Childhood Maltreatment and HIV Risk-Taking among Men Using the Internet Specifically to Find Partners for Unprotected Sex.

IntroductionChildhood maltreatment, whether in the form of sexual abuse, physical abuse, emotional abuse, or neglect, has been linked with a wide variety of adverse outcomes in adulthood. These include mental health problems (e.g., depression, anxiety, post- traumatic stress disorder, attempted suicide, history of substance abuse) (1), HIV risk behaviors (2,3) and obesity (4). This has been true for a number of populations, including men who have sex with men (3,5), heterosexual men (6), lesbians (4), and heterosexual women (2), indicating that the effects of early-life maltreatment are far-reaching and longlasting.Sexual abuse experiences have been linked with a greater risk for practicing risky sex later in life in men who have sex with men (MSM), specifically because of the effect of these experiences on men's psychological health. Childhood sexual abuse was discussed as a precursor to adulthood involvement in HIV risk-taking in Fields, Malebranche, and FeistPrice's (7) research on African American MSM. Catania and colleagues (8: 925) noted that childhood sexual abuse "contributes to the ongoing HIV epidemic among MSM by distorting or undermining critical motivational, coping, and interpersonal factors that, in turn, influence adult sexual risk behavior." Dorais' (5) qualitative study of childhood sexual abuse and HIV risk taking among MSM revealed the former to be associated with an inability to assert oneself with regard to one's sexual safety and a greater tendency toward sexual compulsivity. In their bi-coastal study of HIV-positive MSM, O'Leary, Purcell, Remien, and Gomez (9) reported a link between childhood sexual abuse and engaging in unprotected anal intercourse with serodiscordant partners. In a study of gay and bisexual men attending a midwestern gay pride festival, childhood sexual abuse was found to be related to the likelihood of being HIV-positive, having exchanged sex for money, and the use of sex-related drugs, but not to the practice of unprotected sex (10). In another study of men attending a different city's gay pride festival (11), childhood sexual abuse was found to be related to a history of exchanging sex for drugs and/or money, but not to unprotected anal intercourse. Saewyc and colleagues (12) studied adolescents located in the Pacific Northwest, and concluded that sexual victimization contributed to greater overall HIV risk behavior involvement (based on a composite scale measuring seven different HIV risk practices) among the gay and bisexual students in their sample. Rosario, Schrimshaw, and Hunter (13) also based their work on gay and bisexual adolescents and young adults, and found that childhood sexual abuse was related to having a larger number of sex partners, which in turn was related to a greater likelihood of engaging in unprotected anal sex.In contrast to the preceding, the present authors find it noteworthy that studies examining the effects of other types of childhood maltreatment (e.g., physical abuse, emotional abuse, emotional neglect, physical neglect) on HIV risk taking are very scarce in the published literature. One noteworthy exception is the research conducted by Paul, Catania, Pollack, and Stall (14) on the topic of physical abuse. These authors found that parent-child physical abuse, one component of what they termed "adverse familial experiences," was a mediating factor for six sexual risk factors, including having unprotected sex with a non-primary partner and having unprotected sex with a serodiscordant partner. Much more needs to be learned and reported regarding the effects that childhood physical abuse has on HIV risk-taking later in life, and on the effects that other types of childhood maltreatment have on subsequent involvement in risky practices.Contemporary thinking on the relationship between childhood maltreatment experiences and HIV risk behaviors in adulthood (primarily based on the childhood sexual abuse literature) suggests that the former influence the latter by virtue of their impact upon various aspects of mental health functioning, which in turn is related more closely to risk practices because of its temporal proximity. …