Opinions
Sexual abuse may explain high HIV rates in gay men
We must address trauma that undermines self-esteem, good judgment

September 27 is National Gay Men’s HIV Awareness Day.
We’d been messing around since I was about 10 years old. I figured sex with him and his three younger brothers next door was just a part of our friendship, along with our hikes to Bluff Point, on Long Island Sound, and neighborhood kickball, baseball, football, and foursquare games.
Besides, I enjoyed it a lot. I never felt consciously traumatized.
It would take a 2005 HIV diagnosis to open my mind to how my experience of childhood sexual abuse, and the multiple traumas I experienced throughout my life, undermined my self-esteem and good judgment and put me in the way of the same lethal microbe that killed so many of my friends.
The American Academy of Experts in Traumatic Stress (AAETS) says that 30 percent of all male children are molested in some way. There is a well-documented correlation between sexual abuse and later promiscuity. PTSD, depression, poor self-esteem, dissociative disorders, and anxiety are among the other effects of CSA. Sexual abuse survivors often equate sexual desirability with self-worth—and use sex as an analgesic to blunt the edge of shame that is another insidious effect of CSA.
I know these things, not only from reading about them in the research literature, but because they have played out in my own life—and in the lives of so many gay men.
Behavioral scientists have wrung their hands for more than three decades trying to understand why gay men seem so disproportionately vulnerable to HIV. Recent research makes it abundantly clear that trauma, specifically from CSA, is almost certainly the long-overlooked answer.
Consider: Harvard researchers have found that up to 46 percent of gay and bisexual men who report condomless anal sex—the principal act by which HIV is transmitted between men—were sexually abused as boys.
“That is a huge number,” said Conall O’Cleirigh, a staff clinical psychologist in the psychiatry department at Massachusetts General Hospital and an assistant professor of psychiatry at Harvard. His research on gay men has found that the same mental health issues that can put someone at risk for HIV can also prevent someone living with the virus from adhering to his treatment.
In a national study of 1,552 black gay and bisexual men, O’Cleirigh and his colleagues found that men who experienced CSA—or physical or emotional abuse, or stalking, or being pressured or forced to have sex—when they were younger than 12 years old had more than three male partners in the past six months. The men who had been forced or pressured to have sex as boys were likely to have receptive anal sex.
In another study of 162 men with CSA histories, participants reporting sexual abuse by family members were 2.6 times more likely to abuse alcohol, twice as likely to have a substance use disorder, and 2.7 times more likely to report a sexually transmitted infection in the past year. Not only that, but men whose abuser penetrated them were more likely to have PTSD, recent HIV sexual risk behavior, and a greater number of casual sexual partners. Physical injury and intense fear increased the odds for PTSD even more.
“Having that history is repeatedly associated in every sample of gay men with increased likelihood of being HIV-positive,” said O’Cleirigh. He said that since CSA is “very, very common in gay and bisexual men” it appears to be one of the most significant vulnerabilities that accounts for the disproportionately high rate of HIV among gay men.
Prevention educators long have wanted to believe that handing out condoms, or, more recently, the HIV medication Truvada used as pre-exposure prophylaxis to prevent HIV infection, should suffice for men at the highest risk who engage in unprotected anal sex with partners of unknown HIV status. But increasing rates of new HIV infection among gay men—the only U.S. population with increasing, rather than declining, rates—are proof that condoms and PrEP alone aren’t enough.
The only way to arrest the spread of HIV among gay men is to address the trauma that undermines their self-esteem and good judgment.
An effective risk-reduction/health-promotion intervention that addresses the effects of childhood sexual abuse could help make gay male survivors more conscious of what they are doing and where it’s coming from in their psyche. It could also finally reduce the “hardcore” of gay men beyond the reach of more traditional prevention efforts.
At Boston’s Fenway Health, O’Cleirigh helped recruit the nearly 5,000 gay and bisexual men who participated in Project Thrive, an intervention aimed at helping gay men who experienced CSA to increase their coping skills and ability to be more present in—rather than dissociating from (a common effect of CSA)—their immediate situation, and provide specific skills to evaluate and reassess these situations.
“Treatments [counseling and therapy] are geared toward giving the men a more realistic sense of the world,” said O’Cleirigh, which is an important ingredient of resilience. “As we say to our clients, we can’t change the fact that you were abused, but you can change.”
Healed gay men protect themselves and their partners, and take their meds if they are positive.
