June 15, 2006
Sexual and severe physical abuse in childhood is associated with the following in adults: post-traumatic stress disorder, anxiety, depression, dissociation, substance abuse, revictimization, high-risk sexual behaviors, and engaging in abuse of others. Substance abuse and symptoms of mental illness are associated with lower medication adherence, reduced likelihood of being prescribed therapy, increased morbidity, and poorer quality of life among HIV-positive persons. "Thus, childhood victimization can be directly linked to behaviors that put a person at risk for infectious diseases and reduced treatment adherence," the authors explained.
The researchers conducted a retrospective study to examine abuse rates and their associations with childhood home environments in a sample of individuals being treated in five states in the Deep South: Alabama, Georgia, Louisiana, North Carolina, and South Carolina. Six-hundred eleven consecutively sampled HIV-positive participants from eight infectious disease clinics outside three metropolitan areas in the five states were interviewed. The response rate was 79 percent.
Regardless of gender, approximately one in four respondents was sexually abused prior to age 13. Thirty percent of men and 38 percent of women experienced lifetime sexual abuse. At least 50 percent of respondents reported sexual or severe physical abuse. Having parents who were too drunk or high to care for the family more than doubled the risk of childhood sexual and/or physical abuse, as did being removed from the family. A male guardian physically harming or threatening the participant's mother or stepmother was associated with childhood sexual abuse, and reporting a depressed parent was associated with both forms of abuse. When controlling for sexual orientation, women and non-heterosexual men were more than twice as likely to have experienced both forms of abuse. Even among heterosexual males, the rates of sexual abuse were higher than for previously studied clinical populations.
"The high rates of reported trauma in this sample from the Deep South may help to explain why the HIV epidemic continues unabated as a largely rural and heterosexual disease in this region," the researchers concluded. "The lack of difference by race is in line with other research in the Deep South, suggesting other factors, such as childhood poverty and social structure, may be more important in identifying at-risk groups." "As researchers continue to search for ways to stop the spread of HIV, it is important to provide health care providers and policymakers with knowledge of high rates of previous trauma to develop targeted services and policies that can address root causes of HIV-related transmission behaviors and lack of treatment adherence."