among MSM with childhood sexual abuse (CSA) histories. These relationships have not previously been examined in this group, which has a unique vulnerability for HIV acquisition. A cross-sectional sample of MSM with histories of CSA (N=290) was recruited at study sites in Boston, MA, and Miami, FL. Participants had a mean age of 37.95 years (SD=11.68), 22% were African American and 29.4% identified as Latino. The sample reported a mean of 10.47 (SD=4.38) lifetime PTSD symptoms and 26.4% met the clinical threshold for dissociation. Logistic regression models (adjusted for age, education, and substance use disorder) were used to assess indirect effects of dissociation on the relationship between lifetime PTSD symptoms and condomless anal/vaginal sex episodes with serodiscordant or unknown status partners in the past 3 months. Dissociation accounted for the association between lifetime PTSD symptom severity and condomless sex episodes. The Sobel test (Sobel = 2.04, p= .042; CI 95% bias-corrected bootstrap) suggested significant indirect effects for dissociation. Dissociation among MSM with CSA histories may compromise accurate appraisals of sexual risk and safety and increase vulnerability for HIV acquisition. Further research is warranted to address HIV prevention in the context of PTSD symptom severity to improve the mental health of MSM and increase the effectiveness of HIV prevention interventions.
... The primary dependent variable was any lifetime experience of SV, defined as having been forced or frightened into sex, derived from two sequential survey questions originally implemented in the Urban Men's Health Study Paul et al., 2001;Stall et al., 2003). First, participants were asked "Have you ever been forced or frightened by someone into doing something sexually that you did not want to do?" Participants who answered "no" received a follow-up question: "Sometimes people's views about their experiences change over time. ...
Men who have sex with men (MSM) experience high prevalence of sexual violence (SV), and SV has well-documented effects on health. Research gaps are especially evident for young Black MSM (YBMSM), who experience significant HIV disparities and syndemics, including multiple forms of violence victimization. We examined lifetime prevalence of SV (having been forced or frightened into sexual activity) in a cross-sectional sample of YBMSM (N = 1732), and tested associations of demographic, psychosocial, and structural factors using multivariable regression. YBMSM were recruited between 2013 and 2015 using modified venue-based time-location sampling (e.g., at bars and clubs) in Dallas and Houston, Texas. Approximately 17% of YBMSM experienced any SV in their lifetimes. SV was associated with high school non-completion (OR 1.78; 95% CI 1.15–2.77), lower psychological resilience (OR 0.84; 95% CI 0.71–0.98), lifetime history of homelessness (OR 5.52; 95% CI 3.80–8.02), recent financial hardship (OR 2.16; 95% CI 1.48–3.14), and recent transactional sex (OR 3.87; 95% CI 2.43–6.15). We also examined differences by age of SV onset (childhood versus adulthood). YBMSM with adolescent/emerging adult-onset SV may have been more ambivalent in reporting lifetime SV experience, compared to men with childhood-onset SV, and correlates differed by age of onset. Childhood-onset SV was associated with high school non-completion, lower levels of psychological resilience, history of homelessness, recent financial hardship, and recent transactional sex. Adolescent/emerging adult-onset SV was associated with greater depressive symptoms, history of homelessness, and recent financial hardship. There is a need for multi-level approaches to SV prevention and treatment, including services and supports that are culturally-relevant and responsive to the needs of YBMSM.
... The participants appeared to be predominantly social isolates and experienced difficulties in having appropriate relationships, including romantic relationships, which reflected on their intimacy deficits and emotional loneliness, and contributed to inappropriate, dysfunctional pairing of sex with a child (Cortoni, 2012). They were more often attracted to (or attracted) extremities of dominating, controlling partners, or passive partners (Paul et al., 2001). ...
Violence against women and children, particularly child sexual abuse (CSA) remains a critical public health, human rights, and humanitarian-related issue in South Africa. The research base is largely under-developed in South Africa, given the intense stigmatisation of CSA, low-disclosure rates and inherent barriers to accessing perpetrators for research purposes. An in-depth qualitative study was conducted with twelve males who had sexually abused children and in a therapeutic, rehabilitation programme. Thematic analysis based on two years of recurrent interviews during the therapeutic intervention illustrates their experiences, histories and factors compounding their journeys as victims toward perpetration. We present four themes; Familial abuse and maltreatment; Powerlessness, fear and abandonment; Sexualised lives and sexual abuse experiences; and Powerlessness and lasting impact of exposure to and perpetration of CSA. Findings illustrate unique sex offending trajectories from victimisation to perpetration, particular to the South African context. We present broad and contextual recommendations for research, policy, restorative justice, and practice.
... First, our use of PTSD as a proxy for the experience of trauma is not ideal. Indeed, the experience of trauma is associated with symptoms of BPD, like sexual behavior that confers risk for negative outcomes (Batten et al., 2002;Gratz et al., 2007;Paul et al., 2001), as well as the diagnosis of BPD (Golier et al., 2003). Not all individuals who experience trauma will develop PTSD. ...
High prevalence of borderline personality disorder (BPD) diagnosis is observed among sexual minority samples. It is unclear if sexual minority individuals are systematically diagnosed with BPD at higher rates than heterosexual individuals, and if potential diagnostic disparity can be explained by differences in maladaptive personality domains. Utilizing data from partial hospital patients (N = 1,099) the current study explored (a) differences in the frequency of diagnosis of BPD based on sexual orientation, (b) whether disparities explained differences in psychopathology across groups, and (c) the congruence between traditional methods of BPD diagnosis (i.e., clinical assessment) versus diagnosis based on elevations in self-reported maladaptive personality domains consistent with the alternative model for personality disorders. Sexual minority individuals were more likely to be diagnosed with BPD than heterosexual individuals (odds ratio [OR] = 2.43, p < .001), even after controlling for differences in clinical correlates of BPD diagnosis (age, gender, comorbid posttraumatic stress disorder, maladaptive personality domains; OR = 1.59, p < .05). Diagnostic disparity was highest for bisexual compared with heterosexual patients. These results suggest that clinicians may be predisposed to provide a BPD diagnosis to sexual minority patients that is independent of presenting psychopathology and bear important implications for future research aimed at discerning whether such predisposition is due to measure or clinician bias.
... Experiences of CSA can have significant emotional and behavioral effects for MSM. Research has shown that the prevalence of CSA among MSM is higher than among men in the general population [116]. A number of studies have shown a strong and positive relationship between CSA and higher rates of HIV risk behaviors [117] and infections among MSM [118], and poorer HIV continuum of care outcomes [117]. ...
The United States (US) is on track to achieve the 90-90-90 targets set forth by UNAIDS and the National HIV/AIDS strategy, yet significant racial disparities in HIV care outcomes remain, particularly for young Black men who have sex with men (YBMSM). Research has demonstrated that various types of violence are key aspects of syndemics that contribute to disparities in HIV risk. However, little research has looked collectively at cumulative violent experiences and how those might affect HIV treatment and care outcomes. Drawing on extant literature and theoretical underpinnings of syndemics, we provide a conceptual model that highlights how continuous traumatic violence experienced by YBMSM may affect HIV outcomes and contribute to racial disparities in HIV outcomes. The findings of this focused review suggest a need for research on how continuous exposure to various types of violence influence HIV prevention and treatment outcomes for young Black MSM.
... CSA. The occurrence of CSA was assessed using two items published previously (Mustanski et al., 2007;Paul et al., 2001;Stall et al., 2003). These items were: (a) "Thinking back from your childhood to the present, have you ever been forced or frightened by someone into doing something sexually that you did not want to do?" and (b) "Sometimes people's views about their experiences change over time. ...
Objective: The objective of the present study was to test pathways implied by Disempowerment Theory to predict intimate partner violence (IPV) among men in a same-sex relationship. Background: Sexual minority men in relationships experience rates of IPV comparable with heterosexual women, yet most research on IPV focuses on heterosexual couples. Disempowerment Theory suggests that a range of individual, family-of-origin, and intimate relationship risk factors predict the use of violence to re-establish power in a relationship. Method: Data for the present study were gathered from an online survey completed by sexual minority men currently in a same-sex relationship (n = 339). Analysis of data included two steps: (a) we tested the direct effect of individual, family, and relational predictors on the odds of IPV and (b) we calculated a path model that included relationship power as a link between the predictors (individual, family, and relational) and IPV. Results: In line with Disempowerment Theory, relationship power was negatively associated with IPV. Bivariate analysis indicated an association between childhood sexual abuse and IPV, but childhood sexual abuse was not predictive of IPV through relationship power. Other individual (depression) and relationship-specific (sexual communication and relationship satisfaction) risk factors were associated with IPV indirectly through relationship power. Conclusion: Disempowerment Theory may provide a useful framework for understanding the occurrence of IPV in sexual minority male couples. It may also provide a starting point for the development of multi-component interventions to reduce violence in these couples.
... Yet little recent research has examined the effects of IPV on ART adherence among MSM. Finally, childhood sexual abuse (CSA) is another form of violence that disproportionately affects MSM [76,77] and PLH [78][79][80][81][82]. Research has shown a strong and positive relationship between CSA and HIV risk behaviors and infections [83] and poorer HIV continuum of care outcomes [84] among MSM. Although extant research is mixed, recent literature suggests that trauma and violence might negatively impact ART adherence through a variety of mechanisms. ...