The message for this National Gay Men’s HIV-AIDS Awareness Day should be that helping gay survivors of childhood sexual abuse to heal from trauma can profoundly reshape the way they think and make choices about sex—and about their health.
This is how new HIV infections among the “hardcore” will stop, and the surest way for those of us living with the virus to stay healthy.
John-Manuel Andriote is a Connecticut-based writer.
I was a “chubby” kid. A “husky” kid. Horrible terms that still make me cringe. Food issues stem through the family tree. I remember hearing a family member vomit when I was in elementary school; the residual scraps left floating in the toilet. I tried sticking my finger down my throat as a teen — an easy purge after a buffet binge. “Easy” being a sick way of looking at such a violent act to oneself, but the swiftness of an occasional act turning to addiction is frighteningly simple.
I was in my early 20s when I went on another diet in a series of crash diets, but this one hit different. I barely ate and worked out intensely each day. I decided to reward myself at the end of the week with a large pizza and breadsticks. Devouring a whole pizza (and more) was not new to me. I could down an alarming amount of food and hit the pillow in a haze. I didn’t know about nutrition, calories, or balance for many years to come. The meal went down the toilet, and I resumed my starvation diet. The calorie deficit pushed me closer to addiction’s ledge, and the hunger sent me over.
The sporadic binge turned to several a week — running to the local country store for a smattering of chips, candy, soda, honey buns, cookies, anything to fill me up. Soon, it was a regular appointment, arranging a home buffet to mindlessly stuff my body for hours ‘til I knelt over the ceramic bowl.
The binge-n-purge cycle turned twice daily. If I couldn’t binge at home in private, I would gorge at buffets or in my car — throwing up in restaurants, grocery stores, lobby restrooms. I lived in a house with a septic tank at the start of my illness. I clogged the tank, causing vomit to rise to the surface of the soil. Fearing further damage, I started throwing up in trash bags, collecting them in large bins, and driving them to public toilets to dispose of them. This went on for seven years, all through college, internships, and my first corporate job.
The older man I was with was losing himself at the same time, falling deeper into the abyss of severe depression he’d battled lifelong. We saw the best in each other at the start, and the worst by the demise. His bouts of darkness were beyond my repair, no matter how hard I tried to tackle the impossible fix. How is a 21-year-old supposed to convince a 46-year-old to seek treatment, talk him down from suicidal tendencies, get him to understand people love him? I couldn’t navigate it, and food seemed to be the one thing in my control.
It also became my reward and my excuse to treat myself in the face of any stress or accomplishment. He wants to kill himself: binge. I aced a test: binge. Work was rough: binge. Food was all I lived for. Friends, family, love all took a backseat. I was ruled by a hidden hunger I kept secret from nearly everyone, though my emaciated frame didn’t go unnoticed.
I was productive through the battle, working full time, graduating college summa cum laude, landing a solid job and moving up the ladder. All common addict attributes. Bulimia consumed me ‘til I was nearly 30 — four years after splitting from my first love, two years after he killed himself, and three years into a relationship with the man who would become my husband, and later my ex-husband.
They say the difference between privacy and secrecy is that privacy is about respect, whereas secrecy has shame attached. So, let’s drop the shame and the secrets held far too long. It’s been 12 years since I spent my days, nights, and thousands of dollars gorging and purging for hours. Twelve years since I was face down in a toilet at my own will.
I was a TV producer for a decade, booking more than 15,000 segments through the years. I often received pitches for February’s Eating Disorder Awareness Month and made a point to share these stories every year. Still, every pitch and every spokesperson I booked was with a woman. The stigma surrounding body dysmorphia in men continues despite men representing up to 25 percent of people with eating disorders, with members of the LGBTQ+ community at a higher risk, according to the National Association of Anorexia Nervosa and Associated Disorders. Men are also more likely to not recognize a problem, and their cases tend to be more severe by the time they see a doctor.
Living in secret and hiding is not living. It’s shame-based and the ultimate red flag that something needs to change. It will haunt you ‘til you are unrecognizable to yourself and everyone around you. You don’t need to share your story with the world, but opening up to someone is a crucial step in recovery and healing. Living in lies and maintaining deception is the heaviest of burdens
Addiction is blinding. You are unable to see the joys, the freedoms, and opportunities awaiting when you’re solely focused on soothing your addiction’s rage. Living for the fix pushes every other interest out of focus. When you start to release the devil on your back, you make room for wings to spread and space to fly into passions suffocated far too long.
