Understanding the Impact of Abuse on Men's Risk Behavior

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ABSTRACT Black and Latino sexual minority men are likely to have higher rates of childhood sexual abuse (CSA) than their White counterparts. CSA history among sexual minority men is associated with adverse consequences including substance misuse, poor mental health, revictimization, and high-risk sexual behavior. Because Black and Latino cultures stress traditional forms of masculinity, men may be under pressure to deny certain childhood sexual experiences as abusive out of fear of being perceived as gay or as victims. Most CSA research with sexual minority men relies on quantitative measures that often preclude consideration of cultural variations in how formative sexual experiences are understood, and are based on inconsistent and/or overly restrictive definitions of abuse. Moreover, limited assessment methods may result in failure to detect some abusive experiences (e.g., those involving female perpetrators), which can have harmful health consequences if they remain unrecognized. These issues indicate a need to broaden the conceptualization of CSA to recognize men's appraisals and interpretations of their childhood sexual experiences (CSE). To that end, we will conduct mixed-methods interviews regarding CSE with 40 Black and 40 Latino sexual minority men in New York City. Researchers are calling for interventions that incorporate CSA history into substance abuse treatment and other health services used by men who have sex with men (MSM) and men who have sex with men and women (MSMW). However, these men may be reluctant to access such services for fear of stigma, exposure of their same-sex behavior, general provider mistrust, and perceptions that providers lack training in sexuality. Further, service providers may not be equipped to recognize the need for safe trauma-informed care, particularly as it relates to sexual abuse. To understand provider experiences and treatment protocols, we will interview 30 service providers regarding whether and how sexual histories are addressed in treatment and other health care settings. We propose the following specific aims: 1) to investigate appraisals of childhood sexual experiences among Black and Latino MSM and MSMW and to evaluate these experiences using established criteria for defining sexual abuse; 2) to examine appraisals of childhood sexual experiences relative to sexual identify formation, adult sexual relationships and behaviors, concealment of same-sex behavior, alcohol and drug use, psychological and emotional functioning, and cultural ideologies of masculinity among Black and Latino MSM and MSMW; 3) to examine perspectives of Black and Latino MSM and MSMW and relevant service providers to: a) understand the role of, and need to include, sexual history in treatment and counseling settings; and b) determine service providers' preparedness to address childhood sexual experiences in treatment and counseling settings. This formative research will inform testable approaches to assessing and incorporating sexual abuse history into substance abuse treatment and other health and mental health services used by men with such histories.