The Relationship Between Child and Adolescent Sexual and Physical Abuse and Self-efficacy as an Adult Among HIV-positive Substance Users

Background: Over one million people have HIV infection in the United States (U.S.), where HIV has permeated all regions of the nation and all ethnic and racial groups. HIV transmission occurs through a number of mechanisms, many of which can be exacerbated by substance use. In 2008, nearly one in four of the HIV-positive population was in need of substance use treatment. The lives of HIV-positive substance users can be further complicated by histories of sexual and physical abuse which is related to worse overall health, health behaviors, and health outcomes.

Objective: This study explores the relationship between the age of initiation of abuse, the type of abuse, psychological symptoms that may result from abusive events, and the confidence in one's ability to communicate with a health care provider, get support from family and friends, and manage his or her mood.

Methods: In the current study, 206 HIV-positive patients were recruited from three infectious disease clinics. The participants screened positive for alcohol or substance use and, as part of a larger study, consented to twelve months of integrated HIV-substance use treatment. Using pre-intervention, baseline data, multiple regression analysis was used to examine the relationship between sexual and physical abuse during childhood and adolescence and current self-efficacy among HIV-positive substance users. Mediational analysis was used to test whether psychological symptoms mediated the relationship between abuse and self-efficacy.

Results: Because of the small sample size, individual categories of abuse were reported but interpretations of these results could not be justified. The primary focus of the discussion focused on individuals who experienced any abuse before the age of 19. Any abuse was not directly associated with one's confidence to communicate (p=0.78). In the relationship between any abuse, psychological symptoms, and communication self-efficacy, anxiety and depression trended towards significance (Banxiety=-0.03, p=0.06; Bdepression=-0.02, p=0.10), but was not a mediator of the relationship. Any abuse was not directly associated with one's confidence to seek support from others (p=0.35). When accounting for psychological symptoms, depression was associated with one's confidence to seek support (B=-0.06, p=0.01). Results were inconclusive for determining a mediation relationship. Any abuse trended toward significance of being negatively associated with one's confidence to manage one's mood (B=-0.34, p=0.11). In the relationship between any abuse, psychological symptoms, and mood management self-efficacy, anxiety and depression were associated with one's confidence to manage one's mood (Banxiety=-0.08, p=0.01; Bdepression=-0.06, p=0.01), but were not mediators of the relationship.

Conclusion: The findings suggest that one's confidence to apply positive health behaviors are tied to psychological symptoms and may be tied to histories of abuse. This study suggests that efforts to improve health behaviors should focus on one's self-efficacy in communicating with health care providers, seeking support from others, and managing one's mood. Additional efforts should be made to address symptoms of depression and anxiety and particularly the correlation that abuse may have in aggravating these symptoms.