A model describing childhood sexual abuse, HIV, and PTSD in a sample of high-risk men who have sex with men

Background: This study explored the association between childhood sexual abuse (CSA), HIV-status, posttraumatic stress disorder (PTSD) and adult functioning in a sample of high-risk Men who have Sex with Men (MSM). MSM have disproportionately high rates of CSA and PTSD. In the general population PTSD has been associated with negative health outcomes, including substance abuse, fear of intimacy, and sexual risk; however, these relationships have not been demonstrated among MSM. Critically evaluating these constructs as an integrative model is important to developing specialized interventions for MSM with a history of CSA and PTSD. Methods: Participants were 485 MSM who completed an online survey. Participants were recruited through internet message boards marketed toward men looking for sexual encounters, social media, and word-of-mouth outreach. We assessed for childhood sexual abuse, HIV-status, and current biopsychosocial functioning. Results: Over 60% of HIV-positive MSM reported probable PTSD. Ninety percent of the HIV-positive MSM who reported a history of CSA also endorsed significant PTSD symptoms as adults. Having a history of both CSA and PTSD predicted fear of intimacy, poorer health outcomes, and drug abuse. Neither PTSD nor childhood sexual abuse were associated with sexual risk. Empirical models organizing these relationships were tested via structural equation modeling. PTSD mediated the relationship between CSA and fear of intimacy and poorer health outcome. Conclusions: Early trauma of CSA may increase the risk of developing PTSD once diagnosed with HIV. Our results support the need to routinely screen for PTSD and CSA among MSM, both with and without HIV.