Connections Between Childhood Abuse and HIV Infection

HIV risk behaviors become survival techniques for aboriginal women

In northern Alberta, the Aboriginal (native) female population appears to be overrepresented in the HIV statistics. A qualitative research study was designed to explore the cultural factors that relate to the high HIV infection rate in these women. Eight HIV-positive women were interviewed for the study, representing about one third of the population. A model was developed to explain the relationships that exist between the women's formative years, their self-esteem, and the survival techniques they used prior to becoming HIV-positive. These survival techniques may have placed them in situations that increased their risk of infection with the HIV virus.

The relationship of sexual abuse and HIV risk behaviors among heterosexual adult female STD patients

Some effects of sexual abuse, for example, heightened sexual activity, are also risk factors for infection with the human immunodeficiency virus (HIV). Moreover, Social Cognitive theory suggests that the reduced self-esteem and increased sexual arousal that can result from abuse might alter self-efficacy for performing a behavior and expected outcomes of the behavior, making adoption of preventive behavior more difficult. Studies in the general population, adolescents, and male clients of sexually transmitted disease (STD) clinics, have found associations between childhood sexual abuse and HIV risk behaviors. This study was designed to measure: (a) whatever the association persists among female STD clinic clients; and (b) whether sexual abuse is associated with self-efficacy for condom use or condom use outcome expectations. Among the 83 female STD clinic clients studied, those sexually abused before age 18 had more sexual partners (p < .05), more positive hedonic outcome expectations for condom use (p < .01), and fewer positive partner-related outcome expectations for condom use (p < .05) than those never forced to have sex against their will. In summary, HIV risk behavior among female STD clients varies with childhood sexual abuse and Social Cognitive Theory suggests future directions for prevention.

Professional HIV risk taking, levels of victimization, and well-being in female prostitutes in The Netherlands

Professional HIV risk taking (nonconsistent condom use with clients) of female prostitutes in The Netherlands is addressed within the context of (early) experiences with abuse, well-being, coping behavior, job satisfaction, and financial need. Data were gathered from 127 female prostitutes on condom use, financial need, and professional attitude, and on experiences with violence and abuse, physical complaints, psychosocial problems, and coping responses. Violent traumatic experiences were found to relate to more severe complaints and problems, and a higher frequency of emotion-focused coping strategies. A risk-taking protection style (as opposed to consistent condom use and selective risk taking) appeared to be associated with more severe experiences with violence, both in childhood and in adult life, with more frequent dissociation as a coping behavior, and with more psychosomatic complaints. Of all the relationships found, more severe experiences with violence on the job were most strongly related to a higher professional HIV risk.

Association between history of childhood sexual abuse and adult HIV-risk sexual behavior in Puerto Rican men who have sex with men

This study explored whether homosexually active men who were sexually abused in childhood were more likely to engage in HIV-risk sexual behavior than men who were not sexually abused. Participants were 182 adult men of Puerto Rican ancestry living in New York City who had had sex with other men or with men and women. Quantitative and qualitative methods of exploration were used. Three groups were determined: (a) Abuse group (AB), formed by men who before age 13, had sex with a partner at least 4 years their senior and who felt hurt by the experience and/or were unwilling to participate in it; (b) Willing/not hurt group (W), consisting of men who had an older sexual partner before age 13 but did not feel hurt by the experience and were willing to participate; and (c) No-older-partner group (NOP). The results showed that men in the AB group were significantly more likely than men in the NOP group to engage in receptive anal sex and to do so without protection. Men in the W group were ranked between the other two groups in terms of their unsafe behavior. Age and education were cofactors both for receptive anal sex and for unprotected receptive anal sex. It is concluded that given the need to improve HIV prevention among Puerto Rican men who have sex with men, sexual abuse in childhood may constitute a marker to identify men at increased risk.

Sexual abuse during childhood and adolescence as predictors of HIV-related sexual risk during adulthood among female sexual partners of injection drug users

During the past few decades, increasing attention has been focused on the long-lasting effects that sexual abuse causes for its victims/survivors. This study examines the relationships between experiencing specific types of sexual abuse during childhood and adolescence and involvement in HIV-related sexual risk behaviors during adulthood. The work, which is based on data collected between 1990 and 1993, involved a sample of 2,794 women from Boston, Juarez (Mexico), Los Angeles, San Diego, and San Juan (Puerto Rico) who were the sexual partners of injection drug users. The data indicate that there is a strong link between sexual abuse victimization early in life and involvement later in life in sexual behaviors that place women at risk for contracting HIV. Certain types of sexual abuse (e.g., forced exposure of one's sexual parts, forced touching of one's sexual parts) were found to be more strongly related than were other forms of sexual abuse to subsequent involvement in HIV-related sexual risk behaviors. Likewise, certain types of sexual risk-taking behaviors (e.g., having sexual relations while high, trading sex for drugs and/or money) were found to be related more closely than were other types of sexual risk-taking behaviors to women's sexual abuse histories.

Contextual and interactional factors influencing condom use in heterosexual prostitution contacts

The protection behavior of prostitutes and prostitutes' clients has been studied from a contextual and an interactional point of view. Different protection styles (subject's cognitive and behavioral position regarding condom use) have been identified in both prostitutes (N = 119) and clients (N = 91). Risk-taking prostitutes were found to have the least favorable working conditions, to have the highest financial need, to have the lowest levels of well-being and job satisfaction and to have been victimized more often than consistent condom users and selective risk-taking prostitutes. Consistent condom users among the clients were found to be better educated, to have a less strong external Health Locus of Control, to evaluate condoms and visiting prostitutes more positively, and prostitutes less negatively, and to have more fear of AIDS than non-consistent condom using clients. Various protection styles were found to be thoroughly intertwined with different interaction scenarios. Four different interaction scenarios (a standard, a romantic, a friendship and a fighting scenario) with a different chance of condom use are set forth. It is shown that the scenario approach gives good insight into the process by which unsafe sex in commercial contacts comes about. For both actors, the context and the meaning of prostitution influence the way they play the game. The interaction and its outcome in their turn reinforce their attitudes towards prostitution. Implications for AIDS prevention are discussed.

Women's experiences of repetitively contracting sexually transmitted diseases

Our purpose in conducting this qualitative, descriptive research was to explore and describe women's experiences of repetitively contracting sexually transmitted diseases (STDs). Ten open-ended, semistructured, in-depth interviews with 8 women, along with stories and anecdotes from one author's clinical practice, provided data. Thematic analysis was used to generate themes important to the women. Themes included the power and significance of heterosexual relationships, female powerlessness, the sense that STDs are an inevitable part of a woman's life, stigma, and victimization. The women's explanatory models for the STDs were quite different from those of health care providers evidenced in the professional literature. The findings from this research support the following suggestions for practice: (a) Practitioners and clients should share their explanatory models to work toward safe sexual behavior, and (b) practitioners need to scrutinize their practices to make sure they are not minimizing the risks of STDs.

HIV vulnerability and the adult survivor of childhood sexual abuse

The purpose of this article is to sensitize clinicians working in the field of childhood physical/sexual abuse to the connection between untreated childhood traumatization and HIV high-risk behaviors. The characteristic abuse symptoms of chronic depression, sexual compulsivity, revictimization, and substance abuse are identified as barriers to HIV education and intervention for survivors. An overview of the existing HIV/child abuse connection research, an illustrative case history and a discussion regarding the clinical implications of these connections are offered.