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Psychosocial Predictors of Sexual HIV Transmission Risk Behavior among HIV-Positive Adults with a Sexual Abuse History in Childhood

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Abstract

Childhood sexual abuse (CSA) is associated with HIV sexual risk behavior. Although many psychosocial correlates of sexual risk among HIV-positive persons have been identified, studies predicting continued risk among HIV-positive adults with histories of CSA are limited. This cross-sectional study identified variables predictive of sexual transmission risk behavior among an ethnically diverse sample of 256 HIV-positive adults (women and men who have sex with men; MSM) with CSA histories. Participants were assessed for trauma symptoms, shame related to HIV and sexual trauma, substance use, coping style, and sexual risk behavior. Logistic regression analyses were conducted to identify variables predictive of unprotected sexual behavior in the past 4 months. Unprotected sex was significantly associated with substance use and trauma-related behavioral difficulties among women and men, and less spiritual coping among men. Unprotected sex with HIV negative or serostatus unknown partners was significantly associated with greater trauma-related behavioral difficulties, more HIV-related shame, and fewer active coping strategies. Thus, trauma symptoms, shame, coping style, and substance use were significantly associated with sexual risk behavior among HIV-positive adults with histories of CSA, with models of prediction differing by gender and partner serostatus. HIV prevention intervention for persons with HIV and CSA histories should address trauma-related behavioral difficulties and enhance coping skills to reduce sexual transmission risk behavior.

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References

  • Allers, C. T., Benjack, K. J., White, J., & Rousey, J. T. (1993). HIV vulnerability and the adult survivor of childhood sexual abuse. Child Abuse and Neglect, 17, 291–298.

    Article  PubMed  CAS  Google Scholar 

  • Bartholow, B. N., Doll, L. S., Joy, D., Douglas, J. M., Bolan, G., Harrison, J. S., et al. (1994). Emotional, behavioral, and HIV risks associated with sexual abuse among adult homosexual and bisexual men. Child Abuse and Neglect, 18, 747–761.

    Article  PubMed  CAS  Google Scholar 

  • Beck, A., & Steer, R. (1987). Manual for the Beck anxiety inventory. San Antonio, TX: Psychological Corporation.

    Google Scholar 

  • Bedimo, A. L., Kissinger, P., & Bessinger, R. (1997). History of sexual abuse among HIV-infected women. International Journal of STD & AIDS, 8, 332–335.

    Article  CAS  Google Scholar 

  • Benda, B. B. (2006). Survival analyses of social support and trauma among homeless male and female veterans who abuse substances. American Journal of Orthopsychiatry, 76, 70–79.

    Article  PubMed  Google Scholar 

  • Bingman, C. R., Marks, G., & Crepaz, N. (2001). Attributions about one’s HIV infection and unsafe sex in seropositive men who have sex with men. AIDS and Behavior, 5, 283–289.

    Article  Google Scholar 

  • Boles, S. M., Joshi, V., Grella, C., & Wellisch, J. (2005). Childhood sexual abuse patterns, psychosocial correlates, and treatment outcomes among adults in drug abuse treatment. Journal of Child Sexual Abuse, 14, 39–55.

    Article  PubMed  Google Scholar 

  • Briere, J. (1995). Trauma symptoms inventory (TSI) professional manual. Lutz, FL: Psychological Assessment Resources, Inc.

    Google Scholar 

  • Briere, J. (2002). Treating adult survivors of severe childhood abuse and neglect: Further development of an integrative model. In J. E. B. Myers, L. Berliner, J. Briere, C. T. Hendrix, C. Jenny, & T. Reid (Eds.), The APSAC handbook on child maltreatment (2nd ed. pp. 175–203). Newbury Park, CA: Sage Publications.

    Google Scholar 

  • Briere, J. (2004). Integrating HIV/AIDS prevention activities into psychotherapy for child sexual abuse survivors. In L. J. Koenig, L. S. Doll, A. O’Leary, & W. Pequegnat (Eds.), From child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention (pp. 219–232). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Briere, J., & Elliott, D. M. (2003). Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women. Child Abuse and Neglect, 27, 1205–1222.

    Article  PubMed  Google Scholar 

  • Briere, J., & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Briere, J., Woo, R., McRae, B., Foltz, J., & Sitzman, R. (1997). Lifetime victimization history, demographics, and clinical status in female psychiatric emergency room patients. Journal of Nervous and Mental Disease, 185, 95–101.

