title: Mediation of HIV/STI risk by mental health disorders among persons living in the United States reporting childhood sexual abuse.
abstract: BACKGROUND
  Individuals who experience childhood sexual abuse (CSA) have higher rates of unsafe sexual behaviors and/or HIV or sexually transmitted infection (STI) incidence. Accordingly, sexual minorities also have higher rates of HIV/STI incidence compared with heterosexuals among those abused as children and those who were not. However, little is known concerning the mechanisms by which CSA confers increased sexual risk.
  
  
  METHODS
  Using data from the National Epidemiologic Survey on Alcohol and Related Conditions, we prospectively analyzed the relationship between CSA and recent incident HIV/STIs at wave 2 (2004-2005) while examining mental health and substance-use disorders reported during wave 1 (2001-2002) as putative mediators.
  
  
  RESULTS
  For women, mental health disorders mediated 35% of the effect of CSA on the risk of HIV/STI. Neither alcohol nor drug-use disorders were mediators for HIV/STI risk because of CSA in women. For heterosexual men, mental health disorders (90%), alcohol (24%), and drug-use (46%) disorders mediated some or all of the HIV/STI risk. None of the disorders mediated the risk of HIV/STI in sexual minority men, who had the highest HIV/STI risk among the groups measured.
  
  
  CONCLUSIONS
  CSA is a strong risk factor for risky sexual behavior in adulthood. Our findings indicate that there may be multiple causal pathways from CSA to HIV risk, with different mediators to be targeted for intervention. These differences need to be further studied to design appropriate HIV interventions to reduce the high-risk behaviors among individuals who were sexually abused as children.
authors.affiliation: Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19145, USA. tmsweet@drexel.edu
authors.forename: Thersa
authors.initials: T
authors.lastname: Sweet
authors.forename: Marcia
authors.initials: M
authors.lastname: Polansky
authors.forename: Seth L
authors.initials: SL
authors.lastname: Welles
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology*; D008875:Middle Aged; D011446:Prospective Studies; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000635:transmission*; D014481:United States / Q000453:epidemiology; D055815:Young Adult