Childhood Sexual Abuse and HIV-Related Risks Among Men Who Have Sex with Men in Washington,DC

Childhood sexual abuse (CSA) has been reported to be disproportionately higher among men who have sex with men (MSM) than among heterosexual men; it has also been found to be significantly positively associated with HIV status and HIV risk factors, including unprotected anal intercourse. The purpose of this study was to assess the correlates of CSA in a sample of community-recruited MSM, investigate race as a potential effect modifier, and describe the independent association between CSA and HIV infection in Washington, DC. A total of 500 MSM were recruited by venue-based sampling in 2008 as part of the National HIV Behavioral Surveillance. More than one-half of MSM identified as White, while one-third identified as Black. CSA was reported by 17.5 % of the 451 MSM, with the first instance of abuse occurring at a median age of 8.3 (interquartile range = 5.0, 11.0). In multivariable analysis, HIV-positive men were significantly more likely to report a history of CSA compared to HIV-negative men after adjusting for intimate partner violence in the last 12 months, having been arrested in the last 12 months, and depressive symptoms. HIV-positive MSM had more than four times the odds of reporting CSA after controlling for other correlates (aOR = 4.19; 95 % CI 2.26, 7.75). Despite hypothesizing that race modified the effect of CSA on HIV infection we found this was not the case in this sample. More research is needed to investigate the potential pathway between a history of CSA and HIV infection, and how this contributes to driving the HIV epidemic among MSM in Washington, DC.     

Relationship Between Childhood Sexual Abuse and HIV-Related Risks Among Men Who Have Sex with Men: Findings from Mainland China

Men who have sex with men (MSM) carry the burden of HIV infection in China. Outside of China, a history of childhood sexual abuse (CSA) has been associated with HIV-related risks (behavioral, sexual, and mental health outcomes) among MSM. We therefore evaluated the relationship between CSA and these HIV-related risks among MSM in China. Cross-sectional data were collected via a survey from gay websites and social networking applications from MSM in 30 provinces in mainland China during a 3-month period in 2014 and 2015. Overall, 999 screened MSM who responded to questions on CSA were included. Multinomial logistic regression models—adjusted for sociodemographic confounders—showed that men who reported experiencing regular CSA and contact CSA, respectively, were more likely to use substances (adjusted odds ratio [AOR], 1.91; 95% confidence interval [CI] 1.39–2.62 and AOR, 1.70; 95% CI 1.25–2.31), had a history of sexually transmitted infections (AOR, 1.81; 95% CI 1.29–2.55 and AOR, 1.65; 95% CI 1.18–2.96), had more male sexual partners (AOR, 1.06; 95% CI 1.04–1.09 and AOR, 1.05; 95% CI 1.03–1.08), engaged in more condomless sex with men (AOR, 1.89; 95% CI 1.39–2.56 and AOR, 1.72; 95% CI 1.29–2.30), and experienced more psychological distress (AOR, 1.05; 95% CI 1.02–1.08 and AOR, 1.05; 95% CI 1.03–1.08). Both frequent and contact forms of CSA were positively associated with HIV-related risks among MSM, suggesting that general CSA prevention strategies and interventions are needed to support this population.     

Double Sexual Standards: Sexuality and People with Intellectual Disabilities Who Require Intensive Support

Sexuality and Disability - More than four decades after the onset of deinstitutionalization in the Nordic countries, people with intellectual disabilities in Iceland are still being prevented from...     