    Article  PubMed  CAS  Google Scholar 

  • Brook, D., Brook, J., Whiteman, M., Win, P., Masci, J., Roberto, J., et al. (1998). Psychosocial risk factors and protective factors for condom use among female injection drug users. American Journal of Addictions, 7, 115–127.

    Article  CAS  Google Scholar 

  • CDC. (2003). Advancing HIV prevention: New strategies for a changing epidemic—United States, 2003. Morbidity and Mortality Weekly Report, 52, 329–332.

    Google Scholar 

  • Classen, C. C., Palesh, O. G., & Aggarwal, R. (2005). Sexual revictimization: A review of the empirical literature. Trauma, Violence, & Abuse, 6, 103–129.

    Article  Google Scholar 

  • Clement, U. (1992). Psychological correlates of unprotected intercourse among HIV-positive gay men. Journal of Psychology and Human Sexuality, 5, 133–155.

    Google Scholar 

  • Comer, L., Kenker, B., Kemeny, M. E., & Wyatt, G. E. (2000). Illness disclosure and mental health among women with HIV/AIDS. Journal of Community and Applied Social Psychology, 10, 449–464.

    Article  Google Scholar 

  • Crepaz, N., & Marks, G. (2001). Are negative affective states associated with HIV sexual risk behaviors? A meta-analytic review. Health Psychology, 20, 291–299.

    Article  PubMed  CAS  Google Scholar 

  • Crepaz, N., & Marks, G. (2002). Towards an understanding of sexual risk behavior in people living with HIV: A review of social, psychological, and medical findings. AIDS, 16, 135–149.

    Article  PubMed  Google Scholar 

  • Crepaz, N., & Marks, G. (2003). Serostatus disclosure, sexual communication and safer sex in HIV-positive men. AIDS Care, 15, 379–387.

    Article  PubMed  CAS  Google Scholar 

  • Cunningham, R. M., Stiffman, A., Dore, P., & Earls, F. (1994). The association of physical and sexual abuse with HIV risk behaviors in adolescence and young adulthood: Implications for public health. Child Abuse and Neglect, 18, 233–245.

    Article  PubMed  CAS  Google Scholar 

  • de Vroome, E. M. M., de Wit, J. B. F., Stroebe, W., Sandfort, T. G. M., & van Griensven, G. J. P. (1998). Sexual behavior and depression among HIV-positive gay men. AIDS and Behavior, 2, 137–149.

    Article  Google Scholar 

  • Finkelhor, D. (1994). Current information on the scope and nature of child sexual abuse. The Future of Children, 4, 31–53.

    Article  PubMed  CAS  Google Scholar 

  • Folkman, S., & Lazarus, R. (1988). Manual for the ways of coping questionnaire: Research edition. Palo Alto, CA: Consulting Psychological Press.

    Google Scholar 

  • Godin, G., Savard, J., Kok, G., Fortin, C., & Boyer, R. (1996). HIV seropositive gay men: Understanding adoption of safe sexual practices. AIDS Education & Prevention, 8, 529–545.

    CAS  Google Scholar 

  • Greenberg, J. B. (2001). Childhood sexual abuse and sexually transmitted diseases in adults: A review of and implications for STD/HIV programmes. International Journal of STD & AIDS, 12, 777–783.

    Article  CAS  Google Scholar 

  • Hays, R. D., Paul, J. P., Ekstrand, M. L., Kegeles, S., Stall, R., & Coates, T. J. (1997). Actual versus perceived HIV status, sexual behaviors and predictors of unprotected sex among young gay and bisexual men who identify as HIV-negative, HIV-positive and untested. AIDS, 11, 1495–1502.

    Article  PubMed  CAS  Google Scholar 

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.

    Article  PubMed  CAS  Google Scholar 

  • Kalichman, S. C. (1999). Psychological and social correlates of high-risk sexual behavior among men and women living with HIV/AIDS. AIDS Care, 11, 415–427.

    Article  PubMed  CAS  Google Scholar 

  • Kalichman, S. C. (2000). HIV transmission risk behaviors of men and women living with HIV/AIDS: Prevalence, predictors, and emerging clinical interventions. Clinical Psychology: Science and Practice, 7, 32–47.

    Article  Google Scholar 

  • Kalichman, S. C., Adair, V., Somlai, A. M., & Weir, S. S. (1995). The perceived social context of AIDS: Study of inner-city sexually transmitted disease clinic patients. AIDS Education and Prevention, 7, 298–307.

