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Posttraumatic Cognitions and Condomless Sex Among Men Who Have Sex with Men (MSM) with a History of Childhood Sexual Abuse: The Role of Avoidance Coping


This study explicated associations between trauma-related cognitions and condomless sex, examining avoidance coping style and behavior (i.e., substance use) as intermediate variables, among a group disproportionately affected by both trauma and HIV. Two hundred and ninety HIV-negative MSM with a history of childhood sexual abuse (CSA) completed a cross-sectional psychosocial battery. Trauma-related cognitions were positively associated with more acts of condomless sex. Indirect associations on condomless sex were driven by avoidance coping, but not substance use. Findings indicate a need to address trauma-related cognitions and avoidance coping within interventions for reducing HIV risk among MSM with a history of CSA.

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The data and code are accessible on request from the principal investigator.


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We wish to thank the participants involved in this research study.


This work was supported by NIMH (Grant No. R01MH095624, PI Dr. Conall O’Cleirigh). Dr. Daniel Hall’s time was supported by NCCIH (Grant No. K23AT010157). Dr. Abigail Batchelder’s time was supported by NIDA (Grant No. K23DA043418). Dr. Calvin Fitch’s and Dr. Tiffany Glynn's time was supported by NIAID T32AI007433 (PI: Kenneth Freedberg). Drs. Safren and Ironson were also supported by 1P30MH116867 for author time.

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Authors and Affiliations



DLH: Conceptualization, Formal Analysis, Writing original draft. AWB: Formal Analysis, Writing original draft, review, and editing. CJF: Writing original draft, review, and editing. TRG: Writing original draft, review, and editing. GI: Investigation, Resources, Writing review and editing. HM: Project administration, Writing review and editing. SAS: Investigation, Resources, Writing review and editing. COC: Conceptualization, Formal Analysis, Funding acquisition, Investigation, Resources, Writing review and editing. All the authors agreed for the final version to be submitted for peer review and possible publication.

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Correspondence to Daniel L. Hall.

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IRB approval was granted by all participating institutions, including Fenway Health, Massachusetts General Hospital, and the University of Miami.

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Hall, D.L., Batchelder, A.W., Fitch, C.J. et al. Posttraumatic Cognitions and Condomless Sex Among Men Who Have Sex with Men (MSM) with a History of Childhood Sexual Abuse: The Role of Avoidance Coping. AIDS Behav 27, 667–672 (2023).

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  • Men who have sex with men
  • HIV
  • Trauma
  • Coping
  • Avoidance