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Chtkl Ihusc & .~,cgh'~ t. Vol. 16. pp. g55-b;fi4.

I 9~)2
Printed in the I." S .~, .'~11rlghl,, rcscrvcd

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( op.~rlght ~." 1992 P e r g a m o n Press L t d

SELF-REPORTED C H I L D H O O D AND ADOLESCENT


SEXUAL ABUSE A M O N G ADULT H O M O S E X U A L
AND BISEXUAL MEN
LYNDA S. DOLL
Division of HlV/AIDS, National ('enter tbr Infectious Diseases, (?enters for Disease Control,
Public Health Se~'icc, U.S. Depart.menl of Health and Human Services, Atlanta. GA

DAN JOY
Department of Public Health, San Francisco, CA

BRAD N. BARTHOLOW
Denver Disease Control See'ice. Department of Health and Hospitals, Denver, CO

JANET S .

HARRISON

Division on HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control. Public Health
Service, U.S. Department of ttealth and Human Services, Atlanta. GA

GAIL BOLAN AND JOHN M. DOUGLAS


Denver Disease Control Service. Department of Health and Hospitals. Denver, ('O

L1NDA E. SALTZMAN
Division of [njuD Control, National Center tbr Environmental Health and Injury Control.
Public Health Service, U.S. Department of Health and Human Services, Atlanta, GA

PATRIC1A M. Moss

AND WANDA

DELGADO

Howard Brown Memorial Clinic, Chicago, IL: Now at Ilumana IlospitaI--Michacl Reese. Chicago. IL

Abstract--From May 1989 through April 1990. 1,001 adull homosexual and bisexual men attending sexually transmitted di,~ase clinics were interviewed regarding potentially abusive sexual contacts during childhoLxl and adolescence. Thirty-seven percent of participants rel~rted they had been encouraged or tbrced to have sexual contact before
age 19 with an older or more powerful partner: 949 occurred with men. Median age of the participant at first contact
was 10: median age difference between partners v,as 11 years. Fifty-one percent involved use of force: 33c,~: involved
anal sex. Black and Hispanic men were more likely than white men to report such sexual contact. Using developmentally-based criteria to define sexual abuse, 93% of participants reporting sexual contact with an older or more powerful
855

856

I,. Doll et al.

partner were classified as sexually abused. Our data suggest the risk of sexual abuse may be high among some male
~oulh and increased attention should be devoted to prevention as well as early identification and treatment.

Key It'ords--Sexual Abuse, Homosexuality. Adolescence,Sexual behavior.


INTRODUCTION
LITTLE IS K N O W N about the prevalence or social context of childhood and adolescent
sexual behaviors a m o n g male youth, and in particular their experiences with child sexual
abuse. Finkelhor (1987) estimates between 3 and 31% of American men have been sexually
abused before the age of 18 years. Most (>90%~ have been abused by someone outside their
families and are more likely than abused girls to come from impoverished and single-parent
families (Finkelhor, 1984: Vander Mey, 1988). Few studies have reported data on child or
adolescent sexual abuse experiences of adult homosexual or bisexual men. Approximately
4.9% of a sample of adult homosexual men interviewed in 1970 in the San Francisco Bay area
reported a prepubertal sexual experience involving physical contact with an adult man (Bell &
Weinberg, 1978, Bell, Weinberg, & Hammersmith, 1981 ). Higher rates have been reported in
studies of male prostitutes (25% to 68/;, of samples [Coleman, 1989]) and in studies of gay
adolescents attending a social service agency for gay youth in New York City (22'~. [Martin &
Hetrick, 1988]). Since these data on homosexual men were gathered from studies conducted
more than two decades ago with samples of convenience, or from more recent studies of gay
youth, they may not be representative of other populations of adult homosexual or biscxual men.
The data presented in this paper were collected during a study of homosexual and bisexual
men attending sexually transmitted disease (STD) clinics that examined the prevalence of
sexual abuse during childhood and adolescence and predictors of adult, AIDS-related sexual
behavior, including these abusive sexual contacts. In the current analysis we examined the
descriptive characteristics of clinic attendees' childhood sexual contacts with older or more
powerful male or female partners. We then assessed the percentage of these contacts which
might be defined as abusive, based on a developmental classification of abuse.

