Childhood sexual abuse and HIV sexual-risk behaviour among men who have sex with men in South Africa

Previous research has indicated an association between childhood sexual abuse and an increased risk of engaging in unsafe behaviours during adulthood, including risky sexual practices. This study examines the relationship between self-reported childhood sexual abuse and adult HIV sexual-risk behaviour in a sample of South African men who have sex with men. Potential long-term childhood sexual abuse-related outcomes, including dissociation, recreational and sex-related drug use, depression, impaired interpersonal communication, and adult re-victimisation were treated as variables mediating the relationship between childhood sexual abuse and sexual-risk behaviour. Men using a gay Internet dating site were randomly selected to complete the anonymous electronic survey. Results indicate that one-fourth of participants reported a history of childhood sexual abuse. Men with a history of unwanted sexual activity during childhood were more likely to report recreational and sex-related drug use, and adult re-victimisation experiences. Furthermore, mediation analyses revealed that men who have sex with men who are survivors of childhood sexual abuse are more likely to report drug use and sex-related drug use, and these outcomes in turn are associated with increased HIV risk as measured by number of male sexual partners. These results highlight the importance of mental health services and new approaches in HIV prevention for men who have sex with men who have been sexually abused as children.