History Of Childhood Sexual Abuse Research Articles

Viewing the resurgence of early syphilis in light of increasing male homosexuality and childhood sexual abuse.

Back Ground and Objectives:A rising trend of syphilis has been documented worldwide recently. After decriminalization of homosexuality in India more and more males having sex with males (MSMs) have come out to seek medical advice.Aim:We evaluated sexual behavior of patients with syphilis attending our sexually transmitted infections (STIs) clinic focusing on the factors associated with the increasing MSM practices and rising trend of syphilis among MSM.Materials and Methods:This is a 10-year (2006–2015) descriptive study from among STI patients attending the dermatology outpatient department in a tertiary care center. Recognizing the rising homosexuality, from 2011 onward, we had given a questionnaire to assess their sexual behavior and sexual practices.Results:Analysis of data from 560 cases diagnosed as having STI revealed a rising trend of all STIs including syphilis from 2011 onward. The MSM cases reporting to our STI clinic showed a sustained rise from 2011 onward. The most common STI in MSM was syphilis that too early acquired. More than half of the MSM indulged in bisexual activities and the predominant mode was anoreceptive. Nearly 70% had unprotected contact and most had early sexual debut (<20 years). Thirty-six percent gave a history of childhood sexual abuse (CSA) by a close male acquaintance.Conclusions:After 2011, we have observed a resurgence of early acquired syphilis which coincided with an increase in promiscuous homosexuality. Many of the MSMs were bisexuals and homosexuality was an acquired behavior. An alarming increase in the incidence of CSA was observed in MSMs.

Recovered Memories of Child Sexual Abuse: Forgetting to Remember and Remembering to Forget, Part 3: The Role of Dissociation in Extraordinary Forgetting

This is the third of three articles on recovered memories of child sexual abuse. The results of laboratory studies on memory cannot be generalized to individuals with a history of childhood sexual abuse in whom memory disturbances are prevalent. Trauma is defined and identified as the driver of dissociation. The nature of dissociation and dissociative processes are explored, and the relationship to memory impairment is examined with an emphasis on the mechanisms of compartmentalization and detachment. Memory and the self are inextricably linked, and dissociation results in the fragmentation of autobiographical narrative. Contrary to what is often assumed, memory content is not the appropriate focus of trauma therapy and it is imperative that therapists working with survivors of child sexual abuse are adequately trained.

Strengthening Vicarious Resilience in Adult Survivors of Childhood Sexual Abuse: A Narrative Approach to Couples Therapy

Childhood sexual abuse (CSA) is correlated with numerous adverse effects, both intrapersonal and interpersonal. Couples where one or more partners is a CSA survivor often report problems in social/relational adjustment, emotional expressiveness, revictimization, low relationship satisfaction and stability, and sexual dysfunction. Despite the adverse effects of CSA, some individuals with a history of CSA retain typical levels of functioning, and data from studies of resilience in CSA survivors suggest the importance of social and relational support for favorable outcomes. Resilience is not only an individual factor but also a social, ecological process, and research on vicarious resilience in therapist–client relationships suggests that resilience can be transmitted across relationship systems through a combination of witnessing resilience stories and beliefs about the possibility of resilience and its transmission. We suggest that in romantic partnerships (including nonheteronormative configurations) where one or more partners has a history of CSA, narrative couples therapy is well suited to address the systemic impacts of trauma and resilience by facilitating the transmission of each partner’s resilience to the other. Two narrative interventions, mapping and definitional ceremonies, are suggested to facilitate the transmission of resilience within the couple system through the sharing and witnessing of each other’s subjugated resilience narratives, thereby promoting a re-authored preferred identity based on acceptance, strength, and agency rather than shame, avoidance, and interpersonal difficulty.