Reviewing Strategies for Risk Reduction of Sexual Abuse of Children with Intellectual Disabilities: A Focus on Early Intervention

Individuals with special needs are at an increased risk for sexual assault during childhood as compared to their typically developing peers (Mahoney and Poling in J Dev Phys Disabil 23(4):369–376, 2011). Developmental delays across domains may influence the likelihood of sexual abuse. For example, motor delays may limit un/dressing and other self-care tasks, social delays may inhibit appropriate peer relationships, cognitive delays may prevent a child from discerning abuse from care, language delays may prohibit a child from reporting abuse or rejecting an inappropriate advance, and emotional delays may impact a child’s self-esteem and potential designation as a “victim” (Brown and Turk in Child Abuse Rev 3:26–35, 1994; Melberg Schwier and Hingsburger in Sexuality; your sons and daughters with intellectual disabilities, Paul H. Brookes Publishing Co., Maryland, 2000; Mitchel and Buchele-Ash in J Disabil Policy Stud 10(2):225–243, 2000; Rogers et al. in Int J Disabil Dev Educ 56(3):205–228, 2009). Care providers are frequently cited as the most likely perpetrator of sexual abuse against children with intellectual disabilities, and are likely to be known to the child prior to the abuse occurring (Mahoney and Poling in J Dev Phys Disabil 23(4):369–376, 2011). A strong foundation for healthy sexuality across the lifespan begins in the early years. Enhancing skill deficits across domains can impact a child’s ability to navigate relationships with themselves and others, and can contribute to risk-reduction of sexual assault (Tepper in Contemp. Sex 39(9):i–vi, 2005).     

Psychosocial Syndemic Correlates of Sexual Compulsivity Among Men Who Have Sex with Men: A Meta-Analysis

Efforts have been made to better understand sexual compulsivity by examining salient psychosocial syndemic correlates, though examination of such factors has yielded inconclusive results. Given that research on sexual compulsivity has predominately involved men who have sex with men (MSM), the aims of the current study were to establish the mean effect sizes of seven psychosocial syndemic indicators with sexual compulsivity, to determine if the effect varied as a function of the type of psychosocial syndemic, and investigate the potential moderating effects using MSM samples. A total of 95 studies were included for analyses among the psychosocial syndemic indicators of interest (i.e., depression, anxiety, alcohol use, drug use, intimate partner violence, childhood sexual abuse, and sexual risk behavior). Results revealed a medium mean effect size of sexual compulsivity, the strength of which was significantly moderated by type of psychosocial syndemic indicator. Significant mean effect sizes for all syndemic indicators on sexual compulsivity were found, with depression and anxiety having the strongest relationships; significant moderating effects were found and are discussed. Findings highlight clinical considerations regarding sexual compulsivity and its role within the HIV syndemic framework among MSM.     

Judging the Acceptability of Sexual Intercourse Among People with Learning Disabilities: A Mexico-France Comparison

The respective attitudes of Mexican and French laypeople regarding regular sexual intercourse involving at least one person with learning disabilities were compared. The study was a replication of a study conducted in France in a community sample from Mexico (aged 22–75). Only three of the four factors that were found to have a significant effect among French participants—use of contraceptive devices, level of personal autonomy, and partner’s age—were found to be significant among the Mexican participants. The partner’s handicap factor was not significant, but the impact of the contraception factor was stronger among the Mexican participants than among the French participants. Contrary to what was observed among the French participants, among the Mexican participants the three factors were combined in a strictly additive way. That is, each factor contributed independently to the acceptability judgments.     

深圳市男男性行为人群艾滋病性病感染及相关危险行为研究

目的 了解深圳市男男性行为人群艾滋病性病感染及相关行为特征,为政府制订预防控制措施提供科学依据. 方法用同伴推动法对符合条件的188名男男性接触人群进行调查. 结果深圳市男男性行为人群性网络复杂,性行为方式多样,12.2%有吸毒行为,性病感染达34.6%,文化程度是性传播疾病感染的影响因素. 结论深圳市男男性行为人群高危行为普遍,存在极高的感染艾滋病病毒风险,必须有针对性地加强宣传和干预工作.     

