Sexual abuse and HIV-risk behaviour among black and minority ethnic men who have sex with men in the UK

Black and minority ethnic (BME) men who have sex with men (MSM) face a major burden in relation to HIV infection. It was hypothesised that sexual abuse would predict sexual risk-taking, and that this relationship would be mediated by victimisation and maladaptive coping variables. Four hundred and thirty-two BME MSM completed the survey; 54% reported no sexual abuse and 27% reported sexual abuse. Mann–Whitney tests showed that MSM with a history of sexual abuse reported higher frequency of drug use, and of homophobia and racism than those reporting no prior sexual abuse. A structural equation model showed that the experience of sexual abuse was positively associated with sexual risk-taking and that this relationship was mediated by victimisation variables: frequency of racism and frequency of homophobia and by the maladaptive coping variable: frequency of drug use. The findings can inform the design of psycho-sexual and behavioural interventions for BME MSM.     

Perceived discrimination and mental health symptoms among Black men with HIV

People living with HIV (PLWH) exhibit more severe mental health symptoms, including depression and posttraumatic stress disorder (PTSD) symptoms, than do members of the general public. We examined whether perceived discrimination, which has been associated with poor mental health in prior research, contributes to greater depression and PTSD symptoms among HIV-positive Black men who have sex with men (MSM), who are at high risk for discrimination from multiple stigmatized characteristics (HIV-serostatus, race/ethnicity, sexual orientation). A total of 181 Black MSM living with HIV completed audio computer-assisted self-interviews (ACASI) that included measures of mental health symptoms (depression, PTSD) and scales assessing perceived discrimination due to HIV-serostatus, race/ethnicity, and sexual orientation. In bivariate tests, all three perceived discrimination scales were significantly associated with greater symptoms of depression and PTSD (i.e., reexperiencing, avoidance, and arousal subscales; all p values < .05). The multivariate model for depression yielded a three-way interaction among all three discrimination types (p < .01), indicating that perceived racial discrimination was negatively associated with depression symptoms when considered in isolation from other forms of discrimination, but positively associated when all three types of discrimination were present. In multivariate tests, only perceived HIV-related discrimination was associated with PTSD symptoms (p < .05). Findings suggest that some types of perceived discrimination contribute to poor mental health among PLWH. Researchers need to take into account intersecting stigmata when developing interventions to improve mental health among PLWH.     

Childhood physical and sexual abuse,and adult health risk behaviours among university students from 24 countries in Africa,the Americas and Asia

The goal of this study was to retrospectively estimate the prevalence of childhood physical abuse (CPA) and childhood sexual abuse (CSA) in relation to experience of adult violence, poor mental health, addictive behaviour and sexual risk behaviour among university students from 24 countries in Africa, the Americas and Asia. In a cross-sectional survey, data were collected from 18 404 undergraduate university students (mean age 20.7, SD = 2.9, age range of 16–30 years) from 24 countries. Overall, 5.0%, 2.6% and 1.2% of the students reported childhood physical abuse, childhood sexual abuse and childhood physical and sexual abuse, respectively. In the logistic regression models, adjusting for age, sex, study year, family wealth, and country, having experienced CPA and CSA was associated with increased odds of having any adult violence (physical and sexual partner violence victimisation. Having been in a physical fight, and weapon carrying), any poor mental health (post-traumatic stress disorder, depression symptoms and sleeping problems), addictive behaviour (tobacco use, binge drinking, frequent gambling and obesity) and sexual risk-taking was higher with a self-reported history of CPA and CSA.     

Stress and coping among gay men: age and ethnic differences

Previous studies suggest that perceived stigmatization of sexual minority status, ethnicity, and age are associated with negative mental health outcomes, and other studies suggest that coping styles may influence these outcomes. However, no studies have examined these relationships among gay men of varying ethnicities and age groups. Three hundred eighty-three Black and White, younger, middle-aged, and older adult gay men completed measures of perceived stigmatization, coping style, and mental health outcomes. Black older adult gay men reported significantly higher levels of perceived ageism than the older White group, significantly higher levels of perceived racism than the younger Black group, significantly higher levels of homonegativity than the younger Black and the White groups, and were more likely to use disengaged coping styles than White gay men. However, Black older adult gay men did not experience significantly higher levels of negative mental health outcomes. Results suggest that further research should examine how older Black gay men, who perceive higher levels of stigma while reporting greater use of less effective coping styles, do not appear to be experiencing more negative mental health outcomes as a result.     

