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  2nd International Workshop on HIV & Women
January 9-10, 2012
Bethesda, Maryland
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Sexual Abuse as Child Raises Heart Disease Risk in HIV-Positive Women
  2nd International Workshop on HIV & Women. January 9-10, 2012, Bethesda, Maryland

Mark Mascolini

Being sexually abused as a child independently raised the risk of heart disease in 94 women seen at the Chicago site of the Women's Interagency HIV Study (WIHS) [1], a finding confirming research in the general population. Childhood sexual abuse predicted nontraditional gender roles in the HIV-positive women, and women who reported traditional gender roles had a lower risk of heart disease.

HIV-positive women in the United States often have a history of childhood sexual abuse, and such abuse has been linked to factors that imperil HIV care, such as drug use and antiretroviral nonadherence [2,3]. Research in the general population indicates that women who endured sexual abuse as children tend to adopt nontraditional gender roles, such as aggression and dominance [4,5]. General-population research also found an link between childhood maltreatment (including sexual abuse, physical abuse, and neglect) and cardiovascular disease in adult women [6].

Boston University researchers collaborated with workers at the Stroger Hospital of Cook County in Chicago to assess the impact of childhood sexual abuse on coronary heart disease (CHD) risk in WIHS members in light of sexual roles adopted by those women. The researchers assessed childhood sexual abuse by self-report, and they calculated CHD risk with the Framingham score.

Gender roles were assessed on three scales: the Unmitigated Communion Scale (which focuses on caring for others rather than oneself), the Sexual Relationship Power Scale (which focuses on relationship control and decision-making dominance), and the Silencing the Self Scale, which has four subscales: externalized self-perception (judgment of self by external female stereotypic standards, such as appearance and thinness), silencing the self subscale (inhibition of self-expression to avoid conflicts in relationships), divided self (outward conformation to gender stereotypes while feeling rebellious internally), and care as self-sacrifice (priority to caring for others rather than oneself).

Of the 94 study participants, 86 (91.5%) identified themselves as African American. Women averaged 44.8 years in age, 71% were unemployed, and 43% had less than a high school education. Only 19% were married or had a common-law partner, while the others were never married or were divorced or separated. Twenty-five women (27%) reported childhood sexual abuse.

Statistical analysis that factored in age, education, and employment determined that a history of childhood sexual abuse significantly predicted a higher CHD risk (beta = 0.21, P = 0.003) and tended to predict lower "good" HDL cholesterol (beta = -0.21, P = 0.06).

Childhood sexual abuse also significantly predicted adopting less traditional gender roles. Specifically, women sexually abused as children had lower scores on self-silencing (beta = -0.34, P = 0.003), self-silencing subscale (beta = -0.37, P = 0.001), externalized self (beta = -0.30, P = 0.01), and care as self-sacrifice (beta = -0.32, P = 0.005) and higher scores on sexual relationship power (beta = 0.23, P = 0.04).

Adopting the traditional female role of caring for others more than oneself significantly predicted higher "good" HDL cholesterol (beta = 0.26, P = 0.01). Lower HDL cholesterol was predicted by higher sexual relationship power (beta = -0.20, P = 0.06) and higher sexual relationship control (beta = -0.21, P = 0.052).

Analysis of gender role impact on CHD risk found that decision-making dominance and care as self-sacrifice predicted CHD risk for women who did not experience sexual abuse as children but did not predict CHD risk for women who experienced sexual abuse. "Thus," the researchers explained, "for women without childhood sexual abuse, being more dominant [a stereotypically male behavior] tended to increase CHD risk and prioritizing care for others [a stereotypically female behavior] tended to decrease CHD risk."

The investigators suggested that childhood sexual abuse fosters nontraditional gender roles because women may adopt stereotypically male roles as a way to protect themselves from victimization. Traditional gender roles, they observed, especially caring for others and lower dominance levels, protected against CHD risk in women without a childhood abuse history but not in women who were abused as children.


1. Dale S, Franklin M, Kelso G, et al. Childhood sexual abuse, traditional gender roles, and coronary heart disease risk among women with HIV. 2nd International Workshop on HIV & Women. January 9-10, 2012, Bethesda, Maryland. Abstract P_14.

2. Cohen M, Deamant C, Barkan S, et al. Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV. Am J Public Health. 2000;90:560-565.

3. Coehn MH, Cook JA, Grey D, et al. Medically eligible women who do not use HAART: the importance of abuse, drug use, and race. Am J Public Health. 2004;94:1147-1151.

4. Whiffen VE, Thompson JM, Aube JA. Mediators of the link between childhood sexual abuse and adult depressive symptoms. J Interpersonal Violence. 2000;15:1100-1120.

5. McMullin D, Wirth RJ, White JW. The impact of sexual victimization on personality: a longitudinal study of gendered attributes. Sex Roles. 2007;56:403-414.

6. Batten SV, Aslan M, Maciejewski PK, Mazure CM. Childhood maltreatment as a risk factor for adult cardiovascular disease and depression. J Clin Psychiatry. 2004;65:249-254.