METHOD

Data Collection
From May 1989 through May 1990, 1,001 men ages 18 years or older who self-identified as
homosexual or reported engaging in oral or anal sex with another man in the previous 5 years
were enrolled in the study. STD clinics included Howard Brown Memorial Clinic in Chicago
(N = 320), Denver Metro Health Clinic (N = 348 men), and San Francisco City Clinic (,~.....
333 men). A m o n g men meeting the criteria, 48% of men in Chicago, 46% in Denver, and 53%
in San Francisco agreed to participate and were interviewed. Comparison of data from enrollees with data from men refusing to participate showed no significant differences in age.
race/ethnicity, and educational level. A m o n g study participants as well as those who refused

Research supported in part through an interagency agreement between the ('enters for Disease ('ontrol and the
National Institute of Alcohol Abuse and Alcoholism.
Received for publication November 12, 1991, final revision received February 20, 1992,accepted February'24, 1992.
Reprint requests or requests tbr questionnaires should be addressed to l,ynda [7)o11,Division of HIV/A[DS,(,'enters
tbr Disease Control, 1600 Clifton Road, Mailstop E45. Atlanta, GA 30333.

Childhood sexual abuse in homosexual and bisexual men

857

[ a b l e 1. Developmental Cla~sificalinn of Ma l e Sexual Abuse


Age of Child or
Adolescent
<6
6-1 I
12-1 5
16- I 8

M i n i m u m Age Difference
Between Partners a
3
4
6
10

years
years
years
years

Anal Penetration

Use of Force b

Yes
Yes

Yes
Yes
Yes
Yes

Note Sexual contacts meeting any one of the above criteria tbr a given age group were defined as abusive.
' Age ditlcrcnces not meeting the m i n i m u m criteria were assumed to be peer contacts tbr a given age group.
t, Any verbal threat, physical [brce, or use n f a weapon.

to cnroll, 100% in Chicago and greater than 90% in Denver and San Francisco had engaged in
oral or anal sex with a male partner in the previous 4 months. Project activities were approved
by institutional review boards (IRBs) at participating agencies and all participants gave informed consent prior to being interviewed.
Participants completed a short self-administered questionnaire and were then interviewed
by trained STD clinic staffusing a standard survey instrument. To assess potentially abusive
sexual contact, interviewers asked participants whether they were encouraged or forced to
have sexual contact before the age of 19 with a person whom they perceived as older or more
powerful than themselves. Participants were asked to self-define sexual contact for this question. Those answering affirmatively were asked to recall the first occasion such contact occurred and to describe their own age, the age and gender of the partner, their relationship with
the partner, the type of sexual contact, whether or not verbal or physical force occurred, and
the lcngth of time in months during which the contacts occurred with this partner.
Sexual contacts with older or more powerful male partners were separated into six mutually
exclusive categories: (a) invitation or request to do something sexual, (b) kissing/hugging in a
sexual way, (c) showing sex organs, (d) touching sex organs, (e) oral-genital contact, and (f)
anal-genital contact. Instances of active and passive contact were included in each category.
Each participant was assigned a single score for the most intrusive level of sexual contact, even
though he may have engaged in other behaviors as well. For example, ifa man reported that as
a child he engaged in kissing, oral sex, and anal sex, he was categorized as engaging in anal sex.
Level of force was assessed by defining threatening behaviors as verbal (e.g., threats), physical
(e.g.. holding the participant down), or involving the use of a weapon, such as a knife or gun.
Each participant was assigned a score for the most threatening level of force occurring during
the contact, with involvement of a weapon considered the most threatening. The relationship
between the child or adolescent and the partner was classified into one of four categories based
on the authority status of adult partners and social distance o f n o n a d u l t partners. Adults were
defined as persons 19 years of age or older.
Using criteria similar to those of Finkclhor (1981), participants were also asked to select
their most salient affectivc response at the time of contact from the following adjectives: fear,
shock, surprise, interest, pleasure, guilt/shame, or anger. They were also asked to rate their
current assessment of the encounter using a 5-point Likert scale with endpoints of positive
and negative and a midpoint of neutral. Affective responses at the time of the contact were
grouped into three broad categories: positive (interest, pleasure); neutral (surprise), and negative (fear, shock, guilt/shame, anger).

