Unwanted Sexual Experiences and Sexual Risks in Gay and Bisexual Men: Associations Among Revictimization, Substance Use, and Psychiatric Symptoms.
Unwanted sexual experiences are common in both heterosexual heterosexual /het·ero·sex·u·al/ (-sek´shoo-al)
1. pertaining to, characteristic of, or directed toward the opposite sex.
2. one who is sexually attracted to persons of the opposite sex. and homosexual relationships. Studies show that as many as one in three college women are either pressured or forced to unwillingly engage in sexual relations sexual relations
1. Sexual intercourse.
2. Sexual activity between individuals. , with life-long adverse consequences (Koss, Gidycz, & Wisniewski, 1987; Muehlenhard, Goggins, Jones, & Satterfield, 1991; Muehlenhard & Linton, 1987). Men are also often pressured and coerced to have sex, including coercion coercion, in law, the unlawful act of compelling a person to do, or to abstain from doing, something by depriving him of the exercise of his free will, particularly by use or threat of physical or moral force. from female and male partners. In a sample of mostly heterosexual men, Struckman-Johnson and Struckman-Johnson (1994) reported that 24% of men had been sexually coerced by women after age 16 and 4% had been coerced by men. Similar rates of unwanted sexual contact among men perpetrated by women were reported in earlier studies (Muehlenhard & Cook, 1988; Struckman-Johnson, 1988). Research with gay men and lesbians indicate similar rates of sexual coercion. For example, Waterman, Dawson, and Bologna Bologna (bōlô`nyä), city (1991 pop. 404,378), capital of Emilia-Romagna and of Bologna prov., N central Italy, at the foot of the Apennines and on the Aemilian Way. (1989) reported that 12% of gay men and 31% of lesbians reported being forced to have sex in their current or most recent relationship. Hickson, Davies, Hunt, and Weatherburn (1994) also found that 28% of British gay men had been coerced by a man into unwanted sexual activity. Kalichman and Rompa (1995) reported similar results, with 29% of gay and bisexual bisexual /bi·sex·u·al/ (-sek´shoo-al)
1. pertaining to or characterized by bisexuality.
2. an individual exhibiting bisexuality.
3. pertaining to or characterized by hermaphroditism.
4. men in a midwestern U.S. city reporting sexual coercion. Moreover, 92% of the sexually coercive co·er·cive
Characterized by or inclined to coercion.
co·ercive·ly adv. events identified by Kalichman and Rompa involved unprotected anal intercourse Noun 1. anal intercourse - intercourse via the anus, committed by a man with a man or woman
anal sex, buggery, sodomy
sexual perversion, perversion - an aberrant sexual practice; and therefore conferred con·fer
v. con·ferred, con·fer·ring, con·fers
1. To bestow (an honor, for example): conferred a medal on the hero; conferred an honorary degree on her. significant risks for HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. infection.
Research suggests that several factors are associated with sexual coercion in adulthood. First, studies show that drug use can play an important role in sexual coercion, with cocaine abuse most closely related to unwanted sexual experiences in women (Kalichman, Williams, Cherry, Belcher, & Nachimson, 1998). Men who are sexually coerced by male partners are also more likely than noncoerced men to report drug use in sexual contexts (Kalichman & Rompa, 1995). A second factor associated with sexual coercion in women is a history of childhood sexual abuse. Women who had been sexually abused as children are significantly more likely to experience unwanted sexual intercourse sexual intercourse
or coitus or copulation
Act in which the male reproductive organ enters the female reproductive tract (see reproductive system). as adults (Messman & Long, 1996; Urquiza & Goodlin-Jones, 1996) and are at greater risk for HIV infection (Whitmire, Harlow, Quina, & Morokoff, 1999). In a study of U.S. naval recruits, Merrill, Newell, Gold, and Milner (1997) showed that the likelihood of being raped was nearly five times higher for women with a history of childhood sexual abuse. Mayall and Gold (1995) found that women who experienced sexual assault as adults were more likely to have been victimized as children, and that higher rates of sexual activity formed the link between childhood sexual abuse and unwanted sexual contacts in adulthood. Research suggests that gay and bisexual men who experienced sexual abuse as children are also at substantial risk for HIV infection (Bartholow et al., 1994; Carballo-Dieguez & Dolezal, 1995; Doll et al., 1992). However, childhood sexual abuse has not been investigated in relation to adult male sexual coercion, nor has the link between sexual revictimization and HIV risk behavior been reported in men who have sex with men Men who have sex with men (MSM) is a term used mostly in the United States to classify men who engage in sex with other men, regardless of whether they self-identify as gay, bisexual, or heterosexual. .
Explanations for the association between child sexual abuse Child sexual abuse is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification. and unwanted sexual events in adulthood have emphasized the roles of psychiatric psy·chi·at·ric
Of or relating to psychiatry.
psychiatric adjective Pertaining to psychiatry, mental disorders symptoms such as dissociation dissociation, in chemistry, separation of a substance into atoms or ions. Thermal dissociation occurs at high temperatures. For example, hydrogen molecules (H2 , trauma-related anxiety, and borderline borderline /bor·der·line/ (-lin) of a phenomenon, straddling the dividing line between two categories.
borderline personality characteristics. Arata (1999) and Sandberg, Matorin, and Lynn (1999) found that trauma symptoms were significantly more common among women who had been revictimized as adults compared to women who had only experienced childhood sexual abuse. Dissociation symptoms and maladaptive Maladaptive
Unsuitable or counterproductive; for example, maladaptive behavior is behavior that is inappropriate to a given situation.
Mentioned in: Cognitive-Behavioral Therapy personality characteristics may help explain the relationship between childhood sexual abuse and unwanted sexual contact in adulthood (Rickel & Becker, 1997). Dissociation serves as a cognitive and emotional escape strategy that can be effective in coping with childhood trauma but becomes maladaptive in adulthood. Dissociation in response to fear producing events can translate to ignoring potential risks, including risks for HIV-AIDS (Resnick & Seals, 1995). In the extreme case of dissociation, the self can become disorganized dis·or·gan·ize
tr.v. dis·or·gan·ized, dis·or·gan·iz·ing, dis·or·gan·iz·es
To destroy the organization, systematic arrangement, or unity of. and fragmented in response to childhood trauma, developing into Borderline Personality Disorder bor·der·line personality disorder
A personality disorder marked by a long-standing pattern of instability in interpersonal relationships, behavior, mood, and self-image that can interfere with social or occupational functioning or cause extreme (van der Kolk, 1996). Trauma, dissociation, and borderline characteristics may be important risk factors for substance abuse, unwanted sexual experiences, and sexual revictimization in women (Becker, Rankin, & Rickel, 1998; Miller 1999). However, to our knowledge sexual revictimization, dissociation, trauma-related anxiety, and borderline characteristics have not been investigated in relation to unwanted sexual experiences among gay and bisexual men. The purpose of the current study was, therefore, to extend findings reported in studies of women to men who have sex with men, and to examine revictimization as a risk factor for HIV and other sexually transmitted diseases Sexually transmitted diseases
Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely (STDs) in men who have sex with men.
Consistent with the literature on sexual revictimization, we hypothesized that behavioral risks identified among men who have been sexually coerced as adults would be accounted for by the effects of childhood sexual abuse history. Further, we hypothesized that men with histories of unwanted sexual coercion in both childhood and adulthood would evidence the greatest degree of behavioral risks, both in terms of substance use and sexual relationship risks. We also predicted that unwanted sexual contacts would be associated with symptoms of dissociation, trauma, and borderline personality. Finally, we predicted that childhood sexual abuse history, and its residual psychological symptoms of dissociation, trauma-related anxiety, and borderline personality, would predict high-risk sexual activity in adulthood.
