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?
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