Abuse ('lass~6cation
A developmental classification of abuse (Finkelhor, 1981 ; DeJong, 1989) was devised based
on four components: age of the child or adolescent, the age difference between the partners,
the type of sexual contact, and the use of force (Table 1). Any contact involving force was

858

1,. Doll el al.

classified as abusive at all ages. Any contact involving anal penetration was also considered
abusive for children under 12 years. Finally. developmental differences in defining peer and
nonpeer contact were accounted for by varying the age differences classified as abusive according to the age of the participant at the time of the contact: for participants 0 - 5 years of age
at the time of contact, 3 or more years age difference was defined as abusive: tbr participants
6 - I 1 years of age, 4 or more years difference: 12-15 years of age, 6 or more years difference:
and 16 to 18 years of age, 10 or more years difference.
Statistical Method, s
Chi-square contingency tables were used to c o m p a r e frequency of sexual contacts by sociodemographic characteristics. Brown-Mood nonparametric median tests (SAS Institute. Inc.,
1988) were also used to c o m p a r e medians. Logistic regression analyses with three dependent
variables (positive, neutral, and negative responses) were used to predict the adult's recolleclion of his affective response at the time of the contact and the adult's evaluation of the
contact at the time of the interview. Predictor variables included age of the child or adolescent
at the time of the contact, age difference between the two partners, category of relationship
between the child or adolescent and the partner, whether or not the partner was an adult, type
of sexual contact, n u m b e r of m o n t h s during which sexual contacts occurred with this partner,
and whether force was used.

RESUI.TS
Participant Tmracteristics
Median age of the 1,001 participants at the time of the interview was 31 (range: 18-73).
Seven hundred twenty-seven (73%) were white, 188 (12~) black, 117 (12%) [ lispanic, 15 (2~'f)
Asian, 16 (2%) Native American, and 8(< 1%) other. Most l lispanics (57%) were of Mexican
origin. Seven hundred forty-four participants (74%) had completed more than 12 years of
education. Only 59 (6%) had not compleled high school. Most participants (864 or 86c~ ) sell"
identified as homosexual, with only 116 (12%) and 21 (2%) self-identifying as bisexual or
heterosexual, respectively.
Se~ual Contact with Older or More Powep'lid Partners
A m o n g the 1,001 participants, 369 (37~,!~)reported sexual contact betbre the age of 19 with a
partner whom they perceived as being older or more powerful than themselves. On the first
occasion when such contact occurred, 348 (94~:) had contact with a male partner. 18 (5%)
with a female partner, and 3 (< 1%) with both male and female partners. A m o n g the 18 female
partners, 6 (33%) had sexual contact with boys five years and younger and I 1 (65~) were
family members.
Selected characteristics of the first reported sexual contact with an older or more powerful
male partner are shown in Table 2. Median age of the participant at the time of contact with a
male partner was 10 years (range: 2-17). Median age difference between the two partners was
I 1 years (range: 0-55 years). This age difference was significantly higher for boys under 6 and
adolescents over 15. Overall, 53% of the male partners were adults 19 years of age or older,and
43% were family members. Twelve percent were strangers. Male partners of boys five years or
younger were significantly more likely to be a family m e m b e r (64%: 2 ~ 20.76, p < 0.0001 ).
Most participants reported engaging in either oral-genital (39%) or anal-genital (33'";,) sex
during this contact. While anal contact was less likely to be reported by the boys who were