Participants, Setting, and Procedures
To investigate sexual coercion and sexual revictimization in relation to sexual risks, 595 men attending the June 1999 gay pride festival in Atlanta were recruited to complete self-administered surveys. This festival was chosen as the site for the survey because of the over 300,000 men who attend this annual event and because previous research has shown that men who attend gay pride festivals report significant rates of high-risk sexual behaviors sexual behavior A person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life. (Hickson et al., 1996; Kalichman et al., 1998). Atlanta was selected as the site for the study because of its significant HIV infection rates. Georgia ranks eighth among U.S. states A U.S. state is any one of the fifty subnational entities of the United States, although four states use the official title "commonwealth". The separate state governments and the federal government share sovereignty, in that an American is a citizen both of the federal entity and in cumulative number of AIDS cases, and over 70% of all AIDS cases in Georgia have been reported in metropolitan Atlanta. More than half of Atlanta's AIDS cases have occurred among men who have sex with men (Georgia Division of Public Health, 1998).
Participants were asked to complete an 11-page survey concerning HIV and AIDS as they walked through the area of the festival grounds where retail venders and community organizations occupied display booths, two of which were rented for the purposes of this study. Participants were told that the survey was about sexual relationships, contained personal questions about their sexual history including childhood sexual abuse, was anonymous, and required approximately 15 minutes to complete. Over 85% of men approached agreed to complete the survey. Participants' names were not collected with the survey at any time. Participants were offered $4 for completing the survey, of which half could be donated to a local AIDS service organization AIDS service organizations are community based that provide community support. While their primary function is to provide needed services to individuals with HIV, they also provide support services for their families and friends as well as conduct prevention efforts. ; 45% of the sample chose to donate their entire incentive payment.
Participants completed self-administered anonymous surveys that consisted of measures of demographic information, sexual history, substance use, sexual practices, and scales assessing dissociation, trauma-related anxiety, and borderline personality symptoms. The following sections describe these measures.
Demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. . Participants were asked their age; years of education; income; ethnicity ethnicity Vox populi Racial status–ie, African American, Asian, Caucasian, Hispanic ; home zip code zip code
System of postal-zone codes (zip stands for “zone improvement plan”) introduced in the U.S. in 1963 to improve mail delivery and exploit electronic reading and sorting capabilities. ; whether they self-identified as gay, bisexual, or heterosexual; whether they had been tested for HIV antibodies HIV antibody A self antibody specifically directed against one or more proteins or antigens on the surface of HIV, which may be minimally protective against HIV ; and, if so, the results of their most recent HIV test HIV test Various tests have been used to detect HIV and production of antibodies thereto; some HTs shown below are no longer actively used, but are listed for completeness and context. See HIV, Immunoblot. . Men were also asked if they were exclusively partnered, defined by being in a relationship with only one man for at least 6 months.
Sexual history. To assess sexual history, we asked participants to respond Yes or No to items asking whether they had been sexually abused as a child, treated for an STD (Subscriber Trunk Dialing) Long distance dialing outside of the U.S. that does not require operator intervention. STD prefix codes are required and billing is based on call units, which are a fixed amount of money in the currency of that country. , or exchanged sex for money or drugs. Participants also indicated whether a male relationship partner had ever hit them and whether they feared the consequences of asking male partners to use condoms. History of unwanted sexual contact in adulthood was assessed using an instrument adapted from a widely used measure of sexually coercive experiences in heterosexual relationships (Koss & Gidycz, 1985). We asked men three sexual coercion items: "Have you ever had sexual intercourse (anal intercourse) even though you didn't want to because a man threatened to leave you?"; "Have you ever had sexual intercourse even though you didn't want to because a man threatened to use physical force to make you?"; and "Has a man ever forced or pressured you to have sexual intercourse when you did not want to?"--each responded to as either Yes or No. We used an affirmative AFFIRMATIVE. Averring a fact to be true; that which is opposed to negative. (q.v.)
2. It is a general rule of evidence that the affirmative of the issue must be proved. Bull. N. P. 298 ; Peake, Ev. 2.
3. response to any one or more of these items to define unwanted sexual intercourse. In order to differentiate adult sexual coercion from childhood sexual abuse, we also asked participants to report their age at which these events occurred. Sexual coercion occurring after age 16 was defined as an adult experience. Therefore, sexually coercive experiences in adulthood in this study included those that occurred during late adolescence adolescence, time of life from onset of puberty to full adulthood. The exact period of adolescence, which varies from person to person, falls approximately between the ages 12 and 20 and encompasses both physiological and psychological changes. .
Substance use. Participants were asked if they had used two legal substances (tobacco and alcohol) and 5 illegal substances (marijuana marijuana or marihuana, drug obtained from the flowering tops, stems, and leaves of the hemp plant, Cannabis sativa (see hemp) or C. indica; the latter species can withstand colder climates. , nitrite nitrite
Any salt or ester of nitrous acid (HNO2). The salts are inorganic compounds with ionic bonds, containing the nitrite ion (NO2−) and any cation. inhalants inhalants,
n.pl 1. chemical vapors that are inhaled for their mind-altering effects.
2. in herbology, volatile herbal compounds that are delivered by holding a soaked pad to the nose and mouth, by placing the herbs in steaming water, or or poppers poppers Drug slang A regional street term for amyl nitrate or isobutyl nitrite , powder and crack cocaine, and methamphetamine methamphetamine (mĕth'ămfĕt`əmēn): see amphetamine; methedrine. ) in the previous 6 months. Participants also indicated whether they had used drugs in a sexual context in the past 6 months and whether they had received substance abuse treatment in their lifetime. Responses to these items were coded as dichotomous di·chot·o·mous
1. Divided or dividing into two parts or classifications.
2. Characterized by dichotomy.
di·chot variables, Yes/No.
Sexual practices. Sexual behavior was measured by asking participants to report the number of times they had engaged in anal intercourse, as the insertive partner and as the receptive receptive /re·cep·tive/ (re-cep´tiv) capable of receiving or of responding to a stimulus. partner (responded to separately), as well as the number of times they used or did not use condoms during anal intercourse in the past 6 months. We were particularly interested in anal intercourse because of the high risk that this behavior poses for HIV transmission. Participants also recorded the number of sexual partners with whom they had engaged in each behavior in the previous 6 months. Open response formats were used for the sexual behavior measures to reduce response bias and to minimize measurement error. Measures similar to these have been found reliable in self-reported sexual behavior assessments (Kauth, St. Lawrence, & Kelly, 1991).
Dissociation experiences. To assess symptoms of dissociation, we used six items adapted from the Detachment detachment /de·tach·ment/ (de-tach´ment) the condition of being separated or disconnected.
detachment of retina , retinal detachment subscale of the Dissociative dissociative /dis·so·ci·a·tive/ (-so´se-a´tiv) pertaining to or tending to produce dissociation. Processes Scale that reflected tendencies to feel separated from one's own thoughts and actions (Harrison & Watson, 1996). Example items include "I often lose track of time," "Things around me feel unreal," and "My mind and my body do not feel like they are connected to each other," responded to on 4-point scales (1 = Very Much Like Me, 4 = Very Much Not Like Me, scores range from 6 to 24). The six dissociation items used in the current study were internally consistent, alpha = .82.
