198076 Mediators of the relationship between childhood sexual abuse and subsequent HIV infection among MSM in the EXPLORE study

Tuesday, November 10, 2009: 5:15 PM

Matthew J. Mimiaga, ScD, MPH , Psychiatry, Harvard Medical School and The Fenway Institute, Fenway Health, Boston, MA
Elizabeth Noonan, MS , Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA
Deborah Donnell, PhD , Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA
Steven A. Safren, PhD , Harvard Medical School and The Fenway Institute, Fenway Health, Boston, MA
Conall O'Cleirigh, PhD , Psychiatry, Harvard Medical School and The Fenway Institute, Fenway Community Health, Boston, MA
Margaret A. Chesney, PhD , The University of California at San Francisco, Center for AIDS Prevention Studies, San Francisco, CA
Thomas Coates, PhD , Department of Medicine, Division of Infectious Diseases. Program in Global Health, University of California, Los Angeles, Los Angeles, CA
Beryl Koblin, ScM, PhD , Laboratory of Infectious Disease Prevention, The New York Blood Center, New York, NY
Kenneth H. Mayer, MD , Infectious Diseases, Brown University/The Miriam Hospital/Fenway Community Health, Providence, RI
  
Background: Previous studies have found high rates of childhood-sexual-abuse (CSA) among U.S. men-who-have-sex-with-men (MSM). CSA has been associated with a variety of negative effects later in life including behaviors that place MSM at greater risk for HIV.

Methods: The EXPLORE Study was a behavioral intervention trial conducted in six U.S. cities over 48-months enrolling HIV-negative MSM, with HIV infection as the primary efficacy outcome. Behavioral assessments were done every 6-months via ACASI. Longitudinal regression models were constructed, as well as procedures for testing mediator effects.

Results: Of the 4,295 participants enrolled, 39.7% had a history of CSA. Participants with a history of CSA were at increased risk for HIV-infection over study follow-up (AHR=1.30, 95 percent CI (1.02-1.69)). A significant association was seen between CSA and unprotected anal sex (UA) (AOR=1.24, 95% CI=1.12-1.36) and serodiscordant unprotected anal sex (SDUA) (AOR=1.30, 95% CI=1.18-1.43). Notably, there were differential effects of the EXPLORE intervention for men with versus without CSA. Marijuana/hashish, poppers/inhaled nitrites, crack/rock/powder cocaine, amphetamines, depression, lower-self-efficacy, poorer-communication-skills, poorer-safer-sex-norms, UA, and SDUA significantly mediated the primary relationship between CSA and subsequent HIV-infection.

Conclusions: Findings indicate that HIV-uninfected MSM with CSA histories are at greater risk for HIV-infection, report higher rates of HIV risk behavior, and derive less benefit from prevention programs. The pathways to sexual risk behavior and HIV-infection in MSM are complex, particularly among MSM with CSA. Specifying these pathways may lead to the development of HIV prevention technology to specifically focus the unique prevention needs of this at-risk group.

Learning Objectives:
Describe the mediators of the relationship between a history of childhood sexual abuse and subsequent HIV infection among MSM who were HIV-uninfected at baseline and enrolled in a randomized controlled intervention trial.

Keywords: HIV/AIDS, Gay Men

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an Instructor in Psychiatry at Harvard Medical School.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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