The Impact of Childhood Sexual Abuse and Intimate Partner Violence on Sexually Transmitted Infections
Williams, Corrine, Larsen, Ulla, McCloskey, Laura Ann, Violence and Victims
Childhood sexual abuse (CSA) and adult intimate partner violence (IPV) have both been found to be associated with sexually transmitted infections (STIs) independently, but studies of STIs have rarely looked at victimization during both childhood and adulthood. This paper examines the relationship between CSA, IPV and STIs using data from a nested case-control study of 309 women recruited from multiple health care settings. Overall, 37.3% of women experienced no violence, 10.3% experienced CSA only, 27.3% experienced IPV only, and 25.0% experienced both CSA and IPV. Having ever been diagnosed with an STI was associated with violence (CSA only, odds ratios [OR] = 2.8, 95% confidence intervals [CI] = 1.0-7.5; IPV only, OR = 2.2, 95% CI = 1.0-4.9; CSA and IPV: OR = 4.0, 95% CI = 1.7-9.4), controlling for demographic characteristics. Women who experienced CSA were younger when they were first diagnosed. Understanding how both childhood and adult victimization are associated with diagnosis of STIs is important to reducing the incidence and prevalence of STIs, as well as the associated consequences of STIs.
Keywords: Intimate partner violence; childhood sexual abuse; women's health; sexually transmitted infections
Several studies have linked violence against women and sexually transmitted infections (STIs) worldwide ( Heise, 1994 ; Heise, Ellsberg, & Gottmoeller, 2002 ; Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002 ). Violence against women is a significant problem in the United States. A national survey found that 25% of women had ever been physically or sexually assaulted by a current or former intimate partner, and 1.5% of women were assaulted by a current or former intimate partner in the last year ( Tjaden & Thoennes, 1998 ). In a study of women accessing prenatal care in the United States, women who had ever experienced physical or sexual abuse were more likely to have reported a previous STI diagnosis (Johnson & Hellerstedt, 2002). In this same study, women with a history of sexual abuse were more than twice as likely to test positive for a current STI ( Johnson & Hellerstedt, 2002) . In a study of urban women, almost 95% of whom were African American or Latina, women who were currently being abused were more likely to have had an STI and to be more worried about contracting HIV than women who were not being abused ( Wu, El-Bassel, Witte, Gilbert, & Chang, 2003 ).
Abuse experiences occurring during childhood have been found to be associated with adult health status, including STIs. Almost one million children were the victims of abuse or neglect in 2001, and an estimated 12%-22% of adult women experienced childhood sexual abuse (CSA; Arias, 2004 ; Gorey & Leslie, 1997) . In a sample of gynecology patients, women who reported any history of child abuse were more likely to report frequent gynecological problems and vaginal infections ( Moeller, Bachmann, & Moeller, 1993 ). Women who experienced CSA were also more likely to have ever been diagnosed with an STI ( Hillis, Anda, Felitti, Nordenberg, & Marchbanks, 2000 ; Petrak, Byrne, & Baker, 2000 ). Women who experienced child or adolescent sexual abuse were also more likely to engage in risky sexual behaviors as adults, including trading sex for money or drugs, having multiple sexual partners in the last 30 days, and engaging in more unprotected sex ( Parillo, Freeman, Collier, & Young, 2001 ).
Both CSA and adult victimization need to be taken into account when considering adult health outcomes. Child abuse and neglect may be directly related to negative health outcomes as adults, but it is also indirectly related by increasing the risk of being victimized in adulthood, which has direct negative health consequences ( Arias, 2004 ; Heise et al., 2002 ). First intercourse before age 15, not using birth control at last intercourse and having more than one sexual partner were associated with CSA in a large sample of adolescents ( Stock, Bell, Boyer, & Connell, 1997 ). …