"Sometimes people learn things, in terms of how they operate in different situations later in life, that are based on these early experiences," says Jay Paul, a specialist in medicine with the Center for AIDS Prevention Studies at the University of California, San Francisco. He is co-author of a new study on how coerced sex during childhood can affect gay and bisexual men.
Young kids forced into sex sometimes cope "by numbing out or getting away from their situations, what is called dissociation," Paul says. "Or, you see … heightened levels of substance use [and] heightened levels of sexual activity." Both are especially true with men, he says.
"One of the things kids can learn is that sex can be a tool. It can get seen in a very concrete way as something you give in order to get something. And that also can lead to heightened levels of sexual activity," Paul says.
Combine more sex and more drugs, "and in a way you're setting yourself up for heightened levels of risky sex," he says.
More one-night stands, more unprotected sex, more sex while high on alcohol or drugs and more violence during sex all appeared in his study more often among the men who'd been abused as children than among the men who had not, Paul says.
Men who had been abused also were more likely to be HIV-positive than the men who had not: 24 percent vs. 14 percent, the study says. Rates are highest among men who first were coerced into sex as children but at a slightly older age, Paul says. Men first forced into sex when they were age 6 or younger had HIV-positive rates comparable to the general population, he says.
Paul's analysis is based on part of the Urban Men's Health Study, a telephone survey of nearly 3,000 gay and bisexual men in San Francisco, New York, Chicago and Los Angeles conducted between 1996 and 1998. The study, led by Joseph Catania, of the Centers for Disease Control and Prevention (CDC), examined a variety of health issues, including sexual victimization.
Roughly 20 percent of the participants said they'd been sexually abused as children, a rate higher than for men in general, the study says. Details appear in a recent issue of the journal Child Abuse & Neglect.
Paul says the findings indicate that people who run AIDS-prevention programs need to find out more about the people they're trying to help.
"When you're dealing with these early experiences, and because so much can have an impact on how you view yourself, how you behave in the world, it's really important to realize that just plain education is not going to cut it," he says.
Messages that emphasize avoiding sex "under the influence," for instance, may not work very well when aimed at people who have turned to substance use as a means of coping with their childhood trauma of sexual abuse, the study says.
Instead, Paul says prevention program organizers need to understand better that "this experience in childhood affects how people are functioning here and now in the world today," including how they approach sex and, ultimately, whether they'll be exposed to AIDS.
Personalizing prevention, in fact, is key to success, says a representative of the AIDS prevention office at the CDC.
"One of the main bases for many effective prevention programs is the case management aspect, where it's one-on-one between an affected person or an at-risk person and a counselor," says Katherine Bina, a CDC spokeswoman. "The counselor goes through each of the barriers the person faces, [such as abuse or drug and alcohol use,] and comes up with a very personalized plan."
The CDC, which studies treatment programs nationwide and funds many such programs, "recognizes the need for a holistic, comprehensive approach to HIV prevention," Bina says.
Particularly with gay and bisexual men, she says, "You're dealing with a population with multiple issues … so prevention programs need, at the least, to provide links to services [like] alcohol and drug abuse treatment programs."
Given the prevalence of childhood sexual abuse among these men, the study says finding ways to reach and treat them could have a "powerful impact" on AIDS prevention efforts.