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.

Keywords: Childhood sexual abuse; Distress tolerance; Self-esteem; Substance use.

Fig. 1

The relationship between level of PTSD symptom severity and proportion of sample endorsing high-risk sex, as moderated by substance dependence, self-esteem, and distress tolerance. SUD substance use dependence, SE self-esteem, and DT distress tolerance. Participants were those who engaged in high-risk sex in past 3 months (participants ≥80% adherent to PrEP were considered not to have engaged in recent high risk sex)