title: Psychological and behavioral moderators of the relationship between trauma severity and HIV transmission risk behavior among MSM with a history of childhood sexual abuse.
abstract: Childhood sexual abuse (CSA) is associated with post-traumatic stress disorder (PTSD), which can be associated with condomless sex among men who have sex with men (MSM). However, the impact of moderating factors on the relationship between PTSD symptom severity and condomless sex is poorly understood. We examined whether PTSD symptom severity was associated with condomless sex among MSM with CSA histories, and whether substance dependence, self-esteem, and distress tolerance moderated that relationship (n = 288). Notably, no direct relationship between PTSD symptom severity and condomless sex was found. Adjusted models indicated that condomless sex was differentially impacted by PTSD symptom severity among those without substance dependence (ΔR2= 0.03, p = 0.034) and, counterintuitively, those with high self-esteem (ΔR2= 0.07, p = 0.005). PTSD symptom severity was associated with condomless sex across levels of distress tolerance. Findings indicate that substance use, self-esteem, and distress tolerance should be targeted in high-risk MSM with CSA even if they do not have PTSD.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. abatchelder@mgh.harvard.edu.|Harvard Medical School, Boston, MA, USA. abatchelder@mgh.harvard.edu.|The Fenway Institute, Fenway Health, Boston, MA, USA. abatchelder@mgh.harvard.edu.
authors.forename: Abigail W
authors.initials: AW
authors.lastname: Batchelder
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Ehlinger
authors.affiliation: University of Windsor, Windsor, ON, Canada.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Boroughs
authors.affiliation: School of Medicine, Boston University, Boston, MA, USA.|Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.|Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Program, Veterans Health Adminstration, Washington, DC, USA.
authors.forename: Jillian C
authors.initials: JC
authors.lastname: Shipherd
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.|University of Miami, Coral Gables, FL, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.affiliation: University of Miami, Coral Gables, FL, USA.
authors.forename: Gail H
authors.initials: GH
authors.lastname: Ironson
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|The Fenway Institute, Fenway Health, Boston, MA, USA.
authors.forename: Conall
authors.initials: C
authors.lastname: O'Cleirigh
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D017280:Condoms; D015658:HIV Infections / Q000150:complications / Q000523:psychology* / Q000635:transmission*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D012649:Self Concept; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology; D047568:Unsafe Sex / Q000523:psychology*; D055815:Young Adult
keywords: Childhood sexual abuse; Distress tolerance; Self-esteem; Substance use