Purpose of review:
In the USA, gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. High levels of adherence to antiretroviral therapy (ART) can dramatically improve outcomes for persons living with HIV and reduce the risk of HIV transmission to others. Yet, there are numerous individual, social, and structural barriers to optimal ART adherence. Many of these factors disproportionately impact Black MSM and may contribute to their poorer rates of ART adherence. This review synthesizes the key challenges and intervention opportunities to improve ART adherence among MSM in the USA.
Recent findings:
Key challenges to ART adherence include stigma, violence, depression, and substance use. Black MSM are significantly disadvantaged by several of these factors. There are several promising interventions to improve ART adherence among MSM, and there remains an opportunity to culturally tailor these to the needs of Black MSM populations to enhance adherence. Despite high rates of HIV among MSM, there continues to be a paucity of research on the various contributors to poor ART adherence among this population. Similarly, few interventions have been tested that lead to increased and sustained ART adherence among Black MSM.
... From a SHARP perspective, one of Robert's goals will be to offer Julie the option to explore whether her experiences of childhood sexual trauma reflect the norms of patriarchal rape culture, wherein adult males are able to coerce others, including children, into sex. Robert is also conscious of the disproportionate rate of sexual trauma exposure among boys who grow up to be queer and/or gender-nonconforming (Paul, Catania, Pollack, & Stall, 2001). Constructing health and wellbeing as relational, Robert believes that recovering from the trauma of rape must consist, in part, of preventing that trauma from happening to others (Mollica, 2008). ...
Recent social science data identifies white supremacist racism, neoliberal economic policies and cisgender-heteropatriarchy as three primary systemic engines of traumatic outcomes at the individual level. Social work pedagogy, however, fails to identify such experiences as socially-engineered trauma (SET). Lacking an explicitly anti-oppressive pedagogy, social workers attend to micro-level traumas while ignoring the macro forces leading to trauma exposure among certain populations. The term socioeducation is introduced as a method for discussing macro social systems with clients to support trauma recovery, with the goal of catalyzing client and worker participation in social justice movements seeking to disrupt oppressive systems.
... or less likely to be White (Paul, Catania, Pollack, & Stall, 2001). ...
Black and Latino men who have sex with men (MSM) are disproportionately affected by childhood sexual abuse (CSA). Investigating these histories is often confounded by underreporting and varied definitions of abuse. Unrecognized abuse may manifest in unhealthy ways, specifically psychological distress, substance use, and high-risk sexual behaviors. Black and Hispanic/Latino MSM in New York City discussed formative sexual experiences in in-person interviews. Eligible men reported a sexual experience occurring before age 16 with a man or woman 18 or older at the time. Among interviewees (n = 61), men living with HIV were significantly younger at the time of their first sexual experience with a male partner compared to HIV-negative men. Approximately half of interviewees (47.5%) scored at or above the diagnostic cutoff for post-traumatic stress disorder (PTSD). Hispanic/Latino men had increased odds of scoring at or above the diagnostic cutoff for PTSD compared to Black non-Hispanic men. Further, nearly half of interviewees (46%) scored at or above the diagnostic cutoff for harmful drug use or possible drug dependence. Study findings have implications for future research using an indirect approach to uncovering potential sexual abuse during childhood, and associations with adult health outcomes.
... CSA is understudied among men, and research on sexual minority men is limited to disease or behavior. Various studies sampling gay and bisexual men have found that reported CSA rates are higher (20%-37%) among these groups in comparison to heterosexual men [9][10][11]. These rates do not imply that CSA causes one to be gay or bisexual [12], but suggest that rates for men may be higher than the recorded average in the United States, especially since CSA is defined differently in research and governmental sectors. ...
... • Child molestation: Some young people are taken advantage of by child molesters and pushed into these acts against their will, until they become used to it. In a systematic study of 2881 men who had had sexual relations with other men, Paul et al. (2001) found that one fifth had experienced child sexual molestation. The solution is for parents to keep a continuous watch and check on their youngsters, ensuring that they are always in good company. ...
... What is less well understood is the mediational role of depressive symptomatology in the association between CSA and RSB. It has been hypothesized that those with depressive symptoms might seek to avoid rejection; thus, their ability to negotiate safer sex might be compromised, thereby increasing their risk of engagement in RSBs [16][17][18]. Another pathway through which CSA likely increases engagement in RSBs and contracting STIs is through drug abuse, as prior research has observed that abuse survivors often turn to drugs and substances as a coping mechanism [19,20]. One substance that has recently emerged as problematic is nonmedical prescription drug use, which is associated with increased RSBs [21][22][23]. ...
Purpose
Although data suggest child sexual abuse is linked with increased risk of contracting asexually transmitted infection (STI), the mechanisms through which these experiences are connected remain understudied. Moreover, there is a need to explore how race/ethnicity and gender influence these processes.
Methods
The present study examined the mediational pathways from child sexual abuse to risky sexual behavior to STIs and further evaluated the role of depressive symptomatology and nonmedical prescription drug use on the relationship between child sexual abuse and risky sexual behavior. In addition, race and gender were examined as moderators to account for potential different effects of these mechanisms on females and males and on different racial and ethnic groups. A nationally representative sample of 4,181 youth from the Add Health dataset was used.
Results
Results from a moderated mediation model indicated risky sexual behavior partially mediated the pathway from child sexual abuse to STI contraction and depressive symptomatology and nonmedical prescription drug use partially mediated pathway from child sexual abuse to risky sexual behavior. Race and gender moderated the relationship between risky sexual behavior and STI contraction.
Conclusions
Findings underscore the need for STI prevention efforts among adolescents to focus on risk factors beyond risky sexual behaviors, such as childhood sexual abuse and mental health screening that includes depressive symptomatology and nonmedical prescription drug use. In addition, findings emphasize the need to further examine the different effects on different racial/ethnic and gender subgroups, particularly black women.
... Childhood sexual abuse (CSA) is disproportionately high among men who have sex with men (MSM), with estimated rates ranging between 29.7 and 35.5% [1][2][3][4] as compared to 5-10% of the general male population [5]. The presence of CSA in MSM has been found to be associated with higher rates of HIV sexual risk behavior [6][7][8][9] and with higher rates of HIV and other sexually transmitted infections (STIs) compared to MSM with no history of CSA [10,11]. MSM make up the largest number of individuals living with HIV in the United States (U.S.), have the highest number of new infections each year, and have not shown declines in new HIV infections in the past decade. ...
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
... One study, for example, indicated that adolescents have a higher risk of receiving unwanted online sexual solicitation than adults (Baumgartner, Valkenburg, & Peter, 2010), which is in line with the respondents who stated that they were coerced into sex while using online dating services as teenagers. Studies have also suggested that experiencing sexual abuse is associated with poorer mental health and increased sexual risk taking among MSM compared to MSM who did not experience such abuse (e.g., Houston & McKirnan, 2007;Paul, Catania, Pollack, & Stall, 2001), but more insight is needed regarding the mechanisms of these relationships and the influence of the online dating environment. Specifically, it would be beneficial to examine the prevalence of sexual violence predicated by online dating among SMM and study the mental and sexual health consequences associated with experiencing such coercion. ...
This qualitative study (N = 20) examined the online and mobile dating app use of sexual minority males living in non-metropolitan areas. Many participants reported negative experiences while using dating sites or apps. Specifically, they discussed instances of deception or “catfishing,” discrimination, racism, harassment, and sexual coercion (often mentioned in the context of young, sexually inexperienced men). The results indicate that the use of dating apps could pose mental health risks due to such negative and traumatic experiences. Future research should explore the health and mental health impacts of dating app use in order to improve care and services for the sexual minority male population.
... Additionally, bisexual women frequently report feeling pressured to engage in sex and other sexual activities, such as having sex with multiple partners, with which they are uncomfortable or do not wish to participate (Hequembourg & Brallier, 2009;Kelley et al., 2018;Li et al., 2013), and subsequently report using alcohol to cope with these negative sexual experiences (Hauser & Schwarz, 2016). Furthermore, bisexual individuals have also commonly experienced other types of victimization, including childhood sexual abuse and adult sexual assault (Conron, Mimiaga, & Landers, 2010;Rothman, Exner, & Baughman, 2011;Walters, Chen, & Breiding, 2013)-all of which are associated with higher risk for sex-related substance use (Arreola, Neilands, & Díaz, 2009;Brennan, Hellerstedt, Ross, & Welles, 2007;Lloyd & Operario, 2012;Paul, Catania, Pollack, & Stall, 2001). Therefore, concerns about rejection and the potential for sexual coercion and victimization may increase the M A N U S C R I P T ...
Using alcohol and drugs in sexual contexts is associated with negative health consequences, including increased risk for HIV/STIs, sexual victimization, unplanned pregnancies, and overdose. Evidence suggests millions of adults regularly use alcohol in sexual contexts, thus increasing their risk for these consequences. However, no nationally representative estimates exist for rates of regular alcohol and/or drug use in sexual contexts. Additionally, previous studies suggest sexual minority individuals are more likely to use substances in sexual contexts than heterosexuals; however, none of these studies examined for multiple dimensions or subgroups of sexual orientation. Thus, using two distinct datasets—one large, nationally representative sample (N = 17,491) and an Internet-collected con- venience sample (N = 1001)—we explored the associations between sexual orientation (dimensions and sub- groups) and rates of regular sex-related alcohol and/or drug use in American adults. Results showed that sexual minority individuals were significantly more likely to report regularly using substances in sexual contexts com- pared to heterosexuals; however, results varied based on dimension of sexual orientation and by sex. Across both samples, bisexual individuals exhibited the highest rates of regular sex-related substance use. Findings suggest that sexual minorities, and bisexual individuals in particular, may be at increased risk for regular sex-related substance use and its associated negative health consequences. Future research should include nuanced and multi- dimensional assessments of sexual orientation to investigate sex-related alcohol and/or drug use and its associated risks, as well as examine the potential direct and indirect pathways by which these disparities may be conferred.