Trauma-related anxiety symptoms. To assess trauma-related anxiety, we developed three items that reflect long-term anxiety symptoms that are commonly associated with traumatic events A traumatic event is an event that is or may be a cause of trauma. The term may refer to one of the followiong:
Borderline personality. We used six items from the Borderline Personality scale of the Schedule for Nonadaptive and Adaptive Personality (SNAP) to assess borderline personality characteristics that parallel the diagnostic criteria for Borderline Personality Disorder (Clark, 1993). Sample items include "Sometimes I get so upset I feel like hurting myself," "I'll do almost anything to keep someone from leaving me," and "My mood sometimes changes without good reason," responded to on a 4-point scale (1 = Very Much Like Me, 4 = Very Much Not Like Me, scores range from 6 to 24). The six borderline personality items were internally consistent, alpha = .83.
Data Quality Assurances and Statistical Analyses.
All surveys were examined for inconsistencies and invalid responses. Missing data were omitted from analyses, resulting in slightly different degrees of freedom for various statistical tests. To investigate factors associated with a history of adult sexual coercion, men were classified as either having or not having experienced unwanted sexual contact since age 16. This classification was based on responses to the items directly asking whether men had experienced sexual coercion resulting from threats of abandonment, threats of force, and use of pressure or force, and the age when these events occurred. The resulting groups, men who had been sexually coerced since age 16 and men who had not, were compared on demographic, substance use, and sexual relationship risks using multiple logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. analyses with a likelihood ratio procedure. We first examined the associations between unwanted sexual experiences in adulthood with substance use and risk behaviors. In these analyses, education, ethnicity, income, and HIV status were entered first as covariates, with predictor variables Noun 1. predictor variable - a variable that can be used to predict the value of another variable (as in statistical regression)
variable quantity, variable - a quantity that can assume any of a set of values entered in the next step. To test the hypothesis that childhood sexual abuse accounts for associations between unwanted sexual contact and risk behaviors, the regression analyses were repeated to include history of childhood sexual abuse as a covariate. Adjusted odds ratios and their associated 95% confidence intervals confidence interval,
n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. are reported.
A second set of analyses was conducted to compare men with histories of adulthood and childhood unwanted sexual experiences. For these analyses, we constructed four groups: (a) men who had not experienced unwanted sexual contacts in either childhood or adulthood, (b) men who were sexually coerced as adults but did not experience childhood sexual abuse, (c) men who were sexually abused as children but were not sexually coerced as adults, and (d) men who were both sexually coerced as adults and sexually abused as children. Group comparisons were conducted on categorical That which is unqualified or unconditional.
A categorical imperative is a rule, command, or moral obligation that is absolutely and universally binding.
Categorical is also used to describe programs limited to or designed for certain classes of people. variables using contingency table contingency table
A statistical table that shows the observed frequencies of data elements classified according to two variables, with the rows indicating one variable and the columns indicating the other variable. chi-square tests chi-square test: see statistics. . For four group comparisons, we followed significant omnibus omnibus: see bus. chi-square tests by partitioning To divide a resource or application into smaller pieces. See partition, application partitioning and PDQ. the contingency table with single degrees of freedom multiple comparisons using procedures recommended by Kimball (1954). This method divides the larger table into a series of 2 X 2 contingency tables such that the sum of the partitioned par·ti·tion
a. The act or process of dividing something into parts.
b. The state of being so divided.
a. chi-square values equals that of the larger table. In addition, to correct for inflated error resulting from multiple group comparisons within sets of conceptually related variables, we used a modified Bonferroni correction In statistics, the Bonferroni correction states that if an experimenter is testing n independent hypotheses on a set of data, then the statistical significance level that should be used for each hypothesis separately is 1/n provided by Keppel (1982). In this modification, the alpha level is adjusted for the number of within-set comparisons by multiplying the standard alpha value (p [is less than] .05) by the degrees of freedom for the comparison, and dividing that value by the number of within-set comparisons performed. We applied this correction for all comparisons that were not preceded or followed by a multivariate The use of multiple variables in a forecasting model. test.
We conducted a 2 (experienced unwanted sexual contact in adulthood) x 2 (experienced childhood sexual abuse) multivariate analysis multivariate analysis,
n a statistical approach used to evaluate multiple variables.
n a set of techniques used when variation in several variables has to be studied simultaneously. of covariance Covariance
A measure of the degree to which returns on two risky assets move in tandem. A positive covariance means that asset returns move together. A negative covariance means returns vary inversely. (MANCOVA MANCOVA Multivariate Analysis of Covariance ), controlling for education, ethnicity, income, and HIV status for comparisons on the three psychiatric symptom scales: dissociation, trauma, and borderline personality symptoms. This analysis provided independent tests for the effects of unwanted sexual experiences occurring in adulthood and childhood, as well as the interaction between the two groups.
Finally, we conducted a hierarchical multiple logistic regression analysis using two or more unprotected anal intercourse partners as a single index of high-risk sexual behavior. Four blocks of predictor variables were entered in the following sequence: demographic characteristics, substance use, psychiatric symptom scales, and history of childhood and adulthood sexual victimization victimization Social medicine The abuse of the disenfranchised–eg, those underage, elderly, ♀, mentally retarded, illegal aliens, or other, by coercing them into illegal activities–eg, drug trade, pornography, prostitution. . This analysis, therefore, tested the association between unwanted sexual experiences in adulthood and childhood and high-risk sexual behavior over and above other factors commonly associated with risk.
Among the 595 participants, the median age was 33 (range, 17-72) and the median years of education completed was 15 (range, 7-17). The majority of the sample was White (71%), with the remaining participants being African-American (21%), Hispanic (3%), and other ethnic backgrounds (5%). Twenty-six percent (n = 156) of participants had annual incomes below $20,000, 27% (n = 162) had incomes between $21,000-$30,000, and 49% (n = 274) earned over $30,000 annually. Eighty-six percent of the sample self-identified as gay, 12% bisexual, and 2% heterosexual. Seventy-seven percent of participants were from Georgia, with the majority from the metropolitan Atlanta area. The majority of men (88%) had been tested for HIV antibodies; of those 76% tested HIV negative, 23% HIV positive, and 1% did not know their test results.
History of Unwanted Sexual Contact
One in three men (n = 210, 35%) reported a lifetime history of unwanted sexual intercourse resulting from threats or use of force. Distinguishing between unwanted sexual experiences in adulthood from those in childhood showed that 121 men experienced sexual coercion as adults and 129 had been sexually abused as a child. There was, however, substantial revictimization reported by men in this sample: 40 (3%) men who were sexually coerced as adults also reported childhood sexual abuse, a significantly greater rate of sexual abuse than the 18% of men who were not sexually coerced as adults, [chi square chi square (kī),
n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies. ] (N 595, df 1) = 11.58, p [is less than] .001.
Among men who were sexually coerced as adults (n = 121), 44% (n = 53) had unwanted sexual intercourse because a man threatened abandonment, 50% (n = 60) indicated that unwanted intercourse INTERCOURSE. Communication; commerce; connexion by reciprocal dealings between persons or nations, as by interchange of commodities, treaties, contracts, or letters. occurred because a man threatened to use force, and 53% (n = 64) experienced unwanted intercourse as a result of force, with 37% (n = 45) of coerced men experiencing more than one type of adulthood sexual coercion. The average age of first unwanted sexual intercourse in adulthood was 21.8 years (SD = 8.3) and the average age of the man who was sexually coercive at that first occurrence was 29.4 (SD = 13.7). It was also common for participants to report multiple sexually coercive experiences as adults, with 48% (n = 58) of men reporting three or more sexually coercive adult experiences. Comparisons on demographic characteristics showed that men who had been sexually coerced as adults were significantly less educated, more likely to be ethnic minorities, of lower-income levels, and more likely to have tested positive for HIV antibodies (see Table 1).
