Interaction of abuse, PTSD, depression on men's sex risk

描述(由申请人提供)：有儿童期性虐待(CSA)史的男性比没有儿童期性虐待(CSA)史的男性报告的性行为有很高的艾滋病毒传播风险。由于1/6到1/14的男性报告儿童期性虐待(CSA)病史，有CSA病史的男性人口数量众多，适合进行研究，试图了解具有艾滋病毒感染风险的不断演变的性风险行为模式。在淋病和梅毒发病率长期下降的模式由于男性发病率上升而逆转的情况下，这种努力至关重要。我们对当前男性性危险行为模式研究的特殊兴趣源于主要研究人员的初步发现。这项工作表明，共病的创伤后应激障碍(PTSD)和抑郁在CsA和性危险行为之间的联系中既起到了中介作用，又起到了调节作用。CSA/PTSD/抑郁亚组的终身性伴侣最多(平均为54.3)。为了更好地理解这些发现，我们进化了一个用于男性的模型，该模型最初是为了描述女性从CSA到成年风险的中介途径而开发的。 我们建议通过更充分地调整潜在的混杂/效果修改变量，并通过对终身和当前性行为评估的分析，进一步研究这种新发现的共病创伤后应激障碍/抑郁对男性艾滋病毒相关性行为的作用。我们还将测试我们进化的模型，通过使用结构方程建模(SEM)来评估CSA与具有HIV感染风险的韧性、精神病理学、性适应不良、性网络和性行为之间的关系，从而解释CSA与男性终身性风险行为之间的中介/调节途径。我们建议对费城艾滋病高发区的1200名男性进行横断面随机数字拨号(HDD)调查；其中300人将被过度抽样，以确定异性和同性恋身份的男性(MSM)被招募用于探索性分析，以确定所指出的SM是否适用于MSM以及仅与女性发生过性关系的男性。 研究结果将为构建提供信息，并允许测试一种针对男性的开发的综合模型，该模型确定在环孢素A和艾滋病毒相关性风险之间调解和缓和联系的因素。从这个模型可以建立多维度的艾滋病毒风险降低干预措施。

DESCRIPTION (provided by applicant): More men with than men without childhood sexual abuse (CSA) histories report sexual behavior that has high risk for HIV transmission. Since 1-in-6 to 1-in-14 men report histories of childhood sexual abuse (CSA), the population of men with CSA histories is a numerous and suitable one for research that seeks to understand evolving sexual risk behavior patterns that have HIV infection risk. Such an effort is critical at a time when the pattern of long-term declines in gonorrhea and syphilis rates have reversed due to rate increases in men. Our specific interests in the current study of male sexual risk behavior patterns emanate from preliminary findings of the principal investigator. This work has indicated that co-morbid posttraumatic stress disorder (PTSD) and depression acts as both a mediator and a moderator of the association between CSA and sexual risk behavior. The subgroup with CSA/PTSD/depression had the highest lifetime sexual partners (mean, 54.3). To understand these findings better, we have evolved for use in men a model originally developed to describe the mediating pathway from CSA to adult risk in women. We propose further study of this newly identified role of co-morbid PTSD/depression on men's HIV-related sexual risk behavior by adjusting more fully for potentially confounding/effect-modifying variables and by doing so in analyses of lifetime and current sexual behavior assessments. We also will test the model we have evolved to explain the mediating/moderating pathway between CSA and lifetime sexual risk behavior in men by employing structural equation modeling (SEM) to assess relationships between CSA and resilience, psychopathology, sexual maladjustment, sexual networks, and sexual activity that have HIV infection risk. We propose a cross-sectional, random-digit-dial (HDD) survey of 1,200 men from high AIDS incidence areas of Philadelphia County; 300 of these will be oversampled heterosexually- and homosexually-identifying men who have sex with men (MSM) recruited for exploratory analyses of whether the noted SEM is applicable to MSM as well as to men who only have (had) sex with women. Study results will inform construction and allow testing of a developing, integrative model for men that identifies factors that mediate and moderate linkages between CSA and HIV-related sexual risk. From this model, multidimensional HIV risk reduction interventions can be built.