Gay men sexually abused in childhood more likely to have risky sex and get HIV

An experience of sexual abuse in childhood or adolescence is associated with an increased risk of gay men becoming HIV-positive in adult life, American researchers report in the July 1^st edition of the Journal of Acquired Immune Deficiency Syndromes. The research also showed that men with a history of sexual abuse in early life had higher levels of depression and problematic drug and alcohol use, as well as being less receptive to HIV prevention interventions.

“This is the first study…to demonstrate a predictive relationship between a history of childhood sexual abuse and high rates of HIV infection among HIV-uninfected men who have sex with men,” comment the investigators.

Earlier research has shown that gay and other men who have sex with men are more likely to report a history of childhood sexual abuse than heterosexual men. Other studies have also shown that a history of childhood sexual abuse is associated with sexual risk-taking by adult gay men. There are also data demonstrating a relationship between the experience of sexual abuse as a child and depression and other mental health problems in adult life, as well as poor social skills and drug and alcohol use.

Studies have also demonstrated that gay men with a history of abuse have higher rates of HIV and other sexually transmitted infections. But this research has been limited in its ability to generalise by its cross-sectional design.

Investigators from the EXPLORE study, a prospective study into the effectiveness of behavioural intervention to reduce HIV risk amongst gay men, therefore examined the association between a history of childhood sexual abuse and the risk of becoming infected with HIV. The researchers looked at the relationship between childhood abuse and unprotected anal sex. The mediating role of mental health problems, poor social skills and drug and alcohol use between abuse and infection with HIV or risky sex were also explored.

The study lasted for four years and included a total of 4244 men. These men were recruited to the study in six US cities. All had recently had anal sex with another man, and all the men were HIV-negative at baseline. The men were randomised to receive a behavioural HIV prevention intervention or standard HIV prevention counselling. Every six months they were tested for HIV, and they provided details about their recent sexual behaviour.

To ascertain if an individual had a history of childhood sexual abuse they were asked on entry to the study to say if they had had a sexual experience before the age of 13 with an individual five years or more older than themselves; and/or if they had a sexual experience between the ages of 13 and 17 with an individual who was ten or more years older.

Of the 4244 individuals in the study, 1686 (40%) reported childhood sexual abuse. There were 258 HIV infections during the course of the study, a rate of 2.1 per 100 person years.

The HIV incidence rate differed according to abuse history. It was 1.8 per 100 person years for men with no such history, but 2.5 per 100 person years for men reporting childhood sexual abuse.

Individuals who reported having experienced childhood sexual abuse had an increased risk of HIV infection compared to those with no such history (adjusted hazard ratio = 1.30, 95% CI: 1.02 to 1.69).

Results of the full study showed that the behavioural intervention modestly reduced the risk of HIV infection. This was not, however, the case for men reporting childhood sexual abuse. Men who received the intervention (AHR = 1.06; 95% CI: 0.74 to 1.52), as well as those who were provided with standard safer sex counselling information (AHR = 1.46, 95% CI: 1.04 to 1.95) had an increased risk of acquiring HIV infection.

A significant relationship also existed between childhood sexual abuse and the reporting of unprotected anal sex, including unprotected sex with an HIV-positive man.

Evidence was also found showing that mental health problems, poor coping and communication skills, and the use of drugs and alcohol (all p < 0.001) were significant in the relationship between childhood sexual abuse, risky sex, and subsequent infection with HIV.

“HIV-uninfected men who have sex with men with childhood sexual abuse histories are at a greater risk of HIV infection, report higher rates of HIV sexual risk behaviour, and derive less benefit from prevention programmes,” conclude the investigators. They suggest that the “efficacy of HIV prevention initiatives may be enhanced by incorporating treatment components designed to address the specific mental health concerns [of those] with a history of childhood sexual abuse.”

Aware of the sensitive political nature of their research, the investigators emphasise, “despite the high rates of childhood sexual abuse in the sample, these data do not suggest anything causal regarding the association of abuse and later homosexuality…the majority of men in EXPLORE did not report any type of childhood sexual abuse, so there is little to suggest that childhood sexual abuse ‘causes’ homosexuality, but rather, childhood sexual abuse makes men who have sex with men more likely to engage in HIV risk behaviours.”