Table 1. Demographic Characteristics Among Men Who Have Sex with Men Who Experienced Unwanted Sexual Contacts Since Age 16 and Men Who Have Not. Have not experienced Experienced unwanted sexual unwanted sexual contact contact Characteristic M SD M SD Age 34.6 9.3 33.9 8.9 Years of education 14.8 2.0 13.8 2.3 N % N % Race White 359 76 61 52 African-American 77 16 47 40 Hispanic 15 3 3 3 Other ethnicities 23 5 7 6 Income < $20,000 103 22 53 45 $21-30,000 130 27 32 27 > $31,000 141 51 33 28 Not sexually active 81 17 20 17 Not an exclusive partner 186 40 50 42 Exclusive partner < 6 months 57 12 24 20 > 6 months 146 31 26 22 Sexual orientation Gay 417 88 95 81 Bisexual 50 11 22 19 Heterosexual 5 1 1 1 Tested for HIV 408 80 102 88 HIV Seropositive 78 19 37 37 Characteristic t p Age .7 ns Years of education 4.5 .001 [chi square] p Race White African-American Hispanic Other ethnicities 33.4 .001 Income < $20,000 $21-30,000 > $31,000 31.3 .001 Not sexually active Not an exclusive partner Exclusive partner < 6 months > 6 months 7.3 ns Sexual orientation Gay Bisexual Heterosexual 5.7 ns Tested for HIV 4.6 ns HIV Seropositive 29.2 .001 Note. Ns vary due to missing data.
Unwanted Sexual Contact and Behavioral Risks
Men who experienced pressured or forced (unwanted) sexual intercourse as adults were compared to those who had not been pressured or forced as adults. Multiple regression Multiple regression
The estimated relationship between a dependent variable and more than one explanatory variable. analyses, controlling for years of education, ethnicity, income level, and HIV status showed that men with a history of adult unwanted sexual contact were significantly more likely to report crack cocaine and nitrite inhalant inhalant /in·hal·ant/ (in-hal´ant)
1. something meant to be inhaled; see inhalation (def. 3).
2. a class of psychoactive substances whose volatile vapors are subject to abuse. use than men who had not been coerced as adults. In addition, coerced men were more likely to have received substance abuse treatment. With respect to sexual relationship risks, men who had been sexually coerced were more likely to report unprotected anal intercourse as the insertive partner, any unprotected anal intercourse, and were more likely to have had two or more unprotected anal intercourse partners in the preceding 6 months. Unwanted sexual intercourse was also associated with having exchanged sex for money or drugs. We also found that men with a history of unwanted sexual intercourse were more likely to have been physically assaulted by a male partner and were significantly more likely to report being afraid to request male partners to use condoms (see Table 2). In a test of the revictimization hypothesis, these results remained significant with only slight changes in the observed odds ratios after adjusting for history of child sexual abuse.
Table 2. Substance Use and Sexual Relationship Risks Men Who Have Sex with Men With and Without a History of Unwanted Sexual Contact Have not experienced Experienced unwanted unwanted sexual sexual contact contact (N = 474) (N = 121) N % N % Substance use Tobacco 166 35 58 48 Alcohol 404 87 96 81 Marijuana 126 27 43 39 Powder cocaine 41 9 22 20 Crack cocaine 15 3 21 19 Nitrites 98 21 32 30 Methamphetamine 28 6 16 15 Used drugs as part of sex 57 13 24 22 Treated for substance abuse 44 9 34 28 Sexual behaviors Unprotected insertive anal intercourse 182 40 56 51 Unprotected receptive anal intercourse 170 38 53 47 Any unprotected anal intercourse 224 50 69 63 Unprotected anal intercourse with 2+ partners 51 12 33 31 Treated for an STD 125 26 47 40 Traded sex for money or drugs 60 13 43 36 Physically assaulted by male partner 117 25 70 58 Fears requesting partner to use condoms 7 2 28 23 Adjusted Adjusted for demographics for CSA history OR 95% CI OR 95% CI Substance use Tobacco 1.4 .8-2.2 1.4 .9-2.3 Alcohol 1.0 .5-1.9 1.0 .5-1.9 Marijuana 1.2 .7-2.0 1.3 .8-2.1 Powder cocaine 1.9 .9-3.7 1.9 .9-3.7 Crack cocaine 3.7 1.6-8.6 3.5 1.5-8.2 Nitrites 1.8 1.1-3.1 1.8 1.1-3.1 Methamphetamine 1.8 .8-3.9 1.8 .8-3.9 Used drugs as part of sex 1.5 .8-2.8 1.6 .9-2.9 Treated for substance abuse 2.0 1.1-3.8 2.0 1.1-3.6 Sexual behaviors Unprotected insertive anal intercourse 1.6 1.0-2.4 1.7 1.2-3.3 Unprotected receptive anal intercourse 1.4 .9-2.2 1.4 .9-2.3 Any unprotected anal intercourse 1.6 1.0-2.6 1.7 1.0-2.7 Unprotected anal intercourse with 2+ partners 2.8 1.6-5.3 3.0 1.6-5.4 Treated for an STD 1.6 .9-2.6 1.6 .9-2.6 Traded sex for money or drugs 2.3 1.3-3.9 2.3 1.3-3.9 Physically assaulted by male partner 4.4 2.7-7.3 4.5 2.7-7.4 Fears requesting partner to use condoms 26.3 7.4-94.2 27.8 7.5-102.4 Note. CSA = childhood sexual abuse.
Sexual Revictimization and Behavioral Risks
To investigate the potential effects of child sexual abuse history and sexual revictimization in childhood and adulthood on behavioral risk factors, we compared four groups of men who were subdivided according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. their history of unwanted sexual contacts in adulthood and childhood. As shown in Table 3, men with a history of unwanted sexual contact as both adults and children were most likely to report tobacco use and powder cocaine, crack cocaine, and methamphetamine use in the previous 6 months. In addition, men who had been sexually abused and sexually coerced were more likely to have been treated for substance abuse. In each case, men who reported sexual victimization as either an adult or a child reported a greater likelihood to use substances than men who had not been sexually violated vi·o·late
tr.v. vi·o·lat·ed, vi·o·lat·ing, vi·o·lates
1. To break or disregard (a law or promise, for example).
2. To assault (a person) sexually.
3. (see Table 3). Most of the risks identified among revictimized men parallel risks of men with only a history of unwanted sexual contact in adulthood.