Predictors of parenting attitudes in an at-risk sample: Results from the LONGSCAN study

BackgroundAssociations between parenting attitudes and behavior and children’s adjustment are well-established, including links between negative parenting beliefs and increased risk for child maltreatment and poorer child functioning. Considerably less is known regarding what factors may correspond with parenting attitudes, particularly among at-risk samples. In line with theoretical models of the determinants of parenting, the aim of the study was to investigate correlates of parenting attitudes among child, caregiver, family, and neighborhood factors. Participants and settings/methodsThe study included 1071 4-year-old children (48.8 % female; 55.7 % Black) and their caregivers from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) study. ResultsNumerous factors were consistently related to more positive parenting attitudes (i.e., more appropriate parenting expectations, greater empathy, and valuing non-physical punishment), including greater educational attainment, caregiver history of child sexual and physical abuse, lower levels of children’s internalizing symptoms, greater family income, and lower levels of psychological aggression. Lower levels of caregiver depressive symptoms, greater number of maltreatment allegations, use of nonviolent discipline, and less severity of stressful life events were tied to more adaptive parenting attitudes in one or two domains. ConclusionsCaregiver, child, familial, and environmental factors, as well as child maltreatment, may be important in determining parenting attitudes. Identification of the drivers of parenting attitudes may aid identification and intervention efforts with high-risk samples of caregivers to help improve parenting outcomes.

Violence Inflicted on Latina Transgender Women Living with HIV: Rates and Associated Factors by Perpetrator Type.

Many transgender individuals report violence directed against them. This study examined violence inflicted on transgender Latinas with HIV by primary partners, sexual partners and acquaintances/strangers. Logistic regression was used for analysis. 150 transgender Latinas were recruited. Rates of violence from different perpetrator types were 47-50%. For violence by primary partners, social support from cisgender people was associated with a lower likelihood of violence (AOR 0.56; CI 0.32, 0.98; p < 0.05). For violence by sexual partners, a history of childhood sexual abuse was associated with a higher likelihood of violence (AOR 2.64; CI 1.10, 6.34; p < 0.05). For violence by acquaintances/strangers, discrimination was associated with a higher likelihood of violence (AOR 2.84; CI 1.16, 6.94; p < 0.05) and social support from cisgender people with a lower likelihood (AOR 0.58; CI 0.37, 0.92; p < 0.05). Interventions are needed at individual, institutional and systemic levels to eradicate such violence.

An Experimental Investigation of the Perceived Credibility of Complainants of Sexual Revictimization: Disbelief and Victim-Blame.

This study investigated whether attitudes toward a complainant of sexual assault are affected by the knowledge that the complainant had previously made a similar allegation. This was a 3 (previous allegation; none, child sexual assault or adult sexual assault) × 2 (whether the previous allegation was substantiated) × 2 (the implied mental health status of the complainant; mental health issue vs. none) multifactorial, experimental study, employing independent-measures and hypothetical vignettes depicting stranger rape scenarios. The dependent variables were victim-blame and believability. The participants were 243 female undergraduate students. A multivariate analyses of variance (MANOVA) revealed several main and interactive effects. Allegations of sexual revictimization were associated with different levels of victim-blame and believability depending on when the previous assault occurred. A history of childhood sexual assault reduced the believability of the complainant and when combined with other factors increased the tendency to attribute victim-blame.

A retrospective approach to examining child abuse disclosure

BackgroundOften times, a child’s disclosure is the only forensic evidence available in child abuse cases. Therefore, understanding disclosure patterns of suspected child abuse victims plays a critical role in the forensic investigations of both child physical abuse (CPA) and child sexual abuse (CSA) cases. ObjectiveTo explore adults’ retrospective reports about childhood disclosure of CPA and CSA. Participants and settingCollege students (N = 907) were screened for reported histories of CSA (n = 94) or CPA (n = 109). MethodsThrough an online survey, participants provided anonymous information regarding CSA and CPA experiences along with information about any disclosure events or opportunities that they have encountered since the abuse. ResultsAmong the adults reporting CSA histories, 50 % indicated disclosing the abuse during childhood; 80 % indicated any lifetime disclosure. Among the adults indicating CPA histories, 32 % reportedly disclosed the abuse to someone during childhood with 52 % reporting any lifetime disclosure. For both groups, length of delay until disclosure was bimodal with many individuals reporting immediately and many waiting considerable time. Among adults reporting CSA, a minority (16 %) indicated the abuse came to the attention of authorities, with even fewer CPA cases (8%) reporting authorities were aware of their abuse. Denial and recantation in a formal setting was infrequent regardless of abuse type reported. ConclusionsGiven that participants experiencing CSA and CPA both reported low levels of denial and recantation, forensic investigators and practitioners may benefit from considering consistent interviewing approaches and protocols, regardless of the type of abuse suspected.

