205747 Childhood sexual abuse and HIV risk among MSM sex workers in Boston, Massachusetts: Implications for HIV prevention interventions

Monday, November 9, 2009

Sari L. Reisner, MA , The Fenway Institute, Fenway Health and Harvard School of Public Heatlh, Boston, MA
Matthew J. Mimiaga, ScD, MPH , Psychiatry, Harvard Medical School and The Fenway Institute, Fenway Health, Boston, MA
Kenneth Mayer, MD , Brown University/Miriam Hospital and The Fenway Institute, Fenway Health, Boston, MA
Steven A. Safren, PhD , Harvard Medical School and The Fenway Institute, Fenway Health, Boston, MA
Background: Childhood sexual abuse has been associated with poorer health outcomes and HIV risk among men who have sex with men (MSM). The current study assessed the frequency of CSA and its association to HIV risk behaviors among MSM who engage in sex work.

Methods: Male sex workers (n=32) completed a one-time, semi-structured qualitative interview and quantitative psychosocial assessment battery between January and March 2008; interviews were conducted until redundancy in responses was achieved. Contextual factors related to HIV risk taking were examined using grounded theory. Logistic regression was used to identify factors associated with a history of CSA.

Results: Overall, 41% of participants (mean age=31; 63% white) reported sexual experiences before the age of 13 with someone more than 5 years older than them. MSM with CSA histories had high levels of substance use and psychological distress. Relative to participants without CSA, MSM with CSA histories were more likely to report unprotected anal sex with a serodiscordant or unknown HIV status male partner in the past 12 months (OR=6.61; p=0.01). CSA was also associated with crack-cocaine use (OR=5.60; p=0.05), clinically significant depressive symptoms (CESD score 16+; OR=4.07; p=0.05), and inpatient psychiatric hospitalization (OR=7.31; p=0.05).

Conclusions: MSM sex workers with histories of CSA appear at increased risk of HIV transmission or acquisition. Results suggest that to be effective, interventions with MSM sex workers must intervene at multiple levels, going beyond HIV/STD risk behaviors to address the psychosocial context in which sexual risk behavior occurs.

Learning Objectives:
Identify (1) the frequency of CSA among MSM sex workers; (2) the association of CSA to HIV risk behaviors and psychosocial risk factors among MSM who engage in sex work; (3) the implications of these psychosocial risk factors for HIV prevention interventions.

Keywords: HIV Risk Behavior, Sex Workers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Sari L. Reisner is a Senior Research Associate for Behavioral Science Studies at The Fenway Institute, Fenway Community Health. Reisner holds an M.A. from Brandeis University and a B.A. from Georgetown University. He has more than 5 years of experience coordinating community based research projects focusing on the social and behavioral determinants of HIV/AIDS and STDs, specializing in men who have sex with men (MSM). His behavioral science research interests focus at the intersection of physical and mental health, including substance abuse intervention development, health psychology and behavioral medicine within the context of serious illness (HIV/AIDS and cancer), and the epidemiology of mental illness and substance abuse in marginalized populations, including racial/ethnic minorities and gay, lesbian, bisexual, and transgender (GLBT) communities. He has co-authored more 16 journal articles (published or under review), two book chapters, and numerous abstracts and poster presentations.
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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