Are Asian-American Women Who Were Maltreated As Children At Higher Likelihood for HIV Risk Behaviors and Adverse Mental Health Outcomes?

Background and Purpose: Multiple maltreatment during childhood is increasingly recognized as a risk factor of HIV risk behaviors and adverse mental health outcomes among White and Black women. However, the majority of research on child maltreatment among Asian-Americans has focused on either prevalence of single types of maltreatment among children or predictors of child maltreatment among parents. This study aims to describe the prevalence of single and multiple types of child maltreatment among unmarried Asian-American women, and is the first to systematically investigate whether multiple child maltreatment (e.g., Sexual abuse plus other maltreatment) is associated with HIV risk behaviors and adverse mental health outcomes among Asian-American women.

Methods: Using data from the Asian-American Women's Sexual Health Initiative Project (AWSHIP), we conducted a cross-sectional study of unmarried Chinese, Korean, and Vietnamese women (n = 400), aged 18 to 35, who identified as children of immigrants, using Computer-Assisted Survey Interviews (CASI). Pearson χ2 tests were performed to compare the proportions of HIV risk behavior and mental health outcomes among women who were exposed to child maltreatment. We ran multiple logistic regression models to estimate the effect size of child maltreatment types on HIV risk behaviors and mental health outcomes.

Results: Approximately seven in ten women reported having been maltreated as a child and 6.8% reported any type of sexual abuse. Contrary to the findings from previous studies of other racial groups of women, sexual abuse plus other maltreatment was not associated with HIV risk behaviors, but was associated with an increased risk of having moderate to severe depression by 3 times (Odds ratio 3.2, 95% CI 1.2-8.4) and having attempted suicide in one's lifetime by almost 12 times (Odds ratio 11.7, 95% CI 2.1-66.2) among Asian-American women.

Conclusions and Implications: There was no evidence indicating that multiple child maltreatment was linked to HIV risk behaviors, but it exhibited a robust association with poor mental health outcomes. Asian-American victims may perceive that manifesting their trauma through externalizations, including engaging in risky sexual behaviors, brings greater risk of shame and loss of face to themselves and their families. Hence, Asian-American women who have been sexually abused may choose to internalize their trauma and suffer alone in order to maintain family harmony, which are in accord with Asian-cultural norms. The robust links between multiple child maltreatment and mental health outcomes suggest two important intervention strategies. First, prevention of maltreatment during childhood may reduce mental health problems. Immigrant families have greater exposure to discrimination, financial hardship, and language barriers. Children whose parents face these stressors may be at higher risk for maltreatment. Second, the identification of adults who were victims of multiple child maltreatment is equally important. Interventions for these victims should consider providing family therapy in addition to individual therapy to help both victims and families understand and process the impact of multiple child maltreatment.