Are you angry at me? Negative interpretations of neutral facial expressions are linked to child maltreatment but not to posttraumatic stress disorder

ABSTRACT Background: Individuals with a high prevalence of child maltreatment, e.g. those with borderline personality disorder, tend to see neutral facial expressions as negative. Objective: Our aim was to assess whether this bias is present in individuals with posttraumatic stress disorder (PTSD) and whether it is linked to child maltreatment. Methods: Thirty-nine PTSD participants, 44 traumatized and 35 non-traumatized healthy controls watched 300 one-second movies showing 30 neutral and 270 emotional facial expressions, and indicated whether they interpreted each as a neutral or as one of nine emotional expressions. Results: PTSD individuals did not perform differently than the two control groups in the recognition and interpretation of neutral facial expressions (p’s < .300). Higher levels of childhood sexual and emotional abuse, and physical neglect were linked to more interpretations of neutral facial expressions as contempt (p’s < .043), and (for sexual abuse and physical neglect) to more interpretations of neutral facial expressions as anger (p’s < .014). Comparisons of statistical model fits suggested that childhood sexual abuse was the most relevant predictor of recognition accuracy in our sample. Alexithymia, state dissociation, interpersonal trauma, and number of experienced trauma types were not associated with deficits in the interpretation of neutral expressions. Conclusions: Child maltreatment, especially sexual abuse, may shape the interpretation of neutral facial expressions. Future research should explore whether the observed biases extend to real-life situations. If so, therapists might improve the therapeutic relationship with patients with a history of child maltreatment by paying more attention to their own non-verbal communication and their patients’ responses to it. Furthermore, similarly to individuals with high depressive and high social anxiety symptoms, facial expression recognition training might counteract negativity bias in individuals with a history of childhood (sexual and emotional) abuse, and (physical) neglect.

1268. Clinic Screening for Adverse Childhood Experiences among Persons with HIV: A Pilot Project

BackgroundChildhood trauma has long-lasting implications for adult health as prior work in the general population linked ≥4 adverse childhood experiences (ACEs) to multiple negative health outcomes in adulthood. History of childhood trauma is prevalent in people living with HIV (PLWH); however, screening for history of childhood trauma is not routinely performed in HIV clinical care.MethodsWe conducted a single-center, cross-sectional quality improvement pilot project to (1) define the prevalence of ACEs in PLWH engaged in care and (2) improve linkage with mental health resources. We hypothesized the prevalence of ≥4 ACEs in PLWH would be >21%, the prevalence previously reported in the local, general population. Patients were approached in the course of routine clinical care at an urban, academic HIV outpatient clinic between October 2018 and April 2019 and offered screening for ACEs, depression, and post-traumatic stress disorder (PTSD) using previously validated tools.ResultsForty-nine patients completed the screening. Median age was 48 years [IQR: 37–55]; 69% were male and 53% were gay or bisexual. Most patients identified as black/African American (75%) and white (12%). Median ACEs score was 4 [IQR 1–6], with 51% (95% CI: 36–66%) reporting ≥4 ACEs (Figure 1), and most common ACE being guardian substance abuse (57%) (Figure 2). When compared with men, women had a higher median ACEs score (5 vs. 3, P = 0.04), history of childhood sexual abuse (67% vs. 26%, P <0.001), parent incarceration (53% vs. 24%, P = 0.04), and parental divorce or separation (73% vs. 41%, P = 0.04). Patients with ≥4 ACEs were more likely to have positive PTSD screens (56% vs. 21%, P = 0.02), moderate depression or greater (37% vs. 11%, P = 0.002), and were more likely to accept on-site mental health referral after screening (36% vs. 8%, P = 0.04). Acceptability of screening was deemed “very good” by patients, with median acceptability score 5 [IQR: 4–5] on a 5-point scale.ConclusionOver half of HIV+ patients screened in our clinic reported ≥4 ACEs, more than twice the prevalence of the general population. ACEs screening facilitated linkage of patients with high ACEs scores to mental healthcare. These results highlight the potential value of routine ACEs screening to enhance delivery of trauma-informed HIV primary care. Disclosures All authors: No reported disclosures.

