Journal of Family Violence

, Volume 21, Issue 2, pp 127–135 | Cite as

History of Traumatic Abuse and HIV Risk Behaviorsin Severely Mentally Ill Substance Abusing Adults

  • Robert M. Malow
  • Jessy G. Dévieux
  • Ligia Martinez
  • Fred Peipman
  • Barbara A. Lucenko
  • Seth C. Kalichman
Original Article

Epidemiological studies in the United States estimate HIV seroprevalence rates ranging between 4% and 23% for serious mentally ill adults (SMIA; i.e., schizophrenia, bipolar disorder, and other chronic disorders with psychotic features), with substantially greater estimates for risky sexual behaviors. Among the most consistent factors linked to HIV risk in non-SMIA populations is a history of emotional, physical, or sexual abuse. The current study examined the intersection of abuse history and HIV sexual risk behavior in SMIAs with a group of men (n = 64) and women (n = 115) recruited from eight geographically diverse and representative clinical sites around Florida. A cross-sectional interview revealed a high prevalence of alcohol and other drugs problems, as well as a history of emotional, physical, or sexual abuse in 75% of the participants, with 68% of these reporting multiple types of abuse. Compared to nonabused counterparts, those with a history of abuse reported significantly greater: (a) lifetime and current psychiatric symptoms, (b) recent unprotected sexual intercourse, and (c) crack cocaine, heroin, and marijuana use. No gender differences were detected in the associations of abuse history and sexual risk behaviors. These results underscore the need for HIV prevention efforts targeted to SMIAs and the critical importance of addressing abuse history in interventions with this underserved population.