Zur Häufigkeit der Schuldfähigkeitsbegutachtung von Sexualstraftätern im Erkenntnisverfahren

This study investigated how often and depending on which factors sexual offenders are examined by mental health experts regarding their criminal responsibility. Out of a total of 306 legal charges against sex offenders accused of child sexual abuse (CSA: n?=?145), rape or sexual assault (n?=?89), exhibitionism (n?=?39), sexual abuse of adolescents, mentally defective, physically helpless or warded persons (n?=?18) that were admitted by a criminal court in 2001 in the German federal state of Schleswig-Holstein, 209 (95.6 %) were analyzed regarding the following questions: how often was the accused examined by a mental health professional regarding mental responsibility? Was the chance of being examined systematically related to certain factors (e.g., personality of the accused)? Expert advice regarding the mental responsibility of the accused was obtained by the court in only 34 cases (11.7 %). No systematic relationships of personal variables as well as the modus operandi and the chance of commissioning a mental health expert were found. The main reason for assigning a forensic expert opinion was the vague impression of a psychic disorder. Re-offending increased the rate of a mental health examination only in CSA (34.6 % of re-offenders were examined compared to 9.2 % of first-time offenders), but not in rape or sexual assault. Also age does not predict the commissioning of an expert opinion. Only one fifth of all accused below the age of 21 were investigated by a mental health professional. Results are discussed in terms of legal background, consequences for risk assessment and relapse prevention.     

"HIV testing is so gay": the role of masculine gender role conformity in HIV testing among men who have sex with men

Men who have sex with men (MSM) account for more than half of all new cases of HIV infection in the United States. Yet, many MSM are unaware of their HIV serostatus. Consistent with research indicating that gender role conformity impacts health behaviors, this study examined how masculine norms may influence HIV testing among MSM in the United States. Data from 170 self-identified MSM (age M = 46.45, SD = 12.18) of self-reported negative or unknown HIV serostatus living in the United States were used in this study. About half (52%) of participants reported that they had been tested for HIV within the past 12 months; 48% reported that they had not. Logistic regression was used to examine the association between domains of masculine gender role conformity and HIV testing within the past 12 months, controlling for number of sexual partners in the last 12 months. The masculine norm of heterosexual self-presentation (i.e., desire to be perceived by others as heterosexual) was negatively associated with HIV testing (B = -0.74, SE B = 0.36, O.R. = 0.48, 95% CI [0.24, 0.96]), after controlling for the effect of number of sexual partners. Psychologists and other health professionals may remain mindful of potential implications of HIV testing among MSM, including potential for MSM to view HIV testing as an "outing" procedure.     

Evaluating a novel intervention to reduce trauma symptoms and sexual risk taking: qualitative exit interviews with sexual minority men with childhood sexual abuse

Childhood sexual abuse (CSA) continues to affect sexual minority men (SMM) at disproportionate levels and contributes to multiple negative health outcomes, including sexual-risk taking and HIV acquisition. This paper presents qualitative evaluative feedback from SMM (N = 9) who participated in a 10-session Cognitive Behavioral Therapy-Trauma and Sexual Health (CBT-TSH) intervention to reduce CSA-related posttraumatic stress reaction and distress. The treatment was designed to increase accurate sexual risk appraisals and to improve self-care health behaviors related to HIV/STI acquisition. The researchers identified four emerging themes: (1) motivation to participate, (2) response to cognitive therapy, (3) process of change, and (4) considerations for intervention improvement. These qualitative findings provide useful feedback on the acceptability of an innovative program that integrates CBT for trauma related to CSA with sexual risk-reduction counseling.     

Nature and Prevalence of Childhood Sexual Abuse Among High School Girls and College Students in Zimbabwe

The study investigated the nature and prevalence of self-reported childhood sexual abuse (CSA) among a sample of Zimbabwean girls and college students. A total of 1059 high school girls and college students with a mean age (M = 18.31, SD = 3.66) participated in study. Overall, a CSA prevalence rate of 41.26% was found. The highest CSA prevalence rate was found among respondents who resided on commercial farms and mines (53%). Respondents who lived with their biological parents during childhood were significantly less likely to be sexually abused than were respondents who lived with non-parents such as uncles and brothers-in-law. Only 7.22% of the perpetrators were strangers. This study shows that sexual abuse of children in Zimbabwe is rampant, multifaceted, and linked to cultural factors that must be addressed as part of efforts to confront this scourge.     