The study of sexual violence has gained significant attention in policy and public discourse. Recent efforts have focused on understanding sexual violence as a reflection of societal inequalities, leading to the need for examining the intersectionality of sexual violence. Marginalised communities in England and Wales have experienced increased rates of victimisation, highlighting the importance of raising social and public awareness around sexual violence. Although women and girls are disproportionately affected by sexual violence, a growing body of evidence shows that a significant number of men experience sexual victimisation by both male and female perpetrators. This chapter provides an overview of current perspectives and approaches to the study of sexual violence against men, including prevalence rates, legislation, psychological consequences, constructs of masculinity, and broader socio-cultural issues impacting men.
Research suggests that sexual minority individuals are at increased risk of suicide compared with the general population. As technology continues to develop in sophistication and accessibility, a growing number of research and therapeutic interventions utilize web-based assessments. To facilitate future research on assessing and responding to suicidal thoughts and behaviors, we describe the implementation of procedures for doing so in the context of a limited-interaction, remote cohort study. We describe factors associated with suicidal thoughts and behaviors among sexual minority men (SMM) that can guide risk/benefit assessments in future studies. Descriptive statistics were used to characterize the sample in terms of self-injury/suicidality. Bivariate χ ² tests were conducted to explore differences in these indicators by age, race and ethnicity, sexual orientation, health insurance, region, education, and self-ranked socioeconomic status. Additionally, logistic regressions were used to examine associations between demographic characteristics, various psychosocial syndemic factors, and the four measures of self-injury/suicidality. In addition, we describe the experiences completing the suicidality follow-up protocol within the study. We conducted a nationwide study of 10,607 participants and found that 27.8% had a history of self-injury, 5.6% in the past year, 21.0% had attempted suicide, 18.2% experienced suicidal ideation, and 9.4% had thoughts of killing themselves. Logistic regressions revealed that depression, everyday discrimination based on sexual orientation, childhood sexual assault, and intimate partner violence were the strongest predictors of self-injury and suicidality. Study participants experienced high rates of self-injury and suicidality. Effective protocols can be developed to assess and respond to suicide risk in web-based SMM studies.
Bu araştırma, kendini homoseksüel veya heteroseksüel olarak tanımlayan bireylerde yaşantısal kaçınma, değer odaklı yaşam ve depresyon-anksiyete-stres arasındaki ilişkiyi belirleme ve homoseksüel bireylerde değer odaklılığın depresyon, anksiyete ve stres puanlarını yordama gücünü tespit etmek amacıyla gerçekleştirilmiştir. Araştırma grubu 199’u homoseksüel, 199’u heteroseksüel olmak üzere 398 kişiden oluşmaktadır. Verilerin analizi için Bağımsız Gruplar t-Testi, Pearson çarpım moment korelasyon analizi, Çoklu Standart Regresyon analizi yapılmıştır. Araştırmanın bulguları; eşcinsel davranış eğilimi gösteren bireylerde değer verme ölçeği ilerleme ve tıkanma alt boyutlarının depresyonu %47 (r = .683; p
Despite the continued prevalence of HIV and condoms’ proven effectiveness in HIV prevention, many young men continue to engage in condom use resistance (CUR). Research shows that sexual compulsivity and childhood sexual abuse (CSA) victimization are risk factors for CUR. Given that sexual activity between men is the most common method through which HIV is transmitted, and that men who have sex with men and women (MSMW) are up to five times as likely to contract or transmit HIV as men who have sex with women only (MSWO), understanding the CUR behaviors of MSMW is uniquely important. Young, single men who had had sex with a woman in the past year (N = 623) completed questionnaires assessing their previous sexual experiences with men and women, history of CSA, sexual compulsivity, and CUR to determine how MSMW classification may moderate the associations between these variables. Results revealed full, moderated mediation, such that CSA was significantly associated with sexual compulsivity among MSMW, but not MSWO. Furthermore, sexual compulsivity was subsequently associated with CUR, in a model accounting for 5.35% of CUR variance. Such findings suggest that exposure to CSA may render MSMW especially susceptible to maladaptive, sexually compulsive desires and behaviors. As a result, MSMW may be more likely to disregard the inherent risks associated with condomless sexual activity and engage in CUR. Thus, intervention programs seeking to reduce the transmission of HIV and other STIs should prioritize targeting MSMW who experienced CSA to reduce sexual compulsivity and increase condom use.
BACKGROUND:The dramatic social changes influenced increasingly self-discourses’ homosexual group in which involved with the proportion of homosexual adults identifying as lesbian, gay, bisexual or transgender (LGBT) increased. At the same time, The number of STDspatientsand risky sexual behaviors was steadily higher among them. Research on the risk behavior of sexual problems and STDs among homosexuals in Thailand is still scarce and out of date.
OBJECTIVE:This study investigated predicting factors influenced the risk behavior of sexual problems and STDs and assessing a level of risk behavior of sexual problems and STDs among sexually experienced homosexual adolescents in Thailand.METHODS:A cross-sectional descriptive study was conducted in homosexual adolescents aged 18-21 years at university of Phayao betweenApril -June 2021.The instrument consisted of3 questionnaires;1) the demographic data 2) sexual risk behavior beliefs and self-efficacy test (SRBBS)-Thai version and3) Beck depression inventory II (BDI-II Thai version). Data analysis used descriptive statistics and inferential statistics for risk factors: Odds ratio (OR)with 95% CI with Binary logistic regression: Forward Stepwise (Likelihood Ratio).RESULTS:: According to the 199 participants, the majority of all sexual orientation groups were 18-20 years old, had a loving engagement, coupled family statues with an authoritative parenting style, no family abuse experiences, a family income of between 5,000 and 10,000 baht/month,no depression and no consult anyone in discomfort. At Low riskbehavior of sexual problems and STDs(cutoff point of SRBBS as 9) (90.5%). The Binary logistic regression: Forward Stepwise (Likelihood Ratio) analysis revealed theirCharacteristic of abuse(physical abuse)[adjustedOR = 16.895; (95% CI, 3.730-76.531)] andsexual orientation (bisexual) [adjusted OR = 4.876;(95% CI, 1.119-21.244)] of sexual problems and STDs with overall percentage correct = 91.2%.
CONCLUSIONS AND DISCUSSIONS:A related organization should encourage greater community cognizant of the risk for abuse in the family amongbisexual adolescents. In addition, should include an intervention that prevents victimization, contribute related health staff to routinely screen homosexual adolescents with an experienced family abuse and to provide an action plan in communities where homosexual adolescents who disclose abuse can be referred.
KEYWORDS :sexual risks behavior, homosexual, adolescent
Objective
Several studies highlighted childhood sexual experiences (CSEs) and intimate partner violence (IPV) as risk factors that affected lifetime suicidal ideation. TW had higher rates of CSEs and IPV than cisgender people. The aim of this study was to comprehensively assess the prevalence of CSEs and IPV among TW and their association with lifetime suicidal ideation.
Methods
A cross-sectional survey was conducted among 247 TW in Shenyang and Kunming, China, from April to September 2018. CSEs, IPV, and lifetime suicidal ideation were assessed. Logistic regression models were used to examine the association between self-reported CSEs under 18 years of age, IPV in adulthood, and lifetime suicidal ideation.
Results
In the study, 14.2% (35/247) of the sample participants reported CSEs under 18 years of age; 44.9% (111/247) reported experiencing IPV in adulthood, including 18.6% (44/247) of physical IPV, 27.1% (67/247) of trans-specific identity IPV, 31.6% (78/247) of verbal IPV, and 19.4% (48/247) of sexual IPV; and 26.3% (65/247) had thought about attempting suicide at least one time. CSEs and any form of IPV were significantly associated with suicidal ideation in this sample population. A final stepwise multivariate logistic regression model found that both physical and verbal IPVs were significantly associated with suicidal ideation when controlling for other factors (ORm1 = 2.58, 95% confidence interval (CI) = 1.163–5.724; ORm2 = 2.72, 95% CI = 1.334–5.547).
Conclusions
The findings highlight the effects of CSEs and IPV among TW and suggest the need for research on suicide in the future. Suicide prevention efforts for this invisible and vulnerable population should focus on those with physical and verbal IPV.
Background and aim:
MSM in India experience complex and multiple psychosocial challenges. The current study was conducted with an aim to assess the magnitude and predictors of psychosocial health-related problems including MSM registered in targeted intervention centers in Delhi.
Methods:
A cross-sectional study was conducted among 235 MSMs. Burden of psychosocial health issues among MSM including depression, anxiety, substance abuse, and partner violence was assessed using semistructured questionnaire. Chi-square test was used to study the association of sociodemographic characteristics and psychosocial issues among the study participants.
Results:
The prevalence of depression, anxiety, substance abuse, and partner violence was 45.1%, 37.8%, 27.6%, and 8%, respectively. Age (<24 years), education up to middle school, and being single had significant association with depression. Being sex worker as occupation had a significant association with anxiety and intimate partner violence.
Conclusions:
The study reveals a significant burden of psychosocial problems and throws light toward broadening the spectrum of health assessment among this vulnerable group.
Background:
Sexual minority men report high rates of childhood sexual abuse (CSA) and adulthood suicidality. However, mechanisms (e.g., PTSD symptoms) through which CSA might drive suicidality remain unknown.
