Childhood sexual experiences with an older partner among men who have sex with men in Buenos Aires, Argentina☆
Introduction
Childhood sexual experiences with older partners (CSEOP) are frequently studied to identify possible correlates with behaviors, emotions, and attitudes in adulthood. Some of CSEOP can be considered childhood sexual abuse (CSA). Yet, the lack of a shared definition of the latter often hinders comparisons across studies and the drawing of definite conclusions about its potential effects. For this study, we operationalized CSEOP as any sexual contact (manual, oral, genital, or anal) prior to age 13 with a partner who was at least four years older. This operationalization includes a subset of experiences that we labeled CSA, defined as a CSEOP in which the child felt emotionally or physically hurt (for a detailed discussion on the topic and rationale for our operationalization, see Carballo-Diéguez, Balan, Dolezal, & Mello, 2012).
Gay men have been found to be much more likely than heterosexual men to have experienced unwanted sexual encounters in childhood (27% vs. 1%; Finlinson et al., 2003) and to have had childhood sexual abuse involving penetration (22% vs. 6%; Balsam, Rothblum, & Beauchaine, 2005). Balsam et al. (2005) hypothesized that young men who appear to be gender non-conformant may be specifically targeted for sexual abuse because of their perceived sexual orientation.
Among MSM, a history of CSA has been associated with a wide range of negative outcomes in adulthood. Many of these outcomes are behaviors that may increase the risk of HIV transmission: unprotected receptive anal sex, unprotected sex with a serodiscordant partner, commercial sex trade, and injection drug use (Bartholow et al., 1994, Brennan et al., 2007, Carballo-Diéguez and Dolezal, 1995, Kalichman et al., 2004, Mimiaga et al., 2009). In fact, HIV prevalence has been found to be higher among men reporting CSA than those who do not (Brennan et al., 2007, Kalichman et al., 2004, Lloyd and Operario, 2012). CSA among MSM has also been associated with mental health problems, such as depression, psychological distress, suicidality, eating disorders, drug use, and requiring hospitalization for mental health conditions (Balsam et al., 2011, Bartholow et al., 1994, Feldman and Meyer, 2007, Mimiaga et al., 2009, Ratner et al., 2003).
The long list of negative outcomes emphasizes the serious consequences such experiences may have for children, even into adulthood. Yet, many children seem to survive CSA without developing such problems. In a meta-analysis of 59 studies, Rind, Tromovitch, and Bauserman (1998) concluded that negative consequences were not pervasive in most studies and that men, compared to women, were much less likely to report negative reactions (see also Dallam et al., 1998 and Ondersma, Chaffin, Berliner, Cordon, & Goodman, 1998, for a critique of Rind's article). Stanley, Bartholomew, and Oram (2004) examined psychological adjustment in a sample of MSM and found that men who reported experiences that were non-coercive and not perceived as abusive did not report poorer adjustment, and those who had coercive or abusive experiences did report poorer adjustment. Arreola, Neilands, Pollack, Paul, and Catania (2008) found childhood sexual experiences to be associated with depression and suicidal ideation but only among those who reported being forced. Those who felt the experiences were consensual did not differ from those who did not have childhood sexual experiences on depression and suicidality, although they did report more HIV transmission risk. Jinich et al. (1998) also found that the perception of having been coerced was associated with higher rates of sexual risk behavior.
In two studies of Latino MSM living in the United States (Carballo-Diéguez and Dolezal, 1995, Dolezal and Carballo-Diéguez, 2002), sexual risk behavior in adulthood was associated with CSEOP and was more frequent among those who were coerced, felt physically or emotionally hurt, or who felt their experiences constituted sexual abuse. In the later study, among MSM reporting CSEOP, those who perceived it as sexual abuse were younger at the time it happened and were more likely to report that they were forced, physically hurt, emotionally hurt, and/or threatened. Therefore, the study of early sexual experiences should take into consideration the characteristics of those experiences given that not all experiences are equally traumatic or coercive.
