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 hope you have a great Thanksgiving and can enjoy it with family and friends and that you have things you can be thankful for this past year. That you have your health. Now here is the column I would have liked to share with you this Thanksgiving:
To all my friends and family. This year I am thankful the felon has left the White House. It feels we can all finally breath again. I am so happy his idea of a ballroom at the White House was a joke, and we can once again walk in Jackie Kennedy’s rose garden, and visit the beautiful East Wing. I am thankful the felon’s personal Goebbels, Stephen Miller, lost his job when the reality that he was a fascist was too much to take. It was wonderful to see the Supreme Court wake up and do their job once again. They stopped drinking the MAGA Kool-Aid and voided all the executive orders calling on museums to hide the history of Black Americans, women, and the LGBTQ community. They told the president he didn’t have the right to place tariffs, and that he couldn’t fire legally appointed members of commissions under the rubric of Congress’s control.
Then I am thankful the Congress began to do its job. That so many Republicans grew a set of balls and decided to challenge Speaker Mike ‘sycophant’ Johnson, reminding him they were an independent part of government, and didn’t need to rubber stamp everything the felon wanted. I was thankful to see them extend the SNAP program indefinitely, and the same with the tax credits for the ACA, agreeing to include these important programs in next year’s budget. Then they went further, and paid for the programs, by rescinding all the tax benefits they had given to the wealthy, and corporations, in the felon’s big ugly bill. Finally realizing it is the poor and middle class who they had to help if the country was to move forward. Then I can’t thank them enough for finally passing the Equality Act, and doing it with a veto proof majority, so the felon had to sign it, before he left office. They did the same for the Choice Act, and the Voting Rights Act. It was a glorious year with so much to be thankful for.
Then I am so thankful Congress finally stood up to the felon and said he couldn’t start wars without their approval, and the Supreme Court ruled they were right. That attacking Venezuela was not something he had the right to do. Then the final thing the court did this year I am thankful for, is they actually modified their ruling on presidential immunity, and said the felon’s grifting was not covered, as under their decision that was private, and not done in his role as president. Again, can’t thank them enough for waking up and doing that.
Then there is even more I am thankful for this year. It was so nice to see Tesla collapse, and Musk lose his trillion-dollar salary. The people finally woke up to him and insisted Congress mandate the satellite system he built, basically with money from the government, was actually owned by the government, and he could no longer control who can use it. It was determined he alone would not be able to tell Ukraine whether or not they can use it in their war defending against the Russian invasion. Then I am so thankful Congress went even further, and approved the funds needed by the Ukrainians for long-range missiles, and a missile defense system, accepting Ukraine was actually fighting a proxy war for the West, and Ukraine winning that war would help keep our own men and women off the battlefield.
And speaking of our military, I thank Congress for lifting the ban on transgender persons in the military, and honoring their service, along with the service of women, Black service members, all members of the LGBTQ community, and all minorities. It was fun to see Pete Hegseth being led out of the Pentagon, and being reminded he wasn’t the Secretary of War. There is no Department of War, it is still the Department of Defense, with congressional oversight. Again, so many things to be thankful for this past year. It seemed like my heart runneth over.
Then my alarm went off and I woke up from my big beautiful dream, only to realize I was still living in the Trumpian nightmare.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
Commentary
Elusive safety: what new global data reveals about gender, violence, and erasure
Movements against gender equality, lack of human rights data contributing factors.
“My identity could be revealed, people can say whatever they want [online] without consequences. [Hormone replacement therapy] is illegal here so I’m just waiting to find a way to get out of here.”
-Anonymous respondent to the 2024 F&M Global Barometers LGBTQI+ Perception Index from Iraq, self-identified as a transgender woman and lesbian
As the campaign for 16 Days Against Gender-Based Violence begins, it is a reminder that gender-based violence (GBV) — both on– and offline — not only impacts women and girls but everyone who has been harmed or abused because of their gender or perceived gender. New research from the Franklin & Marshall (F&M) Global Barometers and its report A Growing Backlash: Quantifying the Experiences of LGBTQI+ People, 2022-2024 starkly show trends of declining safety among LGBTQI+ persons around the world.
This erosion of safety is accelerated by movements against gender equality and the disappearance of credible human rights data and reporting. The fight against GBV means understanding all people’s lived realities, including those of LGBTQI+ people, alongside the rights we continue to fight for.
We partnered together while at USAID and Franklin & Marshall College to expand the research and evidence base to better understand GBV against LGBTQI+ persons through the F&M Global Barometers. The collection of barometers tracks the legal rights and lived experiences of LGBTQI+ persons from 204 countries and territories from 2011 to the present. With more than a decade of data, it allows us to see how rights have progressed and receded as well as the gaps between legal protections and lived experiences of discrimination and violence.
This year’s data reveals alarming trends that highlight how fear and violence are, at its root, gendered phenomena that affect anyone who transgresses traditional gender norms.
LGBTQI+ people feel less safe
Nearly two-thirds of countries experienced a decline in their score on the F&M Global Barometers LGBTQI+ Perception Index (GBPI) from 2022-2024. This represents a five percent drop in global safety scores in just two years. With almost 70 percent of countries receiving an “F” grade on the GBPI, this suggests a global crisis in actual human rights protections for LGBTQI+ people.
