Sex Disparities in Adverse Childhood Experiences and HIV/STIs: Mediation of Psychopathology and Sexual Behaviors.
HIV and other sexually transmitted infections (STIs) are important public health challenges in the US. Adverse childhood experiences (ACEs), including abuse (emotional, physical or sexual), witnessing violence among household members, may have an effect on sexual behaviors, which increase the risk of HIV/STIs. The aim of this study was to examine the sex differences in the role of posttraumatic stress disorder (PTSD), major depression (MD), substance use disorders (SUDs), early sexual debut, and intimate partner violence (IPV) perpetration as mediators in the association between ACEs and HIV/STIs. Data were obtained from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Structural equation modeling was used to determine the role of PTSD, MD, SUDs, early sexual debut, and IPV perpetration as mediators in the relationships between ACEs and HIV/STIs. Differences and similarities existed in the mediational roles of psychopathology and sexual behaviors. For example, among men, MD fully mediated physical/psychological abuse (β = 0.0002; p = 0.012) and sexual abuse (β = 0.0002; p = 0.006), and HIV/STIs while among women, MD fully mediated physical/psychological abuse (β = 0.0005; p < 0.001) and parental violence (β = -0.0002; p = 0.012). Among men, IPV perpetration fully mediated sexual abuse (β = -0.0005; p = 0.012) and HIV/STIs while among women, IPV perpetration was not a statistically significant mediator. HIV/STI prevention and intervention programs should use a life course approach by addressing adverse childhood events among men and women and consider the sex differences in the roles of psychopathology and sexual behaviors.
College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B. Downs Blvd, MHC 2503, Tampa, FL, 33612, USA. brownm3@usf.edu.
Monique J
MJ
Brown
Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Saba W
SW
Masho
Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Robert A
RA
Perera
College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B. Downs Blvd, MHC 2503, Tampa, FL, 33612, USA.|Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.|Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
Briana
B
Mezuk
Office of Epidemiology, Division of Disease Prevention, Virginia Department of Health, Richmond, VA, USA.
River A
RA
Pugsley
Health Studies, University of Rhode Island, Kingston, RI, USA.
Steven A
SA
Cohen
D000328:Adult; D002648:Child; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D002650:Child Abuse, Sexual / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder; D005260:Female; D015658:HIV Infections / Q000523:psychology; D006801:Humans; D000066511:Intimate Partner Violence / Q000523:psychology*; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D012725:Sexual Behavior / Q000706:statistics & numerical data; D013179:Spouse Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D014481:United States; D055815:Young Adult
Child abuse; HIV; Mediation; Men; Sexually transmitted diseases; Women
Violence Vict. 2013;28(3):513-30
23862313
Child Abuse Negl. 2010 Nov;34(11):833-41
20943270
Sex Transm Dis. 2009 Jul;36(7):422-4
19390496
J Health Psychol. 2013 Oct;18(10):1330-40
23180873
J Infect Dev Ctries. 2013 Jan 15;7(1):17-27
23324816
MMWR Morb Mortal Wkly Rep. 2010 Dec 17;59(49):1609-13
21160456
Sex Transm Infect. 2009 Dec;85(7):555-60
19625287
Am J Psychiatry. 1994 Sep;151(9):1324-8
8067488
Arch Gen Psychiatry. 2010 Feb;67(2):113-23
20124111
J Health Care Poor Underserved. 2016 Feb;27(1):68-83
27168716
PLoS One. 2013 Jun 11;8(6):e65524
23776494
J Adolesc Health. 2006 Sep;39(3):444.e1-8
16919811
Am J Public Health. 1997 Jun;87(6):938-44
9224173
