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Try out PMC Labs and tell us what you think. Learn More. While research indicates high rates of childhood sexual abuse among Latino men who have sex with men, few studies have examined the long-term health outcomes of childhood sexual abuse specifically among behaviourally bisexual Latino men.
In a sample of behaviourally bisexual Latino men in New York City, we examined associations between childhood sexual abuse and multiple dimensions of adult health: sexual risk behaviours; sexually transmitted infections incidence; polydrug use; depressive symptoms; and perceived stress. We compared outcomes between those with histories of childhood sexual abuse, those reporting peer sexual contact prior to age 13 and those with no sexual contact prior to age Over one-fifth Across all variables, peer sexual contact did not impact these outcomes, underscoring a key distinction between abusive and non-abusive early sexual experiences.
We recommend that sexual abuse prevention policies and programmes better engage Latino youth, and that practitioners serving this population across diverse areas of practice incorporate childhood sexual abuse screening and culturally appropriate treatment and care into practice.
Childhood sexual abuse is a pervasive public health concern facing sexual minority Latino men. research has found childhood sexual abuse to be associated with higher rates of sexual risk behaviours, leading to sexually transmitted infections STIs and HIV infection Bensley, Van Eenwyk, and Simmons ; Markowitz et al.
In contrast to the substantial literature on long-term health outcomes of childhood sexual abuse, the extent to which non-abusive early life sexual experiences impact adult health is largely understudied. Despite this, few studies have examined whether early sexual initiation with peers impacts health outcomes and sexual risk behaviours in adulthood. These researchers found that early sexual experiences did not affect risk in and of themselves; only experiences self-perceived as abusive were associated with increased risk.
Researchers and providers must explore this distinction further, with more contemporary data, in order to better comprehend the long-term influence of childhood experiences on HIV risk in adulthood. As a result, studies of sexual risk in this population often limit their assessments to same-sex activities, such as anal sex between men, and fail to assess other potential sources of sexual risk, such as vaginal sex or anal sex with women. Populations such as bisexual Latino men who occupy multiple marginalised positions are also rarely considered; this paper develops the literature on multiple dimensions of identity through an intersectional approach by researching behaviourally bisexual Latino men as a distinct population.
Research by Rohde-Bowers and colleagues highlighted notable differences between behaviourally bisexual men and men who strictly engage in same-sex acts, reporting higher rates of substance use, more casual sex partners and differences in socio-environmental risk factors e. Given these differing risk profiles, the authors highlight the need for research and interventions to address the needs and risk patterns of specific populations and sub-populations.
Moreover, behaviourally bisexual Latino men contend with numerous dimensions of social marginalisation that may impact risk and resilience factors, both within and outside the context of childhood sexual abuse e. They may face pressures to cover or outright conceal their identities and behaviours within both heterosexual and gay communities Yoshino , which is likely to impact outcomes differently from other populations.
As such, risk and resilience among bisexual Latino men should not be pd to line up with those of gay or heterosexual Latinos. In other populations, childhood sexual abuse has been associated with negative health outcomes across various dimensions of adult health.
Among bisexual Latino men and other Latino men who have sex with men, the association between childhood sexual abuse and HIV sexual risk behaviours is of particular concern. Research by Bensley, Van Eenwyk, and Simmons found childhood sexual abuse to be associated with an eight-fold increase in HIV risk behaviours, measured by condomless intercourse, STI incidence, injection drug use and HIV infection. Likewise, Mimiaga and colleagues found higher rates of HIV and STI transmission, condomless anal intercourse and serodiscordant condomless anal intercourse in men who have sex with men with a history of childhood sexual abuse than those without.
Some evidence suggests that behaviourally bisexual Latino men who do not self-identify as bisexual are at greater risk of engaging in sexual risk behaviours, with one study finding higher rates of STIs, condomless sexual intercourse and substance use during sex among heterosexually identifying Latino men who have sex with men and women compared to both bisexually identifying and exclusively heterosexual Latino men Zellner et al. The relationship between childhood sexual abuse and substance use later in life is well documented.
Boroughs and colleagues found that among a sample of men who have sex with men, those with histories of childhood sexual abuse were 2. Likewise, a year longitudinal study conducted by Fergusson, McLeod, and Horwood found that rates of alcohol dependence and illicit drug dependence at age 30 among those with histories of sexual abuse were positively correlated with the extent of abuse, operationalised on a continuum ranging from no sexual contact to sexual penetration. Notably, few studies have focused on possible connections between childhood sexual abuse and substance use specifically among behaviourally bisexual men, Latino or otherwise.
Although the link between childhood sexual abuse and substance use later in life is well studied, critical research gaps remain. Growing evidence supports that the combined use of multiple substances presents greater risk than use of any one drug in isolation Deschenau, Iftimovici, and Touzeau , prompting researchers to analyse polydrug use i. Numerous factors warrant exploration into the impact of childhood sexual abuse on polydrug use among sexual minority Latino men. In addition to the elevated risk associated with polydrug use, evidence suggests that polydrug use is higher among those with histories of child maltreatment, including childhood sexual abuse Alvarez-Alonso et al.