Backsliding on LGBTQI+ human rights is happening everywhere, even in politically stable, established democracies with human rights protections for LGBTQI+ people. Countries in Western Europe and the Americas experienced the greatest negative GBPI score changes globally, 74 and 67 percent, respectively. Transgender people globally reported the highest likelihood of violence, while trans women and intersex people reported the highest levels of feeling very unsafe or unsafe simply because of who they are.
Taboo of gender equality
Before this current administration dismantled USAID, I helped create an LGBTQI+ inclusive whole-of-government strategy to prevent and respond to GBV that highlighted the unique forms of GBV against LGBTQI+ persons. This included so-called ‘corrective’ rape related to actual or perceived sexual orientation, gender identity, or expression” and so-called ‘conversion’ therapy practices that seek to change or suppress a person’s gender identity or expression, sexual orientation, or sex characteristics. These efforts helped connect the dots in understanding that LGBTQI+ violence is rooted in the same systems of inequality and power imbalances as the broader spectrum of GBV against women and girls.
Losing data and accountability
Data that helps better understand GBV against LGBTQI+ persons is also disappearing. Again, the dismantling of USAID meant a treasure trove of research and reports on LGBTQI+ rights have been lost. Earlier this year, the US Department of State removed LGBTQI+ reporting from its annual Human Rights Reports. These played a critical role in providing credible sources for civil society, researchers, and policymakers to track abuses and advocate for change.
If violence isn’t documented, it’s easier for governments to deny it even exists and harder for us to hold governments accountable. Yet when systems of accountability work, governments and civil society can utilize data in international forums like the UN Universal Periodic Review, the Convention on the Elimination of All Forms of Discrimination Against Women, and the Sustainable Development Goals to assess progress and compliance and call for governments to improve protections.
All may not be lost if other countries and donors fill the void by supporting independent data collection and reporting efforts like the F&M Global Barometers and other academic and civil society monitoring. Such efforts are essential to the fight against GBV: The data helps show that the path toward safety, equality, and justice is within our reach if we’re unafraid of truth and visibility of those most marginalized and impacted.
Jay Gilliam (he/him/his) was the Senior LGBTQI+ Coordinator at USAID and is a member of the Global Outreach Advisory Council of the F&M Global Barometers.
Susan Dicklitch-Nelson (she/her/hers) is the founder of the F&M Global Barometers and Professor of Government at Franklin & Marshall College.
Commentary
Second ‘lavender scare’ is harming our veterans. We know how to fix it
Out in National Security has built Trans Veterans State and Local Policy Toolkit
Seventy years after the first “lavender scare” drove LGBTQ Americans from public service, a second version is taking shape. Executive directives and administrative reviews have targeted transgender servicemembers and veterans, producing a new wave of quiet separations and lost benefits.
The policy language is technical, but the result is personal. Veterans who served honorably now face disrupted healthcare, delayed credentials, or housing barriers that no act of Congress ever required. Once again, Americans who met every standard of service are being told that their identity disqualifies them from stability.
Out in National Security built the Trans Veterans State and Local Policy Toolkit to change that. The toolkit gives state and local governments a practical path to repair harm through three measurable actions.
First, continuity of care. States can keep veterans covered by adopting presumptive Medicaid eligibility, aligning timelines with VA enrollment, and training providers in evidence-based gender-affirming care following the World Professional Association for Transgender Health Standards of Care Version 8.
Second, employment, and licensing. Governors and boards can recognize Department of Defense credentials, expedite licensing under existing reciprocity compacts, and ensure nondiscrimination in state veterans’ employment statutes.
Third, housing stability. States can designate transgender-veteran housing liaisons, expand voucher access, and enforce fair-housing protections that already exist in law.
Each step can be taken administratively within 90 days and requires no new federal legislation. The goal is straightforward: small, state-level reforms that yield rapid, measurable improvement in veterans’ daily lives.
The toolkit was introduced during a Veterans Week event hosted by the Center for American Progress, where federal and state leaders joined Out in National Security to highlight the first wave of state agencies adopting its recommendations. The discussion underscored how targeted, administrative reforms can strengthen veterans’ healthcare, employment, and housing outcomes without new legislation. Full materials and implementation resources are now available at outinnationalsecurity.org/public-policy/toolkit, developed in partnership with Minority Veterans of America, the Modern Military Association of America, SPARTA Pride, and the Human Rights Campaign.
These are technical fixes, but they carry moral weight. They reaffirm a basic democratic promise: service earns respect, not suspicion.
As a policy professional who has worked with veterans across the country, I see this moment as a test of civic integrity. The measure of a democracy is not only who it allows to serve but how it treats them afterward.
The second “lavender scare” will end when institutions at every level decide that inclusion is an obligation, not an exception. The toolkit offers a way to begin.
For more information or to access the toolkit once it is public, visit outinnationalsecurity.org/toolkit.
Lucas F. Schleusener is the CEO of Out in National Security.
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