Unwanted Sexual Experiences and Sexual Risks in Gay and Bisexual Men: Associations Among Revictimization, Substance Use, and Psychiatric Symptoms - Statistical Data Included

Journal of Sex Research, Feb, 2001 by Seth C. Kalichman, Eric Benotsch, David Rompa, Cheryl Gore-Felton, James Austin, Webster Luke, Kari DiFonzo, Jeff Buckles, Florence Kyomugisha, Dolores Simpson

Unwanted sexual experiences are common in both heterosexual 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, 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 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 (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 men in a midwestern U.S. city reporting sexual coercion. Moreover, 92% of the sexually coercive events identified by Kalichman and Rompa involved unprotected anal intercourse and therefore conferred significant risks for HIV 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 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.

Explanations for the association between child sexual abuse and unwanted sexual events in adulthood have emphasized the roles of psychiatric symptoms such as dissociation, trauma-related anxiety, and 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 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 and fragmented in response to childhood trauma, developing into Borderline Personality Disorder (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 (STDs) in men who have sex with men.