The Pervasive Effects of Childhood Sexual Abuse

1Department of Psychiatry, Massachusetts General Hospital 2Harvard Medical School 3Fenway Institute, Fenway Community Health 4Beth Israel Deaconess Medical School.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 01/2012; 59(4):331-4. DOI: 10.1097/QAI.0b013e31824aed80
Source: PubMed
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Available from: Kenneth Mayer, Dec 18, 2013
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    • "[51] Post-traumatic stress symptomatology is characterized by distressing and intrusive thoughts, with which the individual may try to cope through dissociation, substance use, or other strategies which can affect the ability to assess and manage risk.[52]–[54] Hyperarousal, another core symptom of post-traumatic stress, can also affect the individual's ability to accurately assess risk.[52], [55] Interventions to address the sequelae and symptomatology of stressful events and traumatic experiences have shown promise in reducing sexual transmission risk behaviors among HIV-infected individuals with histories of trauma;[11], [12] while such interventions have primarily been developed in high-income countries, increasing emphasis is being placed on the expansion of evidence-based mental health services and the integration of quality mental health care with other medical services for HIV-infected patients in low-income countries.[56], "
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    ABSTRACT: The reduction of HIV transmission risk behaviors among those infected with HIV remains a major global health priority. Psychosocial characteristics have proven to be important correlates of sexual transmission risk behaviors in high-income countries, but little attention has focused on the influence of psychosocial and psychological factors on sexual transmission risk behaviors in African cohorts. The CHAT Study enrolled a representative sample of 499 HIV-infected patients in established HIV care and 267 newly diagnosed HIV-infected individuals from the Kilimanjaro Region of Tanzania. Participants completed in-person interviews every 6 months for 3 years. Using logistic random effects models to account for repeated observations, we assessed sociodemographic, physical health, and psychosocial predictors of self-reported unprotected sexual intercourse. Among established patients, the proportion reporting any recent unprotected sex was stable, ranging between 6-13% over 3 years. Among newly diagnosed patients, the proportion reporting any unprotected sex dropped from 43% at baseline to 11-21% at 6-36 months. In multivariable models, higher odds of reported unprotected sex was associated with female gender, younger age, being married, better physical health, and greater post-traumatic stress symptoms. In addition, within-individual changes in post-traumatic stress over time coincided with increases in unprotected sex. Changes in post-traumatic stress symptomatology were associated with changes in sexual transmission risk behaviors in this sample of HIV-infected adults in Tanzania, suggesting the importance of investing in appropriate mental health screening and intervention services for HIV-infected patients, both to improve mental health and to support secondary prevention efforts.
    Full-text · Article · Dec 2013 · PLoS ONE
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    • "Consistent with our findings, other studies have shown higher rates of multiple partners among men with CSA histories compared with men without CSA histories (Dilorio et al., 2002; Holmes, Foa, & Sammel, 2005). It should also be noted that, consistent with the literature, men who reported CSA were significantly more likely to engage in all of the HIV sexual risk behaviors (Dilorio et al., 2002; O'Cleirigh, Safren, & Mayer, 2012; Markowitz et al., 2011; Pence et al., 2012; Wilson, 2010; Zierler et al., 1991). "
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    ABSTRACT: HIV/AIDS prevalence in South Africa is one of the highest in the world with heterosexual, transmission predominantly promoting the epidemic. The goal of this study is to examine whether, marijuana use and problem drinking mediate the relationship between histories of childhood sexual, abuse (CSA) and HIV risk behaviors among heterosexual men. Participants were 1181 Black men aged, 18-45 from randomly selected neighborhoods in Eastern Cape Province, South Africa. Audio computer assisted, self-interviewing was used to assess self-reported childhood sexual abuse, problem drinking, and marijuana (dagga) use, and HIV sexual transmission behavior with steady and casual partners. Data were analyzed using multiple meditational modeling. There was more support for problem, drinking than marijuana use as a mediator. Findings suggest that problem drinking and marijuana use, mediate HIV sexual risk behaviors in men with histories of CSA. Focusing on men with histories of CSA, and their use of marijuana and alcohol may be particularly useful for designing strategies to reduce, HIV sexual transmission in South Africa.
    Full-text · Article · Sep 2013 · Child abuse & neglect
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    ABSTRACT: Active engagement in HIV clinical care, including uptake and adherence to antiretroviral therapy (ART), is necessary to optimize treatment benefit and can reduce the spread of HIV infection. Among a predominately minority sample of 303 HIV-infected men who have sex with men (MSM) who were either newly diagnosed with HIV or showed evidence of inconsistent engagement in HIV care, we explored rates of exposure to crime, sexual and physical trauma, and associations with factors potentially related to poor engagement in care. Two thirds of participants experienced a crime-related event, and nearly one third reported exposure to physical and/or sexual trauma. All three types of exposure were related to HIV stigma and to concerns about initiating ART. Associations between exposure and social support and HIV disclosure needs were also observed. Findings have implications for the role of trauma exposure and efforts to optimize treatment engagement for HIV-infected MSM.
    Full-text · Article · Jul 2013 · The Journal of the Association of Nurses in AIDS Care: JANAC
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