Table 3. Substance Use and Sexual Relationship Risks Among Men with Adult Unwanted Sexual Contact and Childhood Sexual Abuse Histories Neither adult coercion nor Adult child sexual abuse sexual coercion (N = 385) (N = 81) N % N % Legal Substances Tobacco 125 [33.sup.a] 33 [41.sup.b] Alcohol 333 88 66 84 Illegal Substances Marijuana 101 27 28 37 Powder cocaine 32 [9.sup.a] 15 [20.sup.b] Crack cocaine 11 [3.sup.a] 12 [16.sup.b] Nitrites 81 22 24 32 Methamphetamine 22 [6.sup.a] 9 12 Used drugs as part of sex 46 13 14 19 Treated for substance abuse 32 [8.sup.a] 15 [19.sup.b] Sexual risk behaviors Unprotected insertive anal intercourse 157 [43.sup.a] 41 [55.sup.b] Unprotected receptive anal intercourse 135 37 37 49 Any unprotected anal intercourse 186 [52.sup.a] 49 [65.sup.b] Unprotected anal intercourse with 2+ partners 37 [11.sup.a] 23 [32.sup.b] Sexual risk history Treated for an STD 100 [26.sup.a] 31 [38.sup.b] Traded sex for money or drugs 43 [11.sup.a] 27 [33.sup.b] Fears requesting partner to use condoms 4 [1.sup.a] 12 [15.sup.b] Physically assaulted by partner 81 [21.sup.a] 44 [54.sup.c] Both adult coercion Childhood sexual and childhood abuse sexual abuse (N = 89) (N = 40) N % N % Legal Substances Tobacco 40 [45.sup.b] 25 [63.sup.b] Alcohol 70 81 29 76 Illegal Substances Marijuana 25 29 15 43 Powder cocaine 9 11 7 [21.sup.b] Crack cocaine 4 [5.sup.a] 8 [24.sup.b] Nitrites 17 20 8 24 Methamphetamine 6 [7.sup.a] 7 [20.sup.b] Used drugs as part of sex 11 [13.sup.a] 10 [29.sup.b] Treated for substance abuse 12 [14.sup.ab] 18 [45.sup.c] Sexual risk behaviors Unprotected insertive anal intercourse 25 [29.sup.c] 15 43 Unprotected receptive anal intercourse 35 41 16 44 Any unprotected anal intercourse 38 [45.sup.a] 20 59 Unprotected anal intercourse with 2+ partners 13 [16.sup.a] 10 [29.sup.b] Sexual risk history Treated for an STD 25 28 21 [57.sup.b] Traded sex for money or drugs 17 [19.sup.c] 23 [59.sup.b] Fears requesting partner to use condoms 3 [2.sup.a] 23 [59.sup.c] Physically assaulted by partner 36 [40.sup.b] 26 [68.sup.c] Both adult coercion and childhood Significance sexual abuse after (N = 40) correction [chi square] p Legal Substances Tobacco 17.2 .001 (*) Alcohol 6.5 ns ns Illegal Substances Marijuana 6.3 ns ns Powder cocaine 11.1 .01 (*) Crack cocaine 36.6 .001 (*) Nitrites 4.2 ns ns Methamphetamine 11.1 .01 (*) Used drugs as part of sex 8.1 .05 ns Treated for substance abuse 4.1 .001 (*) Sexual risk behaviors Unprotected insertive anal intercourse 11.0 .01 (*) Unprotected receptive anal intercourse 4.2 ns ns Any unprotected anal intercourse 7.4 .06 ns Unprotected anal intercourse with 2+ partners 24.7 .001 (*) Sexual risk history Treated for an STD 8.7 .03 (*) Traded sex for money or drugs 40.1 .001 (*) Fears requesting partner to use condoms 115.6 .001 (*) Physically assaulted by partner 66.3 .001 (*) Note. Percents with different superscripts are significantly different from each other, p [is less than] .05, (*) indicates difference is significant using p value adjusted for inflated error.
Contrary to the revictimization hypotheses, we found that men with a history of sexual coercion as adults, regardless of their history of childhood sexual abuse, were most likely to report unprotected insertive anal intercourse, multiple unprotected anal intercourse partners, and relationship violence. However, men who had been sexually abused as children and revictimized as adults were most likely to have been treated for an STD and most likely to have exchanged sex for money or drugs. Also consistent with the revictimization hypothesis, we found that men who had been revictimized were the most likely to fear the consequences of requesting partners to use condoms.
Unwanted Sexual Experiences and Symptoms of Dissociation, Trauma, and Borderline Personality
Results of a MANCOVA testing differences between men who had a history of unwanted sexual contacts in adulthood and childhood, controlling for participant education, ethnicity, income, and HIV status, indicated a multivariate main effect for having experienced unwanted sex as an adult, Wilks' Lambda (3, 460) = .93, p [is less than] .001. Subsequent ANCOVAs (all F's df = 1, 462) showed that sexually coerced men reported greater dissociation symptoms, F = 4.27, p [is less than] .05, trauma-related anxiety symptoms, F = 14.64, p [is less than] .001, and borderline personality characteristics, F = 28.73, p [is less than] .001. In addition, there was a significant main effect for history of childhood sexual abuse, Wilks' Lambda (3, 460) = .97, p [is less than] .01; men with a history of childhood sexual abuse reported greater symptoms of borderline personality, F = 6.09, p [is less than] .01, with nonsignificant non·sig·nif·i·cant
1. Not significant.
2. Having, producing, or being a value obtained from a statistical test that lies within the limits for being of random occurrence. differences between groups for dissociation and trauma-related anxiety symptoms. Finally, results indicated a significant interaction effect between the two types of sexual violation sexual violation A form of sexual misconduct defined as physician-patient sexual relations, regardless of who initiated the relationship, which includes genital intercourse, oral sexual contact, anal intercourse, mutual masturbation. histories, Wilks' Lambda (3, 460) = .97, p [is less than] .01. Subsequent ANCOVAs indicated a significant interaction on borderline personality characteristics, F = 4.49, p [is less than] .05, with nonsignificant differences for the other two scales. Further analyses showed that only men who had experienced both adult and childhood sexual coercion scored above the mean on any of the symptom indexes, and that was for borderline symptoms.
Multivariate Prediction of High-Risk Sexual Behavior
A major purpose of the present study was to extend the research literature by investigating the independent effects of sexual coercion on sexual risk behavior in men who have sex with men. We therefore conducted a hierarchical multiple logistic regression analysis, using multiple unprotected anal intercourse partners in the past 6 months as the criterion variable and four blocks of predictor variables: (a) participant education, ethnicity, income, and HIV status; (b) powder cocaine, crack cocaine, and nitrite inhalant use in the past 6 months; (c) scores on the dissociation, trauma-related anxiety, and borderline personality scales; and (d) childhood sexual abuse and adult unwanted sexual contact experiences. Adjusted Odds Ratios (OR) and their associated 95% Confidence Intervals (CI) are reported. Results showed that lower participant income, OR = 1.6, CI = 1.1 - 2.2, a positive HIV status, OR = 2.3, CI = 1.2 - 4.5, and greater powder cocaine use, OR = 4.2, CI = 1.9 - 9.3, significantly predicted multiple unprotected anal intercourse partners. In addition, having been sexually coerced in adulthood significantly predicted multiple unprotected partners, OR = 2.9, CI = 1.4 - 5.7, whereas childhood sexual abuse history did not, OR = 1.1, CI = .5 - 2.2, demonstrating the independent effects of unwanted sexual contact in adulthood on sexual risk behavior.
Results of the current study replicated and extended previous research and confirmed a study hypothesis to show that men with unwanted sexual experiences are at increased risk for multiple behavioral risks including substance abuse, trading sex for drugs, and relationship violence (Leigh, 1990). Sexual coercion in men is also likely to involve unprotected anal intercourse, placing them at high risk for HIV and other sexually transmitted infections (Kalichman & Rompa, 1995). Similar to studies of women (Koss et al., 1987; Whitmire et al., 1999) and other studies of sexual coercion of men (Struckman-Johnson & Struckman-Johnson, 1994; Waterman et al., 1989), one in three men reported a lifetime history of unwanted sexual contact. In support of a study hypothesis, sexually coerced men reported significantly greater substance abuse, unprotected sexual behaviors, and psychological symptoms of dissociation, trauma-related anxiety, and borderline characteristics than men who had not been coerced. However, contrary to our hypothesis, these findings remained significant even after accounting for childhood sexual abuse history. Again contrary to what we expected, childhood sexual abuse history alone was not independently associated with substance abuse or sexual risk behaviors.
