Types and Characteristics of Childhood Sexual Abuse: How Do They Matter in HIV Sexual Risk Behaviors Among Women in Methadone Treatment in New York City?

Abstract

Background: Childhood sexual abuse (CSA) is often considered an important distal factor in HIV sexual risk behaviors; however, there are limited and mixed findings regarding this relationship among women experiencing substance use problems. In addition, research with this population of women has yet to examine differences in observed CSA-HIV sexual risk behaviors relationships by CSA type and characteristics. Objectives: This study examines relationships between CSA coding, type, and characteristics and HIV sexual risk behaviors with main intimate partners among a random sample of 390 women in methadone treatment in New York City who completed individual interviews with trained female interviewers. Results: Findings from logistic regression analyses indicate that CSA predicts substance use with sexual activity, with variations by CSA coding, type, and characteristics; however, the role of CSA is more limited than expected. Having a main partner with HIV risk mediates some relationships between CSA and drinking four or more drinks prior to sex. Intimate partner violence is the most consistent predictor of sexual risk behaviors. Other salient factors include polysubstance use, depression, social support, recent incarceration, relationship characteristics, and HIV status. Conclusions/Importance: This study contributes to understanding of relationships between CSA and HIV sexual risk behaviors and key correlates associated with HIV sexual risk behaviors among women in methadone treatment. It also highlights the complexity of measuring CSA and its association with sexual risk behaviors and the importance of comprehensive approaches to HIV prevention that address psychological, relational, situational, and substance use experiences associated with sexual risk behaviors among this population.

Keywords :

• Childhood sexual abuse measurement
• HIV sexual risk
• methadone treatment

Acknowledgments

The authors thank the participants and methadone treatment staff involved in this study.

Declaration of interest

The authors report no conflicts of interest.

Funding

The original study was funded by the National Institute on Drug Abuse of the National Institutes of Health (R01DA011027 awarded to Nabila El-Bassel). The authors are responsible for this article's content, which does not necessarily reflect official views of the National Institute on Drug Abuse or the National Institutes of Health.

Additional information

Notes on contributors

Malitta Engstrom

Malitta Engstrom is an Assistant Professor at the University of Pennsylvania School of Social Policy & Practice. She integrates numerous years of direct practice and teaching with her research, which highlights attention to women and families in its focus on problematic substance use and intersections with criminal justice system involvement, victimization, HIV and mental health. Central aims of her research, which has been funded by several sources, including the National Institute on Drug Abuse, the John A. Hartford Foundation, and the Penn Center for AIDS Research, involve informing, developing, and testing interventions that address these co-occurring issues.

Katherine Winham

Katherine Winham received her doctoral degree from the Kent School of Social Work at the University of Louisville, where she was awarded the John M. Houchens Prize for Outstanding Dissertation. She is a practicing social worker and licensed marriage and family therapist and holds master's degrees in both fields. With the goal of developing interventions, her research focuses on investigating relationships between victimization experiences and physical and mental health outcomes and high-risk behaviors (substance use, HIV risk behaviors) among vulnerable and underserved populations, especially women involved with the criminal justice system.

Louisa Gilbert

Dr. Louisa Gilbert is a licensed social worker with 25 years of experience developing, implementing and testing multi-level interventions to address HIV/AIDS, substance abuse, trauma, partner violence and other co-occurring issues among vulnerable communities in the U.S. and Central Asia. She has served as the Co-Director of the Social Intervention Group since 1999 and the Co-Director of the Global Health Research Center of Central Asia since 2007. Her specific area of research interest has concentrated on advancing a continuum of evidence-based interventions to prevent intimate partner violence among drug-involved women and women in the criminal justice system.