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

描述（由申请人提供）：有儿童期性虐待史的男性比没有儿童期性虐待史的男性报告的性行为有较高的艾滋病毒传播风险。由于六分之一到十四分之一的男性报告儿童期性虐待史（CSA），因此有儿童期性虐待史的男性群体数量众多，适合进行研究，以了解具有艾滋病毒感染风险的性风险行为模式的演变。在淋病和梅毒发病率长期下降的模式因男性发病率上升而发生逆转之际，这种努力至关重要。我们对当前男性性风险行为模式研究的特殊兴趣源于首席研究员的初步发现。本研究表明，创伤后应激障碍（PTSD）和抑郁症在CSA与性危险行为之间的关系中既起中介作用，也起调节作用。患有CSA/PTSD/抑郁症的亚组终生性伴侣数量最多（平均54.3）。为了更好地理解这些发现，我们发展了一个用于男性的模型，该模型最初是用来描述女性从CSA到成年风险的中介途径。

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.