Several studies of MSM in the United States have found higher rates of CSA among Latinos, compared to non-Latino white participants (Arreola et al., 2005, Balsam et al., 2010, Doll et al., 1992, Newcomb et al., 2009, Parsons et al., 2005). However, little is known about the prevalence and severity of CSEOP or CSA among MSM in Latin American countries. A recent study of CSEOP among MSM in Brazil (Carballo-Diéguez et al., 2012) found that 29% of non-transgender participants had sexual contact prior to age 13 with a partner that was at least four years older, and 39% of those men reported that they were physically or emotionally hurt by the experience. Those with CSEOP reported more male sex partners than those who did not have childhood sexual experiences, but their rates of unprotected sex were not significantly different. Among those who had CSEOP, those who considered it to be sexual abuse had more unprotected insertive anal sex than those who did not, but the groups did not differ on frequency of unprotected receptive sex or number of male sex partners. Of note, Carballo-Diéguez et al. (2012) and Parker (1991) discussed the importance of taking into account cultural factors that may value differently insertive versus receptive anal intercourse, as well as popular childhood games, such as the meia or troca–troca played by boys in which partners are said to take turns masturbating, fellating or, most commonly, penetrating one another. Parker (1991) stated that:
Unfortunately, there is a dearth of similar cultural analysis of CSEOP conducted in other Latin American countries.“Just as older males instruct younger ones in the intricacies and techniques of lovemaking with women, and often even arrange for heterosexual initiation, in meia or troca-troca, the older males offer an initiation into homosexual practices by symbolically feminizing their partners. As one frequently cited expression puts it, Homem, para ser homem, tem que dar primeiro - in other words, ‘A man, in order to be a man, has to give (to take the passive role in anal intercourse) first.”’ (p. 128)
Given the insufficient information on CSEOP among MSM in Latin American countries, we explored the issue as part of a larger study designed primarily to estimate the prevalence of HIV, STIs, and sexual risk behavior among MSM in Buenos Aires, Argentina (Carballo-Diéguez et al., 2011, Pando et al., 2012). Our research questions were: (a) What is the prevalence estimate of CSEOP and CSA among MSM in Argentina? (b) What are the characteristics of those experiences? (c) Are CSEOP and CSA associated with sexual risk behavior and substance use in adulthood? and (d) To what extent do participants equate their CSEOP with CSA?
Section snippets
Methods
We used respondent driven sampling (RDS; Heckathorn, 1997, Heckathorn, 2002) to recruit MSM for this study. Recruitment procedures are described in detail elsewhere (Carballo-Diéguez et al., 2011). In brief, research staff identified 16 MSM (seeds) who purportedly had social networks that could allow them to refer other “men like them” to the study. After being interviewed, respondents were given three coupons each (with an ID number and study contact information) and were asked to distribute
The RDS Sample
Of the 16 seeds, seven did not recruit any participants and four recruited only one. By the end of recruitment, 89% of the participants could be traced back to a single seed after 22 waves of referrals. Participant's personal network size ranged from 1 to 50, with a median of 3. Further details and discussion on this RDS recruited sample appear in Carballo-Diéguez et al. (2011).
A description of the sample is found in Table 1. On average, men were slightly over 30 years old and most had not
Discussion
It is typically very difficult to compare data on childhood sexual experiences across studies because assessments and definitions vary dramatically from study to study (Purcell, Malow, Dolezal, & Carballo-Diéguez, 2004). One advantage of this study is that it used the same survey questions and the same definition of CSEOP as two other studies of Latino MSM: a convenience sample of Latino MSM living in the New York City [NYC] area (Dolezal & Carballo-Diéguez, 2002) and an RDS sample of MSM in
Conclusion
This study presents a unique sample of MSM in Buenos Aires, Argentina, among whom 25% identify as gay and sexual activity with women is common. This finding demonstrates that recruiting based on MSM in Latin American countries can result in very different kinds of men with varying experiences. CSEOP or CSA among MSM may also look quite different from country to country, both in terms of their prevalence and their characteristics.
The bisexual nature of this sample allowed for an interesting
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This research was supported by a grant from the US National Institute of Mental Health (NIMH) (R01-MH073410; Principal Investigator: Alex Carballo-Diéguez, Ph.D.). Additional support came from a grant from NIMH to the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University (P30-MH43520; Principal Investigator: Anke A. Ehrhardt, Ph.D.). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMH or the National Institutes of Health.