Intimate partner violence-mediated association between childhood sexual abuse and HIV infection risk among men who have sex with men

Zhonghua Liu Xing Bing Xue Za Zhi. 2026 Apr 10;47(4):709-716. doi: 10.3760/cma.j.cn112338-20251013-00717.

ABSTRACT

Objective: To explore the association between childhood sexual abuse (CSA) and HIV infection risk among men who have sex with men (MSM), and to examine the mediating role of intimate partner violence (IPV) in the relationship, thereby providing a reference basis for targeted interventions. Methods: A cross-sectional study design was adopted. From July 2023 to January 2024, with the assistance of social organizations for sexual minorities in Wuhan, a total of 1 321 MSM were recruited by convenient sampling and peer-driven sampling methods. The questionnaire designed by the mobile version of Wenjuanxing was used to collect information such as the sociodemographic characteristics, CSA, IPV and HIV high-risk behaviors of subjects. The HIV infection risk score was calculated using the comprehensive risk assessment tool. The effects of CSA and IPV on high-risk behaviors were analyzed by multiple linear regression, and the mediating effect of IPV was tested by the Bootstrap method. Subgroup analyses were conducted according to IPV types and different HIV high-risk behaviors. Results: Among the 1 054 subjects of MSM, the self-reporting rates of those who had experienced CSA and IPV were 22.8% (240/1 054) and 14.8% (158/1 054), respectively. Among high-risk behaviors of HIV, the self-reporting rates of having 2-5 homosexual sexual partners in the last 6 months, unprotected anal sex in the last 6 months, and having multiple sexual partners were 59.1% (623/1 054), 49.2% (519/1 054), and 26.3% (277/1 054), respectively.The multiple linear regression model analysis showed that MSM who had experienced CSA and IPV had a higher HIV infection risk score (β=0.437, 95%CI: 0.051-0.823; β=0.465, 95%CI: 0.008-0.920).Subgroup analysis of IPV types revealed that suffering IPV played a partial mediating role in the relationship between CSA and HIV infection risk score (β=0.045, 95%CI: 0.002-0.110), with the mediating effect accounting for 10.3% of the total effect. Subgroup analysis of high-risk behaviors for HIV revealed that in CSA and unprotected anal sex relationships, comprehensive, suffered and administered IPV (β=0.015, 95%CI: 0.002-0.030; β=0.014, 95%CI: 0.001-0.020; β=0.017, 95%CI: 0.002-0.030) all exerted a complete mediating effect. In the relationship between CSA and parallel multiple sexual partners, the comprehensive and implemented IPV (β=0.009, 95%CI: 0.000-0.020; β=0.011, 95%CI: 0.001-0.020) exert a complete mediating effect. Conclusions: MSM who have experienced CSA directly increase the risk of HIV infection, and can also indirectly increase the risk of HIV infection through IPV. Moreover, the mediating effect of IPV showed specificity in terms of type and behavior.