Sex Disparities in Adverse Childhood Experiences and HIV/STIs: Mediation of Psychopathology and Sexual Behaviors.
Sex Disparities in Adverse Childhood Experiences and HIV/STIs: Mediation of Psychopathology and Sexual Behaviors.
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DOI：
10.1007/s10461-016-1553-0
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发表时间：
2017-06
影响因子：
4.4
通讯作者：
Cohen SA
中科院分区：
文献类型：
--
作者：
Brown MJ;Masho SW;Perera RA;Mezuk B;Pugsley RA;Cohen SA
艾滋病毒和其他性传播感染（STI）是美国重要的公共卫生挑战。不良童年经历，包括虐待（情感、身体或性）、目睹家庭成员之间的暴力行为，可能对性行为产生影响，从而增加感染艾滋病毒/性传播感染的风险。本研究的目的是探讨性别差异的作用，创伤后应激障碍（PTSD），抑郁症（MD），物质使用障碍（SUDs），早期性初次，和亲密伴侣暴力（IPV）犯下的调解员ACE和艾滋病毒/性病之间的关联。数据来自全国酒精及相关疾病流行病学调查第2波（2004-2005年）。结构方程模型被用来确定的作用，创伤后应激障碍，MD，SUDs，早期性首次亮相，IPV犯下的调解员ACE和艾滋病毒/性病之间的关系。精神病理与性行为的中介作用既有差异又有相似之处。例如，在男性中，MD完全介导身体/心理虐待（β = 0.0002; p = 0.012）和性虐待（β = 0.0002; p = 0.006），而在妇女中，MD完全介导身体/心理虐待（β = 0.0005; p < 0.001）和父母暴力（β =-0.0002; p = 0.012）。在男性中，IPV的实施完全介导了性虐待（β =-0.0005; p = 0.012）和艾滋病毒/性传播感染，而在女性中，IPV的实施在统计上并不是一个重要的中介因素。艾滋病毒/性传播感染预防和干预方案应采用生命过程方法，解决男女儿童的不良事件，并考虑到心理病理学和性行为作用的性别差异。
HIV and other sexually transmitted infections (STIs) are important public health challenges in the US. Adverse childhood experiences (ACEs), including abuse (emotional, physical or sexual), witnessing violence among household members, may have an effect on sexual behaviors, which increase the risk of HIV/STIs. The aim of this study was to examine the sex differences in the role of posttraumatic stress disorder (PTSD), major depression (MD), substance use disorders (SUDs), early sexual debut, and intimate partner violence (IPV) perpetration as mediators in the association between ACEs and HIV/STIs. Data were obtained from Wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Structural equation modeling was used to determine the role of PTSD, MD, SUDs, early sexual debut, and IPV perpetration as mediators in the relationships between ACEs and HIV/STIs. Differences and similarities existed in the mediational roles of psychopathology and sexual behaviors. For example, among men, MD fully mediated physical/psychological abuse (β = 0.0002; p = 0.012) and sexual abuse (β = 0.0002; p = 0.006), and HIV/STIs while among women, MD fully mediated physical/psychological abuse (β = 0.0005; p < 0.001) and parental violence (β = −0.0002; p = 0.012). Among men, IPV perpetration fully mediated sexual abuse (β = −0.0005; p = 0.012) and HIV/STIs while among women, IPV perpetration was not a statistically significant mediator. HIV/STI prevention and intervention programs should use a life course approach by addressing adverse childhood events among men and women and consider the sex differences in the roles of psychopathology and sexual behaviors.
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