A history of prolonged childhood sexual abuse is associated with more severe clinical presentation of borderline personality disorder in adolescent female inpatients – A naturalistic study

BackgroundBorderline personality disorder (BPD) is associated with high rates of suicidal and self-injurious behaviors and a substantial proportion of BPD patients have a history of trauma, particularly childhood sexual abuse (CSA). ObjectiveTo compare the clinical presentation severity in female adolescent inpatients with BPD with and without history of prolonged CSA. Participants and settingFemale adolescent BPD patients admitted to a psychiatric inpatient unit. MethodsA retrospective analysis of records of the inpatients, divided into two groups: with (n = 38) and without (n = 40) a history of prolonged CSA. Prolonged CSA was defined as sexual abuse continuing for at least 3 months. Demographic and clinical data, including number and duration of psychiatric hospitalizations until the age 19, non-suicidal self-injury (NSSI), suicide attempts, cigarette smoking, alcohol and drug use, and sexual impulsivity were compared between the two groups. ResultsThe BPD + prolonged CSA group had a larger duration of the first psychiatric hospitalization, number of hospitalizations and cumulative length of hospitalizations compared with the control group. Furthermore, the BPD + prolonged CSA group had a higher number of suicidal attempts, and higher rates of severe NSSI events, cigarette smoking, alcohol use, and sexual impulsivity. ConclusionsThis study demonstrated for the first time that adolescent female BPD inpatients with a history of prolonged CSA, manifest more severe clinical presentation compared to those without prolonged CSA. Hence, it appears essential to encourage therapists to inquire about history of CSA and refer adolescent female BPD inpatients with prolonged CSA to appropriate intensive therapy.

Child Sex Abuse and Recovered Memories of Abuse: Looking Back, Looking Ahead

Sexual abuse of children has garnered a substantial amount of empirical research, state and federal legislation, and media coverage in the past several decades. This article briefly examines the history of child maltreatment and child sexual abuse (CSA) and societal responses to it. A review of selected articles on CSA that were published since the inception of Families in Society reveals how our knowledge of and ideas about sexual abuse, the perpetrators, responses to abuse allegations, and the Freudian concept of repression have changed over time. The phenomenon of repressed and recovered memories of abuse is also discussed, including the articles that were published in the journal. Despite continued disagreement in the field between researchers and clinicians, a summary is provided detailing points of consensus related to CSA and recovered memories.

From surviving to thriving: factors associated with complete mental health among childhood sexual abuse survivors.

Despite many negative health and social consequences of childhood sexual abuse (CSA), some of those with a history of adversity manage to thrive in adulthood and achieve complete mental health (CMH). CMH is defined as the absence of mental illness in combination with almost daily happiness and/or life satisfaction, as well as high levels of social and psychological well-being. The objectives of this study were (1) to identify the pathways linking CSA to CMH in adulthood and (2) to estimate the magnitude of risk and protective factors associated with CMH among those exposed to CSA. A sample of 17,014 respondents aged 20years and older from the 2012 Canadian Community Health Survey-Mental Health was selected including 651 with a history of CSA. Path analysis was used to estimate indirect and direct pathways between CSA, a priori hypothesized risk and protective factors, and CMH. Multivariable logistic regression was then used to investigate the magnitude of effects of the same risk and protective factors on CMH among CSA survivors. After controlling for age, sex, race, education, and marital status, the association between CSA and CMH was mediated by lifetime depression, anxiety, substance abuse, chronic pain, and having a confidant. The strongest predictor of past-year CMH among those with a history of CSA was lifetime depression (OR 0.12, 95% CI 0.07-0.20) followed by having a confidant (OR 6.78, 95% CI 1.89-24.38). The odds of CMH was decreased by over three times among those with a history of substance misuse, and halved for those with lifetime anxiety and/or presence of pain. These findings suggest that CMH among survivors of CSA is related to social and emotional factors such as social support and lifetimehistory of mental health conditions. Future research should investigate the effectiveness of multilevel interventions for promoting recovery among CSA survivors.

