Childhood Sexual Abuse CSA

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Childhood Sexual Abuse (CSA) HIV

• 20 of MSM report CSA and substantial numbers
  report severe CSA trauma.
• CSA is associated for MSM with a wide range of
  sexual, psychological, and interpersonal problems
  in adulthood Catania et al., 1999
• CSA is a significant correlate of high risk
  sexual behaviors Paul et al., 2001.
• CSA is central to a syndemic of sexual and mental
  health problems among MSM Stall et al., 2003

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Defining Childhood Sexual Abuse (CSA)

• Assessing coerced sex
• By direct query
• By inference of power inequities in relationship
  (age differentials the most frequently used
  measure)

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CSA screening question

• Thinking back from your childhood to the
  present, have you ever been forced or frightened
  by someone into doing something sexually that you
  did not want to do? (Nos confirmed by asking
  if they felt differently at the time if so, they
  were included in coerced group.)
• 20 reported CSA before age 18.

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Age and CSA Prevalence
plt.01
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First CSA Perpetrator

• Friend/acquaintance/neighbor 34
• Stranger 24
• Other Relative 15
• Sibling 9
• Step-parent/Parental figure 5
• Authority figure (doctor, etc.) 5
• Parent 4
• Other 3
• Date/boyfriend 1

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No. CSA Occasions

• Once 31
• 2 x 23
• 3 - 5 x 28
• 6 x 21

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Level of Force

• Physical Force/Weapons 44
• Threats of Physical Violence 9

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Sexual Activity in 1st Event

• NO PENATRATIVE ACTS (touching/fondling) 20
• Forced to watch 88
• Fondled sexually 85
• Forced to touch 74
• ANY PENATRATIVE SEX 80
• Oral sex (respondent receptive) 45
• Anal intercourse (actual/attempted) 44
• Oral sex (respondent insertive) 42
• Anal penetration-digit/object 35
• Vaginal intercourse 2

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CSA Experience

• Situation ? Flight/Fright
• Prevent Active Coping
• Helplessness
• Perpetrator ? Adult Betrayal
• Control Strategies
• Modeling
• Sex-?ualization? ? Sex Guilt, Anxiety
• Preoccupation
• Aggression
• Commodity

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Examples of CSA Adult Outcomes

• Regulatory Deficits
• Depression, Suicide
• Escape/Avoidance coping
• Self-Identity, Esteem problems
• Low Interpersonal trust
• Poor sexual health
• Sexual Problems
• Sex Trade
• Rough Sex

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Key Findings Primary Partners

• CSA Greater Depression
• Greater Depression Increased BEA/CEA
  Coping
• BEA Coping Poor Risk Appraisal
• Poor Risk Appraisal More Risk Behavior

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Key Findings Secondary Partners

• CSA Increased Anger, Depression,
  Escape-Avoidance Coping
• Depression Increased Cognitive Escape-Avoidance
  (CEA) Coping
• Anger Increased CEA Coping, Decreased Adaptive
  Coping, More Aggressive Sexual Scripts
• Coping
• Increased Adaptive Better Sexual Skills
• Increased BEA Poor Risk Appraisal
• Increased CEA Poor Sexual Skills
• Poor Risk Appraisal Poor Skills, More Risk
  Behavior
• Aggressive Scripts Poor Sexual Skills
• Poor Sexual Skills More Risk Behavior

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Men with Primary vs. Secondary Partners
Ns 57, 105 for Primary/Secondary
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Conclusions

• Motivational and Coping Factors are key mediating
  components of CSA and High Risk Sexual Behavior
  and their effects are further mediated through
  socio-sexual scripts and regulatory skills
• Strategies that focus exclusively on prevention
  skill building will fail for MSM with more severe
  CSA histories

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Conclusions cont.

• Sex with secondary partners produces a more
  complicated model, sex with primary partners
  yields a simpler model.
• Interpersonal regulatory skills figure less into
  the primary partner model.
• This may suggest that MSM with CSA histories who
  are engaged in primary relationships were either
  less affected over the long term by their trauma
  (e.g., had greater resilience, more post trauma
  support) or have obtained professional help with
  resolving the emotional, sexual, and
  interpersonal issues resulting from CSA.