Childhood sexual abuse in homosexual and bisexual men

859

Table 2. Characteristics of lqrst Sexual Contact with an Older or More Powerful Male Partner Among Adult
tlomosexual or Bisexual .Men Attending STD Clinics

Age of Participant at Time of Contact


6-11
12-15

<6

n
Median age difference
between partners*

47 (14']

I:amily member
Authority figure
Other acquaintance
Stranger

I 7 (68q
0 (()";)
7 (28";
I(4%)

17

16-18

All ages

164 (47<;)

I 15 (33':;)

22 (6':;)

348

12

16.5

II

Relationship with Adult Parlners


29 (48";)
6 ( I(Y; )
I g (30':~)
8 ( 13"; )

(20%)
(25";
(35";
(20"/

72 (39";)

15 143G )
4 ( 11"; )
14 (40";)
2 (6%)

0 (0q)
I (50q)
1 (50";)
0 (0";)

77 (48ci)
1 I (7';)
67 (41':; )
7 (4%)

4 (3";)
2 (2c~)
0 (0'7;:)
26 (23";)
42 (37"; }
42 (37";)

I I5"; )
2 (9':;)
0 (0':;)
I (5q)
1 I (50%)
7 132';)

8 {Y; )
8 (2";)
8 (2%)
73 (21%)
134 (39c;)
115 (33%)

54 (48";)
13 (12ci)
39 (35':;)
6 (5';)

13 (59<.)
4(18%)
5 12Y; )
0 (0':;)

I 71 ( 51 ':; )
49(15%)
107 (32%)
10 (Y;)

22 128% )
19 (24':;)
19 (24";)
20 (_>
~ '',.)

4
5
7
4

30 (16%)
51 (27";)
33 ( l g':; )

Relationship with Nonadult Partners


Family member
Personal friend
Acquaintance
Stranger

13 (59':;)
0 (0':;)
9 (41%)
0 (0%1

49 148"1 )
6 (6':;)
43 (42";)
5 (5";)
I ype of Sexual Contact

Invitation
Kissing
Exposing genitals
louching genitals
Oral-genital contact
A nal-genital contact

I (2";)

3 (2%)

I (2";)
4 (9";.)
13 (28%
17 (36%
10 ( 21%

3 (2";)

4 (2"~.)
33 {20%)
64 (39%)
56 (34";)
Use of Force

No tbrce
Verbal threats
Physical force
Use of wealxm

27 (63q
4 (9%)
10 (23q
2 (5'~;)

77 (48%)
28(18%)
53 (33";)
2 ( I'; )

Note: Adults were detined as persons 19 years of age or older. Adults authority figures included scout, youth and
religious leaders, police, physicians, etc. Other adult acquaintances included neighbors, friends of the thmil.v, etc.
Nonadult personal friends were defined as such by the participant. Nonadult acquaintances included classmates, kids
at camp, neighbors, etc. Participants were assigned single scores tbr the most intrusive type of contact (anal sex most
intrusive) and for the most threatening level of three used (involvement of a weapon most threatening}.
* p < .01 for age comparisons.

y o u n g e s t a t t h e t i m e o f t h e c o n t a c t (21 c,4 t b r t h o s e -<5 y e a r s c o m p a r e d t o > 3 0 % for o l d e r b o y s ) ,


t h e s e d i f f e r e n c e s w e r e n o t s t a t i s t i c a l l y s i g n i f i c a n t . T h e u s e o f f o r c e w a s r e p o r t e d in 4 9 q o f all
contacts. One hundred fifteen (33%) of the contacts were single events with no ongoing sexual
contact between these two partners. For children or adolescents having more than one contact
w i t h t h i s p a r t n e r , m e d i a n n u m b e r o f m o n t h s o f c o n t a c t w a s 12.

