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Background: Anal sex increases the risk of sexually transmitted infections (STIs)/HIV in diverse populations, including heterosexual women and men who have sex with men. Childhood traumas, such as sexual and physical abuse, are linked to increased sexual risk behaviors but associations with anal sex have not been examined.
Methods: We used the National Longitudinal Study of Adolescent to Adult Health waves I (7th-12th grade), III (18-26 years) and IV (24-32 years) (n=12,288 with sample weights) to examine nine childhood trauma indicators: neglect; emotional, physical and sexual abuse; parental binge drinking and incarceration; and witnessing, being threatened with, and experiencing violence. We also summed each dichotomous trauma to measure the cumulative number of traumas. We used logistic regression to examine the association between trauma indicators and self-reporting having ever had anal sex at Wave IV. We tested whether associations differed by gender.
Results: Approximately half of participants experienced no trauma, 28% experienced one, 13% experienced two, 7% experienced three, 3% experienced four, and 2% experienced ≥five. After adjustment for sociodemographics, compared to no trauma, odds of anal sex increased in a stepwise manner from 1.28 (95%CI: 1.09-1.50) for one trauma to 4.13 (95%CI: 2.01-8.49) for ≥five traumas among females. Among males, odds increased from 1.21 (95%CI: 1.04-1.42) to 2.33 (95%CI: 1.25-4.35). Emotional abuse and threatened with violence was associated in both genders, while odds of anal sex were significantly elevated among females who reported physical (AOR=1.31, 95%CI: 1.04-1.46) and sexual abuse (AOR=1.61, 95%CI: 1.25-2.06), parental incarceration (AOR=1.45, 95%CI: 1.14-1.85), and experiencing violence (AOR=1.89, 95%CI: 1.25-2.87).
Conclusions: Those with a history of childhood trauma may be more likely to engage in anal sex, and thus at increased risk of STI/HIV. Women with a high burden of childhood trauma, including those who experienced specific forms of trauma, may be particularly at risk.