Objective:
In a prospective cohort of sexual minority men, we examined: (1) associations between CSA and suicidal thoughts and behaviors; (2) prospective associations between CSA-related PTSD symptoms and suicidal ideation; and (3) interpersonal moderators of these associations.
Participants and setting:
Participants included 6305 sexual minority men (Mage = 33.2, SD = 11.5; 82.0% gay; 53.5% White) who completed baseline and one-year follow-up at-home online surveys.
Methods:
Bivariate analyses were used to assess baseline demographic and suicidality differences between CSA-exposed participants and non-CSA-exposed participants. Among CSA-exposed participants, multivariable logistic regression analyses were used to regress passive and active suicidal ideation at one-year follow-up on CSA-related PTSD symptoms at baseline. Interactions were examined between CSA-related PTSD symptoms and interpersonal difficulties.
Results:
CSA-exposed sexual minority men reported two-and-a-half times the odds of suicide attempt history compared to non-CSA-exposed men (95% CI = 2.15-2.88; p < 0.001). Among CSA-exposed sexual minority men, CSA-related PTSD symptoms were prospectively associated with passive suicidal ideation (adjusted odds ratio [aOR] = 1.38; 95% CI = 1.19; 1.61). Regardless of CSA-related PTSD symptom severity, those with lower social support and greater loneliness were at elevated risk of active suicidal ideation at one-year follow-up.
Conclusions:
CSA-related PTSD symptom severity represents a psychological mechanism contributing to CSA-exposed sexual minority men's elevated suicide risk, particularly among those who lack social support and report loneliness.
Background:
Increasing prevalence of risky sexual behaviors among men who have sex with men (MSM) exacerbate the transmission of HIV. Previous studies had demonstrated that childhood sexual abuse (CSA) was associated with one or more sexual behaviors, but few studies have been conducted among MSM in China.
Objective:
This present study aimed to estimate latent classes of risky sexual behaviors and test for CSA differences in latent class memberships among Chinese MSM.
Participants and setting:
The eligible participants were MSM aged 16 years or older who reported ever having oral or anal sex with men in the past 6 months.
Methods:
Data were obtained from an anonymous questionnaire between September 2017 to January 2018 in three cities in China, and contained questions about sexual-related behaviors and CSA experience. Latent class analysis (LCA) was used to classify the patterns of sexual behaviors and binomial regression was used to examine the relationships among these variables.
Results:
Among 628 MSM, 22.6% reported experiencing CSA. A two-classes pattern of sexual behaviors was identified, with 46.7% in the low-risk class and 53.3% in the high-risk class. MSM who experienced CSA were more likely to be high-risk group compared to those without CSA experiences [odds ratio (OR) = 1.981; 95% confidence interval (CI) =1.329-2.954)].
Conclusions:
CSA was prevalent among Chinese MSM. And MSM with CSA experiences are more prone to be assigned to the high-risk group. Future HIV interventions need to focus on MSM who experienced CSA.
Previous research highlights the need to better understand the complex relationships between factors marginalizing Black men who have sex with men and women (MSMW) living with HIV, including HIV stigma, trauma, and hegemonic masculinity. We examined associations between gender role conflict (GRC), trauma, and HIV stigma in Black MSMW living with HIV. 117 participants completed the UCLA Life Adversities Screener (LADS), measures of GRC, and HIV stigma. A multivariate model with age, gender role, and the LADS as predictors of stigma was statistically significant F (4, 110) = 12.81, p < .0001. The LADS was significantly associated with stigma ( b = 11.06, t = 4.17, p < .0001) and moderated by GRC ( b = 12.19, t = 2.25, p < .05); stigma increased significantly at high, but not low GRC. High GRC heightens the relationship between trauma and HIV stigma in Black MSMW. Future research must investigate associations among trauma burden, stigma, and GRC among vulnerable populations.
In this chapter we review some of the sexual behaviors that are not regarded as common or “normal.” By attempting to understand them, we hope to gain a better understanding of behaviors that are normally practiced.
This chapter reviews the multitude of sexual dysfunctions that men and women can be faced with. Sexual dysfunction is the umbrella term for the inability, for a variety of reasons, to participate in and enjoy sexual activities. In this chapter we examine the various dysfunctions, their biological, emotional, and psychological origins, and the treatment approaches that may be helpful in addressing them.
Objective
The aim of this report is to investigate the nature of the relationship between depression and condomless sex (CLS) among gay, bisexual and other men who have sex with men (GBMSM).
Methods
Data are from the Antiretrovirals, Sexual Transmission Risk and Attitude (ASTRA) study of people living with HIV and attending one of eight HIV outpatient clinics in England (2011–2012) and the Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) study of HIV-negative/unknown status individuals attending one of 20 genitourinary medicine clinics in England (2013–2014). This analysis included GBMSM only. For each study, the prevalence of depressive symptoms (Patient Health Questionnaire-9 score ≥10) was presented according to three categories of sex in the past 3 months (considering anal/vaginal sex with men/women and anal sex with men in separate definitions): (1) no sex, (2) condom-protected sex only and (3) CLS. Multinomial logistic regression with ‘condom-protected sex only’ as the reference group was used to adjust for age and (for ASTRA participants) time since HIV diagnosis.
Results
There were opposing associations of depression with recent sexual behaviour: the prevalence of depression was higher among those who reported no sex and those who reported CLS, compared with those who reported condom-protected sex only. Among the 2170 HIV-positive GBMSM in ASTRA, considering anal/vaginal sex with men/women, the prevalence of depressive symptoms was 32%, 20% and 28%, respectively, among men reporting no sex (n=783), condom-protected sex only (n=551) and CLS (n=836) (global p<0.001). Among the 1477 HIV-negative GBMSM in AURAH, the prevalence of depressive symptoms was 12%, 8% and 13%, respectively, for no sex (n=137), condom-protected sex only (n=487) and CLS (n=853) (global p=0.017). Patterns were similar after adjustment and when only considering anal sex between men.
Conclusions
Depression may be linked both to lack of sexual activity and to sexual risk taking. When investigating associations between depression and CLS, it is important to separate out individuals reporting condom-protected sex only from those reporting no sex.
Sexual minority men (SMM), including gay, bisexual, and other men who have sex with men, experience disproportionately high rates of trauma, including childhood sexual abuse (CSA), intimate partner violence, and chronic trauma in the form of stigma and discrimination. In this chapter we will (1) broadly explore trauma including types of trauma impacting SMM, (e.g., CSA, intimate partner violence, stigma, and discrimination); (2) briefly review existing evidence-based trauma treatments and their limitations for SMM; (3) present a treatment rationale, description, and preliminary results for cognitive behavioral therapy for trauma and self-care (CBT-TSC), an intervention that aims to address trauma and sexual health concerns among SMM; and (4) discuss implications of and future directions for CBT-TSC.
Introduction
Sexual self-concepts are people’s positive and negative perceptions as sexual beings. This study sought to further understand sexual self-concepts among young men who have sex with men with childhood sexual abuse histories. Method: Sixteen (N = 16) participants were interviewed utilizing a hermeneutical phenomenological conceptual framework and methodology. Salient themes were developed and analyzed with the assistance of NVivo. Result: Three themes were found: (1) body image concerns; (2) penile insecurities; and (3) desire for romantic attachment. Conclusion: Findings highlight several perceived factors related to sexual self-concepts that could benefit from additional exploration and consideration when providing mental health services. Nonparticipation was discussed as a limitation and a potential obstacle to service-seeking behavior among individuals that have experienced severe childhood trauma. Further awareness about the paradigm of body image and healthy relationship development could assist in improving mental health concerns among this group.
Background
Adverse Childhood Experiences (ACEs) are associated with a wide range of increased risk behaviors and health consequences, they have not been extensively described in all subpopulations.
Objective
The specific objectives of the study were to describe the prevalence of predefined ACEs among a nationwide sample of men who have sex with men (MSM) and determine associated HIV or sexually transmitted infection (STI) related health outcomes, testing practices, and risk behaviors.
Participants and Setting
Eligible participants were MSM aged 18 years or older who reported male-male sex in the past 12 months.
Methods
Data were obtained from the 2015 cycle of the American Men’s Internet Survey, these data were collected between September 2015 and April 2016, and contained questions related to 8 ACE exposure categories. During analyses conducted between September 2017 and April 2018, multiple log-binomial models were fit to assess associations.
Results
Among 2590 participants, 79.7 % reported exposure to one or more ACE category. Participants exposed to any ACE were more likely to report STI testing (adjusted prevalence ratio [aPR]: 1.07; 95 % confidence interval [95 %–CI]: 1.00, 1.15), illicit substance use (aPR: 1.23, 95 %–CI: 1.05, 1.46), and condomless anal intercourse with another man (aPR: 1.13, 95 %–CI: 1.03, 1.21).
Conclusions
There is a high overall ACE burden among MSM nationally, with potential influences on key HIV/STI behaviors in later life. ACE exposure should be routinely assessed, prevention is ideal but appropriate measures such as trauma informed care should also be considered for adult MSM accessing HIV and STI-related services.
Introduction
This study explores the impact of childhood sexual assault (CSA) on men's sexual function. There is limited understanding on the impact of CSA perpetrated against boys on later adult male sexual function, as there is a dearth of research on this topic. It was hypothesized that men reporting a history of CSA were more likely to report sexual function issues than men with no history of CSA.
Material and methods
A cross-sectional survey study of 1,004 Czech men aged between 15 and 85 years (M = 42.8 years; Standard deviation = 17.6 years) have been conducted. The participants anonymously answered a questionnaire on multiple aspects of their life and sexuality. This questionnaire included sought data on history of CSA and self-reported intravaginal ejaculation latency time and the 5-item International Index of Erectile Function.
