Epidemiological studies in the United States estimate HIV seroprevalence rates ranging between 4% and 23% for serious mentally ill adults (SMIA; i.e., schizophrenia, bipolar disorder, and other chronic disorders with psychotic features), with substantially greater estimates for risky sexual behaviors. Among the most consistent factors linked to HIV risk in non-SMIA populations is a history of emotional, physical, or sexual abuse. The current study examined the intersection of abuse history and HIV sexual risk behavior in SMIAs with a group of men (n = 64) and women (n = 115) recruited from eight geographically diverse and representative clinical sites around Florida. A cross-sectional interview revealed a high prevalence of alcohol and other drugs problems, as well as a history of emotional, physical, or sexual abuse in 75% of the participants, with 68% of these reporting multiple types of abuse. Compared to nonabused counterparts, those with a history of abuse reported significantly greater: (a) lifetime and current psychiatric symptoms, (b) recent unprotected sexual intercourse, and (c) crack cocaine, heroin, and marijuana use. No gender differences were detected in the associations of abuse history and sexual risk behaviors. These results underscore the need for HIV prevention efforts targeted to SMIAs and the critical importance of addressing abuse history in interventions with this underserved population.
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REFERENCES
American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. APA, Washington, DC.
Bartholow, B., Doll, L., Joy, D., Douglas, J., Bolan, G., Harrison, J. S., Moss, P. M., and McKirnan, D. (1994). Emotional, behavioral, and HIV risks associated with sexual abuse among adult homosexual and bisexual men. Child Abuse Negl. 9: 747–761.
Becker, E., Rankin, E., and Rickel, A. (1998). High-risk sexual behavior: Interventions with vulnerable populations. Plenum, New York.
Bensley, L. S., Eenwyk, J. V., and Simmons, K. (1999). Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking. Am. J. Prev. Med. 18: 151–158.
Boudewyn, A. C., and Liem, J. H. (1995). Childhood sexual abuse as a precursor to depression and self-destructive behavior in adulthood. J. Trauma. Stress 8: 445–459.
Briere, J., and Runtz, M. (1987). Post sexual abuse trauma: Data and implications for clinical practice. J. Interpersonal Violence 2: 367–379.
Browne, A., and Finkelhor, D. (1986). Impact of sexual abuse: A review of the research. Psychol. Bull. 99: 66–77.
Burnam, M. A., Stein, J. A., Golding, J. M., Siegel, J. M., Sorenson, S. B., Forsythe, A. B., and Telles, C. A. (1988). Sexual assault and mental disorders in a community population. J. Consulting Clin. Psychol. 56: 843–850.
Carey, M. P., Carey, K., and Kalichman, S. C. (1997). Risk for human immunodeficiency virus (HIV) infection among persons with severe mental illnesses. Clin. Psychol. Rev. 17: 271–291.
Carey, M. P., Weinhardt, L. S., and Carey, K. B. (1995). Prevalence of infection with HIV among the seriously mentally ill: Review of research and implications for practice. Prof. Psychol.: Res. Pract. 26: 262–268.
Cohen, M., Deamant, C., Barkan, S., Richardson, M., Young, M.,Holman, S., Anastos, K., Cohen, J., and Melnick, S. (2000). Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV. Am. J. Public Health 90: 560–565.
Cournos, F., Empfield, M., Horwath, E., McKinnon, K., Meyer, I., Schrage, H., Currie, C., and Agosin, B. (1991). HIV seroprevalence among patients admitted to two psychiatric hospitals. Am. J. Psychiatry 148: 1225–1229.
Dolcini, M. M., Coates, T. J., Catania, J. A., Kegeles, S. M., and Hauck, W. W. (1995). Multiple sexual partners and their psychosocial correlates: The population-based AIDS in multiethnic neighborhoods (AMEN) study. Health Psychol. 14: 22–31.
Gold, S. N., Lucenko, B. A., Elhai, J. D., Swingle, J. M., and Sellers, A. H. (1999). A comparison of psychiatric/psychological symptomatology of women and men sexually abused as children. Child Abuse Negl. 23: 683–692.
Goodman, L. A., and Fallott, R. D. (1998). HIV risk-behavior in poor urban women with serious mental disorders: Association with childhood physical and sexual abuse. Am. J. Orthopsychiatry 68: 73–83.
Grassi, L., Pavanati, M., Cardelli, R., Ferri, S., and Peron, L. (1999). HIV-risk behaviour and knowledge about HIV/AIDS among patients with schizophrenia. Psychol. Med. 29: 171–179.
Hunter, J. A. (1991). A comparison of psychosocial maladjustment of adult males and females sexually molested as children. J. Interpersonal Violence 6: 205–217.