abuse HIV risk factor traumatic 


  1. American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. APA, Washington, DC.Google Scholar
  2. Bartholow, B., Doll, L., Joy, D., Douglas, J., Bolan, G., Harrison, J. S., Moss, P. M., and McKirnan, D. (1994). Emotional, behavioral, and HIV risks associated with sexual abuse among adult homosexual and bisexual men. Child Abuse Negl. 9: 747–761.Google Scholar
  3. Becker, E., Rankin, E., and Rickel, A. (1998). High-risk sexual behavior: Interventions with vulnerable populations. Plenum, New York.Google Scholar
  4. Bensley, L. S., Eenwyk, J. V., and Simmons, K. (1999). Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking. Am. J. Prev. Med. 18: 151–158.CrossRefGoogle Scholar
  5. Boudewyn, A. C., and Liem, J. H. (1995). Childhood sexual abuse as a precursor to depression and self-destructive behavior in adulthood. J. Trauma. Stress 8: 445–459.PubMedCrossRefGoogle Scholar
  6. Briere, J., and Runtz, M. (1987). Post sexual abuse trauma: Data and implications for clinical practice. J. Interpersonal Violence 2: 367–379.CrossRefGoogle Scholar
  7. Browne, A., and Finkelhor, D. (1986). Impact of sexual abuse: A review of the research. Psychol. Bull. 99: 66–77.PubMedCrossRefGoogle Scholar
  8. Burnam, M. A., Stein, J. A., Golding, J. M., Siegel, J. M., Sorenson, S. B., Forsythe, A. B., and Telles, C. A. (1988). Sexual assault and mental disorders in a community population. J. Consulting Clin. Psychol. 56: 843–850.CrossRefGoogle Scholar
  9. Carey, M. P., Carey, K., and Kalichman, S. C. (1997). Risk for human immunodeficiency virus (HIV) infection among persons with severe mental illnesses. Clin. Psychol. Rev. 17: 271–291.PubMedCrossRefGoogle Scholar
  10. Carey, M. P., Weinhardt, L. S., and Carey, K. B. (1995). Prevalence of infection with HIV among the seriously mentally ill: Review of research and implications for practice. Prof. Psychol.: Res. Pract. 26: 262–268.CrossRefGoogle Scholar
  11. Cohen, M., Deamant, C., Barkan, S., Richardson, M., Young, M.,Holman, S., Anastos, K., Cohen, J., and Melnick, S. (2000). Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV. Am. J. Public Health 90: 560–565.PubMedGoogle Scholar
  12. Cournos, F., Empfield, M., Horwath, E., McKinnon, K., Meyer, I., Schrage, H., Currie, C., and Agosin, B. (1991). HIV seroprevalence among patients admitted to two psychiatric hospitals. Am. J. Psychiatry 148: 1225–1229.PubMedGoogle Scholar
  13. Dolcini, M. M., Coates, T. J., Catania, J. A., Kegeles, S. M., and Hauck, W. W. (1995). Multiple sexual partners and their psychosocial correlates: The population-based AIDS in multiethnic neighborhoods (AMEN) study. Health Psychol. 14: 22–31.PubMedCrossRefGoogle Scholar
  14. Gold, S. N., Lucenko, B. A., Elhai, J. D., Swingle, J. M., and Sellers, A. H. (1999). A comparison of psychiatric/psychological symptomatology of women and men sexually abused as children. Child Abuse Negl. 23: 683–692.PubMedCrossRefGoogle Scholar
  15. Goodman, L. A., and Fallott, R. D. (1998). HIV risk-behavior in poor urban women with serious mental disorders: Association with childhood physical and sexual abuse. Am. J. Orthopsychiatry 68: 73–83.PubMedCrossRefGoogle Scholar
  16. Grassi, L., Pavanati, M., Cardelli, R., Ferri, S., and Peron, L. (1999). HIV-risk behaviour and knowledge about HIV/AIDS among patients with schizophrenia. Psychol. Med. 29: 171–179.PubMedCrossRefGoogle Scholar
  17. Hunter, J. A. (1991). A comparison of psychosocial maladjustment of adult males and females sexually molested as children. J. Interpersonal Violence 6: 205–217.CrossRefGoogle Scholar
  18. Jackson, J. L., Calhoun, K. S., Amick, A. E., Maddever, H. M., and Habif, V. L. (1990). Young adult women who report childhood intrafamilial sexual abuse: Subsequent adjustment. Arch. Sex. Behav. 19: 211–221.PubMedCrossRefGoogle Scholar
  19. Kalichman, S. C. (1998). Preventing AIDS: Sourcebook for behavioral interventions LEA, Mahwah, NJ .Google Scholar
  20. Kalichman, S. C., Carey, M. P., and Carey, K. B. (1996). Human immunodeficiency virus (HIV) risk among the seriously mentally ill. Clin. Psychol.: Res. Pract. 3: 130–143.CrossRefGoogle Scholar
  21. Kalichman, S. C., Kelly, J. A., Johnson, J., and Bulto, M. (1994). Factors associated with risk for human immunodeficiency virus (HIV) infection among chronic mentally ill adults. Am. J. Psychiatry 151: 221–227.PubMedGoogle Scholar
  22. Kauth, M., St. Lawrence, J. S., and Kelly, J. A. (1991). Reliability of retrospective assessments of sexual HIV risk behavior: A comparison of biweekly, three-month, and twelve-month self-reports. AIDS Educ. Prev. 3: 207–214.PubMedGoogle Scholar
  23. McLellan, A. T., Metzger, D., and Peters, R. (1992). The fifth edition of the Addiction Severity Index. J. Subst. Abuse Treat. 9: 199–213.PubMedCrossRefGoogle Scholar
  24. Miller, M. (1990). A model to explain the relationship between sexual abuse and HIV risk among women. AIDS Care 11: 3–20.CrossRefGoogle Scholar
  25. Mueser, K. T., Goodman, L. B., Trumbetta, S. L., Rosenberg, S. D., Osher, F. C., Vidaver, R., Auciello, P., and Foy, D. W. (1998). Trauma and posttraumatic stress disorder in severe mental illness. J. Consult. Clin. Psychol. 66: 493–499.PubMedCrossRefGoogle Scholar
  26. Needle, R., Fisher, D., Weatherby, N., Brown, B., Chitwood, D., Cesari, H., Chitwood, D., Booth, R., Williams, M. L., Andersen, M., and Braumstein, M. (1995). Reliability of self-reported HIV risk behaviors of drug users. Psychol. Addict. Behav. 9: 242–250.CrossRefGoogle Scholar
  27. Silverman, A. B., Reinherz, H. Z., and Giaconia, R. M. (1996). The long-term sequelae of child and adolescent abuse: A longitudinal community study. Child Abuse Negl. 20: 709–723.PubMedCrossRefGoogle Scholar
  28. Sorensen, J. L., London, J., and Morales, E. (1991). Group counseling to prevent AIDS. In J. Sorensen, J. L., Wermuth, D. R., Gibson,K. H., Choi, J. S. Guydish, and Batki, S. (eds.), Preventing AIDS in Drug Users and Their Sexual Partners, Guilford, New York City,pp. 99–115.Google Scholar
  29. Stewart, D. L., and Ingle, J. M. (1994). HIV seroprevalence in a chronically mentally ill population. J. Nat. Med. Assoc. 86: 519–523.Google Scholar
  30. Tabachnick, B. G., and Fidell, L. S. (1996). Using Multivariate Statistics, 3rd edn., Harper Collins, New York.Google Scholar
  31. Thompson, N. J., Potter, J. S., Sanderson, C. A., and Maibach, E. W. (1997). The relationship of sexual abuse and HIV risk behaviors among heterosexual adult female STD patients. Child Abuse Negl. 21: 149–156.PubMedCrossRefGoogle Scholar
  32. Vlahov, D., Anthony, J., Munoz, A., Margolick, J., Nelson, K., Celetano, D., Solomon, L., and Polk, B. (1991). The ALIVE study: A longitudinal study of HIV-1 infection in intravenous drug users. NIDA Res. Monogr. 109: 75–100.PubMedGoogle Scholar
  33. Whitmire, L. E., Harlow, L., Quina, K., and Morokoff, P. (1999). Childhood trauma and HIV: Women at risk, Brunnner/Mazel, New York.Google Scholar
  34. Wyatt, G. E., Guthrie, D., and Notgrass, C. M. (1992). Differential effects of women's childhood sexual abuse and subsequent sexual revictimization. J. Consul. Clin. Psychol. 60: 167–173.CrossRefGoogle Scholar
  35. Zanis, D. A., McLellan, A. T., Cnaan, R. A., and Randall, M. (1994). Reliability and validity of the Addiction Severity Index with a homeless sample. J. Subst. Abuse Treat. 11: 541–548.PubMedCrossRefGoogle Scholar
  36. Zierler, S., Feingold, L., Laufer, L., Velentgas, P., Krantrowitz-Gordon, I., and Mayer, R. (1991). Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. Am. J. Public Health 81: 572–575.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Robert M. Malow
    • 1
    • 4
  • Jessy G. Dévieux
    • 1
  • Ligia Martinez
    • 1
  • Fred Peipman
    • 1
  • Barbara A. Lucenko
    • 2
  • Seth C. Kalichman
    • 3
  1. 1.AIDS Prevention ProgramFlorida International UniversityFloridaUSA
  2. 2.University of WashingtonWashingtonUSA
  3. 3.University of ConnecticutConnecticutUSA
  4. 4.Florida International University, College of Health and Urban Affairs, Stempel School of Public Health AIDS Prevention ProgramFloridaUSA

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