Compulsive Sexual Behavior and Risk for Unsafe Sex Among Internet Using Men Who Have Sex with Men

The present study explored the relationship between compulsive sexual behavior (CSB) and unprotected anal intercourse (UAI) for men who have sex with men (MSM) across a number of ethnic/racial groups and who used the Internet to seek sexual partners. A sample of 2,716 MSM (512 Asian, 445 Black, 683 Latino, 348 Other, 728 White) completed on online survey that collected information about their sexual behaviors with partners met online and offline. The survey also included the Compulsive Sexual Behavior Inventory (CSBI). Consistent with the notion that CSB is a stable trait, higher scores on the CSBI were associated with greater odds for engaging in UAI, regardless of the context in which sex partners were met (online or offline). Differences in median CSB scores were generally similar across racial and ethnic groups. The median CSB score was significantly higher for HIV-positive participants than for HIV-negative participants. HIV-prevention interventions are needed among MSM, but should take into account that some may be resistant to risk reduction strategies because of CSB.     

Relation of Childhood Sexual Abuse,Intimate Partner Violence,and Depression to Risk Factors for HIV Among Black Men Who Have Sex With Men in 6 US Cities

Objectives. We assessed the relation of childhood sexual abuse (CSA), intimate partner violence (IPV), and depression to HIV sexual risk behaviors among Black men who have sex with men (MSM).Methods. Participants were 1522 Black MSM recruited from 6 US cities between July 2009 and December 2011. Univariate and multivariable logistic regression models were used.Results. Participants reported sex before age 12 years with someone at least 5 years older (31.1%), unwanted sex when aged 12 to 16 years (30%), IPV (51.8%), and depression (43.8%). Experiencing CSA when aged 12 to 16 years was inversely associated with any receptive condomless anal sex with a male partner (adjusted odds ratio [AOR] = 0.50; 95% confidence interval [CI] = 0.29, 0.86). Pressured or forced sex was positively associated with any receptive anal sex (AOR = 2.24; 95% CI = 1.57, 3.20). Experiencing CSA when younger than 12 years, physical abuse, emotional abuse, having been stalked, and pressured or forced sex were positively associated with having more than 3 male partners in the past 6 months. Among HIV-positive MSM (n = 337), CSA between ages 12 and 16 years was positively associated with having more than 3 male partners in the past 6 months.Conclusions. Rates of CSA, IPV, and depression were high, but associations with HIV sexual risk outcomes were modest.Despite significant medical advances, the HIV epidemic remains a health crisis in Black communities. The Black population represents only 14% of the total US population but accounted for 44% of all new HIV infection (68.9 of 100 000) in 2010.1 Black men who have sex with men (MSM) are disproportionately impacted by HIV compared with other racial/ethnic groups of MSM.1,2 Male-to-male sexual contact accounted for 72% of new infections among all Black men.1 Young Black MSM (aged 13–24 years) have a greater number of new infections than any other age or racial group among MSM.1 Researchers have been challenged with developing HIV prevention strategies for Black MSM.3–7 Higher frequencies of sexual risk behaviors, substance use, and nondisclosure of sexual identities do not adequately explain this disparity.8,9 High rates of sexually transmitted infections (STIs), which facilitate HIV transmission, and undetected or late diagnosis of HIV infection only partially explain disproportionate HIV rates.8Researchers have begun to examine a constellation of health factors that may contribute to HIV among MSM. For example, syndemic theory or the interaction of epidemics synergistically, such as intimate partner violence (IPV) and depression, may help explain HIV-related sexual risk behaviors among Black MSM.9 Childhood sexual abuse (CSA), IPV, and mental health disorders including depression may comprise such a constellation and warrant further exploration.Experiences of CSA have been identified as being associated with negative sexual health outcomes, with MSM reporting higher CSA rates than the general male population.10–12 Men with CSA experiences are more likely than men without CSA experiences to engage in high-risk sexual behaviors,13–21 have more lifetime sexual partners,13–16 use condoms less frequently,13,14,16 and have higher rates of STIs,13,14,17 exchanging sex for drugs or money,13,14,17 HIV,13,14 alcohol and substance use,13–21 and depression.13–15,18,21 