Revictimization was common in our sample, with one third of men who experienced sexual coercion as adults also reporting a history of childhood sexual abuse. Sexual revictimization in men who have sex with men was not associated with dissociation or trauma-related anxiety in the current sample. Men who were sexually victimized both as a child and as an adult scored above the mean on borderline personality symptoms. Consistent with the emotional and relationship dependence of borderline personality (Becker et al., 1998), men with a history of revictimization were by far the most likely to state that they feared the consequences of requesting partners to use condoms. Studies show that (a) women with repeated abuse experience long-term emotional consequences (Koopman, Gore-Felton, & Spiegel, 1997), (b) fear can be a significant barrier to requesting condom 1. condom - The protective plastic bag that accompanies 3.5-inch microfloppy diskettes. Rarely, also used of (paper) disk envelopes. Unlike the write protect tab, the condom (when left on) not only impedes the practice of SEX but has also been shown to have a high failure use, and (c) failure to request condom use places people at risk for HIV infection (Kalichman et al., 1998; van der Straten, King, Grinstead, Serufilira, & Allen, 1995; Wingood & DiClemente, 1997). Efforts to reduce HIV and STD transmission risks among sexually revictimized men will therefore require mental health as well as public health strategies.
This study was conducted using a convenience sample of gay and bisexual men attending a large gay pride event in a city in the southeastern United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. that has a substantial AIDS case rate. Similar to other community-based research with men who have sex with men, our sample was predominantly pre·dom·i·nant
1. Having greatest ascendancy, importance, influence, authority, or force. See Synonyms at dominant.
2. White, of upper-income levels, and highly educated. It is also likely that our sample underrepresents men who are not open about their sexual orientation sexual orientation
The direction of one's sexual interest toward members of the same, opposite, or both sexes, especially a direction seen to be dictated by physiologic rather than sociologic forces. . There is considerable literature documenting social and cultural aspects of homosexuality in the southern United States The Southern United States—commonly referred to as the American South, Dixie, or simply the South—constitutes a large distinctive region in the southeastern and south-central United States. that should also be considered when interpreting our findings. Fundamental religious beliefs; a relative lack of cultural diversity; restrictive community boundaries around class, race, and gender; unbending views of child and adolescent behavior; and an emphasis on relationships to land, home, and family serve as strong forces in shaping sexual identities in the South (Sears, 1991). These powerful cultural influences may account for regional differences in substance use and psychological adjustment among members of southern gay communities (Sears, 1991; Skinner Skin·ner , B(urrhus) F(rederick) 1904-1990.
American psychologist. A leading behaviorist, Skinner influenced the fields of psychology and education with his theories of stimulus-response behavior. & Otis, 1996). Therefore, limitations of our sample caution against over-generalizing our findings to broader populations of men who have sex with men, and all of our study findings require replication with samples drawn from different geographical regions.
Our study also used a cross-sectional survey method, precluding any inferences of causation causation
Relation that holds between two temporally simultaneous or successive events when the first event (the cause) brings about the other (the effect). According to David Hume, when we say of two types of object or event that “X causes Y” (e.g. regarding sexually coercive experiences, psychological symptoms, and sexual risk behaviors. Participants were asked to self-identify situations of sexual pressure or force, and how individuals define such situations is open to subjective interpretation. Our definition of unwanted sexual experiences also combined sexual pressure and sexual force, situations that are likely to have distinct consequences. Therefore, research using more sensitive methods, such as in-depth interviewing techniques, is required to confirm our study findings. Our survey method also relied on self-report of sensitive and often stigmatized experiences and behaviors. The potential for social desirability influences were minimized by anonymous survey procedures, and high rates of sexual abuse, unwanted sexual contact, substance use, multiple sexual partners, and unprotected anal intercourse reported by this sample suggests that participants were primarily honest in their responses. Nevertheless, surveys such as the one reported here can yield biased information, and such biases must be considered when interpreting our study findings. Finally, our measures of sexual coercion may have resulted in inaccurate response patterns (Ross & Allgeier, 1996), and our scales assessing dissociation, trauma, and borderline symptoms resulted in skewed skewed
curve of a usually unimodal distribution with one tail drawn out more than the other and the median will lie above or below the mean.
skewed Epidemiology adjective Referring to an asymmetrical distribution of a population or of data scores with responses for the entire sample below the scale midpoints. Thus, restricted ranges may have reduced the sensitivity of our measures and should be considered when interpreting our results (Allgeier & Lamping, 1998).
We conclude that unwanted sexual experiences represent a prevalent and pervasive problem for men who have sex with men. A complex matrix of substance abuse, dissociation, anxiety, and personality disturbances occur with high-risk sexual behavior in men who have been sexually coerced to a greater extent than men who have not been coerced. Although these characteristics were not associated with childhood sexual abuse, it appears that men who experience unwanted sexual contacts as adults and as children were more vulnerable to some of the behavioral risks we examined. The study results require replication and confirmation using more diverse samples from other geographical regions and the use of more sensitive methodologies. Nevertheless, our findings suggest that interventions are needed to address sexual coercion in the sexual relationships of men who have sex with men. Interventions may draw from the successes of programs developed for reducing sexual coercion in heterosexual relationships (Muehlenhard et al., 1991; Parott, 1998). Many of the strategies used for preventing sexual coercion have also been successful in HIV risk reduction interventions, including sexual assertiveness assertiveness /as·ser·tive·ness/ (ah-ser´tiv-nes) the quality or state of bold or confident self-expression, neither aggressive nor submissive. and communication skills training and interventions to address alcohol and substance use in sexual contexts (Kalichman et al., 1998). Therefore, the same skills-building techniques used to prevent HIV risk behavior and sexual coercion can be brought together to simultaneously address these two related problems. Prevention of both sexual coercion and HIV infection will likely be improved through such integrated approaches.
Table 4. Symptoms of Dissociation, Trauma, and Borderline Personality Among Men with Adult Unwanted Sexual Contact and Childhood Sexual Abuse Histories Neither adult coercion nor child Adult sexual sexual abuse coercion (N = 385) (N = 81) M SD M SD Dissociative experiences 10.5 3.8 12.3 4.1 Trauma symptoms 3.9 2.6 5.3 2.6 Borderline characteristics 10.2 3.8 12.5 4.1 Both adult coercion and Childhood childhood sexual sexual abuse abuse (N = 89) (N = 40) M SD M SD Dissociative experiences 11.2 3.9 12.7 5.4 Trauma symptoms 3.9 2.5 5.5 2.6 Borderline characteristics 10.5 3.8 15.2 4.6 ASC CSA NT Dissociative experiences * Trauma symptoms * Borderline characteristics * * * Note. ASC = Main effect for adult sexual coercion; CSA = Main effect for childhood sexual abuse; INT = interaction effect for adult sexual coercion x childhood sexual abuse. * p < .05.
Allgeier, E. R., & Lamping, J. (1998). Theories, politics, and sexual coercion. In P. Anderson & C. Struckman-Johnson (Eds.), Sexually aggressive sexually aggressive adjective Relating to potentially violent behavior focused on gratification of sexual drives, regardless of the desire for participation on the part of the partner. See Sexually dangerous. women: Current perspectives and controversies (pp. 49-75). New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : Guilford Publications.
