Women Who Suffer ‘Household Dysfunction’ During Childhood More Likely to Engage in Risky Sexual Behavior, Study Says
Women who suffered abuse or other types of "household dysfunction" as a child are more likely to engage in risky sexual behaviors, putting them at increased risk for HIV/AIDS, according to a new report in the September/October edition of the Alan Guttmacher Institute's Family Planning Perspectives, Reuters Health reports (Schorr, Reuters Health, 10/10). The study addresses whether "childhood adversity, including exposure to household dysfunction and varying forms of abuse and violence, has long term consequences on sexual risk behaviors." Susan Hillis, a reproductive health epidemiologist with the CDC's National Center for Chronic Disease Prevention and Health Promotion, and colleagues evaluated responses from 5,060 California women enrolled in Kaiser Permanente managed care plans. Participants were questioned on whether they had experienced any of seven "adverse childhood experiences": physical abuse, verbal abuse, sexual abuse, having a mother who suffered physical abuse, household substance abuse, a mentally ill household member or an incarcerated household member. Researchers then drew connections between the childhood experiences and three sexual risk factors -- having had 30 or more sexual partners, having had sexual intercourse before age 16 and perceiving oneself as at risk for HIV infection. Among the study findings:
- Fifty-nine percent of participants reported having at least one of the adverse childhood events.
- Three percent of participants said they perceived themselves to be at risk for HIV/AIDS, 2% said they had 30 or more sexual partners and 8% had sex before age 16.
- Each category of adverse childhood experiences was associated with an increased risk of engaging in any of the three sexual risk behaviors.
- Women who reported one adverse childhood experience were 1.8 times as likely as women with no adverse events to report having had sex before age 16. Women who reported six or seven adverse childhood events were seven times as likely to have had sex by age 16.
- Women who experienced one adverse childhood event were 1.6 times as likely as women with no adverse childhood events to have had 30 or more sexual partners. Women who reported six or seven adverse events were 8.2 times more likely to have had 30 or more sexual partners.
- Women who reported having one adverse childhood event were 1.2 times more likely to perceive themselves as at risk for HIV as women who had no adverse events. Women who reported six or seven adverse events were 4.9 times as likely to perceive themselves as at risk for the disease.
Focus on Improving Household Conditions
The researchers note that there are several limitations on the study, including the difficulty in quantifying abuse and the potential faultiness of self-reporting. However, they write that the study findings suggest that for individuals with adverse childhood experiences, risky behavior may represent "desperate attempts to achieve intimate interpersonal connections" (Hillis et al., Family Planning Perspectives, September/October 2001). "What you see here is the long term impact of having lived in an unhealthy family. These risk behaviors represent attempts to achieve intimacy that was not experienced during childhood, so people who grow up not taught intimacy are unprepared to protect themselves as adults," Hillis said in an interview with Reuters Health. She added, "While safe sex messages may be useful, it appears that if you begin to address those behaviors after they've developed, it's hard to change them" (Reuters Health, 10/10). The study concludes, "Broader interventions that focus on reducing exposure to familial violence and household dysfunction ... have been shown to achieve their desired goals. Such interventions, though more challenging, may ultimately lead to greater reduction in sexual risk behaviors decades later" (Family Planning Perspectives, September/October 2001).