    PubMed  CAS  Google Scholar 

  • Kalichman, S. C., Greenberg, J., & Abel, G. G. (1997). HIV-seropositive men who engage in high-risk sexual behavior: Psychological characteristics and implications for prevention. AIDS Care, 9, 441–450.

    Article  PubMed  CAS  Google Scholar 

  • Kalichman, S. C., Kelly, J. A., & Rompa, D. (1997). Continued high-risk sex among HIV seropositive gay and bisexual men seeking HIV prevention services. Health Psychology, 16, 369–373.

    Article  PubMed  CAS  Google Scholar 

  • Kalichman, S. C., Roffman, R. A., Picciano, J. F., & Bolan, M. (1998). Risk for HIV infection among bisexual men seeking HIV-prevention services and risks posed to their female partners. Health Psychology, 17, 320–327.

    Article  PubMed  CAS  Google Scholar 

  • Kalichman, S. C., Sikkema, K. J., DiFonzo, K., Luke, W., & Austin, J. (2002). Emotional adjustment in survivors of sexual assault living with HIV/AIDS. Journal of Traumatic Stress, 15, 189–296.

    Article  Google Scholar 

  • Kaplan, M., Asnis, G. M., Lipschitz, D. S., & Chorney, P. (1995). Suicidal behavior and abuse in psychiatric outpatients. Comprehensive Psychiatry, 36, 229–235.

    Article  PubMed  CAS  Google Scholar 

  • Kimerling, R., Armistead, L., & Forehand, R. (1999). Victimization experiences and HIV infection in women: Association with serostatus, psychological symptoms, and health status. Journal of Traumatic Stress, 12, 41–58.

    Article  PubMed  CAS  Google Scholar 

  • Koenig, L. J., Doll, L. S., O’Leary, A. & Pequegnat, W. (Eds.) (2004). From child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention. Washington, DC: American Psychological Association.

    Google Scholar 

  • Lansky, A., Nakashima, A. K., & Jones, J. L. (2000). Risk behaviors related to heterosexual transmission from HIV-infected persons. Sexually Transmitted Diseases, 27, 483–489.

    Article  PubMed  CAS  Google Scholar 

  • Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

    Google Scholar 

  • Liebschutz, J. M., Feinman, G., Sullivan, L., Stein, M., & Samet, J. (2000). Physical and sexual abuse in women infected with the human immunodeficiency virus: Increased illness and health care utilization. Archives of Internal Medicine, 160, 1659–1664.

    Article  PubMed  CAS  Google Scholar 

  • Longshore, D., & Anglin, M. D. (1995). Number of sex partners and crack cocaine use: Is crack an independent marker for HIV risk behavior? Journal of Drug Issues, 25, 1–10.

    Google Scholar 

  • Malow, R. M., Devieux, J. G., & Lucenko, B. (2006). History of childhood sexual abuse as a risk factor for HIV risk behavior. Journal of Trauma Practice, 5, 13–32.

    Article  Google Scholar 

  • Marks, G., Burris, S., & Peterman, T. A. (1999). Reducing sexual transmission of HIV from those who know they are infected: The need for personal and collective responsibility. AIDS, 13, 297–306.

    Article  PubMed  CAS  Google Scholar 

  • Marks, G., Crepaz, N., & Janssen, R. S. (2006). Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS, 20, 1447–1450.

    Article  PubMed  Google Scholar 

  • McMullen, R. J. (1990). Male rape: Breaking the silence of the last taboo. London: Gay Men’s Press.

    Google Scholar 

  • Murphy, D. A., Rotheram-Borus, M. J., & Marelich, W. D. (2003). Factor structure of a coping scale across two samples. Journal of Applied Social Psychology, 3, 627–647.

    Article  Google Scholar 

  • O’Leary, A., Purcell, D., Remien, R. H., & Gomez, C. (2003). Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men. AIDS Care, 15, 17–26.

    Article  PubMed  CAS  Google Scholar 

  • O’Leary, A., Wolitski, R. J., Remien, R. H., Woods, W. J., Parsons, J. T., Moss, S., et al. (2005). Psychosocial correlates of transmission risk behavior among HIV-seropositive gay and bisexual men. AIDS, 19(suppl. 1), S67–S75.

    PubMed  Google Scholar 

  • Parillo, K. M., Freeman, R. C., Collier, K., & Young, P. (2001). Association between early sexual abuse and adult HIV-risky sexual behaviors among community-recruited women. Child Abuse and Neglect, 25, 335–346.