Results
25 men (2.5%) indicated a history of CSA. 71% of the perpetrators where known by the victims, with a minority declaring the crime to authorities (37.5%). Half of those reporting assault also reported sexual function issues in the present or at some time in their life. Significant correlations were recorded between a history of CSA and erectile dysfunction but not significantly with premature ejaculation.
Conclusions
Men who reported a history of CSA are more likely to report sexual function issues than those who do not. The identified association between CSA and sexual function issues in adult life contributes to the small body of literature on the topic. When taking a sexual history, it is recommended to practitioner to include questions about CSA, considering its correlation with erectile dysfunction. An understanding of the relationship between CSA and adult sexual function helps practitioner to improve his patient's well--being and life satisfaction.
Kamnerdsiri WA, Fox C, Weiss P, et al. Impact of Childhood Sexual Assault on Sexual Function in the Czech Male Population. J Sex Med 2020;XX:XXX–XXX.
Men who have sex with men (MSM) are at high risk for physical and mental health conditions and are often discussed in the health literature as “at risk” versus “at promise”. However, there is an ongoing need to examine factors that place MSM “at promise” for optimal well-being. This manuscript examines correlates of resilience, the ability to “bounce back” and function adaptively after adversities, among MSM. One hundred and five MSM with a history of childhood sexual abuse, who were enrolled in a randomized control trial were recruited for a supplemental study assessing resilience and other psychosocial factors. Participants completed measures assessing resilient trait and coping (i.e. “I am able to adapt” and “I tend to bounce back”), symptoms of trauma, trauma-related thoughts, and distress tolerance (ability to regulate unpleasant feelings). Findings from multivariable linear regressions controlling for covariates (age, education, race/ethnicity, and income) indicated that higher resilience was associated with (a) lower trauma scores on reexperiencing severity (b = −1.41, SE = .53, p = .01) and avoidance severity (b = −1.61, SE= .67, p = .02), (b) lower post-traumatic cognitions (b = −11.39, SE = 5.08, p = .03) especially negative cognitions about the self (b = −.44, SE = .16, p = .007), and (c) higher distress tolerance (b = .26, SE = .10, p = .01). Our preliminary findings suggest that resilient coping/traits are important to research after childhood sexual abuse among MSM, potentially assess in clinical settings, and address in interventions.
The common finding linking symptoms such as posttraumatic stress disorder (PTSD) and depression with youth victimization (e.g., sexual abuse) might well be artifactual if preexisting psychopathology or disturbed family relationships create a common risk for both later victimization and later symptoms. This study used a longitudinal, prospective design to examine this issue. In a national random sample telephone survey, children 10 to 16 years old were interviewed and then reinterviewed approximately 15 months later about psychological problems, family relationships and victimization experiences that had occurred in the interim. Victimization in the interim was associated with PTSD-related symptoms and depression measured at Time 2, even after controlling for these symptoms and the quality of the parent–child relationship at Time 1. The association was particularly strong for sexual abuse, parental assault, and kidnapping experiences. However, these data also suggest that some of the apparent association found in cross-sectional studies between victimization and psychopathology may be due to prior psychopathology (but not parent–child relationship problems), which puts children at risk for both victimization and later symptoms.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The incidence and long-term effects of childhood sexual abuse were studied in a clinical sample of 152 adult women. Approximately 44% of female clients presenting to a health center crisis service reported a childhood history of sexual victimization. Prior victimization was associated with increased dissociation, sleep disturbance, tension, sexual problems, and anger on a Crisis Symptom Checklist, as well as greater current use of psychoactive medications, and more frequent histories of suicide attempts, substance addiction, and revictimization. Long-term psychological effects of sexual abuse are interpreted within both a developmental context and in terms of Post Traumatic Stress Disorder. Implications of the current data and related literature for mental health workers are briefly discussed.
Recent clinical reports reveal that a sizable proportion of referrals involve boys. But because child sexual abuse is a problem that is often concealed, studies of reported cases represent only a fraction of the total cases that actually occur. A small number of studies have examined the prevalence of unreported sexual abuse among nonclinical samples. The goal of the present study was to extend this previous work to a national basis. Self-reports of childhood sexual experiences were obtained from 2,972 men in an approximately representative national sample of students in higher education. Although the results are limited in generalizability to other students, this group represents 26% of all persons in the United States aged 18-24. In the present sample, 7.3% of the men reported a childhood experience that met at least one of the following three criteria for sexual abuse: (1) existence of age discrepancy between the child and perpetrator, (2) use of some form of coercion to obtain participation by the victim, and/or (3) a perpetrator who was a care giver or authority figure. The descriptive characteristics of the abusive incidents are briefly reviewed and those characteristics that differentiated among three levels of sexual abuse (exhibition, fondling, and penetration) are presented. Operational definitions of sexual abuse and the behavioral specificity of sexual abuse screening questions for use in future research on men and boys are discussed.
Sexual aggression is a serious and widespread problem in our society. Over the past 15 years considerable effort has been directed toward educating society about the problem and addressing the needs of victims of sexual crimes. Research efforts have focused on both adult and child victims and to a lesser extent on adult sexual offenders. Only recently have any research efforts focused on adolescent offenders. The present study describes the characteristics of 67 male adolescents referred to an outpatient clinic because of deviant sexual behavior. The results of this study indicate that the onset of sexually deviant interests is often in early adolescence and that an effective early treatment could reduce the widespread incidence of sexual crimes and prevent future victimization in our society.
We examined factors influencing responses to questions on sexual behavior among adult respondents 18-49 years old (unweighted N = 2,030) obtained through a random-digit dialing survey. Based on self-disclosure and perceived control theory, we hypothesized that giving people a choice in selecting the gender of their interviewer rather than being assigned an interviewer, and using questions that are ''supportive'' of what may be perceived of as nonnormative behavior (enhanced items), would increase data quality relative to, respectively, matched- or opposite-gender interviewer conditions and standard worded items, The enhanced items facilitated responding to a number of sensitive topics, However, the effects of item wording on item response are often mediated by interviewer conditions. The ''choice'' results suggest that giving respondents greater control decreases question threat. However, the overall findings argue for matching respondents and interviewers on gender over opposite-gender interviewers or allowing respondents to select their interviewer's gender. Wording and interviewer manipulations reduced the discrepancies between men's and women's self-reports of sexual behavior, but they did not eliminate them, and in some cases they had no effect. The present findings suggest that males tend to be influenced by variations in item wording, interviewer gender, and respondent control across a somewhat wider range of sexual topics. In general, the findings recommend matching respondents and interviewers on gender and the use of more supportive wording in sexual behavior questions. However, for assessment of some topics (e.g., sexual violence) in particular segments of the population (e.g., men), other procedures, such as increasing respondent control, may be a better choice. Overall, the data support the view that in terms of preferred procedures, not all sexual topics are created equal.
The results of a quantitative review of 36 studies of the adoption of safer sex among gay and bisexual men are interpreted in terms of the three stages of the AIDS Risk Reduction Model (ARRM). Variables associated with the process of labelling oneself as at risk and of committing oneself to practising safer sex were moderately associated with safer sexual behaviour. One variable we included in the enactment of safer sex - relationship status - was a highly reliable predictor of unsafe sex. Particular attention is paid to the theoretical advances embodied in Catania, Kegeles and Coates (1990) AIDS Risk Reduction Model, its focus on the process of behaviour change and its specification of an enactment stage in which the intention-behaviour gap is addressed. The implications of the results are discussed with respect to a pragmatic knowledge base and future investigations of sexual health.
This article is a reply to M. R. Nash, R. A. Neimeyer, T. L. Hulsey, and W. Lambert's (1998) article in which concerns are expressed about S. Boney-McCoy and D. Finkelhor's (1996) research. The authors concur with Nash et al.'s position that a variety of samples and designs are valuable to the study of child sexual abuse (CSA), although the position is maintained that the independent contributions of family functioning and CSA to child psychopathology are most accurately evaluated with the use of longitudinal data. Additional research questions concerning the interaction of family environment and CSA are raised. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Criticizes and reformulates the learned helplessness hypothesis. It is considered that the old hypothesis, when applied to learned helplessness in humans, has 2 major problems: (a) It does not distinguish between cases in which outcomes are uncontrollable for all people and cases in which they are uncontrollable only for some people (universal vs personal helplessness), and (b) it does not explain when helplessness is general and when specific, or when chronic and when acute. A reformulation based on a revision of attribution theory is proposed to resolve these inadequacies. According to the reformulation, once people perceive noncontingency, they attribute their helplessness to a cause. This cause can be stable or unstable, global or specific, and internal or external. The attribution chosen influences whether expectation of future helplessness will be chronic or acute, broad or narrow, and whether helplessness will lower self-esteem or not. The implications of this reformulation of human helplessness for the learned helplessness model of depression are outlined. (92 ref)
This article contains a comprehensive, critical review of the acquired immunodeficiency syndrome (AIDS)-risk-reduction literature on interventions that have targeted risky sexual behavior and intravenous drug use practices. A conceptually based, highly generalizable model for promoting and evaluating AIDS-risk behavior change in any population of interest is then proposed. The model holds that AIDS-risk reduction is a function of people's information about AIDS transmission and prevention, their motivation to reduce AIDS risk, and their behavioral skills for performing the specific acts involved in risk reduction. Supportive tests of this model, using structural equation modeling techniques, are then reported for populations of university students and gay male affinity group members.
