Cecilia Tomori
The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India
Tomori, Cecilia; McFall, Allison M.; Srikrishnan, Aylur K.; Mehta, Shruti H.; Nimmagadda, Nymisha; Anand, Santhanam; Vasudevan, Canjeevaram K.; Solomon, Suniti; Solomon, Sunil S.; Celentano, David D.
Authors
Allison M. McFall
Aylur K. Srikrishnan
Shruti H. Mehta
Nymisha Nimmagadda
Santhanam Anand
Canjeevaram K. Vasudevan
Suniti Solomon
Sunil S. Solomon
David D. Celentano
Abstract
Background Childhood sexual abuse (CSA) is a significant global public health problem, which is associated with negative psychosocial outcomes and high-risk sexual behaviors in adults. Men who have sex with men (MSM) often report higher prevalence of CSA history than the general population, and CSA may play a key role in MSM’s greater vulnerability to HIV. Methods This study examined the prevalence of CSA history and its impact on the number of recent HIV-related risk behaviors (unprotected anal intercourse, high number of male and female sexual partners, alcohol use, drug use, and sex work in prior 6 months) and lifetime risk behaviors and experiences (high number of lifetime male and female sexual partners, early sexual debut, injection drug use, sex work, and intimate partner violence) among 11,788 adult MSM recruited via respondent driven sampling across 12 sites in India, with additional insights from thematic analysis of qualitative research with 363 MSM from 15 sites. Results Nearly a quarter (22.4 %) of participants experienced CSA, with substantially higher prevalence of CSA in the South and among kothis (feminine sexual identity). Qualitative findings revealed that older, trusted men may target young and, especially, gender nonconforming boys, and perpetrators’ social position facilitates nondisclosure. CSA may also initiate further same-sex encounters, including sex work. In multivariable analysis, MSM who experienced CSA had 21 % higher rate of recent (adjusted rate ratio [aRR = 1.21], 95 % confidence interval [CI]: 1.14–1.28), and 2.0 times higher lifetime (aRR = 2.04, 95 % CI: 1.75–2.38) HIV-related behaviors/experiences compared with those who did not. Conclusion This large, mixed-methods study found high overall prevalence of CSA among MSM (22.4 %), with substantially higher prevalence among MSM residing in the South and among more feminine sexual identities. Qualitative findings highlighted boys’ vulnerabilities to CSA, especially gender nonconformity, and CSA’s role in further sexual encounters, including sex work. Additionally, CSA was associated with an elevated rate of recent, and an even higher rate of lifetime HIV-related risk factors. Our results suggest an acute need for the development of CSA prevention interventions and the integration of mental health services for MSM with histories of CSA as part of HIV-prevention efforts.
Citation
Tomori, C., McFall, A. M., Srikrishnan, A. K., Mehta, S. H., Nimmagadda, N., Anand, S., …Celentano, D. D. (2016). The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India. BMC Public Health, 16(1), Article 784. https://doi.org/10.1186/s12889-016-3446-6
Journal Article Type | Article |
---|---|
Acceptance Date | Jun 25, 2016 |
Online Publication Date | Aug 12, 2016 |
Publication Date | Aug 12, 2016 |
Deposit Date | Sep 13, 2017 |
Publicly Available Date | Oct 17, 2017 |
Journal | BMC Public Health |
Publisher | BioMed Central |
Peer Reviewed | Peer Reviewed |
Volume | 16 |
Issue | 1 |
Article Number | 784 |
DOI | https://doi.org/10.1186/s12889-016-3446-6 |
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Copyright Statement
© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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