Attachment, Sense of Entitlement in Romantic Relationships, and Sexual Revictimization Among Adult CSA Survivors.

Insecure attachment orientations are disproportionately frequent in child sexual abuse (CSA) survivors and have been found to mediate some of the effects of CSA on adult interpersonal and romantic difficulties, including sexual revictimization (SR). A sense of relational entitlement (SRE) has received growing attention in psychological discourse and research in recent years. It reflects both adaptive (assertive) and pathological (restricted or inflated) attitudes to the assertion of needs and rights and has not been studied in adult CSA survivors. The purpose of this study was to examine associations between CSA, attachment orientations, SR, and SRE. Sixty-seven Israeli women aged 25 ± 3.95 years (30 adult CSA survivors and 37 healthy female controls with no history of CSA) completed a demographic questionnaire and self-reported measures of adult attachment orientations, sense of entitlement in romantic relationships, and adult SR. CSA survivors reported greater attachment anxiety and attachment avoidance, more restricted SRE, and higher revictimization rates than control women. No difference was found between the groups in inflated SRE. In the CSA but not the control group, anxious and avoidant attachment orientations were significantly and negatively associated with assertive SRE. Insecure (anxious and avoidant) attachment fully mediated the association between CSA and restricted SRE. Our findings suggest that the interplay between insecure attachment and CSA is related to a sense of impaired assertive entitlement and elevated restricted entitlement in adult CSA survivors. This entitlement pattern can be destructive to survivors' romantic relationships and should be addressed in therapy.

Posttraumatic Growth in Complex PTSD

Objective: Although efforts have been made to study mechanisms and mediators of posttraumatic growth (PTG - positive sequelae of coping with trauma), little has been done to investigate PTG as a concept in the context of complex PTSD, a disorder recently delineated in ICD11. This article considers PTG in relation to complex PTSD, primarily as associated with childhood sexual abuse. Method: Using clinical case material and available literature, we explore the emergence of PTG in the treatment of patients with complex PTSD and examine factors contributing to its appearance. Results: Despite extensive early traumas, including those associated with histories of ongoing childhood sexual abuse, patients may be capable of PTG. While factors favoring PTG may include temperamental resilience and other as yet ill-defined personality traits, the presence of safe, supportive and enduring therapeutic and extra-therapeutic relationships, appear to address insecure attachments related to trauma and be of considerable importance in fostering possibilities for PTG. Conclusions: While much remains to be learned, encouraging and helping establish varieties of accepting, trusting and nurturing contacts in real world and psychotherapy and introducing and exploring the concept of PTG within therapy, can help patients suffering from complex PTSD address the underlying developmental deficiencies they have endured, facilitate treatment, and promote PTG.

Medically Unexplained Symptoms and Antecedent Sexual Abuse: An Observational Study of a Birth Cohort.

