Childhood violence is an independent predictor of HIV seroconversion in a cohort of
young men who have sex with men in Vancouver, Canada
A.J. Schilder1, T.R. Orchard2, K. Chan3, W. Michelow4, T.L. Patterson5, S.A. Strathdee5, J.S.G. Montaner6, D. Moore6, R.S. Hogg7, Vanguard Study
1B.C. Centre for Excellence in HIV/AIDS, BC HIV Treatment Registry, Vancouver, Canada, 2University of Western Ontario, Faculty of Health Sciences, London, Canada, 3B.C. Centre for Excellence in HIV/AIDS, Biostatistics, BC HIV Treatment Registry, Vancouver, Canada, 4B.C. Centre for Excellence in HIV/AIDS, Epidemiology, Vancouver, Canada, 5University of California San Diego, Child School of Medicine, San Diego, United States, 6BC Centre for Excellence in HIV AIDS & University of British Columbia, Faculty of Medicine, Vancouver, Canada, 7BC Centre for Excellence in HIV AIDS & Faculty of Health Sciences, University of British Columbia, Population Health, Vancouver, Canada
Background: Among heterosexuals,
child physical abuse (CPA) before age 17 has been linked to vulnerability for
HIV infection, but similar research is scarce for men who have sex with men
(MSM). We studied whether CPA was associated with HIV seroconversion among
Methods: MSM aged 15-30 years, living in Vancouver completed a self-administered
questionnaire and underwent HIV testing annually from 1995-2003. We compared MSM who reported CPA with those who did not and
identified predictors of HIV seroconversion using Cox regression.
participants completed questionnaires and had a documented HIV sero-status. The
mean age was 45 years (range: 21-79) and 85% were born in Canada.
Overall, 42% of men identified as gay, 36% as homosexual, and 12% as
straight. A total of, 211 (73.5%) participants did not experience any
CPA, 76 (26%) experienced CPA, 70 (24%) experienced sexual abuse before age 17,
and 36 (17%) experienced both. In the Cox regression model, MSM reporting CPA were 4.89
times more likely to be HIV+ than those
who did not [95% CI: 1.65-14.48)], after adjusting for unprotected
receptive anal intercourse [Adj RH: 6.73; 95% CI: 2.48-18.28], and high school
education or greater [Adj RH: 0.16; 95% CI: 0.06-0.44].
Conclusions: CPA was an important independent predictor
of HIV seroconversion among young MSM in Vancouver.
These data have important implications for gay men's health services,
suggesting that new approaches for public health practice examine how gender,
collective trauma and high rates of CPA are barriers to HIV prevention. Health
practitioners might facilitate psychiatric interventions for MSM with CPA
experiences and use harm reduction that includes secondary prevention to
promote their access to HIV antiretroviral therapy.
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