Childhood sexual abuse among Black men who have sex with men: A cornerstone of a syndemic?

Elwin Wu,Matt A Price

doi:10.1371/journal.pone.0206746

Abstract

BackgroundThe sequelae of childhood sexual abuse (CSA) includes HIV infection, engagement in HIV risk behaviors, substance misuse, and intimate partner violence (IPV). Although Black men who have sex with men (MSM) are disproportionately infected with HIV in the U.S.—especially in urban locations such as New York City—there is limited research with larger samples of Black MSM of varied HIV status regarding the prevalence of CSA and the potential negative consequence with respect to a “syndemic,” i.e., the co-occurrence of adverse conditions such as HIVrisk, substance misuse, and IPV.MethodsBlack MSM (N = 1,002) recruited in New York City from 2009–2015 completed a screening assessment eliciting self-reported data on age, CSA, self-reported HIV status, number of male sexual partners, number of acts of condomless anal intercourse (CAI), substance misuse, and IPV. Hypothesis testing utilized logistic and linear regression models with self-reported data on CSA (independent variable) and indicators of the following syndemic factors: HIV risk, substance misuse, and IPV.ResultsMore than one-fourth (28.1%) met criteria for experiencing CSA. CSA was associated with significantly greater odds of being HIV-positive (AOR = 1.5; 95% CI = 1.1–2.0); number of male sexual partners (b = 2.0, SE = 0.5, p = .002) and condomless acts of anal intercourse (b = 4.3, SE = 1.6, p = .007); odds of binge drinking (AOR = 1.5; 95% CI = 1.1–2.0) and illicit substance use (AOR = 1.5; 95% CI = 1.1–2.0); and odds of experiencing current IPV (AOR = 1.7; 95% CI = 1.2–2.3). CSA was associated with significantly greater odds of concurrently experiencing 2 or more syndemic factors (AOR = 2.0, 95% CI = 1.4–2.9, p < .001); concurrently experiencing 2 or more syndemic factors was significantly associated with having a riskier HIV status (for being HIV-positive: AOR = 1.5, 95% CI = 1.1–2.1, p = .02; for having an unknown HIV status: AOR = 3.7, 95% CI = 1.9–12.9, p = .04).ConclusionsAmong Black MSM, CSA is a prevalent problem and is a significant antecedent to HIV, substance misuse, and IPV indicators and risk. Addressing CSA may be a valuable approach to remedy the syndemic of HIV, substance misuse, and violence that has burdened MSM, especially Black MSM, in the U.S.

Highlights

Men who have sex with men (MSM) have a disproportionate burden of the HIV/AIDS epidemic since its onset in the U.S [1,2]
childhood sexual abuse (CSA) was associated with significantly greater odds of being HIV-positive (AOR = 1.5; 95% CI = 1.1–2.0); number of male sexual partners (b = 2.0, SE = 0.5, p = .002) and condomless acts of anal intercourse (b = 4.3, SE = 1.6, p = .007); odds of binge drinking (AOR = 1.5; 95% CI = 1.1–2.0) and illicit substance use (AOR = 1.5; 95% CI = 1.1–2.0); and odds of experiencing current intimate partner violence (IPV) (AOR = 1.7; 95% CI = 1.2–2.3)
CSA was associated with significantly greater odds of concurrently experiencing 2 or more syndemic factors (AOR = 2.0, 95% CI = 1.4–2.9, p < .001); concurrently experiencing 2 or more syndemic factors was significantly associated with having a riskier HIV status

Summary

Introduction

Men who have sex with men (MSM) have a disproportionate burden of the HIV/AIDS epidemic since its onset in the U.S [1,2]. HIV health disparities experienced by MSM have proven to be persistent despite the successes in biomedical and behavioral prevention and treatment efforts to date. Advances such as antiretroviral therapy that can achieve viral suppression, pre-exposure prophylaxis (PrEP), behavioral risk reduction programs, and structural interventions (e.g., needle and syringe programs) that have resulted in decreases since 2000 in transmissions from mother-to-child, injecting drug use, and heterosexual transmission; yet, MSM have witnessed an increase in transmission rates over the same time period [2,3]. Black men who have sex with men (MSM) are disproportionately infected with HIV in the U.S.—especially in urban locations such as New York City—there is limited research with larger samples of Black MSM of varied HIV status regarding the prevalence of CSA and the potential negative consequence with respect to a “syndemic,” i.e., the co-occurrence of adverse conditions such as HIVrisk, substance misuse, and IPV

Methods

Results

Conclusion