Arata, C. M. (1999). Repeated sexual victimization and mental disorders mental disorders: see bipolar disorder; paranoia; psychiatry; psychosis; schizophrenia. in women. Journal of Child Sexual Abuse, 7, 1-17.
Bartholow, B., Doll, L., Joy, D., Douglas, J., Bolan, G., Harrison, J., Moss, P., & McKirnan, D. (1994). Emotional, behavioral, and HIV risks associated with sexual abuse among adult homosexual and bisexual men. Child Abuse and Neglect, 9, 747-761.
Becker, E., Rankin, E., & Rickel, A. (1998). High-risk sexual behavior: Interventions with vulnerable populations. New York: Plenum In a building, the space between the real ceiling and the dropped ceiling, which is often used as an air duct for heating and air conditioning. It is also filled with electrical, telephone and network wires. See plenum cable. Press.
Carballo-Dieguez, A., & Dolezal, C. (1995). Association between a history of childhood sexual abuse and adult HIV-risk sexual behavior in Puerto Rican Puer·to Ri·co
Abbr. PR or P.R.
A self-governing island commonwealth of the United States in the Caribbean Sea east of Hispaniola. men who have sex with men. Child Abuse and Neglect, 5, 595-605.
Clark, L. A. (1993). Schedule for nonadaptive and adaptive personality manual for administration, scoring, and interpretation. Minneapolis, MN: University of Minnesota Press The University of Minnesota Press is a university press that is part of the University of Minnesota. External link
Doll, L. S., Joy, D., Bartholow, B., Harrison, J., Bolan, G., Douglas, J., Saltzman, L., Moss, P., & Delgado, W. (1992). Self-reported childhood and adolescent sexual abuse among adult homosexual and bisexual men. Child Abuse and Neglect, 16, 855-864.
Georgia Division of Public Health. (1998). HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome surveillance report. Atlanta, GA: Author.
Harrison, J. A., & Watson, D. (1996). Dissociative processes in normal-range functioning. Unpublished manuscript, University of Iowa Not to be confused with Iowa State University.
The first faculty offered instruction at the University in March 1855 to students in the Old Mechanics Building, situated where Seashore Hall is now. In September 1855, the student body numbered 124, of which, 41 were women. , Iowa City Iowa City, city (1990 pop. 59,738), seat of Johnson co., E Iowa, on both sides of the Iowa River; founded 1839 as the capital of Iowa Territory, inc. 1853. Among its manufactures are foam rubber, animal feed, paper, and food products. The city is the seat of the Univ. .
Hickson, F. C., Davies, P. M., Hunt, A., & Weatherburn, P. (1994). Gay men as victims of nonconsensual sex. Archives of Sexual Behavior Archives of Sexual Behavior is an academic sexology journal and the official publication of the International Academy of Sex Research.
Contributions consist of empirical research (both quantitative and qualitative), theoretical reviews and essays, clinical case , 23, 281-294.
Hickson, F., Reid, D., Davies, P., Weatherburn, P., Beardsell, S., & Keogh, P. (1996). No aggregate change in homosexual HIV risk behaviour among gay men attending the Gay Pride Festivals, United Kingdom, 1993-1995. AIDS, 10, 771-774.
Kalichman, S. C., & Rompa, D. (1995). Sexually coerced and noncoerced gay and bisexual men: Factors relevant to risk for human immunodeficiency virus human immunodeficiency virus
Human immunodeficiency virus (HIV)
A transmissible retrovirus that causes AIDS in humans. (HIV) infection. The Journal of Sex Research, 32, 45-50.
Kalichman, S. C., Williams, E., Cherry, C., Belcher, L., & Nachimson, D. (1998). Sexual coercion, domestic violence, and negotiating condom use among low-income African-American women. Journal of Women's Health Women's Health Definition
Women's health is the effect of gender on disease and health that encompasses a broad range of biological and psychosocial issues. , 7, 371-378.
Kauth, M. R., St. Lawrence, J. S., & Kelly, J. A. (1991). Reliability of retrospective assessments of sexual HIV risk behavior: A comparison of biweekly bi·week·ly
1. Happening every two weeks.
2. Happening twice a week; semiweekly.
n. pl. bi·week·lies
A publication issued every two weeks.
1. Every two weeks. , three-month, and twelve-month self-reports. AIDS Education and Prevention, 3, 207-214.
Keppel, G. (1982). Design and analysis: A researcher's handbook (2nd ed.). New York: Prentice Hall Prentice Hall is a leading educational publisher. It is an imprint of Pearson Education, Inc., based in Upper Saddle River, New Jersey, USA. Prentice Hall publishes print and digital content for the 6-12 and higher education market. History
In 1913, law professor Dr. .
Kimball, A. W. (1954). Short-cut formulas for the exact partition A reserved part of disk or memory that is set aside for some purpose. On a PC, new hard disks must be partitioned before they can be formatted for the operating system, and the Fdisk utility is used for this task. of 252 in contingency tables. Biometrics, 10, 452-458.
Koopman, C., Gore-Felton, C., & Spiegel, D. (1997). Acute stress disorder Acute Stress Disorder Definition
Acute stress disorder (ASD) is an anxiety disorder characterized by a cluster of dissociative and anxiety symptoms occurring within one month of a traumatic event. symptoms among sex abuse survivors seeking treatment. Journal of Child Sexual Abuse, 6, 65-85.
Koss, M. P., & Gidycz, C. A. (1985). Sexual experiences survey: Reliability and validity. Journal of Consulting and Clinical Psychology The Journal of Consulting and Clinical Psychology (JCCP) is a bimonthly psychology journal of the American Psychological Association. Its focus is on treatment and prevention in all areas of clinical and clinical-health psychology and especially on topics that appeal to a broad , 53, 422-423.
Koss, M. P., Gidycz, C. A., & Wisniewski, N. (1987). The scope of rape: Incidence and prevalence of sexual aggression and victimization in a national sample of higher education higher education
Study beyond the level of secondary education. Institutions of higher education include not only colleges and universities but also professional schools in such fields as law, theology, medicine, business, music, and art. students. Journal of Consulting and Clinical Psychology, 55, 162-170.
Leigh, B. C. (1990). The relationship of substance use during sex to high-risk sexual behavior. The Journal of Sex Research, 27, 199-213.
Mayall, A., & Gold, S. (1995). Definitional issues and mediating variables in the sexual revictimization of women sexually abused as children. Journal of Interpersonal in·ter·per·son·al
1. Of or relating to the interactions between individuals: interpersonal skills.
2. Violence, 10, 26-42.
Merrill, L. L., Newell, C., Gold, S., & Milner, J. (1997). Child abuse and sexual revictimization in a female Navy recruit sample. US Naval Health Research Center Report (Number 97-5), 1-21.
Messman, T. L., & Long, P. (1996). Child sexual abuse and its relationship to revictimization in adult women: A review. Clinical Psychology Review, 14, 397-420.
Miller, M. (1999). A model to explain the relationship between sexual abuse and HIV risk among women. AIDS Care, 11, 3-20.
Muehlenhard, C. L., & Cook, S. W. (1988). Men's self-reports of unwanted sexual activity. The Journal of Sex Research, 24, 58-72.
Muehlenhard, C. L., Goggins, M., Jones, J., & Satterfield, A. (1991). Sexual violence and coercion in close relationships. In K. McKinney & S. Sprecher (Eds.), Sexuality in close relationships (pp. 155-175). Hillsdale, NJ: Lawrence Erlbaum.
