CORVALLIS, Ore. - Men who engage in risky sexual behavior with other men report much higher rates than average of experiencing severe childhood sexual abuse, according to a new study in the November issue of the International Journal of Child Abuse & Neglect.
According to the study, about 20 percent of men who have sex with men are sexually abused as children, a rate similar to that found among heterosexual women. The difference is that 80 percent of gay and bisexual men, compared to 20 percent of heterosexual women, who are sexually abused report experiencing "severe" abuse, often involving violence. Both men and women who are abused as children tend to engage in what researchers define as "high-risk" behavior as adults, which includes unprotected sexual encounters.
This research is based on a 2002 survey of approximately 1,000 gay and bisexual men in San Francisco and extends earlier work conducted in 1996 which surveyed several thousand gay and bisexual men in San Francisco, Los Angeles, New York and Chicago. The results of the two surveys confirm that approximately 20 percent of gay and bisexual men have a history of childhood sexual abuse.
In the more recent study, researchers point to the high prevalence of sex abuse being a major contributing factor to psychosocial conditions that have sustained the HIV epidemic over several decades. In 2002, the HIV rate for men who have sex with men in general was about 26 percent. However, that HIV rate jumped to 34 percent for men who report a history of childhood sexual abuse.
"Thirty-five percent is the HIV rate you find in Sub-Saharan Africa," said Joseph Catania, a professor of public health in the College of Health and Human Sciences at Oregon State University and lead author on the study. Catania has worked in public health for more than 25 years on issues related to infectious diseases and sexual health. "This is a chilling number that shows we must deal with the sexual abuse issue."
The effects of childhood sexual abuse are pervasive for both men and women. Studies show that abuse victims have more school-related problems as teens, a variety of sexual health problems including teenage pregnancies among girls and high rates of sexually transmitted diseases. People who experience severe trauma may have life-long challenges in relationships, work and health. That sexual abuse increases risk for HIV infection is not surprising, but what has not been well understood is how it contributes to this and other types of health problems. Having a better understanding of how this happens will guide efforts at prevention and treatment.
In the recent study, investigators found a subset of men who have been sexually abused that tend to "mentally check-out" during sex, Catania said.
"They experience a severe form of coping that involves disassociating from the present, a form of mentally retreating to a safe place until something awful passes. This happens to people who have experienced other types of trauma as well. From a disease prevention perspective it may be quite debilitating," he said.
"In addition, we found some of the men with abuse histories use drugs or alcohol excessively when they have sex. The drug and alcohol use is also a means of coping with emotional issues around sexual trauma, but it may also be another means of mentally escaping from the present when it involves sex. The result is you are not in good shape to be making healthy decisions."
Sexual abuse trauma has other diverse and negative effects on the interpersonal skills needed to negotiate safe sex. Men with sexual trauma histories are also more likely to get raped in adulthood or find themselves in abusive and violent romantic relationships.
Catania said the reason both gay and bisexual men and heterosexual women tend to have similar rates of experiencing childhood sexual abuse is that perpetrators are often male authority figures or men who have access to children and are in a position to take advantage of a childhood infatuation or crush.
"During the early stages of sexual development, gay and bisexual youth, just like heterosexual youth, will form emotional attachments in the form of crushes or infatuations on adult authority figures. The difference is that gay and bisexual youth form these attachments with same gender adults," Catania said. "And adult males are much more likely, by a large margin, to be perpetrators of sexual abuse than are adult women."
Based on their findings, the researchers came to three conclusions. First, the complex challenges faced by men with severe childhood sexual abuse experiences may limit the effectiveness of typical short-term HIV risk reduction programs; more intensive treatment maybe needed. Secondly, Catania said clinical psychologists and psychiatrists with patients who have sexual abuse histories should routinely consider issues of sexual health; patterns and types of sexual partners may be useful markers for identifying more problematic cases.
Finally, Catania said public service messages directed at removing the stigma of childhood sexual abuse may increase use of health and mental health services.
"When it comes to HIV and sexually transmitted infections (STIs), current intervention strategies focus on intervening early on before men become infected, which is a significant challenge, or intervening after they have become infected to prevent further spread of the disease to other sex partners," Catania said.
According to Catania, these interventions tend to be brief and very focused. He said this type of intervention does not serve men with histories of sexual abuse since their problems are more pervasive and complex.
"There is a lot of social stigma around sexual abuse, particularly for men," he said. "An important next step then is to reduce the stigmatization of men who are confronting these issues and provide them with the help they need."
Researchers from the Center for AIDS Prevention Studies at University of California San Francisco contributed to this study.
A copy of the study can be found at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V7N-4TVY5FX-2&_user=576687&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000029364&_version=1&_urlVersion=0&_userid=576687&md5=22f368250ee9c0e2f6783563d0fc9356
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