David Jenkin’s story reveals a great deal about the largest unaddressed risk factor in HIV/AIDS transmission, namely trauma.
Childhood sexual abuse (CSA) and intimate partner violence are common causes of trauma and violence in vulnerable populations. Below are important statistics about violence and trauma and its connection to HIV/AIDS. In comparison to the general population, people living with HIV tend to report experiencing more traumatic life events, particularly those that are violent & abusive.
Most of the HIV that is transmitted worldwide occurs through intimate relationships. Policies that educate and increase health literacy via best prevention practices to youth before they become sexually active are necessary to build “sexual self esteem.” It is when girls are confident in their decisions to have sex only when they’re ready that they can delay sex and prevent HIV or unwanted pregnancies. On the other hand, boys can also benefit from this type of education prior to their first sexual experience and build their sexual self esteem – which can also further delay sex or prevent HIV and pregnancy/becoming a father before they are ready. (1)
There are three main ways violence is thought to increase a woman’s risk for HIV infections:
- Through forced sexual intercourse with an infected partner
- By limiting women’s ability to negotiate condom use
- By establishing a pattern of sexual risk taking among individuals assaulted in childhood and adolescence
Sexual abuse can affect a person’s risk of getting HIV in many ways. Besides the obvious risk of getting the virus through forced sex, sexual abuse affects the way that you deal with sex, how you feel about your body, and your perceptions of self-worth. For some, this makes them not want to deal with sex at all; others may look to relationships to give them back what had been stolen from them.
Violence perpetrated against women is linked to risks for sexually transmitted infections, including HIV infection. Studies conducted in the US show that women in violent and abusive relationships are less likely to use condoms, more likely to incur abuse as a result of requesting condoms and more likely to contract sexually transmitted infections (STIs) than women who have not been in violent relationships.
Childhood Sexual Abuse (CSA) is defined as sexual activity before the age of 18 that may or may not involve force, and ranges from unwanted touch to sexual penetration with an object and/or sexual intercourse. The experience of CSA has lifetime consequences. CSA has been linked to psychiatric disorder and substance use with the latter often being used as a coping mechanism. Women under the influence of drugs and/or alcohol are less likely to use barrier protection. Histories of sexual violence affect decisions women make related to risks for HIV and STIs such as choice of partners and the ability to negotiate condom use with partners.
In a national study with data from the National Institute of Mental Health (NIMH) Multisite HIV Prevention Trial, it was found that men with a history of unwanted sexual activity during childhood were significantly more likely than men without such history to report risky sexual behaviors, alcohol problems and drug use. In this study, men who reported unwanted sexual activity during childhood were 6.79 times as likely as other men to report unwanted sexual activity since age 13.11 CSA is also linked with risky HIV sex behaviors among women, including unprotected sexual intercourse, sex with multiple partners, trading sex, and adult sexual revictimization. (12)
- 1 in 4 girls is sexually abused by age 18. (5)
- The National Institute of Justice estimates one million new cases of sexual assault and rape each year in the USA alone. A significant percentage of these cases are adolescent & child victims. (2)
- Rates of CSA in Men who have Sex with Men (MSM) have been estimated to be higher than in the rest of the population, with some researchers estimating that 37% of all MSM have experienced CSA. (3)
- 15% of sexual assault and rape victims are under age 12; 29% are age 12-17; 44% are under age 18; 80% are under age 30. (6)
- In the United States, 1 in 6 women and 1 in 33 men reported experiencing an attempted or completed rape at some time in their lives. (7)
- Between 88 percent and 94 percent of intimate partner violence victims seek medical attention for injuries to the head and neck, and 56 percent of those have facial fractures. (8)
- Women victims of gender-based violence have an increased risk of HIV and being HIV positive is also a risk factor for violence against women. (9)
2. http://ezproxy.library.nyu.edu:2598/content/j3166q7w46736089/fulltext.pdf Assessment of Childhood Sexual Abuse: Clinical Measures, Evaluation, and Treatment Mark V. Sapp
3. http://clinicaltrials.gov/ct2/show/NCT00797654 April 10, 2009
4. Arosarena et al. Maxillofacial Injuries and Violence Against Women. Archives of Facial Plastic Surgery, 2009; website: http://www.sciencedaily.com/releases/2009/01/090119210431.htm
5. Duke University; Women’s Center; Sexual Assault Support Services
6. U.S. Dept of Justice, 2004. National Crime Victimization Survey
7. CDC: Understanding Sexual Violence; 2007
8. Arosarena et al. Maxillofacial Injuries and Violence Against Women. Archives of Facial Plastic Surgery, 2009; http://www.sciencedaily.com/releases/2009/01/090119210431.htm
9. Gender Based Violence & HIV/AIDS http://www.paho.org/English/ad/ge/Viol-HIV_FS0705.pdf
10. (Kalichman et al., 1998; Wingood & DiClemenete, 1997)
12. A meta-analysis of the relationship of child sexual abuse to HIV risk behavior among women; Arriola, Louden, Doldren, Fortenberry; 2005