Such findings suggest that sexual risk reduction counseling may need to be tailored for MSM with CSA experiences.15Childhood sexual abuse histories have also been correlated with sexual revictimization, including IPV.22–24 One study with population-based estimates of CSA found that gay and bisexually identified men had higher odds of reporting CSA (9.5 and 12.8, respectively) compared with heterosexual men.25 For sexual minority men, CSA histories were associated with higher HIV and STI incidence.25 However, research examining CSA, revictimization, and sexual risk behaviors is lacking among Black MSM.In one existing study, Black and Latino MSM with CSA histories identified their trauma experiences as influencing their adult sexual decision-making.26 Among Black MSM in 2 additional studies, emotional distress and substance use were attributed to having CSA experiences (Leo Wilton, PhD, written communication, October 2, 2013).27 In an ethnically diverse sample of 456 HIV-positive MSM, CSA was associated with insertive and receptive condomless anal sex.19Similar to CSA, IPV has not been extensively examined among MSM or Black MSM,28 but may be associated with sexual risk behaviors. Intimate partner violence is defined as a pattern of controlling, abusive behavior within an intimate relationship that may include physical, psychological or emotional, verbal, or sexual abuse.29 Little research exists on IPV among same-sex couples despite incidence rates being comparable to or greater than that of heterosexual women.28,30–34 Important IPV information comes from the National Intimate Partner and Sexual Violence Survey, a nationally representative survey for experiences of sexual violence, stalking, and IPV among men and women in the United States.28 Among men who experienced rape, physical violence, or stalking by an intimate partner, perpetrator differences by gender were found among gay, bisexual, and heterosexual men; 78% of bisexual and 99.5% of heterosexual men reported having only female perpetrators, and 90.7% of gay men reported having only male perpetrators.28 Being slapped, pushed, or shoved by an intimate partner during their lifetime was reported by gay (24%), bisexual (27%), and heterosexual (26.3%) men.28Intimate partner violence has been linked to condomless anal sex, HIV infection, substance use, CSA, and depression.35–37 Being an HIV-positive MSM has been linked with becoming a victim of IPV.38,39 Welles et al. found that being an African American MSM who initially disclosed having male partners and early life sexual abuse experiences was associated with IPV victimization.39 Wilton found that a high percentage of Black MSM reported IPV histories: emotional abuse (48.3%), physical abuse (28.3%), sexual abuse (21.7%), and stalking abuse (29.2%; Leo Wilton, PhD, written communication, October 2, 2013). Such findings lend to the importance of exploring, both independently and together, the association of CSA and IPV with sexual risk behaviors.Some studies have reported the influence of mental health (e.g., depression) on sexual risk behaviors among MSM,9,40,41 whereas others have not corroborated such findings.42 Greater rates of depression among MSM than among non-MSM samples43–45 and elevated rates of depression and anxiety among Black MSM have been reported.46 The Urban Men’s Health Study, a cross-sectional sample of MSM in 4 US cities, did not find a significant relationship between high depressive symptoms and condomless anal sex.42 However, the EXPLORE study, a randomized behavioral intervention for MSM in 6 US cities, supported the association between moderate depressive symptoms and an increased risk for HIV infection.47 Moderate levels of depression and higher rates of sexual risk were also reported for HIV-infected MSM over time.48 Another study conducted with 197 Black MSM found that moderate depressive symptoms were associated with having condomless anal sex with a serodiscordant casual partner.49 These mixed findings support the need to better understand the relationship between the severity of depression (i.e., moderate vs severe) and HIV risk behaviors.The HIV Prevention Trials Network 061 study, also known as the BROTHERS (Broadening the Reach of Testing, Health Education, Resources, and Services) Project, was a multisite study to determine the feasibility and acceptability of a multicomponent intervention for Black MSM. The current analysis aims to assess the prevalence of CSA, IPV, and depressive symptomology, and examine the relationships between these factors and insertive and receptive condomless anal sex and number of sexual partners in a large cohort of Black MSM.     