Moreover, polydrug use has been shown to increase risk of psychological distress Kelly et al. Thus, polydrug use may pose an elevated concern for survivors of abuse with trauma-induced psychological distress. Despite this, research has overwhelmingly analysed the impact of childhood sexual abuse on singular drug use, with very few if any analysing the impact of childhood sexual abuse on polydrug use and co-occurring psychological distress. The association between childhood sexual abuse and negative mental health outcomes later in life, including depression, post-traumatic stress disorder, loneliness, isolation and anxiety disorders Banyard, Williams, and Siegel ; Springer et al.
Ample evidence also indicates that survivors of childhood sexual abuse are more prone to experiencing anxiety and post-traumatic stress Boroughs et al. Moreover, the link between childhood sexual abuse and post-traumatic stress disorder may be more profound among sexual minorities, with one study finding that sexual minorities with histories of childhood sexual abuse had between 1.
Interestingly, despite a vast body of research focused on childhood sexual abuse and mental health outcomes, the majority has focused solely on psychopathological outcomes, with very few studies examining the impact of childhood sexual abuse on non-pathological mental health outcomes that impact daily functioning e.
Examining associations between childhood sexual abuse and perceived stress i. Research elsewhere indicates that perceived stress may also act as a mediating factor in the development Fincham et al. Moreover, stress and other non-pathological psychological outcomes can and do impact the general well-being of childhood sexual abuse survivors, and bear investigation in their own right. The present study expands upon existing literature related to childhood sexual abuse as a predictor of adult health morbidities and addresses a critical research gap by focusing on bisexual Latino men as a distinct group.
While studies focusing on men who have sex with men have examined the effects of childhood sexual abuse on sexual risk with male partners, this analysis examines sexual risk behaviours with both male and female partners. Current literature specific to men who have sex with men is also largely limited to analysing same-sex sexual risk behaviours as the sole outcome; this paper extends this framework to multiple facets of adult health by examining not only sexual risk behaviours, but also STI incidence, polydrug use and mental health outcomes.
Using this framework, we hope to analyse whether childhood sexual contact will affect adult mental health, sexual risk and substance use more generally, or whether those experiences must be abusive in order to have such effects. We predict that a history of childhood sexual abuse will be associated with higher rates of sexual risk behaviours, measured by frequency of insertive and receptive condomless anal intercourse with men and condomless vaginal intercourse; higher STI incidence; higher rates of polydrug use; and greater likelihood of screening for clinically ificant depressive symptoms and perceived stress.
We further predicted that non-abusive peer sexual contact would not be associated with these outcomes. Participants were recruited in two large metropolitan areas with large Latino populations in New York City and New Jersey. Participants were screened for eligibility using the following inclusion criteria: age 18—60 ; sex male ; ethnicity Latino descent ; history of sexual encounters with both men and women behaviourally bisexual ; and recent sexual encounters bisexually active within the preceding six months.
Data were collected in connection with a broader project on risk and protective factors among HIV-negative bisexual Latino men; consequently, all participants were HIV-negative. Those meeting eligibility criteria through the automated screening process were asked to schedule a time and date for the in-person interview process, available in English or Spanish. Of the potential participants screened, met the inclusion criteria and were included in the study.
Demographic characteristics included age years , annual income and level of formal education less than high school, high school diploma or high school equivalency, some college, Bachelors degree or higher. As mentioned above, the sample was homogenous regarding ethnicity Latino , sex male , sexual behaviour bisexual and HIV status negative.
Participants were asked to report the age of their first sexual experience whether manual, oral, genital or anal. This definition is consistent with statutory rape laws in numerous states that criminalise sexual contact with persons under the age of 13, including New York Whitman This definition is also consistent with findings that statutory rape cases involving victims aged 12 or younger in which there was an age gap of four or more years were most likely to be perceived as abusive, regardless of the nature of the contact Koon-Magnin and Ruback Participants who reported sexual contact prior to age 13, but no incidents in which the other person was at least four years older, were categorised as reporting peer sexual contact and retained in analyses as a separate group for comparison.
Sexual risk behaviours were measured by the frequency of condomless penetrative sex acts with both men and women. Participants were asked to report the frequency of receptive condomless anal intercourse with men, insertive condomless anal intercourse with men and condomless vaginal intercourse with women within the preceding two months Cook, Valera, and Wilson Given the inclusion criteria, all participants were HIV-negative.
In regression analyses, participants were classified as either having received one or more positive result s from an STI test within their lifetime, or never having received a positive STI result. We operationalised polydrug use as the recreational use of three or more of the following substances see Parsons, Grov, and Golub within the preceding four months: marijuana; pain killers such as Vicodin or Codeine; prescription sedatives such as Valium or Xanax; prescription stimulants such as Ritalin or Adderall; prescription erection pills such as Viagra or Cialis; ecstasy; ketamine; powdered cocaine; GHB; methamphetamine; LSD; PCP; mushrooms; crack-cocaine; heroin; and steroids.