Medically unexplained symptoms (MUS) are common and associated with high consumption of health care resources. Cross-sectional studies in selected and clinical populations show consistent linkages between history of childhood sexual abuse (CSA) and presentation with MUS and somatization. However, there are almost no well-controlled prospective studies in population samples. Data were gathered in a longitudinal study of a New Zealand birth cohort born in 1977. Hospital e-record data for the period 2008-2015 (age, 30-38 years) were searched for a subsample of 408 study participants who were resident in one District Health Board region, and details of MUS contacts were recorded. Retrospective reports of CSA (<16 years) were obtained at ages 18 and 21 years. Associations between CSA and MUS were sequentially adjusted using logistic regression methods for both childhood confounders assessed before age 16 years and potential mediating mental health/family context up to age 30 years. Twenty (4.9%) participants were classified as having MUS, of whom 11 had a history of CSA. Severe CSA involving attempted/completed sexual penetration was strongly associated with risk of MUS (odds ratio = 11.6, 95% confidence interval = 4.3-31.7, p < .001). A substantial association remained after statistically adjusting for confounding and mediating mental health/family context (adjusted odds ratio = 5.1, 95% confidence interval = 1.2-21.3, p = .024). This strong association was specific to severe CSA (as opposed to childhood physical abuse) and to MUS rather than medically explained symptoms. CSA involving attempted/completed penetration was strongly associated with attendance at secondary level care for MUS. Implications for prevention and treatment of MUS are discussed.

Sexual Assault in the Military and Increased Odds of Sexual Pain Among Female Veterans.

To examine whether the relationship between childhood sexual abuse and sexual function in civilian women is also found among female veterans, and to consider the additional effects of sexual assault in the military. Using a retrospective cohort design, participants (N=1,004) from two midwestern Department of Veterans Affairs medical centers and associated clinics completed a telephone-assisted interview on sexual assault, sexual pain, and mental health. Binary logistic regression was used to compare the rates of sexual pain between women with no sexual assault history, histories of childhood sexual abuse alone, histories of sexual assault in the military alone, and histories of childhood sexual abuse and sexual assault in the military. Female veterans with histories of childhood sexual abuse and sexual assault in the military reported the highest rates of sexual pain (χ(3)=40.98, P<.001), posttraumatic stress disorder (PTSD, χ(3)=88.18, P<.001), and depression (χ(3)=56.07, P<.001), followed by women with sexual assault in the military histories alone, women with childhood sexual abuse histories alone, and women with no sexual assault. Female veterans with histories of childhood sexual abuse and sexual assault in the military were 4.33 times more likely to report sexual pain, 6.35 times more likely to report PTSD, and 3.91 times more likely to report depression than female veterans with no sexual assault. The relationship between sexual assault and sexual pain in female veterans is distinct from their civilian peers. For female veterans, sexual assault in the military is more detrimental to sexual function (specifically sexual pain) than childhood sexual abuse alone, and the combination of childhood sexual abuse and sexual assault in the military confers the greatest risk for sexual pain. Given this difference in sexual health, treatments for sexual dysfunction related to a history of childhood sexual abuse in civilian women may not be adequate for female veterans. Female veterans may require a targeted treatment approach that takes into account the particular nature and consequences of sexual assault in the military.

Retention Strategies in Working With Justice-Involved Women.

Research-based findings with vulnerable populations are strengthened by strong retention rates at the time of postintervention data collection. Women in the criminal justice system face a variety of gender-specific challenges including histories of childhood and adult sexual and physical abuse, substance abuse, untreated mental health problems, and chronic housing insecurity that can hinder follow-up of a research sample. The authors highlight a variety of retention strategies that they successfully used in their work with women following incarceration in local county jails.

A Matched Cohort Study of the Association Between Childhood Sexual Abuse and Teenage Pregnancy

PurposeThis matched cohort study aims to determine whether teenagers with a history of childhood sexual abuse (CSA) are at greater risk of consulting for a pregnancy and related complications than teenagers from the general population. It also aims to compare provoked abortion, live births, and fetal losses of participants who were sexually abused in childhood and those of the general population. MethodsA total of 661 girls (aged 13–18 years) with a corroborated by Child Protection Services CSA report between 2001 and 2010 were matched to 661 girls from the general population upon age, biological sex, urban Child Protection Services area, and public drug insurance admissibility at reporting date. Pregnancy consultations and complications during pregnancy and delivery were documented using diagnoses from public health insurance administrative databases from January 1996 to March 2013. Socioeconomic status was controlled. ResultsResults indicate that compared with participants from the general population, those with a history of CSA were 4.6 times more likely to consult for at least one pregnancy, 5.3 times more likely to consult for at least one complication during pregnancy or delivery, and on average 5.2 and 3.3 times more likely to consult for at least one live birth and provoked abortion, respectively. There were too few observations to compare fetal losses between groups. ConclusionsMedical interventions for teenage pregnancies and related complications should take into consideration a possible history of CSA to reinforce gynecological follow-up and treatment for girls who were sexually abused and to prevent unfavorable outcomes.