A Sexuality and Relationship Training Program for Women with Intellectual Disabilities: A Social Story Approach

A multi-method study design involving three different phases was used to develop four social stories that could be used as part of a sexuality and relationship training program for women with intellectual disabilities. Phase 1 entailed a systematic review of the literature and results indicate that social stories provide a suitable methodology for teaching socially desirable responses related to sexuality and relationships. Phase 2 entailed a focus group with women with intellectual disabilities and results showed that they wanted more information about different types of relationships, including romantic relationships. They also wanted to understand what types of behavior (e.g. different types of greetings) were appropriate for the different types of relationships. Next, four social stories were written based on the results of these two phases. Finally, these four social stories were implemented in Phase 3 with ten caregivers of women with intellectual disabilities in order to evaluate the appropriateness of the stories. Results showed that three of the four social stories were appropriate, and that one required re-writing as it was not appropriate for the specific context, as women at that facility did not have the opportunity to go on dates. A suggestion was made that the story be re-written to reflect romantic relationships as opposed to dating.     

Beyond the Down Low: Sexual Risk,Protection, and Disclosure Among At-Risk Black Men Who Have Sex with Both Men and Women (MSMW)

Little information is available about sexual risk, protective, and disclosure practices among Black bisexually active men and how these may be amenable to intervention when necessary. In-depth interviews were conducted with 30 at-risk urban Black men who have sex with both men and women (MSMW). Participants reported protecting themselves and their partners through routine HIV testing, using condoms consistently, engaging in strategic positioning during sexual activity, and limiting the number of sexual partners. In addition, they described several reasons for not using protection, including not having condoms available, enjoying sexual activity more without condoms, and perceiving female partners to be "safer" than male partners. Disclosure of bisexuality was complex and reportedly difficult, in particular to female and gay-identified male partners. Future interventions must not only build protection and disclosure skills among MSMW, but also increase broader social awareness and acceptance of male bisexuality.     

Capacity to Consent: Policies and Practices that Limit Sexual Consent for People with Intellectual/Developmental Disabilities

Sexuality and Disability - Consent determination is a common practice that has been championed as a logical approach (Lyden in Sex Disabil 25(1):3–20, 2007) to the sexual activity of...     

Reactions to Self-Sampling for Ano-Rectal Sexually Transmitted Infections Among Men Who Have Sex with Men: A Qualitative Study

Little is known about men’s potential motivations and barriers associated with specific sexually transmitted infections (STI) testing methods. In this study, we examined experiences of self-sampling for ano-rectal STI among men who have sex with men (MSM) in a midwestern community in the U.S. A total of 75 MSM were recruited from community venues throughout Indianapolis, Indiana. Participants completed semi-structured interviews, were asked to obtain ano-rectal self-sample in a private restroom, and were asked open-ended questions about their experiences with ano-rectal self-sampling for STI. Participants included 35 White, 27 Black, and 13 Latino MSM who ranged in age from 18 to 57 years. Regardless of sexual practices, most participants who obtained an ano-rectal self-sample (68/75) reported that the sampling procedure was relatively painless and physically easy. However, regardless of previous receptive anal sex, participants also expressed concerns about the nature of the test (i.e., inserting something into their rectum), which required increased levels of privacy and cleanliness compared to collection of urine samples. Self-sampling proved to be a feasible and acceptable method of collecting ano-rectal STI specimens among MSM. Increased testing for ano-rectal STI among MSM may require addressing the location of sampling and testing sites, existing negative perceptions of ano-rectal self-sampling, and the measures in place to promote privacy and cleanliness.     

Online Hookup Sites for Meeting Sexual Partners Among Men Who Have Sex with Men in Rhode Island, 2013: A Call for Public Health Action

