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Article Excerpt
In the United States, gay and bisexual men continue to carry the burden of new HIV infections (Centers for Disease Control and Prevention [CDC], 2003). Studies using opportunistic samples have shown that childhood sexual abuse significantly predicts negative health outcomes such as risk for HIV and other sexually transmitted infections, as well as mental health outcomes, including depression, suicidal ideation, and substance abuse among adults (Briere, Evans, Runtz, & Wall, 1988; Briere & Zaidi, 1989; Browne & Finkelhor, 1986; Dhaliwal, Gauzas, Antonowicz, & Ross, 1996; Holmes, 1997; Holmes & Slap, 1998; Koenig, Doll, O'Leary, & Peguegnat, 2003; Lenderking et al., 1997; Miller, 1999; Molnar, Berkman, & Buka, 2001; Remafedi, Farrow, & Deisher, 1991). Although most childhood sexual abuse research has focused on women, the research on childhood sexual abuse among men shows that the prevalence of childhood sexual abuse is higher among gay and bisexual men than heterosexual men (Jinich & Slap, 1998; Laumann, Gagnon, Michaels, & Michael, 1993; Paul, Catania, Pollack, & Stall, 2001), approximating that of women according to some studies (Doll et al., 1992; Finkelhor & Dziuba-Leatherman, 1994; Jinich et al., 1998). The recognition of high rates of childhood sexual abuse among gay men and indications that experiences of childhood sexual abuse may vary by gender has led to a growing interest in how childhood sexual abuse affects health outcomes of gay men.
Results of research on the consequences of childhood sexual abuse among women often are generalized to men, despite conflicting findings regarding gender differences (Dhaliwal et al., 1996; Rind, Tromovitch, & Bauserman, 1998; Stanley, Bartholomew, & Oram, 2004). A study of differences based on a symptom checklist among men and women who had experienced childhood sexual abuse found no statistically significant differences between men and women in psychological sypmtomatology, whereas both genders compared with nonabused individuals had significantly more problems with depression and anxiety (Briere et al., 1988). Some studies that do find differences, however, report that men are more likely to externalize behavior aggression, but women are more likely to internalize behavior depression (Briere, 1988; Finkelhor, Hotaling, Lewis, & Smith, 1990). Further, a meta-analysis of studies of college students revealed that among those who reported childhood sexual abuse, men reacted much less negatively than women (Rind et al., 1998). The variations in findings between women and men suggest that childhood sexual abuse sequelae may be more homogeneous for women than for men. Whereas women experience overwhelmingly experience negative psychological outcomes resulting from childhood sexual abuse, men show greater variability in their responses to childhood sexual abuse.
Discrepant findings may result from the use of inconsistent criteria for what constitutes childhood sexual abuse. An extensive review of the literature on childhood sexual abuse among boys found that prevalence estimates ranged from 4% to 76% depending on the definition used and the population studied (Holmes & Slap, 1998). The definition of childhood sexual abuse often is based solely on an age discrepancy of 5 or more years between the child (usually under age 18) and the perpetrator, assuming that the power differ-ential between the child and older person inherently constitutes abuse (Lenderking et al., 1997; Rind et al., 1998). Findings from a convenience sample of gay and bisexual men, however, found that self-esteem and sexual identity development did not differ between boys who reported consensual sex between the ages of 12 and 17 years old with someone older and those who reported no sex during that time (Rind, 2001). Thus, conceptualizing childhood sexual abuse as sex in childhood with someone older, and not distinguishing consensual from forced sex, may be undermining the ability to differentiate the variety of outcomes seen in adulthood that results from a range of childhood sexual experiences. For example, a study from Canada found that the prevalence of childhood sexual abuse was 26% when only the age differential was used but dropped to 12.5% when both the experience of coercion and an age differential of 5 years were required to define childhood sexual abuse (Stanley, Bartholomew, & Oram, 2004). By differentiating coercive from consensual sex, the authors also found outcome differences between the two subgroups. Those who reported consensual sex with older partners described their experiences as neutral or positive, whereas those who were coerced had greater adjustment problems including difficulties with competitiveness, coldness, expressiveness, and general interpersonal problems.
The wide range of outcomes among men and the high rates of childhood sexual abuse among gay men warrant further examination of childhood sexual abuse specifically among gay and bisexual men. While the studies cited are not specific to HIV-related health outcomes, the findings suggest that the link between childhood sexual abuse and health outcomes, including HIV, may vary by kind of childhood sexual experience and call for a more refined analysis of childhood sexual experiences among gay and bisexual men and the potential effects of these early experiences. Specifically, we must begin...
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