The relationship between sexual victimization and HIV risk behaviors and attitudes in a community sample of women: A structural equation analysis

Recent research studying the long-term effects of childhood sexual abuse (CSA) in women suggests that there is a relationship between it and risky sexual behaviors in adulthood. In this study, the relationship between CSA and HIV risk behaviors and attitudes is examined among a community sample of women. Hypothesized mediators of this relationship are: adult sexual victimization and relationship violence, psychosexual attitudes, anticipated negative partner reactions, sexual assertiveness (to refuse unwanted sex, insist on condom use, and communicate regarding HIV risk), and family of origin environment. Data from 510 women assessed at three time points each six months apart were examined using structural equation analyses. Nested comparisons assessed the importance of the proposed mediators. Cross-group comparisons examined fit in two subsamples of community and continuing education women. Longitudinal structural equation analyses suggested that as a set, the constructs could account for a large proportion of variance in the three dependent constructs: 35% of unprotected vaginal, oral, and anal sex; 20% of perception of risk; and 51% of partner risk factors. Unprotected sex was significantly predicted by more: adult sexual victimization, positive psychosexual attitudes, assertiveness regarding communication; and by less condom use assertiveness. Perceived risk was significantly predicted by anticipating a negative partner reaction and by less communication assertiveness. Partner risk was significantly predicted by adult sexual abuse and less condom use assertiveness. Nested comparisons suggested that both direct and mediated relationships were significant and that the inclusion of all mediating constructs significantly improves overall fit. CSA significantly predicted sexual victimization in adult relationships. Positive family of origin environment was significantly negatively correlated with CSA and predicted less: adult sexual abuse, relationship violence, and anticipation of a negative partner reaction to HIV assertiveness; it also significantly predicted more positive psychosexual attitudes and communication sexual assertiveness. Cross-group comparisons suggest that the pattern of relationships among constructs is largely stable across groups. It is proposed that feelings of powerlessness in sexual situations underlie this association between sexual victimization and HIV risk behaviors and attitudes. Implications for intervention with women who have experienced sexual victimization as well as limitations of the study are discussed