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The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India.
BMC Public Health. 2016 08 12; 16:784.BP

Abstract

BACKGROUND

Childhood sexual abuse (CSA) is a significant global public health problem, which is associated with negative psychosocial outcomes and high-risk sexual behaviors in adults. Men who have sex with men (MSM) often report higher prevalence of CSA history than the general population, and CSA may play a key role in MSM's greater vulnerability to HIV.

METHODS

This study examined the prevalence of CSA history and its impact on the number of recent HIV-related risk behaviors (unprotected anal intercourse, high number of male and female sexual partners, alcohol use, drug use, and sex work in prior 6 months) and lifetime risk behaviors and experiences (high number of lifetime male and female sexual partners, early sexual debut, injection drug use, sex work, and intimate partner violence) among 11,788 adult MSM recruited via respondent driven sampling across 12 sites in India, with additional insights from thematic analysis of qualitative research with 363 MSM from 15 sites.

RESULTS

Nearly a quarter (22.4 %) of participants experienced CSA, with substantially higher prevalence of CSA in the South and among kothis (feminine sexual identity). Qualitative findings revealed that older, trusted men may target young and, especially, gender nonconforming boys, and perpetrators' social position facilitates nondisclosure. CSA may also initiate further same-sex encounters, including sex work. In multivariable analysis, MSM who experienced CSA had 21 % higher rate of recent (adjusted rate ratio [aRR = 1.21], 95 % confidence interval [CI]: 1.14-1.28), and 2.0 times higher lifetime (aRR = 2.04, 95 % CI: 1.75-2.38) HIV-related behaviors/experiences compared with those who did not.

CONCLUSION

This large, mixed-methods study found high overall prevalence of CSA among MSM (22.4 %), with substantially higher prevalence among MSM residing in the South and among more feminine sexual identities. Qualitative findings highlighted boys' vulnerabilities to CSA, especially gender nonconformity, and CSA's role in further sexual encounters, including sex work. Additionally, CSA was associated with an elevated rate of recent, and an even higher rate of lifetime HIV-related risk factors. Our results suggest an acute need for the development of CSA prevention interventions and the integration of mental health services for MSM with histories of CSA as part of HIV-prevention efforts.

Authors+Show Affiliations

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA. ctomori1@jhu.edu.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.YR Gaitonde Centre for AIDS Research and Education, Chennai, India.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.Johns Hopkins Krieger School of Arts and Sciences, Baltimore, MD, USA.YR Gaitonde Centre for AIDS Research and Education, Chennai, India.YR Gaitonde Centre for AIDS Research and Education, Chennai, India.YR Gaitonde Centre for AIDS Research and Education, Chennai, India.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA. YR Gaitonde Centre for AIDS Research and Education, Chennai, India. Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA. Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27520978

Citation

Tomori, Cecilia, et al. "The Prevalence and Impact of Childhood Sexual Abuse On HIV-risk Behaviors Among Men Who Have Sex With Men (MSM) in India." BMC Public Health, vol. 16, 2016, p. 784.
Tomori C, McFall AM, Srikrishnan AK, et al. The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India. BMC Public Health. 2016;16:784.
Tomori, C., McFall, A. M., Srikrishnan, A. K., Mehta, S. H., Nimmagadda, N., Anand, S., Vasudevan, C. K., Solomon, S., Solomon, S. S., & Celentano, D. D. (2016). The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India. BMC Public Health, 16, 784. https://doi.org/10.1186/s12889-016-3446-6
Tomori C, et al. The Prevalence and Impact of Childhood Sexual Abuse On HIV-risk Behaviors Among Men Who Have Sex With Men (MSM) in India. BMC Public Health. 2016 08 12;16:784. PubMed PMID: 27520978.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India. AU - Tomori,Cecilia, AU - McFall,Allison M, AU - Srikrishnan,Aylur K, AU - Mehta,Shruti H, AU - Nimmagadda,Nymisha, AU - Anand,Santhanam, AU - Vasudevan,Canjeevaram K, AU - Solomon,Suniti, AU - Solomon,Sunil S, AU - Celentano,David D, Y1 - 2016/08/12/ PY - 2016/01/21/received PY - 2016/06/25/accepted PY - 2016/8/14/entrez PY - 2016/8/16/pubmed PY - 2017/8/17/medline KW - Childhood sexual abuse KW - Gender nonconformity KW - HIV KW - India KW - Men who have sex with men KW - Risk-behaviors SP - 784 EP - 784 JF - BMC public health JO - BMC Public Health VL - 16 N2 - BACKGROUND: Childhood sexual abuse (CSA) is a significant global public health problem, which is associated with negative psychosocial outcomes and high-risk sexual behaviors in adults. Men who have sex with men (MSM) often report higher prevalence of CSA history than the general population, and CSA may play a key role in MSM's greater vulnerability to HIV. METHODS: This study examined the prevalence of CSA history and its impact on the number of recent HIV-related risk behaviors (unprotected anal intercourse, high number of male and female sexual partners, alcohol use, drug use, and sex work in prior 6 months) and lifetime risk behaviors and experiences (high number of lifetime male and female sexual partners, early sexual debut, injection drug use, sex work, and intimate partner violence) among 11,788 adult MSM recruited via respondent driven sampling across 12 sites in India, with additional insights from thematic analysis of qualitative research with 363 MSM from 15 sites. RESULTS: Nearly a quarter (22.4 %) of participants experienced CSA, with substantially higher prevalence of CSA in the South and among kothis (feminine sexual identity). Qualitative findings revealed that older, trusted men may target young and, especially, gender nonconforming boys, and perpetrators' social position facilitates nondisclosure. CSA may also initiate further same-sex encounters, including sex work. In multivariable analysis, MSM who experienced CSA had 21 % higher rate of recent (adjusted rate ratio [aRR = 1.21], 95 % confidence interval [CI]: 1.14-1.28), and 2.0 times higher lifetime (aRR = 2.04, 95 % CI: 1.75-2.38) HIV-related behaviors/experiences compared with those who did not. CONCLUSION: This large, mixed-methods study found high overall prevalence of CSA among MSM (22.4 %), with substantially higher prevalence among MSM residing in the South and among more feminine sexual identities. Qualitative findings highlighted boys' vulnerabilities to CSA, especially gender nonconformity, and CSA's role in further sexual encounters, including sex work. Additionally, CSA was associated with an elevated rate of recent, and an even higher rate of lifetime HIV-related risk factors. Our results suggest an acute need for the development of CSA prevention interventions and the integration of mental health services for MSM with histories of CSA as part of HIV-prevention efforts. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/27520978/The_prevalence_and_impact_of_childhood_sexual_abuse_on_HIV_risk_behaviors_among_men_who_have_sex_with_men__MSM__in_India_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3446-6 DB - PRIME DP - Unbound Medicine ER -