R a c i a l ~ E t h n i c D~lli'rences
Black and Hispanic participants were significantly more likely than white participants to
report a sexual contact with an older or more powerful partner (black: 52%: Hispanic, 50%,
w h i t e : 3 2 % , X : = 3 0 . 2 5 , p < 0 . 0 0 0 1 ). H i s p a n i c p a r t i c i p a n t s w e r e s i g n i f i c a n t l y y o u n g e r t h a n
w h i t e o r b l a c k p a r t i c i p a n t s w h e n t h e c o n t a c t o c c u r r e d ( m e d i a n age: H i s p a n i c . 8, w h i t e , 10,
b l a c k , 1 0 : 2 = 5 . 9 7 , p < .05) a n d m o r e l i k e l y t o r e p o r t a n a g e d i f f e r e n c e o f 5 o r m o r e y e a r s
b e t w e e n p a r t n e r s ( H i s p a n i c , 9 1 % : b l a c k , 8 0 % , w h i t e , 78%: x 2 = 9 . 9 7 , p < .04).

g60

L. Doll et al.

Table 3. Comparison of Affeetive Response to Sexual Contact with an Older or .More Powerful Male Partner at Two
"rime Periods
Afl~ctive Respunse at T i m e of ('ontact

Aflective Response at
T i m e or" lntervie~
Negative
Neutral
Positive
lotal
_

. . . . . .

Negati~ e
132
45
18
195

Neutral

(39";)
( I 3"; )
(5";)
(58':;)

26
11
12
49

(8";.)
(3";)
(4";)
( 15'; )

I'oslti~ e
24
42
26
92

(7";)
( I 3';.)
(8";)
(27'::)

lotal
182 (54";)
98 ( 2 9 '~: )
5~ ( 17'; I

Note: r ~ , e l v e participants refused or v, ere unv,illing to e~aluate their experience.

Se~ual Contacts with Male P('('t:s


Sexual contacts were categorized as occurring between peers if the age difference between
the partners did not exceed the m i n i m u m age differences in the abuse classification (Table 1 ).
Eighteen (9%) of 108 participants who were I I years or younger during the reported instance
had sexual contact with a male peer. Of these, 18, 8 (44%) had sexual contact with family
members. Oral and anal sex occurred in 11 (61%) and 4 (22%) of the contacts, respectively.
Seven contacts (39%) involved the use of tbrcc.
An additional 32 (28'?k) of I 15 participants ages 12 to 15 ,,'ears reported sexual contact with
a peer. Ofthese, 17 (53~.~-.) reported contact with family members. Oral or anal sex occurred in
equal numbers of contacts (1 I, or 34'.',',, each). Eighteen contacts (56~',.) included the use
o f force.

.4[]ective Re.s7)onse.s to S(,xtml ('onlact with Male t'artner.s


Twenty-six participants (8%) evaluated their sexual contact as positive, 132 (39'~;) as negative, and 11 (3%) as neutral at both the time of the contact and during interview (Table 3).
While 64% of participants who were in late adolescence ( 16-18 years) recalled reacting negalively at the time of the contact, by the time of the interview approximately 50% of these
participants continued to evaluate the experience negatively. In contrast, 54% of participants
w h o were 5 years or less at the time of the contact recalled having a negative response to the
experience, although by adulthood 70% evaluated the experience negatively.
l.ogistic regression analyses (]]able 4) showed that the most significant predictors of a
Table 4. Predictors of Affective Responses to ,~xual ('ontaet with an Older or ~,lore Powerful M a l e Partner
I

Variable

Parameter
Estimate

Standard
I!rror

Participants"
('hi-square

/)

All;.:cti,.e R e s p o n s e

Evaluation at Time of Contact


Force used
Adult partner
Months of contact with
this partner

1.9965
0.6348

0.2620
(I.2365

5~.086 [
7.2009

0.(XX) I
0.0073

Negative

0.0117

0.0046

6.3637

(I.0116

Positi,.c

Force used
Younger age of
child/adolescent
Greater age difference
between partners

1.4742

0.2375

38.5242

0.0001

Negah', c

0.1307

0.0320

16.6781

0.0001

Negative

0.0299

0.01 I0

7.4479

0.0064

Negative

Ncgahv

E,.aluation at l i m e of Intervie',~,

N o t e Sample size for analyses: for responses at time of contact, Negative (A - 195), Neutral L~/ 49). Positive (.\'
927: lbr responses at t i m e o f inter~ie~. Negative (.\'
182), N e u t r a l (N
98). Positive (.\'
56k

