Impact of childhood sexual abuse on sex trading and other HIV risks among men in methadone treatment

Objective: This study examines the relationship between childhood sexual abuse (CSA) and subsequent sex trading and other HIV risks among a random sample of 356 adult males in methadone maintenance treatment programs (MMTP) in New York City. Method: Multivariate regressions were used to conduct a series of mediational analyses to examine the effects of depression and anxiety (psychopathology), and early substance use initiation and substance use in adulthood (substance use) on the relationships between CSA and two separate outcomes: 1) sex trading and 2) other HIV risks. Results: The prevalence estimate for CSA was 39%. More than half of the men reported ever engaging in sex trading (54%) and having a history of sexually transmitted infections (51%). Forty percent reported ever sharing needles. Mediational analyses found that the relationship between CSA and sex trading was only partially mediated by psychopathology and substance use. However, the relationship between CSA and HIV risks was completely eliminated, demonstrating the strong mediational effects of psychopathology and a history of substance use. Conclusion: These findings provide strong evidence for the roles played by early drug use initiation, adult substance use and psychopathology on the path from CSA to sex trading and other HIV risks. They highlight the need to design, test and implement HIV prevention programs for male survivors of CSA that intervene at different stages of the life course and that integrate substance abuse and trauma-related treatments with HIV risk-reduction behavioral skills.