    Article  PubMed  CAS  Google Scholar 

  • Purcell, D. W., Parsons, J. T., Halkitis, P. N., Mizuno, Y., & Woods, W. J. (2001). Substance abuse and sexual transmission risk behavior of HIV-positive men who have sex with men. Journal of Substance Abuse, 13, 185–200.

    Article  PubMed  CAS  Google Scholar 

  • Rich, C. L., Combs-Lane, A., Resnick, H. S., & Kilpatrick, D. G. (2004). Child sexual abuse and adult sexual revictimization. In L. J. Koenig, L. S. Doll, A. O’Leary & W. Pequegnat (Eds.), From child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention (pp. 49–68). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Robins, A. G., Dew, M. A., Kingsley, L. A., & Becker, J. T. (1997). Do homosexual and bisexual men who place others at potential risk for HIV have unique psychological profiles? AIDS Education & Prevention, 9, 239–251.

    CAS  Google Scholar 

  • Rotheram-Borus, M. J., Mahler, K. A., Koopman, C., & Langabeer, K. (1996). Sexual abuse history and associated multiple risk behavior in adolescent runaways. American Journal of Orthopsychiatry, 66, 390–400.

    Article  PubMed  CAS  Google Scholar 

  • Schiff, M., El-Bassel, N., Engstrom, M., & Gilbert, L. (2002). Psychological distress and intimate physical and sexual abuse among women in methadone maintenance treatment programs. Social Service Review, 76, 302–320.

    Article  Google Scholar 

  • Semple, S. J., Patterson, T., & Grant, I. (2000). Psychosocial predictors of unprotected anal intercourse in a sample of HIV positive gay men who volunteer for a sexual risk reduction intervention. AIDS Education & Prevention, 12, 416–430.

    CAS  Google Scholar 

  • Senn, T. E., Carey, M. P., Vanable, P. A., Coury-Doniger, P., & Urban, M. (2006). Childhood sexual abuse and sexual risk behavior among men and women attending a sexually transmitted disease clinic. Journal of Consulting and Clinical Psychology, 74, 720–731.

    Article  PubMed  Google Scholar 

  • Senn, T. E., Carey, M. P., Vanable, P. A., Coury-Doniger, P., & Urban, M. (2007). Characteristics of sexual abuse in childhood and adolescence influence sexual risk behavior in adulthood. Archives of Sexual Behavior, 36, 637–645.

    Article  PubMed  Google Scholar 

  • Sikkema, K. J., Hansen, N. B., Kochman, A., Tarakeshwar, N., Neufeld, S., Meade, C. S., et al. (2007). Outcomes from a group intervention for coping with HIV/AIDS and childhood sexual abuse: Reductions in traumatic stress. AIDS and Behavior, 11, 49–60.

    Article  PubMed  Google Scholar 

  • Sikkema, K. J., Hansen, N. B., Tarakeshwar, N., Kochman, A., Tate, D. C., & Lee, R. S. (2004). The clinical significance of change in trauma-related symptoms following a pilot group intervention for coping with HIV-AIDS and childhood sexual trauma. AIDS and Behavior, 8, 277–291.

    Article  PubMed  Google Scholar 

  • Sikkema, K. J., Kalichman, S. C., Hoffman, R. G., Koob, J. J., Kelly, J. A., & Heckman, T. (2000). Coping strategies and emotional wellbeing among HIV-infected men and women experiencing AIDS-related bereavement. AIDS Care, 12, 613–624.

    Article  PubMed  CAS  Google Scholar 

  • Sikkema, K. J., Kochman, A., DiFranceisco, W., Kelly, J. A., & Hoffman, R. G. (2003). AIDS-related grief and coping with loss among HIV-positive men and women. Journal of Behavioral Medicine, 26, 165–181.

    Article  PubMed  Google Scholar 

  • Simoni, J. M., Demas, P., Mason, H., Drossman, J., & Davis, M. (2000). HIV disclosure among women of African descent: Associations with coping, social support, and psychological adaptation. AIDS and Behavior, 4, 147–158.

    Article  Google Scholar 

  • Sobel, E., Shine, D., DiPietro, D., & Rabinowitz, M. (1996). Condom use among HIV-infected patients in South Bronx, New York. AIDS, 10, 235–236.

    Article  PubMed  CAS  Google Scholar 

  • Stein, J. A., Rotheram-borus, M. J., Swendeman, D., & Milburn, N. G. (2005). Predictors of sexual transmission risk behaviors among HIV-positive young men. AIDS Care, 17, 433–442.