It’s taken a lot of work, therapy, reflection and learning. Not to say I’m recovered, not to say I’m healed. I’ll forever have this devil on my back. It’s about learning to quiet his rage, soothe his anxiety, and ensure his safety and love. It’s a lifelong path of healing more with each day, each year.
And there is always hope. Even in the deepest depths of despair and isolation and ‘I’ll-never-get-better-ness.’ Whatever your circumstances, those tinges of hope are worth clinging to. They’ll carry you through.
I don’t know where I’ll be next year, let alone a future once so clear. And I’m okay. You’re okay. The other side isn’t perfect. Nothing is. But what a gift to make it there and experience life unshackled from your ghost.
There’s so much to see.
Kyle Ridley is an Emmy Award winning journalist with more than two decades in print and television.
Opinions
Why trans suffering is more palatable than trans ambition
We are most readily accepted when framed as victims
In the current media and political climate, stories of trans suffering move quickly. Stories of trans ambition do not.
A trans teenager denied healthcare. A trans woman attacked on public transit. A trans man struggling with homelessness. These narratives circulate widely, often accompanied by solemn op-eds, viral posts, and carefully worded statements of concern. The pain is real. The coverage is necessary. But there is a quieter pattern beneath it: trans people are most readily accepted when they are framed as victims—and most resisted when they present themselves as agents with desire, confidence, and upward momentum.
This distinction has sharpened in recent years. As anti-trans legislation has proliferated across statehouses and election cycles have turned trans lives into talking points, the public script has narrowed. Trans people are legible as objects of harm, but far less comfortable to many audiences as subjects of ambition. Survival is tolerated. Aspiration is destabilizing.
The reason suffering travels more easily is not mysterious. Pain reassures the audience. It positions trans people as recipients of concern rather than participants in competition. A suffering subject does not threaten status hierarchies; they confirm them. Sympathy can be extended without requiring a recalibration of power, space, or expectations. In this framing, acceptance remains conditional and charitable.
Ambition disrupts that arrangement. A trans person who wants more than safety—who wants money, authority, visibility, creative control, or institutional influence—forces a different reckoning. Ambition implies permanence. It implies entitlement. It implies that trans people are not passing through society’s margins but intend to occupy its center alongside everyone else.
You can see this discomfort play out in real time. When trans people speak about wanting success rather than safety, the response often shifts. Confidence is scrutinized. Assertiveness is reframed as arrogance. Desire is recoded as delusion. The language changes quickly: “unstable,” “narcissistic,” “out of touch,” “ungrateful.” In public discourse, confidence in trans people is frequently treated not as a strength, but as a warning sign.
Media narratives reinforce this dynamic. Even ostensibly positive coverage often relies on redemption arcs that center suffering first and ambition second—if at all. Success is framed as overcoming transness rather than inhabiting it. A trans person can be praised for resilience, but rarely for dominance, excellence, or command. Achievement must be softened, contextualized, and made reassuring.
This is especially visible in cultural reactions to trans people who refuse modesty. Trans figures who express sexual confidence, professional competitiveness, or political authority routinely face backlash that their cis counterparts do not. They are accused of being “too much,” of asking for too much space, of wanting too much too fast. The underlying anxiety is not about tone; it is about proximity. Ambition collapses the safe distance between observer and observed.
Politically, this preference for suffering over ambition is costly. Movements anchored primarily in pain narratives struggle to articulate futures beyond harm reduction. They mobilize sympathy but have difficulty sustaining leadership. A politics that can only argue from injury is perpetually reactive, always responding to the next threat rather than shaping the terrain itself.
This matters in a moment when trans rights are no longer debated only in cultural terms but in administrative, legal, and economic ones. Influence now depends on institutional literacy, long-term strategy, and the willingness to occupy decision-making spaces that were never designed with trans people in mind. Ambition is not a luxury; it is a prerequisite for durability.
Yet ambition remains suspect. Trans people are encouraged to be grateful rather than demanding, visible rather than powerful, resilient rather than authoritative. Even within progressive spaces, there is often an unspoken expectation that trans people justify their presence through pain rather than through competence or vision.
This is not liberation. It is containment.
A society that can tolerate trans suffering but recoils at trans ambition is not offering equality; it is managing discomfort. It is willing to mourn trans deaths but uneasy about trans dominance, trans leadership, or trans desire that does not ask permission. It prefers trans people as evidence of harm rather than as evidence of possibility.
