J.M. Wiginton * (1), S. Murray (2), S. Baral (3), T. Sanchez (4) (1) San Diego State University, School of Social Work, San Diego, United States, (2) Johns Hopkins University Bloomberg School of Public Health, Department of Mental Health, Baltimore, United States, (3) Johns Hopkins University Bloomberg School of Public Health, Center for Public Health & Human Rights, Department of Epidemiology, Baltimore, United States, (4) Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, United States
BACKGROUND: Posttraumatic stress disorder (PTSD) has been linked to HIV transmission risk behaviors among cisgender gay, bisexual, and other men who have sex with men (MSM) in the United States (US), and interpersonal violence carries the highest conditional risk of developing PTSD. Among MSM who have experienced interpersonal violence, characterizing risk factors for PTSD is critical to inform preventive and therapeutic intervention strategies.
METHODS: Using a 2020 nationwide cross-sectional survey of 2,886 MSM (21.5% of 13,433 MSM surveyed) who reported ever experiencing interpersonal violence, we performed multivariable modified Poisson regressions with robust variance estimators to examine differences in prevalence of current PTSD by how participants attributed the experience of violence (as occurring because of one's same-sex practices, as not occurring because of one's same-sex practices, or unsure of whether or not it occurred because of one's same-sex practices). We also examined the relationship between PTSD and past-year serodiscordant condomless anal sex. Control variables included age, education, race/ethnicity, sexual identity, urbanicity, and HIV status. Model results are reported as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI).
RESULTS: Median age of participants who experienced interpersonal violence was 27 years (interquartile range: 22-43); 78.8% identified as gay (n=2,273), and 62.2% (n=1,794) were non-Hispanic white. Interpersonal violence was attributed to same-sex practices by 45.8% (n=1,321) of participants; 46.3% (n=1,335) did not make this attribution, and 7.0% (n=203) were unsure. Overall, 23.0% (n=665) had PTSD, and PTSD prevalence was greater among participants who attributed the violence to their same-sex practices (25.9%[342/1,321]; aPR[CI]=1.54[1.33-1.78]) or who were unsure (33.5%[68/203]; aPR[CI]=1.80[1.44-2.25]) compared to those who did not make the attribution (18.1%[242/1,335]). Those who met criteria for PTSD were more likely to report serodiscordant condomless anal sex (27.0%[237/879] versus 21.3%[428/2,007]; aPR[CI]=1.22[1.08-1.38]).
CONCLUSIONS: Findings reveal the potential role of attribution in PTSD risk for violence-exposed US MSM and suggest a likely pathway between violence exposure, PTSD, and serodiscordant condomless anal sex. Future research with longitudinal designs will be needed to establish temporal ordering to test this pathway. Moreover, progress on ending the US HIV epidemic will require interventions that simultaneously address mental and sexual health among violence-exposed MSM.