Childhood sexual abuse in homosexual and bisexual men

861

negative response at the time o f the sexual contact were the use of force and having an adult
partner. A positive response at the time of contact was correlated with greater n u m b e r of
months of contact between the two partners. Significant predictors o f a negative response at
the time of the interview included the age of the child, the age difference between the partners,
and the use of force.
To examine age differences in predictors of affective responses, we also conducted separate
logistic regression analyses for participants who were in early or late childhood (< = 11 years;
N = 211 ) and early or late adolescence ( 12-18 years; N = 137) at the time o f t h e contact. The
most consistent predictor of a negative response for both age groups and for both periods was
whether or not force had been used.

Interpreting Sexual ,4buse


Based on the developmental scale of abuse, 343 (93%) of the sexual contacts with older or
more powerful partners would be considered abusive. This included 100% of the contacts
between the participants and female partners, 100% of contacts occurring when the participant was five years or younger, and 323 (94%) of all male-male contacts. One hundred
twenty-four contacts (36%) were considered to be abusive because of the age difference between partners, 18 (5%) because of the use of force, 3 (< 1%) because o f anal sex when the
participant was l l years or younger, and 198 (58%) because of the combination of two or
more components of the definition.

DISCUSSION
With the exception of data from samples of male prostitutes, the prevalence o f sexual abuse
in our population was considerably higher than that reported from most studies of male
sexual abuse (Finkelhor, 1984. 1987). This may reflect the characteristics o f our sample or
perhaps an increased comfort level on the part of our participants to disclose sexual abuse.
Certain characteristics and experiences of our sample in their youth may have led to a
greater potential for abuse. Coleman (1989) suggests that young gay youth often lack peer and
familial support as they explore their sexuality and sexual identity. With little connection to
gay communities and other gay youth, they may be confused about their right or ability to
refuse any unwanted sexual contact or, perhaps, seek sexual contacts in dangerous environments that put them at risk for sexual exploitation. Some adult men may also seek contact
with what they perceive as particularly vulnerable male youth, youth who lack secondary
sexual characteristics, or youth who may exhibit stereotypical female characteristics (Harry,
1985, 1989). In a study of the sexual orientation of 175 adult male sex offenders, Groth and
Birnbaum (1978) found that most (76%) o f their sample of incarcerated men who molested
boys self-labeled as heterosexual and stated that they were attracted to the feminine features of
sexually immature, prepubertal boys. These incarcerated men may not be representative of
men who have sexual contacts with young boys. Furthermore, the extent to which youth who
subsequently engage in sex with other men as adults differ from other youth with respect to a
range of behavioral characteristics is unclear. Nonetheless, the Groth and Birnbaum study is
suggestive of why the prevalence of childhood or adolescent sexual abuse in homosexual or
bisexual men may be somewhat higher than those reported for general populations of men
(Finkelhor, 1987).
Recent media attention about sexual abuse, as well as the availability of support groups for
male survivors of sexual abuse, may also have reduced barriers to disclosure of sexual abuse
(Finkelhor, 1984: Nielsen, 1983). This same attention may also result in some adults redefin-

862

I,. Doll ctal.