Frequent use of websites and mobile telephone applications (apps) by men who have sex with men (MSM) to meet sexual partners, commonly referred to as “hookup” sites, make them ideal platforms for HIV prevention messaging. This Rhode Island case study demonstrated widespread use of hookup sites among MSM recently diagnosed with HIV. We present the advertising prices and corporate social responsibility (CSR) programs of the top five sites used by newly diagnosed HIV-positive MSM to meet sexual partners: Grindr, Adam4Adam, Manhunt, Scruff, and Craigslist. Craigslist offered universal free advertising. Scruff offered free online advertising to selected nonprofit organizations. Grindr and Manhunt offered reduced, but widely varying, pricing for nonprofit advertisers. More than half (60%, 26/43) of newly diagnosed MSM reported meeting sexual partners online in the 12 months prior to their diagnosis. Opportunities for public health agencies to promote HIV-related health messaging on these sites were limited. Partnering with hookup sites to reach high-risk MSM for HIV prevention and treatment messaging is an important public health opportunity for reducing disease transmission risks in Rhode Island and across the United States.An estimated 1.2 million people in the United States live with human immunodeficiency virus (HIV) according to 2015 estimates published by the Centers for Disease Control and Prevention (CDC).¹ Although men who have sex with men (MSM) represent 4% of the U.S. male population, they account for 61% of all new HIV infections.² Sexual behaviors contributing to HIV transmission among MSM may be facilitated by websites and mobile telephone applications (apps), which are increasingly popular vehicles for MSM to meet sexual partners.^3–8 Although websites and apps differ in services offered and message delivery, many have the primary purpose of facilitating sexual encounters. Hereinafter, we collectively refer to websites and apps that MSM use to meet sexual partners as “hookup sites.” Some hookup sites use global positioning system software to allow subscribers to identify nearby sexual partners.⁸Use of hookup sites to meet sexual partners among MSM is more prevalent than among other populations. MSM are up to seven times more likely than non-MSM to have sex with a partner they met online,⁵ and an estimated 3–6 million MSM meet sexual partners using Internet-based technology.⁷ A meta-analysis found that nearly half of MSM surveyed had met sexual partners online;⁷ another study found that 85% of MSM use the Internet to meet other men for sex.⁵ The anonymity, affordability, and accessibility of meeting partners online appeals to many MSM, for whom meeting partners in traditional social settings may pose challenges because of stigma associated with having sex with other men.⁹MSM who use the Internet to meet sexual partners are more likely to engage in higher-risk behavior than men who do not meet partners online, including having more frequent condomless anal intercourse, having more sexual partners, having more sex with anonymous or non-main partners, having more sex with HIV-positive partners, and more often using drugs and alcohol during sex.^4,8,10,11 Hookup sites can be used to locate partners for “barebacking,” or intentional condomless sex.^3,8 Men who meet partners online may have limited knowledge of HIV prevention tools; a 2012 study found that MSM who met partners online had limited knowledge about pre-exposure prophylaxis (PrEP) and postexposure prophylaxis.¹²Despite the growing body of research linking hookup sites to high-risk behavior, few studies have explored the associations between these sites and disease transmission. A 2014 study found that MSM who used apps to meet sexual partners had greater odds of testing positive for gonorrhea and chlamydia compared with MSM who did not meet their partners online, but did not find any increased risk for syphilis or HIV.⁴ Although another 2014 article posited that Craigslist advertisements for sexual encounters were correlated with HIV infection, a closer review of the analyses suggested that transmission was not correlated with Craigslist use at the individual level.⁶ These findings suggest that hookup sites may facilitate disease transmission by expediting the process of meeting sexual partners,⁹ but this issue warrants further scientific exploration and public policy attention.     

Childhood Sexual Abuse and Adult Sexual Dysfunction: Response to Commentary by Rind and Tromovitch (2007)

Rind and Tromovitch (2007) raised four concerns relating to our article (Najman, Dunne, Purdie, Boyle, & Coxeter, 2005. Archives of Sexual Behavior, 34, 517–526.) which suggested a causal association between childhood sexual abuse (CSA) and adult sexual dysfunction. We consider each of these concerns: magnitude of effect, cause and effect, confounding, and measurement error. We suggest that, while the concerns they raise represent legitimate reservations about the validity of our findings, on balance the available evidence indicates an association between CSA and sexual dysfunction that is of “moderate” magnitude, probably causal, and unlikely to be a consequence of confounding or measurement error. Editor’s note. The authors were asked by the Editor to offer a reply to the article by Rind and Tromovitch.