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  AIDS 2022
July 29 - Aug 2
24th Intl AIDS Conference
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View on Targeted Violence, Being a Teen, Tied to PTSD in US MSM
  AIDS 2022, July 29-August 2, Montreal
Mark Mascolini
US cisgender men who have sex with men (MSM) who attributed interpersonal targeted violence to being gay or bisexual had a 55% higher risk of post-traumatic stress disorder(PTSD) in a 2886-man nationwide survey [1]. Men who reported PTSD proved about 20% more likely to have serodiscordant condomless anal sex. (Serodiscordant here means one partner has HIV infection and the other does not.)
Researchers from San Diego State University noted prior research that found MSM bear a higher burden of interpersonal violence, often because of sexual prejudice. Such targeted violence, in turn, caries a high risk of PTSD, which also affects MSM more than some other groups. Other work ties PTSD to HIV transmission risk behaviors in MSM.
The San Diego team sought to address these issues by analyzing data from the 2020 American Men’s Internet Survey. Among 13,081 men who began the survey, 2886 (22%) answered questions about physical violence:
- Has someone ever physically hurt you (pushed, shoved, slapped, hit, kicked, choked or otherwise physically hurt you)?
- Do you believe any of these experiences of physical violence was/were related to the fact that you have sex with men?
Multivariable modified Poisson regression with robust variance estimation explored differences in prevalence of current PTSD according to whether men attributed the experience of violence to same-sex practices (that is, to being gay or bisexual), did not attribute violence to same-sex practices, or were unsure whether violence occurred because of same-sex practices. In the first Poisson regression analysis, the independent variable was violence attribution and the dependent variable PTSD. In the second Poisson analysis, the independent variable was PTSDand the dependent variable was serodiscordant condomless anal sex.
The 2886 men averaged 33.5 years in age (median 27), 9% were teens, 62% non-Hispanic white, 79% homosexual or gay-identified, and 18% bisexual. A large minority of the group, 42%, had a college degree or graduate education, 39% lived in a central metropolitan area, 11% tested positive for HIV, and 71% were HIV-negative.
Almost one quarter of men, 23%, reported serodiscordant condomless sex, and 23% had PTSD. Similar proportions of survey respondents attributed interpersonal violence to their being MSM (46%) or did not attribute violence to their same-sex practices (47%). The remaining 7% were unsure about making such an attribution.
Among men who did not make the attribution to gay sex, 18% had PTSD; among men who did make the attribution, 26% had PTSD; and among men who were unsure of the attribution, 33.5% had PTSD. Poisson regression estimated that, compared with MSM not attributing violence to having sex with men, respondents who made such an attribution ran a 55% greater risk of PTSD (adjusted prevalence ratio [aPR] 1.55, 95% confidence interval [CI] 1.34 to 1.79). And men who were unsure about making that attribution had an 80% greater risk of PTSD (aPR 1.80, 95% CI 1.44 to 2.25).
Further analysis linked younger age (15 to 19 vs 20 or older) to a greater predicted proportion with PTSD for men who attributed violence to same-sex practices (about 40% predicted PTSD prevalence for teens vs about 25% predicted prevalence for older men) and for men unsure about making that attribution (about 40% predicted prevalence for teens vs about 30% predicted prevalence for older men). Age was not associated with predicted PTSD prevalence in men who did not attribute interpersonal violence to being gay.
Compared with men without PTSD, those with PTSD had a 22% higher adjusted prevalence ratio for serodiscordant condomless sex (aPR 1.22, 95% CI 1.08 to 1.38).
The researchers concluded that MSM ran a higher risk of PTSD if they attributed interpersonal violence to sexual prejudice against gay sex. That risk ran even higher for teens and for menunsure about attributing interpersonal violence to same-sex practices. The investigators called for improved screening to identify cisgender MSM who may be exposed to violence and for longitudinal studies to establish the time sequence of HIV acquisition risk via PTSD pathways.
1. Wiginton JM, Murray S, Baral S, et al. Targeted violence as a risk factor for posttraumatic stress disorder and HIV acquisition risks among cisgender gay, bisexual, and other men who have sex with men in the United States. AIDS 2022, July 29-August 2, Montreal. Abstract OAD0504.