Childhood sexual abuse linked to commercial sex activity among adult men

By Karla Gale

NEW YORK (Reuters Health) – Men who were sexually abused before age 13 are more likely to engage in the buying or selling of sex and other unsafe sexual practices as adults, putting them at higher risk of contracting HIV, a new study has found.

"We often think of childhood sexual abuse as a problem for women and ignore or discount the impact of such abuse for men…(so) I think that the findings highlight the importance of childhood sexual abuse among men," Dr. Colleen DiIorio, of Emory University in Atlanta, told Reuters Health.

Dr. Dilorio and colleagues analyzed data collected at 37 STD clinics throughout the US by the National Institute of Mental Health Multisite HIV Prevention Trial. Their findings appear in the February issue of the American Journal of Public Health.

The subjects of the current analysis included 2676 men, ages 18 to 70, who reported having participated in unprotected vaginal or anal intercourse at least once in the prior 90 days. They also had at least one other risk factor, such as having sex with more than one partner or with an injection drug user.

Having been subjected to unwanted or uninvited sexual activity before age 13 with a person at least 5 years older was reported by 25.2% of subjects. This group was at almost seven times the risk as those without a history of childhood abuse to experience unwanted sexual activity since age 13.

The researchers further found that men who had been forced to have sex as children were more than twice as likely as their counterparts to have engaged in buying or selling sex during adulthood. Abuse survivors engaged more frequently in unprotected sexual activity and in sex with multiple sex partners as adults, which appears to have been at least partially mediated by the commercial sexual activity.

Dr. Dan Jones, of Appalachian State University in Boone, North Carolina, commented on these findings: "It seems that people who have been sexually molested tend to have lower self-esteem. Sometimes they don't have the feeling that they deserve good fortune, so they are more willing to put themselves at risk, and are less prone to take care of themselves and stay healthy and safe."

Regarding prostitution, Dr. Jones said, "Sometimes victimized teens run away from home to maintain safety. If they leave home before they're financially solvent or have gotten their education, the basic economic need to feed oneself is more likely to lead one to engage in prostitution."

He agrees with the suggestion by Dr. Dilorio's team that information on childhood sexual abuse should be obtained as part of the routine sexual history interview conducted when men seek care at STD clinics. "I'm fairly confident that counseling would be helpful as a preventive measure to keep men from doing these self-destructive things," he said.

One problem, Dr. Jones added, is that men tend to be less likely than women to seek help for these issues. He explained, "Often their perpetrators are other men, therefore the stigma of homosexuality and questions about their sexual identity make it even harder for them to talk about the sexual abuse."

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