A history of childhood sexual abuse overshadows all other factors that place a woman at risk for contracting HIV infection, suggests a new UCLA and Charles R. Drew University study. The American Journal of Health reports the findings in its April issue.
â€œOur findings disprove the notion that HIV-positive women are promiscuous or drug addicts,â€? said Dr. Gail Wyatt, principal investigator and associate director of behavioral sciences for the UCLA AIDS Institute. â€œHIV caregivers need to look more carefully at HIV-infected womenâ€™s sexual histories and offer appropriate resources for dealing with past trauma.â€?
The UCLA/Drew Women & Family Project followed 490 women in Los Angeles. Half of the group was HIV-negative and half was HIV-positive. Each HIV-positive woman was matched with an HIV-negative partner of similar ethnicity, age, and marital and socioeconomic status. Over two years, the researchers interviewed each woman in person every six months about her sexual behavior and disease management and tested her for new sexually transmitted diseases.
Of the total women surveyed, UCLA researchers found that 49 percent were sexually abused as children, 43 percent suffered sexual abuse as adults, and 41 percent were or had been in physically violent relationships.
â€œSexual abuse before age 18 increased a womanâ€™s risk for becoming HIV-positive more than any other factor,â€? said Wyatt, a professor of psychiatry and biobehavioral sciences at the UCLA Neuropsychiatric Institute. â€œThis finding crossed all racial and ethnic groups.â€?
In addition to sexual abuse, HIV-positive women were more likely to possess fewer years of formal education and to live in poverty than their HIV-negative counterparts.
â€œSexual abuse has its own unique effect on womenâ€™s decision-making,â€? Wyatt said. â€œBut abused women who live in poverty have greater difficulty moving on with their lives. Their lack of economic resources severely restricts their choices. This makes them dependent on men who continue to abuse them and put them at risk for HIV.â€?
Women who reported chronic childhood sexual abuse were seven times more likely to engage in high-risk unprotected sexual behavior as adults. Most dramatically, the number of HIV-positive women who had suffered rape doubled that of HIV-negative women in all ethnic categories.
â€œWe found that the same factors that increase a womanâ€™s risk for contracting HIV might also contribute to her risk for rape and domestic abuse,â€? Wyatt said. â€œRelationships with coercive and abusive partners severely diminish a womanâ€™s ability to negotiate safer sex.â€?
According to Wyatt, few HIV-prevention programs address the effects of childhood abuse on sexual risk-taking.
â€œYou canâ€™t tell abused women to use condoms and â€˜just say no to drugs,â€™â€? Wyatt stressed. â€œHIV service providers need to ask more questions about their patientsâ€™ sexual history. It may not be the number of partners that matters â€” but the type of predatory person they gravitate toward.
â€œThose who use alcohol or drugs may be self-medicating to dull the pain of their pasts,â€? she said. â€œPhysicians need to ask these women why theyâ€™re doing what theyâ€™re doing.â€?
The UCLA/Drew study also challenges caregiversâ€™ assumptions about HIV-infected womenâ€™s sexual behavior â€” and medical providersâ€™ stereotypes about who gets infected.
â€œBecause public health clinics treat more women of color with HIV, these clinicians perceive the women as uncooperative if they donâ€™t change their risk-taking behavior,â€? Wyatt said. â€œBut theyâ€™re missing the full picture. White women with HIV donâ€™t go to public clinics as frequently because they can afford private care.â€?
Finally, Wyatt said, the health-care system needs to consider offering psychotherapy to everyone who needs it â€” not just those with the ability to pay. As the UCLA/Drew study demonstrates, the inability to resolve childhood sexual abuse measurably influences risky adult behavior â€” which shapes AIDS epidemics.
â€œSexual abuse will alter the course of anyoneâ€™s life,â€? Wyatt said. â€œThe aftereffects donâ€™t go away by themselves. Most of these women didnâ€™t get help after they were abused.â€?
The National Institute of Mental Health funded the study.
Wyattâ€™s UCLA co-authors included Dr. John K. Williams, Dr. Christina Ramirez Kitchen, Dr. Tamra Loeb, Dr. Jennifer Vargas Carmona, Dr. Lacey Wyatt, Dr. Dorothy Chin and Nicole Presley, and Dr. Hector Myers of UCLA and Drew University.