Gender differences in victimized homeless adolescents

Most of what we know about sexual abuse comes from efforts to examine female children victimized by men. Although some researchers have identified similarities between male and female victims of sexual abuse, few studies have examined gender-specific factors associated with sexual health practices among homeless adolescents. The aim of this study was to explore how gender and history of sexual abuse influence cognitive-perceptual and behavioral factors associated with sexual health practices of homeless adolescents. This study was a secondary analysis of data collected for a cross-sectional study of the sexual health practices of homeless adolescents. The sample consisted of 414 youths (104 males who reported sexual abuse and 124 who did not; and 95 females who reported sexual abuse and 75 who did not; 16 did not provide these data). Homeless adolescent females with a history of sexual abuse scored higher (indicating a shorter perspective) on a measure of future time perspective than females with no sexual abuse. Males who reported no sexual abuse scored higher than abused females on perceived health status and higher than abused males on assertive communication. With respect to perceived health status, males who reported no sexual abuse scored significantly higher than females who reported sexual abuse (p = .04). Males with no sexual abuse had significantly higher assertive communication scores than did males who had experienced sexual abuse (p = .015). We found that male and female abuse victims differ in terms of their cognitive-perceptual and behavioral factors associated with sexual health practices. Early identification of those who have been abused is critical so that interventions can be developed. Effective short-term interventions are needed for the adolescent victims of Child Sexual Abuse (CSA), particularly those who are homeless and prone to further sexual victimization.     

Measuring Abuse Sequelae: Validating and Extending the Trauma Symptom Checklist–40

This study used the Trauma Symptom Checklist–40 (TSC–40) to index both childhood sexual abuse (CSA) and childhood physical abuse (CPA) in a college student sample of both men and women (N = 441). Although the TSC–40 was designed as a measure of CSA trauma, this study concludes the measure is appropriately reliable for indexing the traumatic sequelae of CPA as well as CSA in nonclinical samples. This study also explored the effects of gender and abuse severity on resulting symptomatology, finding that women and severely abused individuals report the most negative sequelae. Both CSA and CPA emerged as significant explanatory variables in TSC–40 scale scores beyond gender, supporting its validity for indexing traumatic sequelae in nonclinical samples.     

Virtual and physical venues as contexts for HIV risk among rural men who have sex with men.

Rural men who have sex with men (MSM) have few identifiable venues in which to congregate and meet potential sex partners. The Internet provides a venue for rural MSM to meet, and this is potentially troubling because studies of urban MSM suggest that HIV risk is higher for men who date online. The goals of this study were to identify venues where rural MSM meet their sexual partners and to examine their association with high-risk sexual practices. Six hundred sixty-three predominantly single, gay, Caucasian MSM completed an online survey of their sexual activities. Results showed that the Internet and bars were the most popular venues for meeting sex partners. Highest rates of risk behaviors were associated with Internet dating and venues in which immediate sexual encounters typically occur, suggesting that prevention in rural areas should target multiple-risk environments.     

Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample

In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD?=?5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR?=?0.85, 95% CI: 0.78-0.93; social support AOR?=?0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR?=?0.79, 95% CI: 0.71-0.89; social support AOR?=?0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR?=?0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.     

Childhood Sexual Abuse and the Perpetration of Violence: The Moderating Role of Gender

This study sought to increase specificity in our knowledge of links among child sexual abuse (CSA), aggression, and physical intimate partner violence (IPV) perpetration by criminal offenders, with particular interest in gender. Participants were 202 men and 72 women (N = 274), who were recruited from an urban pretrial supervision program. Women reported higher rates of CSA than men. After controlling for relevant covariates, CSA was associated with general aggression and severe IPV. We found a gender by CSA interaction; CSA was associated with aggression and severe IPV for women, but not men. Findings provide preliminary evidence that CSA impacts aggression and IPV perpetration differently for female offenders compared to male offenders and gender-specific treatment might be warranted in pretrial settings.     

