HIV risk among men who have sex with men who have experienced childhood sexual abuse: systematic review and meta-analysis

Previous research has indicated a high prevalence of childhood sexual abuse (CSA) among men who have sex with men (MSM) in the United States, and has suggested that CSA history is a risk factor for HIV infection in MSM. We conducted a systematic review to identify, synthesize, meta-analyze, and critique the current state of relevant literature. Systematic review methodology was utilized to identify 12 studies that compared MSM with a history of CSA to MSM without a history of CSA on HIV risk indicators including HIV serostatus, sexually transmitted infections (STIs), sexual behaviors, and illicit drug use. Overall, 27.3% (n = 4,263) of the MSM in all included studies (n = 15,622) reported a CSA history. Across the studies that used probabilistic sampling (n = 8,240), the estimated prevalence of CSA was 21.8% (n = 1,800). Meta-analysis indicated that MSM with CSA history were more likely to be HIV positive [odds ratio (OR) = 1.54; 95% confidence interval (CI) = 1.22-1.95)] and to engage in recent unprotected anal intercourse (OR = 1.85, 95% CI = 1.36-2.51). Studies also indicated that MSM with a history of CSA were more likely to report frequent casual male partners, substance use, and sex while under the influence of alcohol or other drugs. Trends across studies indicated a need for interventions to assess CSA history and address effects of CSA on sexual risk behavior of MSM. Inconsistencies across studies indicated a need to reach consensus among researchers and providers in defining CSA.