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Childhood sexual abuse, MSM, PTSD, Sexual Risk, Substance use


Michael Boroughs



Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.


Men who have sex with men (MSM) are disproportionately affected by childhood sexual abuse (CSA) compared to heterosexual men. CSA has been associated with a wide range of adverse outcomes later in life, including engagement in sexual risk behaviours (e.g., condomless anal intercourse), that place MSM at greater risk for HIV acquisition and transmission. Although the links between CSA and sexual risk are well-established among MSM, little research has investigated psychosocial factors that may mediate this relationship. Using a mixed-method approach, this study (a) explored psychosocial factors as pathways linking a composite of complex CSA experiences (i.e., CSA complexities) with sexual risk (N = 297 HIV-uninfected men; Mage = 38.0, SD = 11.6) and (b) drew upon the perspectives and experiences of a subset of MSM with histories of CSA (n = 39). Mediation analyses provided some support for hypotheses. CSA complexities were positively associated with sexual risk behaviours (i.e., condomless anal and/or vaginal intercourse) cross-sectionally and negatively associated with change in sexual risk behaviours over time. CSA complexities had a positive indirect effect on sexual risk behaviours only through the PTSD avoidance symptom cluster cross-sectionally, but not over time. There were no significant indirect effects of CSA complexities on sexual risk behaviours through substance use and other PTSD symptom clusters both cross-sectionally and over time. Thirty-nine audio recorded and transcribed impact statements were analyzed to provide insight into how CSA is related to cognition, affect, behaviour, and resilience among MSM. Findings are discussed in terms of their implications for informing HIV prevention interventions.