For medications, we asked specifically about use without prescriptions. Mental health outcomes were measured using the item Brief Symptom Inventory. The Brief Symptom Inventory is a self-administered questionnaire used to gauge psychiatric symptoms indicative of nine mental health outcomes: somatisation; obsession-compulsion; interpersonal sensitivity; depression; anxiety; hostility; phobia; paranoia; and psychoticism Derogatis and Spencer Participants were asked to rank each item on a 5-point scale ranging from 0—4 to represent the severity of depressive symptoms within the preceding seven days.
Raw scores were calculated by summing responses for each item, potentially ranging from 0— T-scores of. Although not a diagnostic tool, Brief Symptom Inventory depression subscale scores have shown to be highly correlated with clinical diagnosis of DSM-IV affective disorders, including Major Depressive Disorder, and moderately correlated with a diagnosis of post-traumatic stress disorder in outpatient settings Brodbeck et al.
The Perceived Stress Scale is a self-administered questionnaire used to quantify levels of stress within the preceding month. For each item, participants ranked the frequency with which they experienced various feelings or situations indicative of stress e. Four items were reverse coded according to instrument protocol, and responses to each item were summed to formulate raw scores possible range of 0— The Perceived Stress Scale measures appraised stress, which can have a major impact on day-to-day functioning in spite of being distinct from psychiatric symptomatology.
History of childhood sexual abuse and history of peer sexual contact were treated as our primary independent variables. Receptive and insertive condomless anal intercourse with male partners, condomless vaginal intercourse with female partners, lifetime STI incidence, polydrug use, clinically ificant depressive symptoms and high perceived stress were analysed as dependent variables.
We first conducted descriptive statistics to analyse health outcomes and behaviours among the three specified groups. We then examined bivariate relationships between independent variables and each health outcome, and conducted multivariate analyses using logistic regression models controlling for income and education. In bivariable and multivariable models, odds ratios OR and adjusted odds ratios aOR , respectively, are reported for each adult health outcome. Given the homogeneity of the sample in terms of sex male , ethnicity Latino , sexual behaviour bisexual and HIV status negative , it was not necessary to control for these variables.
A total of participants provided data on all measures included in regression models; in regression models, only participants providing data for all measures were included in analysis. Sample characteristics appear in Table 1. Given the inclusion criteria, the sample was entirely male, Latino, behaviourally bisexual and over age Both receptive and insertive condomless anal intercourse were more common among those with a history of childhood sexual abuse Nearly one-third The sample scored relatively high on the Brief Symptoms Inventory depression subscale, and over a quarter Incidence of clinically ificant depressive symptoms was ificantly higher among the childhood sexual abuse group Bivariable and multivariable analyses of sexual risk behaviours appear in Table 2.
Conversely, peer sexual contact was not found to be ificantly associated with receptive condomless anal intercourse. In bivariable and multivariable models, neither childhood sexual abuse nor peer sexual contact ificantly increased odds of engaging in insertive condomless anal intercourse or condomless vaginal intercourse.
In bivariable and multivariable analyses see Table 3 , neither childhood sexual abuse nor peer sexual contact were ificantly associated with lifetime STI incidence or polydrug use. from bivariable and multivariable regression analyses for clinically ificant depressive symptoms and perceived stress appear in Table 4. Participants reporting peer sexual contact did not face greater odds of screening for clinically ificant depressive symptoms. Reports of clinically ificant depressive symptoms and high perceived stress by childhood sexual abuse CSA and peer sexual contact PSC.
This finding underscores the need to study behaviourally bisexual Latino men as a group separate from generalised and Latino-specific men who have sex with men populations, given that condomless vaginal intercourse is rarely addressed in men who have sex with men research. The relationship between childhood sexual abuse and receptive condomless anal intercourse corroborates other findings pointing to childhood sexual abuse as a factor contributing to engagement in sexual and HIV risk behaviours Bensley, Van Eenwyk, and Simmons ; Mimiaga et al. Recent HIV surveillance data indicate that if current infection rates continue, one in four Latino men who have sex with men will be diagnosed with HIV in their lifetime Centers for Disease Control and Prevention Given this alarming projection, the need to target prevention efforts towards social and environmental factors underlying HIV risk behaviours and engage high-risk Latino men who have sex with men and women , such as those with histories of childhood sexual abuse, is critical.
Notably, findings from our sample diverge from research with other populations, including generalised populations of Latino men who have sex with men Boroughs et al. Although this finding may be unique to our sample, we also consider the possibility that mitigating or protective factors specific to bisexual Latino men may buffer the effects of childhood sexual abuse on these outcomes.
Moderating factors such as resiliency, familyism, religiosity and social and community support have been shown to mitigate the effects of childhood sexual abuse on substance use Ai et al. Protective factors are likely to differ markedly between bisexual Latino men and other populations including Latino men who have sex with men , given their unique lived experiences, social communities and support, and contention with multiple levels of social marginalisation. Thus, protective and resilience factors among bisexual Latino men are likely to moderate the effects of childhood sexual abuse on health outcomes differently than other populations.Sex tothe Wingo isa
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