235704 Early life traumatic stressors and the mediating role of post-traumatic stress disorder (PTSD) in incident HIV infection among 13,276 U.S. men, comparisons by sexual orientation and race/ethnicity: Results from the National Epidemiologic Survey on Alcohol and Related Conditions, 2004-2005

Wednesday, November 2, 2011

Sari L. Reisner, MA , The Fenway Institute, Fenway Health and Harvard School of Public Health, Boston, MA
Kathryn L. Falb, MHS , Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA
Matthew J. Mimiaga, ScD, MPH , Psychiatry, Harvard Medical School/Massachusetts General Hospital and The Fenway Institute, Fenway Health, Boston, MA
Background: Traumatic life events in childhood during critical periods of development have long-term psychological sequelae, which may affect risk for HIV infection across the life course.

Methods: Data were from a nationally representative sample of 13,276 U.S. men (NESARC, 2004-2005). Weighted multivariable logistic regression models examined (1) the association of childhood violent events before age 18 on 12 month incident HIV infection; (2) whether post-traumatic stress disorder (PTSD) diagnosis (clinical interview) mediated the association between early life events and incident HIV-infection.

Results: The 12 month HIV incidence was <1% (0.35%); 44% of new infections were among racial/ethnic minorities and 31% among men who have sex with men (MSM). One third of the sample (33%) reported one or more early life stressors (physical abuse, sexual abuse, neglect, verbal violence, witnessed parental violence). In a weighted, multivariable logistic regression model adjusted for age, education, family socioeconomic position, and sexual orientation, each additional early life violent event was associated with an elevated odds of HIV-infection (aOR=1.22; 95% CI=1.06, 1.39). There was evidence that PTSD partially mediated the relationship between early life traumatic events and HIV; however, the robustness of mediated effects differed substantially for MSM compared to non-MSM, and for racial/ethnic minorities compared to whites.

Conclusion: Experiencing early life violent family stressors was associated with incident HIV infection. Early traumatic life events and HIV infection were differentially mediated by PTSD depending on one's sexual orientation and race/ethnicity. Findings have implications for HIV prevention, including interventions for HIV risk reduction and PTSD treatment.

Learning Areas:
Epidemiology
Public health or related research

Learning Objectives:
(1) To describe the role of early life stressful events (experienced before age 18) in incident HIV infection in the past 12 months (age 18+). (2) To evaluate whether sexual orientation and race/ethnicity moderate the relationship between early life stress and HIV infection. (3) To empirically test whether PTD mediates the relationship between early life stress and incident HIV infection among men. (4) To consider implications of findings for HIV prevention efforts.

Keywords: HIV/AIDS, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Sari Reisner, MA is a Research Analyst at The Fenway Institute, Fenway Health in Boston, MA and a doctoral student in social and psychiatric epidemiology in the Department of Society, Human Development, and Health at Harvard School of Public Health. His current research is guided by a human developmental, life course approach to the study of mental and physical health disparities, including: (1) the social and psychiatric epidemiology of HIV; (2) application of new methodologies to study the health of marginalized and underserved populations. He has co-authored more than 25 peer-reviewed publications on sexual and gender minority health, and has experience in the design, implementation, and evaluation of community-based research, including federally and state-funded intervention studies. He has presented his research nationally at conferences such as APHA, the Society of Behavioral Medicine, and the CDC National HIV Prevention Conference, as well as internationally, at the International AIDS Conference. He is an editorial consultant for the American College of Physicians, Physicians Information and Education Resource (PIER), and a member of the Transgender Research Group at the National Center for Population Research in LGBT Health. Mr. Reisner earned a Masterís degree from Brandeis University and a Bachelorís degree from Georgetown University.
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.