Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE Study.
Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE Study.
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在探索研究中，儿童性虐待与MSM之间的艾滋病毒冒险行为和感染高度相关。
DOI：
10.1097/qai.0b013e3181a24b38
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发表时间：
2009-07-01
期刊：
影响因子：
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通讯作者：
Mayer KH
中科院分区：
文献类型：
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作者：
Mimiaga MJ;Noonan E;Donnell D;Safren SA;Koenen KC;Gortmaker S;O'Cleirigh C;Chesney MA;Coates TJ;Koblin BA;Mayer KH
先前的研究发现，美国男性同性恋者（MSM）的儿童性虐待（CSA）率很高。CSA历史与以后生活中的各种负面影响有关，包括使MSM处于更大的艾滋病毒感染和传播风险的行为。目前的分析是第一次检查CSA和HIV感染，无保护的肛交，血清不一致的无保护的肛交，以及这些关系的大样本的HIV未感染的男男性接触者之间的介质之间的纵向关联。EXPLORE研究是一项在美国6个城市进行的为期48个月的行为干预试验，以HIV感染作为主要疗效结局。每6个月通过保密的计算机化评估进行一次行为评估。构建纵向回归模型，调整随机化组、研究中心的地理位置、入组时的年龄、教育程度和种族/民族。在入组的4295名参与者中，39.7%有CSA病史。有CSA病史的参与者[调整后的风险比= 1.30，95%置信区间（CI）：1.02至1.69]在研究随访期间HIV感染的风险增加。CSA病史与无保护肛交（校正比值比= 1.24，95%CI：1.12至1.36）和血清不一致的无保护肛交（校正比值比= 1.30，95%CI：1.18至1.43）之间存在显著相关性。在报告CSA的参与者中，EXPLORE干预对降低HIV感染率没有影响。报告CSA的参与者更有可能出现抑郁症状并使用非处方药。CSA的历史和随后的HIV感染之间的预测关系，观察这个大样本的HIV未感染的男男性行为者。研究结果表明，未感染艾滋病毒的男男性接触者与CSA的历史是在更大的风险，艾滋病毒感染的性风险行为的报告率较高，并可能从预防计划中获得较少的好处。未来的艾滋病预防干预措施应解决特定的心理健康问题的男男性接触者与CSA的历史。
Previous studies have found high rates of childhood sexual abuse (CSA) among US men who have sex with men (MSM). CSA history has been associated with a variety of negative effects later in life including behaviors that place MSM at greater risk for HIV acquisition and transmission. The present analysis is the first to examine the longitudinal association between CSA and HIV infection, unprotected anal sex, and serodiscordant unprotected anal sex, as well as mediators of these relationships among a large sample of HIV-uninfected MSM. The EXPLORE Study was a behavioral intervention trial conducted in 6 US cities over 48 months with HIV infection as the primary efficacy outcome. Behavioral assessments were done every 6 months via confidential computerized assessments. Longitudinal regression models were constructed, adjusting for randomization arm, geographical location of study site, age at enrollment, education, and race/ethnicity. Of the 4295 participants enrolled, 39.7% had a history of CSA. Participants with a history of CSA [adjusted hazards ratio = 1.30, 95% confidence interval (CI): 1.02 to 1.69] were at increased risk for HIV infection over study follow-up. A significant association was seen between history of CSA and unprotected anal sex (adjusted odds ratio = 1.24, 95% CI: 1.12 to 1.36) and serodiscordant unprotected anal sex (adjusted odds ratio = 1.30, 95% CI: 1.18 to 1.43). Among participants reporting CSA, the EXPLORE intervention had no effect in reducing HIV infection rates. Participants reporting CSA were significantly more likely to have symptoms of depression and use nonprescription drugs. A predictive relationship between a history of CSA and subsequent HIV infection was observed among this large sample of HIV-uninfected MSM. Findings indicate that HIV-uninfected MSM with CSA histories are at greater risk for HIV infection, report higher rates of HIV sexual risk behavior, and may derive less benefit from prevention programs. Future HIV prevention interventions should address the specific mental health concerns of MSM with a history of CSA.