Top Ten Questions Male Sexual Abuse Survivors Want to Know from Health Care Research

Sexual abuse is an often overlooked public health issue for boys and men. Given its prevalence and well-documented connection to mental and physical health disorders, the relevance of male survivor input and engagement in health care research is profound. Using a community-based participatory research design, an in-person focus group with male survivors of sexual abuse and researchers was conducted. This paper describes the top ten research questions male sexual abuse survivors would like to have answered. Survivors were most interested in knowing how sexual abuse and assault impact men’s emotional and sexual functioning, what factors are involved in preventing and treating sexual assault-related emotional distress, and what can be done to prevent sexual abuse of boys and men. The fact that some of the questions survivors expressed an interest in knowing about have actually previously been investigated by researchers suggests a disconnect in translating evidence-based findings. Clinical and research implications include designing outreach interventions and gender-specific psychoeducation to increase engagement and access to care for men.     

Psychology of computer use: XX. Sexual abuse recalled: evaluation of a computerized questionnaire in a population of young adult males

Development of a computerized questionnaire for investigating prevalence of child sexual abuse as "unwanted sexual contact" prior to Age 17 and associated long-term mental health sequelae is described. The computerized technique has technical advantages, and in a study of 200 university men elicited significantly more recall of prior abuse (in 14% of subjects) than a paper questionnaire.     

The effects of HIV-related thought suppression on risk behavior: cognitive escape in men who have sex with men.

This study investigated the relationship between suppressing thoughts about HIV risk and several outcomes related to HIV risk, including sexual risk behavior and HIV prevention service use, in men who have sex with men (MSM). Synthesizing the ironic processing theory (D. M. Wegner, 1994) with a cognitive escape paradigm (D. J. McKiman, D. G. Ostrow, & B. Hope, 1996), it was hypothesized that thought suppression might increase risk by leading MSM to "escape" from sexual safety norms and engage in risky sex behaviors and, via a paradoxical process, increase future use of community prevention services. Results from a sample of MSM (N = 709) indicated that thought suppression was positively related to concurrent sexual risk behavior and to future use of prevention services.     

A short-term group treatment model for gay male survivors of childhood sexual abuse living with HIV/AIDS

HIV-positive gay male survivors of childhood sexual abuse (CSA) face three layers of trauma: childhood abuse, homophobic oppression, and HIV/AIDS. Additionally, CSA has been shown to increase HIV risk behavior among gay men, and the trauma of HIV infection often parallels the experience of CSA. Effective coping strategies are particularly important for people living with HIV/AIDS in order to adapt to physical, psychological, and social implications of infection. However, coping strategies once adaptive in the context of CSA may become maladaptive in adulthood. Interventions are needed that enhance coping and address CSA for survivors living with HIV/AIDS to protect their own health and to prevent new transmissions. This article presents a group model found to be efficacious for treating gay male survivors of CSA living with HIV/AIDS.     

Social support,psychological vulnerability,and HIV risk among African American men who have sex with men

Previous research has suggested a need to understand the social-psychological factors contributing to HIV risk among African American men who have sex with men (MSM). We conducted individual in-depth interviews with 34 adult African American MSM to examine their personal experiences about: (i) sources of social support, (ii) psychological responses to the presence or absence of social support and (iii) influences of social support on sexual behaviours. The majority of participants described limited positive encouragement and lack of emotional support from family, as well as few meaningful personal relationships. Feelings of isolation and mistrust about personal relationships led many participants to avoid emotional intimacy and seek physical intimacy through sexual encounters. Findings highlight a need for multilevel interventions that enhance social support networks and address the social-psychological, emotional and interpersonal factors that contribute to HIV risk among African American MSM.     

Retrieval inhibition of trauma-related words in women reporting repressed or recovered memories of childhood sexual abuse

Several authors have argued that survivors of childhood sexual abuse (CSA) who report to have repressed their traumatic memories are more skilled in forgetting emotional stimuli than survivors who have always remembered the abuse. The current experiment employed a list-wise directed forgetting task to investigate whether women reporting repressed (n = 16) or recovered (n = 23) memories of CSA are better at forgetting disturbing material, relative to women reporting having always remembered their abuse (n = 55) or reporting no history of abuse (n = 20). We found no support for the hypothesis that women reporting repressed or recovered memories of CSA are especially versed in inhibiting retrieval of trauma-related words. Additional analyses revealed that participants characterized by a repressive coping style did not display a superior retrieval inhibition mechanism for negative material.