Muehlenhard, C. L., & Linton, M. A. (1987). Date rape date rape n. forcible sexual intercourse by a male acquaintance of a woman, during a voluntary social engagement in which the woman did not intend to submit to the sexual advances and resisted the acts by verbal refusals, denials or pleas to stop, and/or physical and sexual aggression in dating situations: Incidence and risk factors. Journal of Counseling Psychology Counseling psychology as a psychological specialty facilitates personal and interpersonal functioning across the life span with a focus on emotional, social, vocational, educational, health-related, developmental, and organizational concerns. , 34, 186-196.
Parrot, A. (1998). Meaningful sexual assault prevention programs for men. In P. Anderson & C. Struckman-Johnson (Eds.). Sexually aggressive women: Current perspectives and controversies (pp. 205-223). New York: Guilford Publications
Resnick. H.. & Seals, B. (1995. June). Assessment of violence and post-trauma reactions. Paper presented at The National Association of People With AIDS The People With AIDS (PWA) Self-Empowerment Movement was a movement of those diagnosed with AIDS and grew out of San Francisco. The PWA Self-Empowerment Movement believes that those diagnosed as having AIDS should "take charge of their own life, illness, and care, and to minimize (NAPWA NAPWA National Association of People with AIDS (since 1983; Washington, DC)
NAPWA North American Police Work Dog Association ) National Workshop on HIV and Violence, New York, NY.
Rickel, A., & Becker, E. (1997). Keeping children from harm's way harm's way
A risky position; danger: a place for the children that is out of harm's way; ships that sail into harm's way. . Washington, DC: American Psychological Association The American Psychological Association (APA) is a professional organization representing psychology in the US. Description and history
The association has around 150,000 members and an annual budget of around $70m. .
Ross, R. R., & Allgeier, E. R. (1996). Behind the pencil/paper measurement of sexual coercion: Interview-based clarification of men's interpretations of sexual experiences survey items. Journal of Applied Social Psychology, 26, 1587-1616
Sandberg, D. A., Matorin, A., & Lynn, S. (1999). Dissociation, posttraumatic posttraumatic /posttrau·mat·ic/ (post?traw-mat´ik) occurring as a result of or after injury.
Following or resulting from injury or trauma. symptomatology symptomatology /symp·to·ma·tol·o·gy/ (simp?to-mah-tol´ah-je)
1. the branch of medicine dealing with symptoms.
2. the combined symptoms of a disease.
n. , and sexual revictimzation: A prospective examination of mediator mediator n. a person who conducts mediation. A mediator is usually a lawyer, or retired judge, but can be a non-attorney specialist in the subject matter (like child custody) who tries to bring people and their disputes to early resolution through a conference. and moderator moderator - A person, or small group of people, who manages a moderated mailing list or Usenet newsgroup. Moderators are responsible for determining which email submissions are passed on to the list or newsgroup. effects. Journal of Traumatic Stress Traumatic stress is recognized by the Diagnostic and Statistical Manual of Mental Disorders  as an acute emotional condition associated with reactive anxiety. , 12, 127-138.
Sears, J. T. (1991). Growing up gay in the south: Race, gender, and journeys of the spirit. New York: Haworth Press.
Skinner, W., & Otis, M. (1996). Drug and alcohol use among lesbian and gay people in a southern U.S. sample: Epidemiological epidemiological
emanating from or pertaining to epidemiology.
the associative relationships between the frequency of occurrence of a disease and its determinants, its predisposing and precipitating , comparative and methodological findings from the Trilogy A company founded in 1979 by Gene Amdahl to commercialize wafer scale integration and build supercomputers. It raised a quarter of a billion dollars, the largest startup funding in history, but could not create its 2.5" superchip. Project. Journal of Homosexuality The Journal of Homosexuality (ISSN 0091-8369) is a long-standing peer-reviewed academic journal (founding editor Charles Silverstein) published by The Haworth Press, Inc., in New York. , 30, 59-92.
Struckman-Johnson, C. (1988). Forced sex on dates: It happens to men too. The Journal of Sex Research, 24, 234-241.
Struckman-Johnson, C., & Struckman-Johnson, D. (1994). Men pressured and forced into sexual experiences. Archives of Sexual Behavior, 23, 93-114.
Urquiza, A. J., & Goodlin-Jones, B. (1996). Child sexual abuse and adult revictimization with women of color not of the white race; - commonly meaning, esp. in the United States, of negro blood, pure or mixed.
See also: Color . Violence & Victims, 9, 223-232.
van der Kolk, B. (1996). The complexity of adaptation to trauma: Self-regulation, stimulus discrimination, and characterological development. In B. van der Kolk, A. Mcfarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on the mind, body, and society (pp. 182-213). New York: Guilford.
van der Straten, A., King, R., Grinstead, O., Serufilira, A., & Allen, S. (1995). Couple communication, sexual coercion, and HIV risk reduction in Kigali, Rwanda. AIDS, 9, 935-944.
Waterman, C. K., Dawson, L. J., & Bologna, M. J. (1989). Sexual coercion in gay male and lesbian relationships: Predictors and implications for support services support services Psychology Non-health care-related ancillary services–eg, transportation, financial aid, support groups, homemaker services, respite services, and other services . The Journal of Sex Research, 26, 118-124.
Whitmire, L. E., Harlow, L., Quina, K., & Morokoff, P. (1999). Childhood trauma and HIV: Women at risk. New York: Brunner-Mazel.
Wingood, G. A., & DiClemente, R. J. (1997). The effects of an abusive Tending to deceive; practicing abuse; prone to ill-treat by coarse, insulting words or harmful acts. Using ill treatment; injurious, improper, hurtful, offensive, reproachful. primary partner on the condom use and sexual negotiation practices of African-American women. American Journal of Public Health The American Journal of Public Health (AJPH) is a peer reviewed monthly journal of the American Public Health Association (APHA). The Journal also regularly publishes authoritative editorials and commentaries and serves as a forum for the analysis of health policy. , 87, 1016-1018.
Manuscript accepted September 5, 2000
Seth C. Kalichman, Eric Benotsch, David Rompa, Cheryl Gore-Felton, James Austin, Webster Luke, Kari DiFonzo, Jeff Buckles This article is about the comic strip. For the fastener, see Buckle
Buckles is a comic strip by David Gilbert about the misadventures of a naïve dog. Buckles debuted on March 25, 1996. , Florence Kyomugisha, and Dolores Dolores (or Delores) was a common given name (until the 1960s in the USA); it is cognate with the English word "dolorous" (meaning sorrowful) and equivalent in meaning. Simpson Medical College of Wisconsin
The authors thank the staff of AIDS Survival Project of Atlanta for their assistance with data collection and the gay community of Atlanta for their support of this research. National Institute of Mental Health The National Institute of Mental Health (NIMH) is part of the federal government of the United States and the largest research organization in the world specializing in mental illness. (NIMH) Grant R01-MH57624 and Center Grant P30 MH52776 supported this research.
Address correspondence to Seth C. Kalichman, Center for AIDS Intervention Research (CAIR CAIR Council on American-Islamic Relations
CAIR Clean Air Interstate Rule (EPA)
CAIR Center for AIDS Intervention Research
CAIR Changing Attitudes in Recovery
CAIR California Association for Institutional Research ), Medical College of Wisconsin, 8701 Watertown Plank Road a road surface formed of planks.
See also: Plank , Milwaukee. WI 53226: e-mail: firstname.lastname@example.org.