Early life traumatic stressors and the mediating role of post-traumatic stress disorder (PTSD) in incident HIV infection among U.S. men, comparisons by sexual orientation and race/ethnicity

Published: April 14, 2011

Abstract

BACKGROUND: Stressful life events in childhood during critical periods of development have long-term psychological and neurobiological sequelae, which may affect risk for HIV infection across the lifecourse.

METHODS: Data were from a nationally representative sample of 13,274 U.S. men (NESARC, 2004-2005). Weighted multivariable logistic regression models examined (1) the association of childhood violent events before age 18 on 12 month incident HIV infection; (2) whether post-traumatic stress disorder (PTSD) diagnosis (clinical interview) mediated the association between early life events and HIV.

RESULTS: Overall, the 12 month HIV incidence was <1% (0.35%); 44% of new infections were among racial/ethnic minorities and 31% among men who have sex with men (MSM). One third of the sample (33.5%) reported one or more early life stressors (physical abuse, sexual abuse, neglect, verbal violence, witnessed violence). In a weighted, multivariable logistic regression model adjusted for age, education, family socioeconomic position, and sexual behaviors, each additional early life violent event was associated with an elevated odds of HIV-infection (aOR=1.32; 95% CI=1.16, 1.50). Adding PTSD to this adjusted model, PTSD was highly associated with incident HIV infection (aOR=5.75; 95% CI=4.76, 6.95). There was evidence that PTSD partially mediated the relationship between and early life events and HIV (aOR=1.14; 95% CI=1.02, 1.28).

CONCLUSION: Experiencing early life violent family stressors was associated with HIV infection among men. Early life events and HIV infection were mediated by PTSD which has implications for understanding disparities in HIV infection. Interventions are urgently needed that address the long-term sequelae of childhood violence.

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