While most gay men have reduced behavior practices at high risk for HIV infection, there is growing evidence that many also lapse to unsafe sex. This study examined situational factors related to risk behavior lapses as well as coping strategies used by men who successfully resist lapse urges. A convenience sample of 470 men patronizing gay bars or attending social organization meetings in four cities was surveyed. Forty-five percent of men were classified as "lapsers" (those who had had unprotected anal intercourse in the previous 6 months) and 24% were classified as "resisters" (those who successfully resisted urges to engage in this behavior). All provided information concerning the importance of factors related to the most recent occurrence of either unsafe sex or resisting unsafe urges. Most episodes of unsafe sex occurred outside monogamous relationships and with partners of unknown HIV serostatus, although simply inquiring about partner serostatus was relatively common. Lapsers rated affectionate feelings and wishing to please a partner as well as spontaneity of unsafe sex as the most important situational factors surrounding high-risk behavior. Resisters of unsafe sex urges reported active cognitive self-guidance, experience in safe sex, and recall of both AIDS fears and safety benefits as their most important coping strategies. Gay men who continue high-risk behavior may be overrelying on partner reports of negative serostatus. Lapse prevention approaches tailored to situations that create increased risk vulnerability must be developed. Teaching skills already used by men who successfully resist unsafe sex urges might be one approach.
Studies have reported high rates of childhood abuse in people with psychiatric illness. This study examined whether dissociative symptoms are specific to patients with histories of abuse. Ninety-eight female psychiatric inpatients completed self-report instruments that focused on childhood history of trauma, dissociative symptoms, and psychiatric symptoms in general. Sixty-three percent of the subjects reported physical and/or sexual abuse. Eighty-three percent had dissociative symptom scores above the median score of normal adults, and 24% had scores at or above the median score of patients with posttraumatic stress disorder. Subjects with a history of childhood abuse reported higher levels of dissociative symptoms than those who did not.
This paper describes the sexual behavior changes made by 686 gay and bisexual men in San Francisco between 1984 and 1988, focusing on the individual maintenance of this behavior change over time. There were drastic reductions in insertive and receptive unprotective anal intercourse over time and the vast majority of subjects were able to maintain these changes for at least 12 months prior to the last interview. A total of 12 percent of participants admitted to relapsing to unprotected receptive anal intercourse following initial behavior change; 10 percent reported engaging in unprotected receptive anal sex during every year of the study period. Men were more likely to practice unprotected anal intercourse in 1988 if at baseline they were younger, practiced unprotected anal intercourse, reported more sex partners, did not have a close friend or lover with AIDS, and engaged in fewer other health-related behaviors.
AIDS education and prevention campaigns have resulted in the most profound modifications of personal health-related behaviors ever recorded. The response of gay and bisexual men to the threat of AIDS can guide other prevention programs once the necessary motivations, impediments, and correlates of this change are better understood. We review and critique the research literature and suggest limitations of existing studies for making inferences about nongay, nonurban, and non-White populations. We recommend increased efforts to understand the role of alcohol and other drugs in AIDS risk behavior and suggest the importance of self-efficacy and social support for initiating and maintaining behavior change.
This study was undertaken to determine the reliability of self-reported sexual behavior using the test and retest technique when used with self-reported sexual behavior. The subjects were 116 asymptomatic homosexual men who participated in another study (an examination of behavioral and demographic determinants of HIV antibody status). The subjects were asked to complete two questionnaires. The first contained demographic and sexual behavior questions. The second, administered an average of 6 weeks later, used a subset of the questions in the first questionnaire. The reliability of the test-retest procedure was measured by the Kappa statistic, which assesses the proportion of agreement between two data items, accounting for the amount of agreement expected by chance. The highest degree of reliability as measured by Kappa was found with demographic information, smoking history, and sexual orientation. Self-reported sexual behaviors for the previous 6 months generally had the next highest degree of reliability as measured by Kappa. Questions examining change over the previous 5 years had the lowest reliability. Behavior changes during the time between questionnaires, subjectivity of the answer categories, and social desirability of the answers are three factors that may result in a lack of reliability in this self-reported sexual behavior questionnaire. This raises methodological concerns about the measurement of behavioral risk factors for AIDS and the ability to assess meaningfully subjective reports of behavioral change.
This article is a reply to M. R. Nash, R. A. Neimeyer, T. L. Hulsey, and W. Lambert's (1998) article in which concerns are expressed about S. Boney-McCoy and D. Finkelhor's (1996) research. The authors concur with Nash et al.'s position that a variety of samples and designs are valuable to the study of child sexual abuse (CSA), although the position is maintained that the independent contributions of family functioning and CSA to child psychopathology are most accurately evaluated with the use of longitudinal data. Additional research questions concerning the interaction of family environment and CSA are raised.
Interpretation and comparison of studies on child sexual abuse (CSA) in women are difficult because of the wide variations in definitions of this phenomenon represented by the measures used. We used data from a sample of 2,003 women to demonstrate the implications of the use of different measures of CSA on reports of incidence rates and the relation between CSA and depression. We used dichotomous measures, measures that take severity of sexual abuse experience into account, and measures that included or excluded similar‐aged peers as possible perpetrators of CSA. The choice of measure of CSA resulted in up to a 300% difference in incidence rates within this sample. Similarly, measures differed in the strength of their relationships to depression.
From the reviews of the First Edition."An interesting, useful, and well-written book on logistic regression models . . . Hosmer and Lemeshow have used very little mathematics, have presented difficult concepts heuristically and through illustrative examples, and have included references."—Choice"Well written, clearly organized, and comprehensive . . . the authors carefully walk the reader through the estimation of interpretation of coefficients from a wide variety of logistic regression models . . . their careful explication of the quantitative re-expression of coefficients from these various models is excellent."—Contemporary Sociology"An extremely well-written book that will certainly prove an invaluable acquisition to the practicing statistician who finds other literature on analysis of discrete data hard to follow or heavily theoretical."—The StatisticianIn this revised and updated edition of their popular book, David Hosmer and Stanley Lemeshow continue to provide an amazingly accessible introduction to the logistic regression model while incorporating advances of the last decade, including a variety of software packages for the analysis of data sets. Hosmer and Lemeshow extend the discussion from biostatistics and epidemiology to cutting-edge applications in data mining and machine learning, guiding readers step-by-step through the use of modeling techniques for dichotomous data in diverse fields. Ample new topics and expanded discussions of existing material are accompanied by a wealth of real-world examples-with extensive data sets available over the Internet.
While the sexual abuse of males is now well documented, the literature lacks sufficient data on the long-term effects for adult males sexually victimized during childhood and is even less informative regarding treatment of this population. This study describes a sample of 25 adult males who were sexually abused as children. The clients' responses to a questionnaire, case records and clinical observations describe three primary characteristics common among subjects: sexual compulsiveness, masculine identity confusion, and relationship dysfunction. Male socialization appears to be a key variable in explaining the difficulty men have in acknowledging the abuse as well as an underlying dynamic that must be considered in the overall treatment approach.
Prevalence data on the social distribution and AIDS‐related risk behavior of men who have sex with men are presented from two national probability surveys [General Social Survey (GSS) and National Health and Social Life Survey (NHSLS)] and a probability survey of urban centers in the U.S. [National AIDS Behavioral Surveys (NABS)]. Men residing in large cities, the highly educated, and Whites were more likely to report sex with men. In the urban sample (NABS), one third reported sex with women. In addition, minority men were more likely to report sex with men and women. More than half of the men with an HIV risk factor reported consistent condom use. The surveys were based on two different modes of interviewing (self‐administered and telephone), conducted independently of each other and by different organizations. The prevalence estimates from these surveys are consistent with each other and with other population‐based surveys in the United States and Europe. We discuss these data in light of the ongoing debate among sex researchers about how to interpret current population estimates of homosexual behavior compared to estimates reported by Kinsey and his colleagues (1948 and 1953). We discuss some possible sources or explanations for this difference (sampling, reporting, change over time). What we found, taking into consideration conceptual and definitional issues, is that the difference may not be as large as it at first seems. We also discuss our findings on the social distribution and sexual risk behavior of homosexual and bisexual men residing in the major urban centers of the U.S. and implications for strategies needed to combat the AIDS epidemic.
If a target population, such as gay males, is relatively rare and not easily identifiable, it can be expensive and technically difficult to survey. Often, the population data available for planning such a survey is of suspect reliability. These obstacles often lead to the abandonment of careful probability sampling, relying instead on convenience samples such as organization membership lists or patrons of gay bars. The use of such haphazard sampling seriously undermines the credibility of surveys to estimate population characteristics or measure behaviors. This paper describes the implementation of a two‐stage telephone survey design that, while complex, achieves a probability sample of gay males in four major cities at reasonable cost. The design is based on an adaptive sampling approach which uses data from early stages of the survey to improve the efficiency of subsequent stages. Both the practical and theoretical issues involved in the design are discussed.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
This research explores the impact of interview mode on respondents' willingness to reveal illicit or undesirable behavior and mechanisms by which interview mode influences response tendencies. A field experiment was designed to control mode effects due to sampling and screening so that the impact of response anonymity (through use of self-administered questionnaires [SAQs]) and social distance in the interviewer-respondent relationship (telephone vs. personal communication) could be tested. Respondents aged 18-45 were randomly assigned to interview mode: telephone, face-to-face, or self-administered. Admission of illicit drug use and alcohol use was most likely in the personal mode with SAQs, slightly less likely in personal mode without SAQs, and least likely in the telephone mode. The magnitude of the mode differentials was larger for blacks than for whites, and larger among respondents who are more mistrustful of others. Results support the notion that response effects due to mode of interview derive, at least in part, from interview mode differences in ability to assuage respondents' confidentiality concerns. Greater social distance between interviewer and respondent in the telephone interview, compared with face-to-face communication, makes it more difficult for the researcher to make convincing confidentiality guarantees. The response anonymity provided by SAQs also appears to increase respondents' willingness to reveal sensitive behavior, especially among racial/ethnic minorities.
