History of Forced Sex, MSM, and HIV/STIs

 

Forced Sex, MSM, and HIV/STIs

 

Introduction

 

This paper examines the role of sexual violence in young men and boys who identify as men who have sex with men (MSM), and surmises its effects on high risk behaviors and HIV/STI transmission and acquisition. There is limited research on sexual violence as a predicate for HIV/STI risk and drug use in MSM. Increasingly higher rates of HIV/STIs in MSM have driven researchers to investigate the behavioral correlates and demography of this sexual minority population, but few studies have considered the subjective experience of sexual violence and poverty as indicators for high risk sexual behavior, including HIV/STI transmission, and illicit drug use among MSM. The relationship between the prevalence and correlates of experiencing sexual violence by a male in MSM and risk for drug use and STIs highlights the need for evidence-based multi-component interventions to address syndemic health disparities in this unique and diverse population.

A review of the literature reveals a variety of descriptions for sexual violence, each of which is defined in the specific context of the research. This project will use the term sexual violence to describe a range of experiences, such as forced sex, sexual abuse, sexual molestation, rape, sexual assault, nonvolitional sex, and early sexual debut. According the Centers for Disease Control and Prevention, the term sexual violence is used to describe sexual activity when consent is not explicitly obtained or not freely given. The following text will review the history of research on sexual violence among MSM and its association with high risk behaviors, including higher HIV/STI rates, psychological trauma and depression, drug use, and other negative health outcomes.

Previous studies have found high rates of sexual violence in US MSM, but the research has primarily focused on the psychological aspects of health, and the prevalence of HIV/STIs that are the result of sexual violence. There is little research that examines how poverty, drug use, and experiencing sexual violence in early childhood and adolescent development are associated with higher rates of HIV/STIs among MSM at the population level.

Heightened levels of vulnerability for sexual minorities have stimulated research on HIV/STI risk among MSM who have experienced sexual violence, especially in childhood. Loyd’s research on childhood sexual abuse (CSA) as an indicator for risk behavior associated with HIV infection in MSM found that MSM with CSA history were more likely to be HIV positive and engage in unprotected anal sex. Their research also indicated that MSM with a history CSA were more likely to report frequent male partners, substance use, and sex while under the influence of alcohol and drugs. Unlike most studies that focus on more proximal factors of risk such as substance use behaviors, partner characteristics, partner concurrency, and contextual factors that influence condom use and sexual decision making, Loyd’s research is aimed at understanding how earlier life events, such as childhood sexual abuse, determine HIV risk behavior in MSM.

A study of HIV vulnerabilities and coercive sex at same-sex sexual debut among MSM in Beijing, China identified HIV risk factors correlated with sexual violence and revealed how coercive sex at MSM sexual debut is linked to a variety of negative health outcomes (Pan et. al., 2014). This research suggests that psychological distress, maladaptive coping techniques, internalization of sexual power imbalances, and weak sexual negotiation skills may account for correlations between early coercive sex and subsequent HIV risk. Both Loyd and Pan et. al., observed how an individual’s early sexual experiences can potentially serve as a long-term model that shapes perceptions of what behaviors and personal characteristics are sexually arousing or socially acceptable, and how they or their partners are expected to engage in sex. Condom use, illicit drug use, and future acts of sexual violence are linked to early experiences of nonvolitional sex in childhood development.

By estimating the prevalence of lifetime nonvolitional sex (NVS) among MSM by demographic characteristics, Nasrullah et al., described associations with HIV related sexual risk behaviors in line with Loyd and Pan et. al, (2015). Like this project, Nasrullah et al, used The National Survey of Family Growth (NSFG) to characterize how sexual violence experienced by MSM in childhood and adolescent development is linked to future negative health outcomes and high risk behaviors such as illicit drug use, sex without a condom, and multiple sexual partners. The relationship between risk factors for HIV/STI and childhood sexual abuse, intimate partner violence, and depression among sexual minorities indicates how early life events shape future health outcomes (Williams et al, 2015). Psychological and behavioral problems associated with lifetime prevalence of non-consensual sex in men reveals the critical need for more population based studies on the role of sexual violence in determining high risk behavior. Research aimed at understanding childhood sexual abuse as a predictor of sexual risk-taking and HIV risk behaviors is paramount in addressing syndemic health disparities in sexual minority communities. 

