Mediators of childhood sexual abuse and high-risk sex among men-who-have-sex-with-men
Mediators of childhood sexual abuse and high-risk sex among men-who-have-sex-with-men
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DOI：
10.1016/j.chiabu.2007.12.010
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发表时间：
2008-10-01
影响因子：
4.8
通讯作者：
Neilands, Torsten
中科院分区：
文献类型：
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作者：
Catania, Joseph A.;Paul, Jay;Neilands, Torsten
目的：对男男性行为者 (MSM) 的儿童性虐待 (CSA) 和 HIV 风险行为中介因素进行检查。方法：来自城市 MSM (N = 1078) 双框架调查的数据提供了 CSA 患病率估计，并对 CSA 风险行为中介因素的两个潜在变量模型（由伴侣类型定义）进行了检验。结果：据报道，CSA 患病率为 20%。对于第二性关系中的 MSM，我们的建模工作确定了连接 CSA 和高风险行为的两条总体但相互关联的途径（例如，两条途径都包括对人际技能的影响）：（1）CSA-动机-脚本-技能-Risl<行为； (2)CSA-动机-应对-风险评估-技能-风险行为。对于处于主要关系中的男性来说，有一个总体路径，包括CSA-动机-应对-风险评估-风险行为过程。探索性分析表明，与仅在次要关系中存在 CSA 病史的男性相比，其动机问题较少，并且具有更好的应对和人际交往能力。 结论：CSA 通过扭曲或破坏关键的动机、应对和人际因素，进而影响成人性危险行为，从而导致 MSM 中持续的艾滋病毒流行。此外，男性所参与的成人关系类型可以作为成人 CSA 相关问题的标志。这些研究结果是在当前理论和艾滋病毒预防策略的背景下进行讨论的。 实践意义：从我们的研究结果直接推断到实践是有限的。然而，我们可以得出一些一般性的结论。首先，有严重 CSA 经历的男性面临的复杂挑战可能会限制典型的短期艾滋病毒风险降低计划的有效性；可能需要更强化的治疗。其次，治疗有 CSA 病史的 MSM 患者的临床心理学家和精神科医生应该（如果还没有的话）定期考虑性健康问题；性伴侣的模式和类型可能是识别更多问题案例的有用标记。最后，旨在消除 MSM CSA 污名的公共服务信息可能会增加对健康和心理健康服务的使用。 (C) 2008 Elsevier Ltd. 保留所有权利。
Objective: Mediators of childhood sexual abuse (CSA)and HIV risk behavior were examined for men-who-have-sex-with-men (MSM).Method: Data from a dual frame survey of urban MSM (N = 1078) provided prevalence estimates of CSA, and a test of two latent variable models (defined by partner type) of CSA-risk behavior mediators.Results: A 20% prevalence of CSA was reported. For MSM in secondary sexual relationships, our modeling work identified two over-arching but inter-related pathways (e.g., both pathways include effects on interpersonal skills) linking CSA and high-risk behavior: (1) CSA-Motivation-Scripts-Skills-Risl< Behavior; and (2) CSA-Motivation-Coping-Risk Appraisal-Skills-Risk Behavior. For men in primary relationships, there was one over-arching pathway including CSA-Motivation-Coping-Risk Appraisal-Risk Behavior processes. Exploratory analyses indicated that men with a history of CSA in only primary relationships versus only secondary relationships had, for example, fewer motivational problems, and better coping and interpersonal skills.Conclusions: CSA contributes to the ongoing HIV epidemic among MSM by distorting or undermining critical motivational, coping, and interpersonal factors that, in turn, influence adult sexual risk behavior. Further, the type of adult relationships men engage in serve as markers for adult CSA-related problems. The findings are discussed in the context of current theory and HIV prevention strategies.Practice implications: Direct extrapolation from our findings to practice is limited. However, there are general implications that may be drawn. First, the complex challenges faced by men with severe CSA experiences may limit the effectiveness of typical short-term HIV risk reduction programs; more intensive treatment maybe needed. Secondly, Clinical Psychologists and Psychiatrists with MSM patients with CSA histories should, if not already, routinely consider issues of sexual health; patterns and types of sexual partners may be useful markers for identifying More problematic cases. Lastly, public service messages directed at destigmatizing CSA for MSM may increase use of health and mental health services. (C) 2008 Elsevier Ltd. All rights reserved.