Previous research has consistently found an association between childhood sexual abuse and greater rates of adult sexual risk behavior. The purpose of the proposed research is to investigate psychological processes that mediate the relation between childhood sexual abuse and adult sexual risk behavior. Improved understanding of this relationship is essential to inform the development of sexual risk reduction interventions for women who were sexually abused as children. Two conceptual models will guide the research. First, the Information-Motivation-Behavioral Skills model, an influential and empirically-supported theory of health behavior, suggests that HIV-related information, motivation, and behavioral skills are important determinants of sexual behavior;thus, child sexual abuse may lead to deficits in these areas. Alternatively, the traumagenic dynamics model, an influential and empirically-supported model of the effects of childhood sexual abuse, suggests that child sexual abuse leads to traumatic sexualization, stigmatization, betrayal, and powerlessness, and that these four traumagenic dynamics lead to adverse outcomes, including increased rates of sexual risk behavior. To evaluate these models, we will recruit 400 women from a public STD clinic. Each woman will provide written informed consent and will then complete an audio computer- assisted self-interview to assess childhood sexual experiences, adult sexual risk behavior, HIV-related information, safer sex motivation, traumatic sexualization, stigmatization, betrayal, powerlessness, and substance use. Behavioral skills will be assessed through role-plays and simulation scenarios. The collected data will be used to determine: (a) how different definitions of childhood sexual abuse affect estimates of its prevalence, and how different definitions affect the relation between childhood sexual abuse and adult sexual risk behavior;(b) which constructs mediate the relation between childhood sexual abuse and adult sexual risk behavior;and (c) which theory, the Information-Motivation-Behavioral Skills model or the traumagenic dynamics model, better mediates the relation between childhood sexual abuse and adult sexual risk behavior. The results from this research will guide the development of sexual risk reduction interventions for women who were sexually abused as children. The proposed research addresses an important public health priority, namely, reducing HIV rates among women, particularly among racial minority women, who are disproportionately affected by both childhood sexual abuse and HIV. The innovative approach used in this project will integrate two largely separate bodies of research (i.e., sexual health research and child sexual abuse research), and will use state-of-the-science statistical techniques to compare the two conceptual frameworks that have guided these separate bodies of research. Project Narrative The proposed research will lay the groundwork for developing a HIV-risk reduction intervention for women who were sexually abused as children by (a) exploring variables that mediate the relation between childhood sexual abuse and adult sexual risk behavior, and (b) comparing two prominent theoretical models that suggest different mediators of this relation. The information gained will allow for the development of a science-based intervention, which can help to reduce rates of HIV among women, particularly among racial minority women, who have higher rates of both childhood sexual abuse and HIV.