ing a childhood experience from contact between consenting individuals to one of sexual
exploitation, particularly as there is more public awareness of the potentially abusive use of
power and status differential between adult and child sex partners.
Methodological constraints actually suggest that our data may underestimate the amount,
or inadequately describe the full range, of abusive contact that occurred. Interviewers only
asked in detail about the first instance of scxual contact with an older or more powerful
partner and did not gather specific information about contacts in which the authority or adult
status of the partner resulted in sexual contact even without overt physical or verbal three.
T i m e constraints also did not permit interviewers to ask about potentially abusive contact
with partners who were of the same age or younger than the participant. Indeed, an additional
267 of the 1001 participants reported oral or anal contact with a male partner before the age of
16 years but answered negatively to the question about older or more powertul partners.
Forty-nine (18%) of these 267 men would be classified as having been sexually abused based
upon the age difference between partners alone.
Existing studies examining racial/ethnic difl;ercnces in sexual abuse do not permit comparison of the prevalence or social context of these experiences for homosexual or bisexual men
(DeJong, E m m c t t & Hervada, 1982a, 1982b" Pierce & Pierce, 1984). Researchers havc suggested that, in comparison with sexually abused girls, sexually abused boys are more likely to
come from backgrounds typical of other child abuse cases, namely families of lower socioeconomic status (Finkelhor, 1984). Hence the higher prevalencc of sexual abuse a m o n g minority
youth in our study may, in part, reflect demographic differences between racial/ethnic groups
in the United States. Men of lower socioeconomic status m a v also be over represented a m o n g
clients receiving treatment at large S T D clinics, resulting in the higher prevalence rates of
sexual abuse in our population relative to other reported samples of men. However, the higher
prevalence rates may also reflect the closer scrutiny of families of lower socioeconomic status
by public agencies, which also reflect the closer scrutiny of families of lower socioeconomic
statues by public agencies, may, in turn, result in more disclosure of the abuse. Such disclosure in childhood could p r o m p t the adult participant's memory' of these negative experiences
rather than reinforce the denial or repression described by m a n y clinicians (Gelinas, 1983).
Finally, our study supported previous research showing that the use of force and variables
related to the age of the two partners predicted a negative response to the sexual contact
(Finkelhor, 1981 : Haugaard & Tilly, 1988). However, m a n y of our participants evaluated the
contact neutrally or positively either at the time of the experience or as an adult. Clinicians
have suggested that these responses may represent a refraining of the experience in a more
positive light in order to deal with a potentially overwhelming negative experience (Gelinas,
1983). Several investigators havc also criticized research on sexual abuse for tbcusing entirely
on the sexual aspects ofintergenerational relationships and neglecting the intimacy and caring
that may arise within such relationships (Sanfort, in press). Others have criticized researchers
who assume that all intergenerational sexual relationships are emotionally traumatic (Jones,
1991). While these may be important considerations in some relationships, the level of force
used in the sexual contact reported by some of our participants suggests that intimacy and
caring may not have been a significant c o m p o n e n t of m a n y of these relationships.
Examination of both our study sample and methodology suggest caution in generalizing
our data on sexually abusive contacts to other groups of homosexual or bisexual men. Men
attending an S T I ) clinic may not be representative of their respective communities, sociodemographically or behaviorally. They may also not be representative of nonurban, or nonhomosexually identified men who have sex with men. Furthermore, since median n u m b e r of
years between the reported sexual contact and the intervicw was 20 and in some instances
participants were recalling events from early childhood, these retrospective data are subject to
a variety of criticisms related to their reliability and validity.

Childhood sexual abuse in homosexual and bisexual men

863

However, this study represents an initial examination of sexually abusive contacts in a


population whose childhood and adolescent experiences have been understudied. Understanding these patterns of sexual abuse is important for the clinical assessment of individuals
requiring treatment related to sexual abuse as well as the development of prevention programs. Such data may also be helpful in understanding and preventing attempted suicide
among gay or bisexual youth (Remafedi, Farrow, & Deisher, 1991) as well as AIDS-related.
high-risk sexual behavior (Zierler, et al., 1991). Finally, while there are potentially many
factors influencing sexual identity formation (Money, 1988), examination of sexual abuse
during childhood may elucidate both the process of identity formation as well as conflicts
related to sexuality that are experienced by some men.
Additional data on the individual characteristics of abused youth, their male partners, and
the social contexts in which abusive contacts occur are needed to provide a more complete
picture of the sexual abuse experienced by men. Collection of prevalence data on nonclinic
based populations is also important in order to generalize to a broader group of adult homosexual or bisexual men. However, data from this and previous studies provide a foundation
on which to build or expand intervention programs. Providing good medical and psychological treatment tbr a sexually abused male youth is critically important. Improving skills of
medical and social service personal in identification and early intervention should be important elements of all treatment programs. Equally crucial, however, are primary prevention
programs for at-risk youth and their families. While there is little research to date evaluating
their effectiveness, increasing public awareness of the prevalence of male sexual abuse and
training children to recognize and respond to unwanted and inappropriate sexual contact
have been suggested as strategies to reduce the incidence of sexual abuse. Providing social
support for youth during transitional periods of childhood and adolescence, with particular
emphasis on gay youth, has also been recommended to help reduce opportunities for exploitation among vulnerable individuals.
,,lcknowh'dgement.~--We thank Eric Johnson, Robert Frye, Ph.D.. James A. Mercy, Ph.D., Julie I)oetsch. Don
Barrett, and our interviewers at each site for their important contributions.