    Article  PubMed  CAS  Google Scholar 

  • Tarakeshwar, N., Hansen, N. B., Kochman, A., & Sikkema, K. J. (2005). Gender, ethnicity and spiritual coping among bereaved HIV-positive individuals. Mental Health, Religion & Culture, 8, 109–125.

    Article  Google Scholar 

  • Thompson, N. J., Potter, J. S., Sanderson, C. A., & Maibach, E. W. (1997). The relationship of sexual abuse and HIV risk behaviors among heterosexual adult female STD patients. Child Abuse and Neglect, 21, 149–156.

    Article  PubMed  CAS  Google Scholar 

  • UNAIDS. (2006). Report on the global HIV/AIDS epidemic. Retrieved November 25, 2006, from http://www.unaids.org/en/HIV_data/2006GlobalReport/default.asp

  • Van Dorn, R. A., Mustillo, S., Elbogen, E. B., Dorsey, S., Swanson, J. W., & Swartz, M. S. (2005). The effects of early sexual abuse on adult risky sexual behavior among persons with severe mental illness. Child Abuse & Neglect, 29, 1265–1279.

    Article  Google Scholar 

  • van Heck, G., & de Ridder, D. (2001). Assessment of coping with loss: Dimensions and measurement. In M. S. Stroebe, R. O. Hansson, W. Stroebe, & H. Schut (Eds.), Handbook of bereavement research: Consequences, coping and care (pp. 449–469). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • West, M. (2000). Homophobia: Covert and overt. In G. Mezey & M. King (Eds.), Male victims of sexual assault (2nd ed., pp. 17–34). Oxford: Oxford University Press.

    Google Scholar 

  • Wingood, G. M., & DiClemente, R. J. (1997). Child sexual abuse, HIV sexual risk and gender relations of African-American women. American Journal of Preventive Medicine, 13, 380–384.

    PubMed  CAS  Google Scholar 

  • Wolitski, R. J., Parsons, J. T., & Gomez, C. A. (2004). Prevention with HIV-seropositive men who have sex with men: Lessons from the Seropositive Urban Men’s Study (SUMS) and the Seropositive Urban Men’s Intervention Trial (SUMIT). Journal of Acquired Immune Deficiency Syndromes, 37, S101–S109.

    Article  PubMed  Google Scholar 

  • Wyatt, G. E., Longshore, D., Chin, D., Vargas Carmona, J., Loeb, T., Myers, H. F., et al. (2004). The efficacy of an integrated risk reduction intervention for HIV-positive women with child sexual abuse histories. AIDS and Behavior, 8, 453–462.

    Article  PubMed  Google Scholar 

  • Wyatt, G. E., Myers, H. F., Williams, J. K., Kitchen, C. R., Loeb, T., Carmona, J. V., et al. (2002). Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy. American Journal of Public Health, 92, 660–665.

    Article  PubMed  Google Scholar 

  • Zierler, S., Feingold, L., Laufer, D., Velentgas, P., Kantrowitz-Gordon, I., & Mayer, K. (1991). Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. American Journal of Public Health, 81, 572–575.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This research was supported by grants RO1-MH62965 (awarded to Kathleen J. Sikkema, Ph.D.), P30-MH62294 (Center for Interdisciplinary Research on AIDS; CIRA), and T32-MH20031 from the National Institute of Mental Health. The authors gratefully acknowledge our community collaboration with the Callen-Lorde Community Health Center in New York City and Sharon Neufeld for assistance with this manuscript.

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Authors and Affiliations

  1. Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA

    Kathleen J. Sikkema & Arlene Kochman

  2. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Kathleen J. Sikkema, Nathan B. Hansen & Ashley M. Fox

  3. Department of Psychology, Yale University, New Haven, CT, USA

    Kathleen J. Sikkema & Christina S. Meade

  4. Duke University School of Nursing, Duke University Medical Center (DUMC 3322), 307 Trent Drive, Durham, NC, 27710, USA

    Kathleen J. Sikkema

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  1. Kathleen J. Sikkema
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Correspondence to Kathleen J. Sikkema.

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Sikkema, K.J., Hansen, N.B., Meade, C.S. et al. Psychosocial Predictors of Sexual HIV Transmission Risk Behavior among HIV-Positive Adults with a Sexual Abuse History in Childhood. Arch Sex Behav 38, 121–134 (2009). https://doi.org/10.1007/s10508-007-9238-4

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