This retrospective study investigated the relation between unwanted childhood sexual contact with adults and subsequent sexual attitudes and behaviors relating to further victimization and perpetration of unwanted sexual behavior for male and female college students. From the completed questionnaires (N = 209), 40.5% of the females and 49.5% of the males reported at least one unwanted sexual experience with an adult prior to age 16. A high percentage of both males and females who had unwanted experiences also reported unwanted sexual experiences in adulthood. In addition, males with unwanted adult-child sexual experiences reported perpetrating acts of sexual aggression as an adult. Those who had unwanted childhood sexual experiences were also more permissive and instrumental in their attitides toward sexuality.
this study estimates lifetime and current (prior six months) prevalence of psychological reactions to child sexual abuse (CSA) by gender and ethnicity (Hispanic versus non-Hispanic White) in a representative community sample
we examine the prevalence of 15 psychological symptoms attributed to sexual abuse among respondents with CSA and 11 specific psychiatric disorders among those abused as children and the unabused
current symptoms and diagnoses reflect long-term sequelae (at least two years after the abuse) because CSA is defined as before age 16, and respondents were at least 18 years old (PsycINFO Database Record (c) 2012 APA, all rights reserved)
One possible consequence of childhood sexual abuse (CSA) is adult sexual promiscuity. It is important to see sexual promiscuity as an example of compulsive behavior. Much compulsive behavior is regarded as an attempt to control anxiety and to repress powerful emotions from conscious awareness. By looking at promiscuity as a consequence of CSA, new insights into the promiscuous patient are obtained that allow for new and alternative therapeutic interventions. Four examples from clinical practice illustrate various effects of CSA on adult sexual behavior. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Of 327 homosexual and bisexual men participating in an ongoing cohort study pertaining to risk factors for HIV infection who completed a survey regarding history of sexual abuse, 116 (35.5%) reported being sexually abused as children. Those abused were more likely to have more lifetime male partners, to report more childhood stress, to have lied in the past in order to have sex, and to have had unprotected receptive anal intercourse in the past 6 months (odds ratio 2.13; 95% confidence interval 1.15–3.95). Sexual abuse remained a significant predictor of unprotected receptive anal intercourse in a logistic model adjusting for potential confounding variables.KEY WORDS: sexual abuse; HIV transmission; safe sex.
As a result of medical advances seropositive men may expect to have a longer and healthier life span than in the past. It is therefore increasingly important to determine which factors are related to the mental health of seropositive gay men, as well as those associated with a satisfying, yet safe sexual lifestyle. This study examined sexual behavior, indicators of mental health, and determinants of AIDS-preventive behavior among a group of seropositive gay men and a control group of seronegative gay men in the Netherlands. Most seropositive men consistently practiced AIDS-preventive behavior. Nevertheless, if the definition of potentially unsafe sexual behavior is broadened to include oral sex to ejaculation, a sizable proportion of seropositive men had to be categorized as having had unsafe sex. Depression scores were higher among seropositive men than among the general population, but not significantly higher than among seronegative controls. Depression was not related to unprotected anal sex. The attitudes and the intention toward condom use were positive. Seropositive men used recreational (noninjection) drugs relatively often, but this was generally not associated with unprotected anal sex. Seropositive men attached more value to anal sex than seronegative controls, but again, this preference was not related to practicing unprotected anal sex. In the relatively few cases that unprotected anal sex among seropositive men did occur, it appeared to be related to lower behavioral control and to a weaker safe-sex intention. Perceived barriers to condom use and low perceived risk were also associated with unprotected anal sex among seropositive men. Although depression was not directly related to unprotected anal sex, seropositive men with higher depression levels were less motivated to use condoms and perceived more barriers to condom use.
We explored the prevalence of childhood sexual abuse among adult gay and bisexual men and measured the association between childhood sexual abuse and high-risk sexual behavior in adulthood. Two separate population-based samples of gay and bisexual men (n = 1,941) residing in Portland and Tucson were surveyed. Over one quarter reported a history of childhood sexual abuse (sexual behavior with someone at least 5 years older prior to age 13, or with someone at least 10 years older when between ages 13 and 15). Men who were abused were more likely to engage in sexual risk behavior than men who were not abused (e.g., unprotected anal intercourse with non-primary partners in the previous 12 months: 21.4% vs. 15.0%, p < .001).="" perception="" of="" having="" been="" coerced="" was="" associated="" with="" greater="" sexual="" risk.="" furthermore,="" childhood="" sexual="" abuse="" and="" level="" of="" coercion="" were="" associated="" with="" reported="" levels="" of="" hiv="" infection="" among="" gay="" and="" bisexual="" men.="" it="" is="" recommended="" that="" existing="" programs="" for="" those="" at="" risk="" for="" hiv="" be="" modified="" to="" deal="" with="" these="" issues,="" and="" that="" efforts="" to="" bring="" about="" behavior="" change="" will="" require="" approaches="" that="" go="" beyond="" simply="" increasing="" knowledge="" and="">
This cross-sectional study of 155 sexually active HIV-positive men (48% homosexual, 39% bisexual, 13% heterosexual) sampled at an outpatient clinic in Los Angeles found that negative affective states (depression-dejection, tension-anxiety, confusion-bewilderment, anger arousal, and keeping anger inward) were significantly associated with having engaged in unprotected anal intercourse in the most recent sexual encounter with a male partner. Negative affect was not associated with unprotected vaginal or anal intercourse with most recent female partners. Path analyses suggested that the association of negative affect (composite score) and unsafe sex with male partners was mediated by participants' use of alcohol/drugs in the 3 hours before the sexual encounter. Additionally, the association of depression-dejection and unsafe sex tended to be mediated by attributions of responsibility for protecting sex partners (i.e., more responsibility attributed to partners than to self). The findings support a psychological escape model of sexual risk behavior in seropositive men and demonstrate the need for secondary prevention programs for HIV-positive persons.
Sexual harassment and sexual coercion have received considerable public attention. However, the extent of these problems nationally and the breadth of their health consequences are not fully understood. We estimated the national prevalence of sexual harassment and sexual coercion, and examined their relationship to HIV risk in the general U.S. population. Data came from a 1992 telephone survey of a random probability sample of 2,030 U.S. adults aged 18–49 years. Nationally, 16% of men and 33% of women reported having been sexually harassed, and 4% of men and 16% of women reported having been sexually coerced. Significantly higher HIV risk was observed among male victims of sexual harassment compared to nonvictims (32% vs. 22%), but not among women (17% vs. 14%). HIV risk for men did not differ by having experienced sexual coercion (31% vs. 23%), but female victims reported more risk behavior than nonvictims (26% vs. 13%). Greater HIV risk found among victims argues for prevention efforts that focus on their particular needs.
This chapter deals with sampling issues for surveys related to HIV risk and illness. Surveys are used to study a wide variety of issues related to the AIDS epidemic, for example: 1. General population surveys provide information about the public’s knowledge of AIDS and its modes of transmission, about attitudes toward persons with AIDS, about behaviors that put persons at risk of contracting AIDS, and about the effectiveness of public media campaigns relating to AIDS. 2. Client surveys of users of AIDS counseling and testing services provide information about the characteristics and behaviors of these persons and about the types and effectiveness of the services provided. 3. Surveys of members of high-risk groups, such as gay men, bisexuals, i.v. drug users, and prostitutes, provide information on the members’ risk behaviors, knowledge about AIDS, attitudes to changing risk behaviors, and contacts, if any, with counseling and testing services. The sampling methods that may be employed for general population surveys are well established. Depending on whether a general population survey is to be conducted by face-to-face or telephone interviewing, standard area or random digit dialing (RDD) sampling methods may be used. Area sampling
Some inadequacies of the classical conditioning analysis of phobias are discussed: phobias are highly resistant to extinction, whereas laboratory fear conditioning, unlike avoidance conditioning, extinguishes rapidly; phobias comprise a nonarbitrary and limited set of objects, whereas fear conditioning is thought to occur to an unlimited range of conditioned stimuli. Furthermore, phobias, unlike laboratory fear conditioning, are often acquired in one trial and seem quite resistant to change by “cognitive” means. An analysis of phobias using a more contemporary model of fear conditioning is proposed. In this view, phobias are seen as instances of highly “prepared” learning (Seligman, 1970). Such prepared learning is selective, highly resistant to extinction, probably noncognitive and can be acquired in one trial. A reconstruction of the notion of symbolism is suggested.
To study the relationships between retrospective reports of exposure to interparental violence in childhood and rates of psychosocial adjustment problems in young adulthood in a birth cohort of New Zealand subjects.
Data were gathered during the course of an 18 year longitudinal study of a birth cohort of 1,265 New Zealand children. At age 18 retrospective reports of exposure to interparental violence were obtained. At this time the cohort was also assessed on measures of psychosocial adjustment including mental health problems, substance abuse behaviors, and criminal offending.