Longitudinal Analysis of Syndemic Psychosocial Problems Predicting HIV Risk Behavior Among a Multicity Prospective Cohort of Sexually Active Young Transgender Women in the United States.

Worldwide, young transgender women (YTW) contend with exceptionally high risks of HIV infection. Cross-sectional studies have suggested that co-occurring epidemics or "syndemics" of psychosocial problems may accelerate HIV acquisition and transmission through elevated sexual risk behavior among transgender women. We aimed to examine how a syndemic of 7 psychosocial problems potentiates HIV sexual risk behavior among a multicity, longitudinal cohort of sexually active YTW in the United States. Between 2012 and 2015, 233 YTW from Boston, MA, and Chicago, IL, completed behavioral surveys at baseline, 4, 8, and 12 months. We used generalized estimating equations to examine the prospective relationship of overlapping psychosocial problems and HIV sexual risk behavior (ie, condomless anal or vaginal sex) among YTW. The prevalence of 7 psychosocial syndemic problems was substantial at baseline and remained high at each time point: 6.4% reported polydrug use in the past 4 months (excluding stimulants); 7.7% reported heavy alcohol use in the past 4 months; 10% reported a history of childhood sexual abuse; 15.9% reported stimulant use in the past 4 months; 41.7% reported experiencing lifetime intimate partner violence; 42.1% reported clinically significant depressive symptoms; and 68.6% reported lifetime transgender-specific victimization. We identified a statistically significant positive "dose-response" relationship between the number of psychosocial syndemic problems and condomless anal or vaginal sex over time. The accumulation of "syndemic" psychosocial problems predicted HIV sexual risk behavior in a prospective cohort of YTW. Given the high prevalence of psychosocial problems and HIV sexual risk behavior, as well as having the highest HIV incidence among any risk group, the HIV prevention agenda requires a shift toward improved assessment of psychosocial comorbidities and stronger integration with gender-affirming and supportive mental health, violence recovery, and addiction treatment services for this population.

Maternal and Child Sexual Abuse History: An Intergenerational Exploration of Children's Adjustment and Maternal Trauma-Reflective Functioning.

Objective: The aim of the current study was to investigate associations, unique and interactive, between mothers’ and children’s histories of childhood sexual abuse (CSA) and children’s psychiatric outcomes using an intergenerational perspective. Further, we were particularly interested in examining whether maternal reflective functioning about their own trauma (T-RF) was associated with a lower likelihood of children’s abuse exposure (among children of CSA-exposed mothers).Methods: One hundred and eleven children (Mage = 9.53 years; 43 sexual abuse victims) and their mothers (Mage = 37.99; 63 sexual abuse victims) participated in this study. Mothers completed the Parent Development Interview (PDI), which yielded assessments of RF regarding their own experiences of abuse, and also reported on their children’s internalizing and externalizing symptoms.Results: Children of CSA-exposed mothers were more likely to have experienced CSA. A key result was that among CSA-exposed mothers, higher maternal T-RF regarding their own abuse was associated with lower likelihood of child CSA-exposure. Mothers’ and children’s CSA histories predicted children’s internalizing and externalizing symptoms, such that CSA exposure for mother or child was associated with greater symptomatology in children.Conclusion: The findings show that the presence of either maternal or child CSA is associated with more child psychological difficulties. Importantly in terms of identifying potential protective factors, maternal T-RF is associated with lower likelihood of CSA exposure in children of CSA-exposed mothers. We discuss these findings in the context of the need for treatments focusing on increasing T-RF in mothers and children in the context of abuse to facilitate adaptation and reduce the intergenerational risk.