Long-Term Outcomes of Childhood Sexual Abuse Among Bisexual Latino Men: Adult Mental Health, Substance Use, and Sexual Risk Behaviors

Background and purpose. Childhood sexual abuse (CSA) is a pervasive public health concern that disproportionately affects sexual minority Latino men. The effects of CSA extend well beyond short-term psychological trauma and child/adolescent behavior, with strong evidence indicating that survivors of CSA face elevated risk of numerous health morbidities in adulthood, including psychopathology, alcohol and substance use, and sexual risk behaviors associated with HIV/STI transmission. This study explored the long-term impact of CSA among sexual minority Latino men.

Methods. Among a sample of 148 bisexual Latino men in New York City, we examined associations between CSA and multiple dimensions of adult health and behavior: sexual HIV risk behaviors, STI incidence, polydrug use (use of 3+ substances), depressive symptoms, and perceived stress (i.e., appraised stress). We compared each outcome among those with histories of CSA, those reporting early sexual contact (ESC) prior to the age of 13, and those with no sexual contact prior to age 13. Using this model, we sought to analyze whether early sexual experiences affect adult mental health and sexual risk more generally, or whether those experiences must be abusive in order to have such effects.

 Results. Over one-fifth (22.3%) of participants reported a history of CSA. Men with a history of CSA reported high rates across all outcomes: nearly half (49%) reported unprotected sex within the past two months; 21% reported an STI diagnosis within their lifetime; one-third reported polydrug use within the past four months; 42% screened for clinically significant depressive symptoms; and two-thirds (67%) screened for high perceived stress. CSA was significantly associated with engaging in receptive condomless anal intercourse (aOR=3.59, p<.01, SE=2.0), high perceived stress (aOR=2.48, p<.06, SE=1.13), and clinically significant depressive symptoms (aOR=2.7, p<.05, SE=1.25). Across all variables, ESC did not impact outcomes as CSA did, underscoring a key distinction between abusive and non-abusive ESC.

Conclusion and implications. Findings from this study confirm high rates of CSA among sexual minority Latino men, and support a link between CSA, HIV risk behaviors, and negative mental health outcomes. The high prevalence of depressive symptoms presents a critical need for mental health services that are responsive to the needs of sexual minority Latinos and survivors of CSA. Survivors of CSA were also at greater odds of screening for high perceived stress, which may support previous findings that perceived stress moderates the maintenance and severity of traumatic stress. Results further underscore the need for CSA prevention policies and programs to better engage Latino youth. We further recommend that social workers across diverse areas of practice incorporate CSA screenings and treatment into practice.