Study: Trauma Linked to Sexual Risk Behaviors in Some Men
Men who have experienced traumatic life events – such as physical assault, life-threatening accidents, and imprisonment – are more likely to engage in sexual risk behaviors that may expose them to HIV, a new study concludes.
Researchers surveyed 1,342 male retail workers in Kazakhstan about their exposure to twelve distinct types of trauma in addition to their engagement in both unprotected and transactional sex. While the majority of men who participated in the study were ethnic Kazakhs, about one-third identified as ethnic minorities from Tajikistan, Kyrgyzstan, and other central Asian countries.
Study findings, published last month in AIDS and Behavior, show that about one-tenth of the men traded money, goods, or drugs for sex in the past three months, and one-third engaged in unprotected sex during that same period.
Trauma was shockingly high among the men who participated in the study. Nearly one-third of men indicated that they had experienced one to two traumatic events, and over one-third indicated they had experienced three or more traumatic events. The most common types of trauma were being arrested, being questioned by state officials, and experiencing a life-threatening event.
Statistical tests revealed a connection between the number of traumatic events in one’s life and individual HIV risk behavior. Kazakh men who had experienced one to two traumatic events in life, for instance, were nearly four times more likely to have traded money, goods, or drugs for sex. Those who had experienced three or more traumatic events were eight times more likely to have engaged in that same behavior. Unprotected sex, moreover, was twice as prevalent in Kazakh men who had experienced three or more traumatic events.
Despite the striking relationship between trauma and HIV risk behavior in Kazakh men, there were no significant increases in risk behavior among external migrant workers who had experienced trauma. Both groups of men had similar rates of trauma.
Lynn Murphy Michalopoulos, lead author of the study and Associate Professor at Columbia University School of Social Work, expressed serious concern at the high rate of trauma in the study population.
“In terms of the public health impact,” said Michalopoulos, “the high prevalence of potentially traumatic event exposure found among both Kazakhstani and external migrants provides evidence for the development of trauma-informed programming in general in this region.”
The most obvious explanation for the link between trauma and sexual risk behavior would be that some men use commercial sex and unprotected sex as coping mechanisms to deal with the psychological burden of trauma. But this explanation does not account for researchers’ finding that there is no link between trauma and sexual risk behaviors in non-Kazakh men.
“While more research is needed to disentangle this complex relationship, the findings provide support for the development of trauma-informed HIV prevention programs, specifically with the assessment of trauma and development of evidence-based and culturally relevant interventions,” added Michalopoulos.
The relationship between trauma and HIV sexual risk behavior has serious implications for how we address the epidemic. Among some men, mental health services that focus on trauma may help to reduce their sexual risk for HIV infection.