Adverse childhood experiences and sexual health outcomes and risk behaviors among a nationwide sample of men who have sex with men.

ABSTRACT

BACKGROUND: Adverse Childhood Experiences (ACEs) are associated with a wide range of increased risk behaviors and health consequences, they have not been extensively described in all subpopulations. OBJECTIVE: The specific objectives of the study were to describe the prevalence of predefined ACEs among a nationwide sample of men who have sex with men (MSM) and determine associated HIV or sexually transmitted infection (STI) related health outcomes, testing practices, and risk behaviors. PARTICIPANTS AND SETTING: Eligible participants were MSM aged 18 years or older who reported male-male sex in the past 12 months. METHODS: Data were obtained from the 2015 cycle of the American Men's Internet Survey, these data were collected between September 2015 and April 2016, and contained questions related to 8 ACE exposure categories. During analyses conducted between September 2017 and April 2018, multiple log-binomial models were fit to assess associations. RESULTS: Among 2590 participants, 79.7 % reported exposure to one or more ACE category. Participants exposed to any ACE were more likely to report STI testing (adjusted prevalence ratio [aPR] 1.07; 95 % confidence interval [95 %-CI] 1.00, 1.15), illicit substance use (aPR 1.23, 95 %-CI 1.05, 1.46), and condomless anal intercourse with another man (aPR 1.13, 95 %-CI 1.03, 1.21). CONCLUSIONS: There is a high overall ACE burden among MSM nationally, with potential influences on key HIV/STI behaviors in later life. ACE exposure should be routinely assessed, prevention is ideal but appropriate measures such as trauma informed care should also be considered for adult MSM accessing HIV and STI-related services.