Associations of Childhood Sexual Abuse and HIV Prevalence: Examination of Racial Differences Open Access

Gravens, Laura (2013)

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Background: There is a known disparity in HIV rates among blacks and especially black MSM in the United States. Associations between history of childhood sexual abuse (CSA) and HIV prevalence have been found among at-risk populations. CSA is more prevalent among MSM than heterosexual men. However, not much is known about how race and CSA may interact to affect HIV risk.

Objective: To determine what relationships exist between CSA and HIV prevalence, and how race and other intermediate factors may play a role in that relationship.

Results: Respondents who experienced CSA differed significantly from those who did not: they were more likely to be black, more likely to be HIV-positive, have more unprotected anal intercourse (UAI) partners, be currently homeless and have a history of homelessness, have lower safe sex norms and lower resiliency. Respondents who were black differed significantly from respondents who were white: They were more likely to experience CSA, more likely to be HIV positive, have fewer UAI partners, be less likely to engage in UAI, more likely to be homeless and have a history of homelessness, less likely to have insurance, less likely to use injection and non injection drugs, more likely to be in poverty, and have higher resiliency scores. Race, CSA and the interaction of race and CSA was significantly associated with HIV prevalence while controlling for other factors.

Conclusions: CSA and race are associated with HIV infection, and race is predictor of CSA. This relationship may contribute to the racial disparities in HIV prevalence.

Table of Contents

List of Tables and Figures - x

Chapter 1: Introduction - 1

Introduction - 2

Aims and Objectives - 3

Study Background - 3

Summary - 4

Chapter 2: Literature Review - 5

MSM Disparities in HIV Prevalence - 6

Racial Disparities in HIV Prevalence - 7

Childhood Sexual Abuse and HIV Risk - 7

MSM Disparities in Childhood Sexual Abuse - 8

Racial Disparities in Childhood Sexual Abuse - 8

Social Factors Leading to CSA - 9

Income and SES - 9

Neighborhood - 10

Family Structure - 11

Gender Nonconformity - 12

Protective Factors -12

Definitions of Childhood Sexual Abuse -13

Hypotheses -14

Chapter 3: Manuscript - 16

Abstract - 17

Introduction - 18

Data and Methods - 21

Results - 22

Discussion - 24

References - 35

Appendices - 41

SAS Code - 45

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