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Childhood Sexual Abuse in Black Men who have Sex with Men: Results from three Qualitative Pilot Studies.

Childhood Sexual Abuse in Black Men who have Sex with Men: Results from three Qualitative Pilot Studies. Sheldon D. Fields, PhD, APRN-BC, FNP David Malebranche, MD, MPH Sonja Feist-Price, PhD. Funding and Support . The Collaborative HIV-Prevention Research  in Minority Communities Program

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Childhood Sexual Abuse in Black Men who have Sex with Men: Results from three Qualitative Pilot Studies.

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  1. Childhood Sexual Abuse in Black Men who have Sex with Men:Results from three Qualitative Pilot Studies. Sheldon D. Fields, PhD, APRN-BC, FNP David Malebranche, MD, MPH Sonja Feist-Price, PhD

  2. Funding and Support • The Collaborative HIV-Prevention Research in Minority Communities Program • Director: Barbara Marin, PhD • Faculty: Hector Carillo, DrPH; Tor Neilands, PhD; Margaret M. Dolcini, PhD; Olga Grinstead, PhD, and Jeanne Tschann, PhD • University of Rochester-School of Nursing • Emory University-Division of Medicine • University of Kentucky-School of Education

  3. AIDS and Black MSM, 2003 • Cumulative AIDS cases among all Black men: 261,616 • Number of cases attributed to MSM: 104,646 (40%) • Black men diagnosed in 2003 with AIDS: 13,735 • Black male AIDS case rate: 109.2/100,000 (The highest among all men).

  4. Childhood Sexual Abuse (CSA) • Definition: Unwanted and inappropriate sexual solicitation of, or exposure to a child by an older person, genital touching or fondling, or penetrating in terms of oral, anal or vaginal intercourse or attempted intercourse(Andrews et al., 2002). • Contact and Non-contact CSA • 1 in 5 sexually abused children is either Black or Latino (American Humane Society, 1988; Kercher & Mcshane, 1984; Peters, 1976).

  5. CSA and HIV Risk among MSM • Estimates of CSA among MSM varies 20% - 39% • CSA among MSM is more intense, longer, and violent. • CSA has been linked to HIV risk behavior. • Higher risk of lifetime IDU (Holmes, 1997) • Higher rates of unprotected receptive anal sex (Carballo-Dieguez & dolezal, 1995). • Prostitution and higher rates of STD’s (Zierler et al., 1991) • Latino MSM twice as likely to report CSA than non-Latino MSM (Arreola, et al, 2005). • Few studies have examined the issue of CSA among Black MSM exclusively.

  6. Dr. Sonja Feist-Price • Title: Black men who identify as heterosexual and secretly have sex with men • Purpose: To understand the lived experiences of heterosexually identified Black men who have sex with women and men, which would serve to inform a culturally relevant HIV prevention intervention. • Methods: • Interviews conducted April 2003 – April 2004 • Sample: 30 Black MSM/W recruited through use of flyers and a key informant in Lexington, KY and Atlanta, GA.

  7. Objectives • To understand the lived experiences of Black MSW/M. • To investigate their sexual practices and risk taking behavior. • To identify culturally relevant HIV prevention needs.

  8. Study Findings

  9. CSA Study Findings “I was at the 6th grade going to the 7th. My teacher .... approached me. ‘Why don’t I give you a ride home?’ I said, ‘Yeah.’ Gave me a ride home, or nearby home. We kind of went in circles. And then we stopped—at that time it was like a rocky road—and then back onto the black pavement, there was this road we called like the back road. The back way going to school and home. And he pulled over to the side and he said some things like, ‘Do you want me to touch it for you?’ …And I said, ‘Yeah.’ Just because at the time, I was thinking, more like is it supposed to be this way? Something not right? He started kissing on the crotch area and a car passed by and all of a sudden he stopped. He said, OK, zip up your pants. And it went on for about three months after that—kind of off and on. Not all the time.” “…every time he would slide me $5.” (Atlanta, 44).

  10. CSA Study Findings The immediate impact of the experience: “ I remember I was playing football and if someone would say, ‘You sissy. Catch the ball.’ I would fight him. You know. If they called me a certain name like that. They don’t know, you know what I’m saying? But, the guy would, if I’m playing basketball or something, ‘You sissy…’ People used to wonder why I would fight like that. Words would just tick me off. I would just start fighting.” (Atlanta, 44).

  11. CSA Study Findings The first sexual experience: “Well my actual first time, I was molested, so it was with a guy [his biological father]…. I was maybe five or six. I was coming out of kindergarten and going into the first grade and part of my second grade year. It stopped like [during] my third grade year totally … We actually got into a fight…. It got to…most of it was oral, but when it came to penetration, I tried to fight him off and my uncle actually stopped it and he overheard it and he walked in and was like, ‘What are you doing to your son?” (Lexington, 25)

  12. CSA Study Findings “That actually ended the sexual part, but the physical part, it was like ‘If I can’t do that, then I’ll just beat you.’ He used to make me do everything from standing in the corner to sleep standing up and I better not lean against the wall, to literally making me stand in the middle of a dark closet”. (Lexington, 25) The immediate impact of the experience: “I stayed depressed a lot. And my therapist made me realize that until I forgave my father, or let go of whatever animosity I had towards him I would stay in that depression. And I had to do that.” (Lexington, 25)

  13. Other Major Findings: Episodes of depression is a major problem. • CSA sexual scripts are sometimes played out in adult sexual behaviors. • Culturally relevant therapeutic treatment modalities are needed • Further studies are needed to explore the relationship between self-abusing behavior (i.e., drug and alcohol use and abuse) and sexual risk taking. Men question the link between their same-sex sexual desires, behavior and CSA.