Am J Health Behav. 2012 Mar;36(3):408-23
22370441
Drug Alcohol Depend. 2008 Jan 1;92(1-3):27-36
17706375
J Youth Adolesc. 2016 Aug;45(8):1527-45
27289554
Curr HIV/AIDS Rep. 2005 Nov;2(4):194-9
16343378
Arch Gen Psychiatry. 2004 Aug;61(8):807-16
15289279
Womens Health (Lond). 2012 May;8(3):313-21
22554178
J Trauma Stress. 1997 Jul;10(3):437-52
9246651
Psychol Med. 2010 Sep;40(9):1453-66
19939326
J Trauma Stress. 1996 Apr;9(2):195-205
8731542
Psychiatr Serv. 2001 Apr;52(4):508-13
11274498
AIDS Care. 2013;25(10):1219-26
23356590
Sex Transm Dis. 2013 Jun;40(6):447-52
23677018
PLoS One. 2012;7(3):e32538
22403672
Curr Opin HIV AIDS. 2012 Jul;7(4):326-31
22498480
AIDS Behav. 2009 Aug;13(4):798-810
19462228
Am J Psychiatry. 2014 Apr;171(4):426-35
24525762
AIDS. 2006 Mar 21;20(5):731-9
16514304
Asian J Psychiatr. 2013 Dec;6(6):494-9
24309860
Pediatrics. 2000 Jul;106(1):E11
10878180
J Youth Adolesc. 2010 May;39(5):514-27
20229264
AIDS Behav. 2014 Feb;18(2):381-9
23474641
J Am Board Fam Med. 2016 May-Jun;29(3):303-7
27170787
Am J Orthopsychiatry. 1985 Oct;55(4):530-541
4073225
Scand J Public Health. 2014 Aug;42(6):511-7
24906552
Am J Prev Med. 2010 Jul;39(1):93-8
20547282
Child Abuse Negl. 1996 May;20(5):447-55
8735380
Am J Public Health. 2011 Jan;101(1):120-7
21088271
East Afr J Public Health. 2009 Aug;6(2):184-90
20000027
Soc Sci Med. 2015 Apr;131:48-57
25753285
Trop Med Int Health. 2013 Aug;18(8):925-33
23692352
Drug Alcohol Depend. 2015 Nov 1;156:297-303
26454837
J Interpers Violence. 2016 May 3;34(5):1021-1038
27147276
Subst Use Misuse. 2016 Sep 18;51(11):1451-61
27326749
J La State Med Soc. 2013 Jul-Aug;165(4):219-26
24133786
J Trauma Dissociation. 2009;10(3):276-96
19585337
Indian J Dermatol Venereol Leprol. 2002 Jan-Feb;68(1):25-7
17656863
Early Interv Psychiatry. 2011 Nov;5(4):271-89
21883973
Am J Prev Med. 2011 Feb;40(2):128-38
21238860
Pediatrics. 2010 Apr;125(4):e778-86
20231180
J Homosex. 2014;61(2):288-306
24383859
J Affect Disord. 2004 Oct 15;82(2):217-25
15488250
Br J Psychiatry. 2010 Mar;196(3):186-91
20194539
J Interpers Violence. 2018 Oct;33(20):3125-3161
26944339
AIDS. 2007 Jan 11;21(2):231-5
17197815
Am J Mens Health. 2008 Sep;2(3):291-5
19477792
Soc Psychiatry Psychiatr Epidemiol. 2015 Oct;50(10):1601-7
25702167
Subst Use Misuse. 2014 Aug;49(10):1311-6
24708431
J Urban Health. 2014 Feb;91(1):96-106
23657905
Dev Psychopathol. 2001 Fall;13(4):1021-38
11771905
Sex Transm Dis. 2006 Apr;33(4):265-71
16434886
Child Abuse Negl. 2010 Nov;34(11):842-55
20888640
AIDS Care. 2014;26(11):1411-8
25090474
Sex Transm Dis. 2001 Aug;28(8):468-71
11473220
Psychopharmacology (Berl). 2016 Jan;233(1):39-48
26395990
Child Abuse Negl. 2013 May;37(5):353-9
23312991
J Trauma Dissociation. 2014;15(4):420-35
24354509
PLoS One. 2016 Mar 17;11(3):e0150986
26986056
Addict Behav. 2010 Jan;35(1):68-71
19775820
PLoS Med. 2013;10(2):e1001396
23468598
J Epidemiol Community Health. 2011 Nov;65(11):1006-13
21321063
Fam Plann Perspect. 2001 Sep-Oct;33(5):206-11
11589541
J Youth Adolesc. 2016 Apr;45(4):777-92
26902469
J Child Sex Abus. 2012;21(5):571-92
22994694
Am J Prev Med. 1998 May;14(4):245-58
9635069
Sex Transm Dis. 2007 Jun;34(6):389-91
17108850
AIDS Behav. 2011 Jan;15(1):153-62
20069447
J Adolesc Health. 2012 Nov;51(5):503-9
23084173
Pediatrics. 2016 Apr;137(4):
26966132
Child Care Health Dev. 2006 May;32(3):303-9
16634975
Sex Transm Dis. 2013 Jul;40(7):575-81
23965773
Psychol Trauma. 2013 Sep 1;5(5):409-416
24660048
J Womens Health (Larchmt). 2012 Jan;21(1):73-9
21992618
JAMA Pediatr. 2013 Jan;167(1):70-5
23403625
J Interpers Violence. 2014 Mar;29(5):928-47
24288188
Sex Health. 2011 Mar;8(1):95-101
21371391
Fam Plann Perspect. 2001 Nov-Dec;33(6):268-75
11804436
J Trauma Stress. 2013 Feb;26(1):64-70
23417876