None of this is an argument against documenting suffering. That work remains essential, particularly as legal protections erode and violence persists. But suffering cannot be the only admissible register of trans life. A politics that cannot imagine trans people as ambitious cannot sustain trans people as free.
Ambition does not negate vulnerability. Desire does not erase harm. Wanting more than survival is not ingratitude—it is the baseline condition of citizenship. The question is not whether trans people deserve ambition. The question is why it remains so unsettling when they claim it.
Until that discomfort is confronted, acceptance will remain conditional. Sympathy will remain cheap. And trans futures will continue to be negotiated on terms that stop just short of power.
Isaac Amend is a writer based in the D.C. area. He is a transgender man and was featured in National Geographic’s ‘Gender Revolution’ documentary. He serves on the board of the LGBT Democrats of Virginia. Contact him on Instagram at @isaacamend
First what isn’t. That would be snow removal in D.C. I understand the inches of sleet that fell on the nearly four inches of snow, and historic days of freezing weather, make it very difficult. But it took three days until they brought out the bigger equipment. Then businesses and homeowners were told they wouldn’t be fined for not clearing their sidewalks, which they have to do by law. That clearly made things worse. The elderly and disabled have an exemption from that, others shouldn’t be given one. Then there was no focus on crosswalks, so pedestrians couldn’t get around, and no apparent early coordination with the BIDS.
Then there are about 2,200 National Guard troops strolling D.C., yes strolling, at least before the snow. Why weren’t they given immediate snow removal duty. If the president gave a damn about our city he would have assigned them all to help dig out the city. We could have used their equipment, handed out shovels, and put the Guard to use immediately. Maybe the mayor put in her request for the Guard a little late.
I have met and chatted with many Guard members across the city. A group from Indiana regularly come to my coffee shop, though I haven’t seen them since the snow. I always thank them for their service — I just wish it wasn’t here. Nearly all agree with me, saying they would rather be home with their families, at jobs, or in school. I’ve met Guard members from D.C., West Virginia, Indiana, Mississippi, and Louisiana. My most poignant meeting was with one Guard member from West Virginia the day after his fellow Guard member was murdered. Incredibly sad, but avoidable; she should never have been assigned here to begin with. The government estimates it costs taxpayers $95,000 a year for each deployment. So, again, instead of strolling the streets, they should have been immediately assigned to assist with snow removal. Clearly the felon, his fascist aides, and incompetent Cabinet, are too busy supporting the killing of American citizens in Minneapolis, to care about this. I thank those Guard members now helping nearly a week after the snow began to fall. I recognize this was a difficult storm. I hope the city will learn from this for the future.
Now for something happening in D.C. that shouldn’t be. A host of retreads have announced they are candidates for office in both the June Democratic primary, and general election. Some are names you might remember but hoped were long gone. Two left the Council under ethical clouds. One is Jack Evans. He announced his candidacy for City Council president. I like Jack personally, having known him since he served on a Dupont ANC. This race is a massive waste of time and money, as he will surely lose. Even before his ethics issues were made public, and his leaving the Council under a cloud in 2020, he ran for mayor in 2014. At that time, he received only 5% of the vote, even in his own Ward. At 73, he should accept his electoral career is over. Another person who left the Council over questionable ethics, Vincent Orange, who is nearly 70, announced he is running for mayor. He did that last in 2014, when he got only 2% of the vote in the primary. He is another one who will surely lose. Both will likely qualify for city funding, wasting taxpayer money. I know I will be called an ageist. But reality is, in most cases, it’s time for a new generation to take the lead. Another person who has served before, was defeated for reelection, is now trying for a comeback on the Council. I think the outsized egos of these individuals should not be foisted on the voters. If they are really interested in serving the community, there are many ways to do it without holding elective office.
Then there is ICE and the continuing situation in Minneapolis. I applaud Democrats in Congress for holding up long-term funding for ICE for at least two weeks and getting the felon to negotiate. Now not every ICE agent behaves like the gestapo, but their bosses condone the behavior of the ones who do. Secretary of Homeland Security, Kristi Noem, who shot her dog, and Trump’s Goebbels, Stephen Miller, seem to think nothing of causing the deaths of American citizens.
Now the felon’s FBI and DOJ are arresting journalists; then going to Georgia and removing stored ballots from the 2020 election, all because the felon is still obsessed with that loss. His disappearing DNI, Tulsi Gabbard, was involved in that for some reason. The felon is a sick, demented, old man. They must all be stopped before they completely destroy our democracy.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
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