  14. Dr. David Malebranche • Title: Masculinity and HIV risk among Black MSM • Purpose: Qualitatively describe domains of masculine socialization that may influence sexual risk among black MSM. • Methods: • Interviews conducted June – August 2003 • Sample: 29 Black MSM from internet and intercept method at Piedmont Park

  15. Objectives • 1) Investigate the subjective life experiences of black men who have sex with men (BMSM). • 2) Explore the social context in which BMSM shape their notions of what it means to be a man or masculine. • 3) Determine the relationship between BMSM sense of masculinity and their subjective sexual identity. • 4) Explore the relationship of BMSM definitions/experiences of masculinity, sexual identification labels, and their sexual behavior decision-making process (choice of sexual partners, sex with women, use of condoms, etc).

  16. CSA Study Findings

  17. Childhood Sexual Abuse • “I was 7 or 8. He [male cousin] molested me all the way up until I was like 17 or somethin’.” (28) • “I guard sexuality. In it’s complete form. I don’t feel comfortable hugging people.” (24) • “I did him [male cousin], came in him and everything. He’s like ‘man you good to be young.’ And after that it was like nothing but suicidal thoughts. I wanted to kill myself.” (31) • “I thought it [CSA] was natural. All my cousins were doing it.” (22) • “It [CSA] came back to haunt me years later. I began to fear being around other guys.” (39)

  18. Dynamics of CSA • Insidious nature of CSA • Manipulation with curiosity, fear, intimidation • Age-related dynamics (older male relatives) • Depression, PTSD, suicidal thoughts • Lack of verbal communication • Homosexual “blame” on CSA • Association of same-sex desire with CSA • Unprotected sex

  19. Other Major Themes/Findings • Poor verbal communication skills • Lack of black male role models • Dependence on maternal relationship • Varying definitions of masculinity • Problems with “gay” identity label • Sexual scripts and behavior influenced by childhood experiences

  20. Dr. Sheldon D. Fields • Title: Social connections, mental health and HIV risk behaviors among young Black MSM. • Purpose: Qualitatively investigate the effects of social connections, mental health, and HIV risk behaviors among young black MSM. • Methods: • Interviews conducted: February 2004 – May 2005 • Sample: 28 Black MSM recruited through an established CBO, flyers, and snowballing.

  21. Objectives of Study • To explore the social connections of young black MSM as related to their HIV risk behavior. • Family • Friends • Community (Gay and Black Community) • Religion/Spirituality • To explore the mental health issues of young black MSM that place them at risk for HIV.

  22. CSA Study Findings

  23. Childhood Sexual Abuse • “Um, like it wasn’t my choice but like, um, like one of my cousins, like, when I was younger [chuckle] like, um,…pretty much like I guess you would say like molest or whatever. But that went on for like a couple years”. • “But, um,…like I remember the last couple times and I was into it. I’m sorry, I mean I’m not gonna lie like, [chuckle] as far as like going down or whatever like I didn’t mind it. But when it stopped, I kinda like tried to block everything out” (Age 24).

  24. Dynamics of CSA • Most often a family member (Cousin, or Uncle). • Very few told anybody about their CSA. • Attribution of CSA experience to their current sexuality. • Higher number of male sexual partners. • Trend of psychological sequelae similar to women with CSA (PTSD, Depression).

  25. Other Major Themes/Findings • Spiritual distress among Black MSM. • High degree of recreational drug use (Marijuana and alcohol). • Social isolation from the black and gay communities. • Racism

  26. Major Conclusions • CSA among Black MSM is clearly a issue. • Significant mental health issues exist. • Chicken or the egg: Which came first. • CSA is the real down low issue. • Unclear direct linkage to HIV sexual risk behavior.

  27. Next Steps: CSA in Black MSM • Future Research Needed: • Larger prevalence studies. • CSA as an independent predictor of HIV sexual risk. • Larger in-depth qualitative study. • Mental health sequelae studies. • Spiritual/Religious conflict related to CSA and MSM behavior. • Culturally relevant mental health treatment modalities. • Raise overall awareness of CSA among Black MSM.

  28. Contact Information • Sheldon D. Fields PhD, APRN-BC, FNP Assistant Professor of Nursing University of Rochester-School of Nursing 601 Elmwood Ave, PO Box SON Rochester New York, 14642 (585)-275-9943 Sheldon_Fields@URMC.Rochester.edu

  29. Contact Information • David Malebranche, MD, MPH Assistant Professor of Medicine Emory University-Division of Medicine 49 Jesse Hill Jr. Drive Atlanta Georgia 30303 (404) 778-1630 dmalebr@emory.edu

  30. Contact Information • Sonja Feist-Price, PhD Professor of Rehabilitation Counseling University of Kentucky-Collge of Education 229 Taylor Ed. Building Lexington, Kentucky 40506-0001 859-257-4270 smfeis@uky.edu

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