Jackson, J. L., Calhoun, K. S., Amick, A. E., Maddever, H. M., and Habif, V. L. (1990). Young adult women who report childhood intrafamilial sexual abuse: Subsequent adjustment. Arch. Sex. Behav. 19: 211–221.
Kalichman, S. C. (1998). Preventing AIDS: Sourcebook for behavioral interventions LEA, Mahwah, NJ .
Kalichman, S. C., Carey, M. P., and Carey, K. B. (1996). Human immunodeficiency virus (HIV) risk among the seriously mentally ill. Clin. Psychol.: Res. Pract. 3: 130–143.
Kalichman, S. C., Kelly, J. A., Johnson, J., and Bulto, M. (1994). Factors associated with risk for human immunodeficiency virus (HIV) infection among chronic mentally ill adults. Am. J. Psychiatry 151: 221–227.
Kauth, M., St. Lawrence, J. S., and Kelly, J. A. (1991). Reliability of retrospective assessments of sexual HIV risk behavior: A comparison of biweekly, three-month, and twelve-month self-reports. AIDS Educ. Prev. 3: 207–214.
McLellan, A. T., Metzger, D., and Peters, R. (1992). The fifth edition of the Addiction Severity Index. J. Subst. Abuse Treat. 9: 199–213.
Miller, M. (1990). A model to explain the relationship between sexual abuse and HIV risk among women. AIDS Care 11: 3–20.
Mueser, K. T., Goodman, L. B., Trumbetta, S. L., Rosenberg, S. D., Osher, F. C., Vidaver, R., Auciello, P., and Foy, D. W. (1998). Trauma and posttraumatic stress disorder in severe mental illness. J. Consult. Clin. Psychol. 66: 493–499.
Needle, R., Fisher, D., Weatherby, N., Brown, B., Chitwood, D., Cesari, H., Chitwood, D., Booth, R., Williams, M. L., Andersen, M., and Braumstein, M. (1995). Reliability of self-reported HIV risk behaviors of drug users. Psychol. Addict. Behav. 9: 242–250.
Silverman, A. B., Reinherz, H. Z., and Giaconia, R. M. (1996). The long-term sequelae of child and adolescent abuse: A longitudinal community study. Child Abuse Negl. 20: 709–723.
Sorensen, J. L., London, J., and Morales, E. (1991). Group counseling to prevent AIDS. In J. Sorensen, J. L., Wermuth, D. R., Gibson,K. H., Choi, J. S. Guydish, and Batki, S. (eds.), Preventing AIDS in Drug Users and Their Sexual Partners, Guilford, New York City,pp. 99–115.
Stewart, D. L., and Ingle, J. M. (1994). HIV seroprevalence in a chronically mentally ill population. J. Nat. Med. Assoc. 86: 519–523.
Tabachnick, B. G., and Fidell, L. S. (1996). Using Multivariate Statistics, 3rd edn., Harper Collins, New York.
Thompson, N. J., Potter, J. S., Sanderson, C. A., and Maibach, E. W. (1997). The relationship of sexual abuse and HIV risk behaviors among heterosexual adult female STD patients. Child Abuse Negl. 21: 149–156.
Vlahov, D., Anthony, J., Munoz, A., Margolick, J., Nelson, K., Celetano, D., Solomon, L., and Polk, B. (1991). The ALIVE study: A longitudinal study of HIV-1 infection in intravenous drug users. NIDA Res. Monogr. 109: 75–100.
Whitmire, L. E., Harlow, L., Quina, K., and Morokoff, P. (1999). Childhood trauma and HIV: Women at risk, Brunnner/Mazel, New York.
Wyatt, G. E., Guthrie, D., and Notgrass, C. M. (1992). Differential effects of women's childhood sexual abuse and subsequent sexual revictimization. J. Consul. Clin. Psychol. 60: 167–173.
Zanis, D. A., McLellan, A. T., Cnaan, R. A., and Randall, M. (1994). Reliability and validity of the Addiction Severity Index with a homeless sample. J. Subst. Abuse Treat. 11: 541–548.
Zierler, S., Feingold, L., Laufer, L., Velentgas, P., Krantrowitz-Gordon, I., and Mayer, R. (1991). Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. Am. J. Public Health 81: 572–575.
ACKNOWLEDGMENT
This work was funded in part by Grant RO1 AA12115 from the National Institute on Alcohol Abuse and Alcoholism to Dr. Malow.
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Malow, R.M., Dévieux, J.G., Martinez, L. et al. History of Traumatic Abuse and HIV Risk Behaviorsin Severely Mentally Ill Substance Abusing Adults. J Fam Viol 21, 127–135 (2006). https://doi.org/10.1007/s10896-005-9012-0
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DOI: https://doi.org/10.1007/s10896-005-9012-0