Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men's Health Study

Objective: The prevalence and characteristics of childhood sexual abuse (CS A) among men who have sex with men (MSM), and links with sexual risk are ex plored. A model linking CSA and sexual risk among MSM is proposed. Method: A telephone probability sample of urban MSM (n = 2881) was recruite d and interviewed between November 1996 and February 1998. The interview co vered numerous health issues, including history of sexual victimization. Results: One-fifth reported CSA, primarily by non-family perpetrators. Init ial CSA experiences are characterized by high levels of force (43% involved physical force/weapons), and penetrative sex (78%; 46% reported attempted or actual anal intercourse). Such men are more likely than never-coerced me n to engage in high risk sex (unprotected anal intercourse with a non-prima ry partner or with a serodiscordant male). In multivariate analyses, the ef fect of childhood sexual coercion on sexual risk is mediated by substance u se, patterns of sexual contacts, and partner violence, but not by adult sex ual revictimization or by depression. Conclusions: Findings are interpreted within the context of social learning theory and prior research on sexual risk-taking. The high risk for CSA amo ng MSM, which can predispose such men to patterns of HIV sexual risk, warra nts new approacches in HIV prevention. (C) 2001 Elsevier Science Ltd. All r ights reserved.