Young people reporting high levels of exposure to interparental violence had elevated rates of adjustment problems at age 18. These problems included mental health problems, substance abuse behaviors and criminal offending. Analyses using multiple logistic regression showed that much of this elevated risk was explained by social and contextual factors associated with exposure to interparental violence. However, even after adjustment for confounding factors, exposure to father initiated violence was associated with increased risks of anxiety, conduct disorder and property crime, while exposure to mother initiated violence was associated only with increased risks of later alcohol abuse/dependence.
Children exposed to high levels of interparental violence are an at risk population for psychosocial adjustment problems in young adulthood. Much of the elevated risk of these children arises from the social context within which interparental violence occurs. Nonetheless, exposure to interparental violence, and particularly father initiated violence, may be associated with later increased risks of anxiety, conduct disorder, problems with alcohol, and criminal offending.
From May 1989 through April 1990, 1,001 adult homosexual and bisexual men attending sexually transmitted disease clinics were interviewed regarding potentially abusive sexual contacts during childhood and adolescence. Thirty-seven percent of participants reported they had been encouraged or forced to have sexual contact before age 19 with an older or more powerful partner; 94% occurred with men. Median age of the participant at first contact was 10; median age difference between partners was 11 years. Fifty-one percent involved use of force; 33% involved anal sex. Black and Hispanic men were more likely than white men to report such sexual contact. Using developmentally-based criteria to define sexual abuse, 93% of participants reporting sexual contact with an older or more powerful partner were classified as sexually abused. Our data suggest the risk of sexual abuse may be high among some male youth and increased attention should be devoted to prevention as well as early identification and treatment.
Inevitably, in a wide ranging review, there will be some important omissions. The main difficulties in assessing the available information have been the lack, in so many studies, of analysis along gender lines, the lack of control groups, and, in many instances, too small sample size. Despite these limitations there has, over the past decade, been an upsurge of interest in and awareness of the significance of the sexual abuse of boys. It permits us to identify a number of important trends and to draw certain conclusions. Firstly, the scale of the sexual abuse of boys is much greater than was believed 10 years ago. There is no reason to think this is simply an artifact of definition, or information gathering, or indeed of an increased willingness to recognize abusive behaviour between children, even though these will all have an effect. Whilst the trend is clear, the actual prevalence rate is difficult to determine, with a reported range of between 3% and 31%. A current 'best guess' suggests contact abuse in the range of 2-5% in the male population. As each study controls for its own definition of abuse, the narrowing in the ratio of boys to girls abused can be accepted as quite reliable, and additional evidence of a delayed recognition effect. Retrospective community evidence shows 1 boy is abused for every 2-4 girls abused. In contrast, the highest clinical ratios are for 1 boy to every 4 girls. Those who work with runaways, male child prostitutes, or child and adolescent psychiatric inpatient units appear particularly likely to encounter abused boys. Secondly, a variety of explanations have been advanced to explain the apparent under-reporting or under-detection of the sexual abuse of boys. Prominent among them have been the boy's fears of disbelief and of being labelled homosexual. Police patterns of reporting extra-familial abuse may mask its extent from protection or health agencies, which is important because extra-familial abuse does appear to be more common in boys, especially older boys, than girls. Although there has been some diminution of the cultural denial that girls can be abused, a parallel decrease of denial regarding boys has lagged behind. This is particularly true of father-son and of the much less common mother-son abuse. It is plausible that certain 'alertors' are more relevant for boys. The recent development of aggressive behaviour, homophobic anxiety, co-abuse of a sibling and abusing behaviour in particular deserve consideration.(ABSTRACT TRUNCATED AT 400 WORDS)
This report presents a three-stage model (ARRM) that characterize people's efforts to change sexual behaviors related to HIV transmission. ARRM focuses on social and psychological factors hypothesized to influence (1) labeling of high risk behaviors as problematic, (2) making a commitment to changing high risk behaviors, and (3) seeking and enacting solutions directed at reducing high risk activities. The proposed model integrates important concepts from prior behavioral medicine and human sexuality studies, specifies their differential import to achieving the goals associated with each stage of the model, and denotes factors hypothesized to influence people's motivation to continue the change process over time. Current findings are discussed within this three-stage model and directions for further research are suggested. Recent findings from our ongoing studies of gays and heterosexuals in San Francisco are presented.
Sexual abuse of male children by their mothers is rarely reported. However, it may not be as rare as commonly believed. Eight case histories are presented which exemplify mothers' sexual abuse of their sons to satisfy the mothers' own needs. In no case was the mother psychotic. In seven cases the mother began the seduction and sexual abuse while the son was prepubescent and continued until at least early adolescence. As adults, each of these sons experienced difficulty maintaining an intimate emotional and sexual relationship with one person, and most presented with some degree of depression. Substance abuse was present in five of eight cases.
The amount of research concerning the prevalence and consequences of child sexual abuse has increased dramatically during the past decade. Too little attention has been paid to possible methodological influences on this research. This investigation reports on the influences of response rate, ordering of questions, and definition of child sexual abuse on the results of a survey of college students' childhood and adolescent sexual experiences. Response rates affected prevalence rate estimates, and the use of varying definitions of child sexual abuse affected estimates of both prevalence and consequences. The importance of the awareness of these methodological issue in future research efforts is discussed.
Little information exists on the childhood sexual victimization of males as it occurs in nonclinical samples. Employing a broad funnel-type of questionnaire methodology, the current study examined childhood sexual victimization in two samples of college men consisting of 253 and 329 students from a large Midwestern and Southeastern university, respectively. There was general consistency between the two samples in the prevalence and descriptive features of the abuse. However, different definitions of abuse generated markedly different outcomes in the data. Depending on the definition utilized, prevalence rates varied from 4% to 24% of the samples being defined as "abused." Moreover, the quality of experiences varied by definition. Using less restrictive definitions, the experiences reported by men were distinctively different from those reported in studies of college women or clinical samples of boys. This study identifies methodological and definitional issues as being critical to the study of childhood sexual victimization, particularly among males.
As part of a prospective study in Toronto, Canada of male sexual contacts of men with either acquired immunodeficiency syndrome (AIDS) or an AIDS-related condition (primary cases), separate interviews were conducted in 1984-1985 with primary cases and their corresponding sexual contacts. Seventy-five primary cases and their corresponding sexual contacts were asked details concerning the sexual activities involved in their sexual encounters. Spearman correlation coefficients were calculated for the responses regarding frequency of various sexual activities between the primary case and his corresponding contact. Comparison of responses revealed good to excellent correlations for the majority of the sexual activities. Regression analysis of responses (dependent variable = contact's response; independent variable = primary's response) revealed the tendency for primary cases to report greater numbers of various activities than sexual contacts, as illustrated by regression coefficients that were consistently less than unity. Agreement between primary responses and sexual contact responses appeared to be affected by the time lapsed from the last sexual encounter with the contact and the date of the primary case's interview. No effect on agreement was observed when primary case diagnosis and the total number of other sexual partners of primary cases were considered. The authors conclude that such data can be captured with sufficient reliability and validity for use in epidemiologic investigations to assess the risk of acquisition of human immunodeficiency virus for the more common forms of sexual activity. However, some caution may be necessary in interpreting the results for some activities (anal digit insertion, anilingus) since agreement is less satisfactory for these activities.
The major finding in this study of 41 serial rapists is the large numbers of reported and unreported victims. For over 1200 attempted and completed rapes, there were 200 convictions. The hidden rapes or earliest nonreported victims of these men as boys and adolescents were identified from their families, their neighborhood, and their schools. Examining the possible link between childhood sexual abuse and criminal behavior in this sample of 41 serial rapists, 56.1% were judged to have at least one forced or exploitive abuse experience in boyhood, as compared to a study of 2,972 college males reporting 7.3% experiencing boyhood sexual abuse. Looking within the abused samples, 56.1% of the rapists reported forced sex, compared to the college sample's 30.4%. Also, the rapist sample revealed higher rates of family member as abuser (48.4%), compared to 22.2% for the college sample. Retrospective reconstruction of the sexual activities and assertive behaviors of these men as boys reveals that 51% of the boys reenact the abuse as a preadolescent with their earliest victims being known to them (48% as neighborhood girls), family (25% as sisters), or girlfriend (25%). The onset of rape fantasies in midadolescence (mean age 16.9) crystalizes the earlier sexually initiated behaviors into juvenile behaviors of spying, fetish burglaries, molestations, and rapes. Repetition of these juvenile behaviors set their criminal patters on strangers--their next group of victims. To reduce victimization, serial rapists need to be identified early and stopped. This means acknowledging and reporting boy sexual abuse. This includes being sensitive to the reenactment behaviors noted in the initiated activities of abused children, which in turn need to be differentiated from peer play. Closer attention needs to be paid to families with incest behavior to insure that younger children are protected. Adolescents showing early repetitive juvenile delinquent behaviors must be assessed for physical and sexual abuse, and intervention must be planned to deal with the victimization. In the investigation and apprehension of serial rapists, law enforcement might pay closer attention to fetish burglaries and the spying, secretive behaviors that serve as the prototype for rape behavior.
Data is presented identifying factors associated with the impact of sexual abuse on children. A group of 369 sexually abused children and a comparison group of 318 children recruited from the community were compared on a parent-completed behavior rating scale. Data describing the abused children were also available from a 38-item symptom checklist completed by the child's social worker. Using a score based on the symptom checklist as the measure of the impact of sexual abuse, 15 variables were in the final regression equation explaining 42% of the variance in impact. Using a score based on parent-generated data, 5 variables were in the final equation explaining 20% of the variance. The significance of the variables in identifying factors associated with an increased impact of abuse is discussed.