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Ri, s u m S - - l ) e mai 1989 *,).a~ ril 1990. IOtll horn rues homosexucls el biscx uels \ u s dans des consultations tic maladies
sexuellement transmises onl ,~16 interrog(,s sur leurs 6ventuels contacts sexuels abusifs au eours de leur enfance ou de
leur adolescence. l remc sept pourccnt des participants ont signal6 qu'ils avaient ,5t(: encouragOs ou forcOs a avoir des
contacts sexuels avant l'fige de 19 tins avec un partenaire plus 'ago et plus fort qu'eux-mOmes. 94 pourcent dc ces
contacts ont eu lieu a~cc des partenaires masculins. I.''agc mo.~en du participant lors du premier contact ,Stait (te 10
ans" la difference d'age m o y e n n e entre les deux partenaires ctait I I ans. ( ' i n q u a n t e el un pourccnt ont impliqu(,
I'utilisation de la force: 33 pourcent des contacts sexuels 0talent anaux. I.es h o m m e s noirs el hispaniques signalaient le
plus f 6 q u e m m e n t ce t.~pe de relation sexuclle, l.orsqu'on utilise pour d6finir I'abus sexucl des crit,Sres relatifs au
d,Sveloppement des enlants, 03 pourcent des participants signalant un contact scxuel avec t,n partenaire plus 'ag6 el
plus puissant peuvent 0ire consid6r6s c o m m e victimes de sOviccs sexuels. Nos donn6es suggOrent que le risque d'abus
scxuel peut ,Sire tr,Ss 0Icy0 parmi terrains adolescents masculins ct que plus attention devrait 61re aplxwt6e fi la
prO',entinn, a I'identihcation prOc~_'c el a u traitemcnt.
R e s u m e n - - D c s d e Ma.~o 198~J a Abril 1990. fueron entrcvistados 1001 homoscxuales y bisexuales m a s c u h n o s adultt~s
que asistian a clinicas de enlermedades s(.'xualmente transmisibles en relaci6n a contactos sexuales potencialmente
abusivos durante su nihe,, v adolescnecia. El treintisiete poreiento de los participantes reportaron que habian sido
a n i m a d o s o forzados a tener contacto sexual antes de los 19 aflos (_'on un compafiero mayor y mils poderoso: 94";
ocurri6 con hornbres. I.a media de edad del participanle era I0, la media en la diferencia tie edad entre la pareja era
I 1. El c m c u e n t i u n o porciento inclu~,6 la fuerza, 33"; mcluy6 sex() anal. l.os sujetos masculinos negros o hispanos
Ionian re'as tendencia a reporlar este contacto sext.al que los hombres blancos. Utilizando crilerios basa~dns en el
desarrollo e,.oluti'~o para detinir el abuso sexual, 93"~ de los participantes que reporlaron contaclo sexual con una
pareja mayor o mils podcrosa fueron clasificados c o m o sexualmente abusados. Nuestros datos sugicren que el riesgo
de abuso sexual puede m" alto en algunos .i6~enes y ex necesario dedicarle mils atenci6n a la prevenci6n asi comoa la
identificaci6n temprana y al tratamiento.