 

1.       HIV risk among men who have sex with men who have experienced childhood abuse: systematic review and metanalysis (Loyd 2012)

2.       HIV vulnerabilities and coercive sex at same-sex sexual debut among men who have sex with men in Beijing, China (Pan et. Al, 2014)

3.       Nonvolitional sex and HIV-related sexual risk behaviours among MSM in the United States (Nasrullah et al, 2015)

4.       Relation of Childhood Sexual Abuse, Intimate Partner Violence, and Depression to Risk Factors for HIV Among Black Men Who Have Sex With Men in 6 US Cities (Williams et al, 2015)

5.       Lifetime prevalence, characteristics, and associated problems of non­consensual sex in men: cross sectional survey (Coxell et al, 1999)

Objective: To identify the lifetime prevalence of non­consensual sexual experiences in men, the relationship between such experiences as a child and as an adult, associated psychological and behavioral problems, and help received.

Design: Cross sectional survey.

6.       Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men's Health Study. (Paul et al, 2001)

OBJECTIVE: The prevalence and characteristics of childhood sexual abuse (CSA) among men who have sex with men (MSM), and links with sexual risk are explored. A model linking CSA and sexual risk among MSM is proposed.

METHOD: A telephone probability sample of urban MSM (n = 2881) was recruited and interviewed between November 1996 and February 1998. The interview covered numerous health issues, including history of sexual victimization.

7.       History of childhood sexual abuse and HIV risk behaviors in homosexual and bisexual men. (Brennan 2007)

OBJECTIVES: We examined the prevalence and frequency of childhood sexual abuse and their association with sexual risk among a sample of gay and bisexual men. Methods. Cross-sectional data were collected by survey from randomly selected gay and bisexual men who attended the 1997 and 1998 Minneapolis/St. Paul Gay, Lesbian, Bisexual, and Transgender Pride Festivals. Data included demographics, sexual activity, history of childhood sexual abuse, HIV status, history of sexually transmitted infection, use of sex-related drugs (such as crack, cocaine, Ecstasy, amyl nitrate, crystal methamphetamine, and Special K), and history of exchanging sex for payment. Results. childhood sexual abuse was reported by 15.5% of the survey respondents (n = 134). Those who reported experiencing abuse regularly were more likely to (1) be HIV positive, (2) have exchanged sex for payment, and (3) be a current user of sex-related drugs. Neither unsafe sex nor sexually transmitted infections were associated with childhood sexual abuse.

CONCLUSIONS: These findings show that more than 1 in 7 gay and bisexual men in a non-clinical, festival-based setting were victims of childhood sexual abuse and that childhood sexual abuse was associated with alarmingly high rates of men who were HIV infected and antecedent risk behaviors.

8.       Childhood Sexual Abuse Is Highly Associated With HIV Risk–Taking Behavior and Infection Among MSM in the EXPLORE Study (Mimiaga et al, 2009)

Lenderking et al² found that MSM who were sexually abused as children were more likely to have an increased number of male partners across their lifetime and were more than twice as likely to have had unprotected receptive anal intercourse in the past 6 months relative to MSM who were not sexually abused. 

O’Leary et al demonstrated that MSM who were abused in childhood not only placed themselves at risk through sexual behavior but also put others at risk. 

9.       The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India (Tomori et al, 2016)

CSA has been identified as an important predictor of high risk sexual behavior later in life for both men and women, including early sexual debut, unprotected sex, multiple partners, and engagement in transactional sex, which increase the risk of HIV and other sexually transmitted infections (STIs)

10.   Age of MSM Sexual Debut and Risk Factors: Results from a Multisite Study of Racial/Ethnic Minority YMSM Living with HIV (Outlaw et al, 2007)

..there is limited data regarding factors associated with sexual debut for young men who have sex with men (YMSM). Early sexual debut poses potential health risks, such as contracting HIV with an increased risk of unprotected intercourse. …five syndemic conditions, including CSA, depression, heavy alcohol use, stimulant use and polydrug use, were found to enhance the likelihood of HIV seroconversion, in direct proportion to the number of syndemic conditions experienced.

11.   Main Reasons for Never Testing for HIV Among Women and Men Aged 15–44 in the United States, 2011–2015 (Febo-Vasquez et al, 2015)

12.   Book: Dangerous Intimacy (Christopher A Brooks)

 

 

Coercive Sex

Physical force

Chemical substances

Psychological manipulation

Perceived obligation

 

To obtain the lifetime prevalence of forced sex among MSM, we need to collect data on the following variables:

Sexual debut before age 16

Reports forced sex (especially before age 16)

Reports substance use and/or abuse

Reports household income at or below 30K/y

Reports never testing for HIV (1. Unlikely to have been exposed to HIV, and 2. Never been offered an HIV test). I think we should include this variable in our study because it is theoretically linked to the stigma, shame, and self-denial associated with HIV vulnerability. What percent of the population in question reports never testing for HIV and how is this related to other variables such as forced sex, substance use, and income?