Publication Date



Open access

Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Psychology (Arts and Sciences)

Date of Defense


First Committee Member

Gail Ironson

Second Committee Member

Steven Safren

Third Committee Member

Adam Carrico

Fourth Committee Member

Neil Schneiderman

Fifth Committee Member

Allan Rodriguez

Sixth Committee Member

Conall O'Cleirigh


Men who have sex with men (MSM) with histories of childhood sexual abuse (CSA) are at disproportionate risk for sexually transmitted infections (STIs) and HIV. Psychological variables explain part of this; however, standing alone, they fail to account for all of the increased risk. This secondary data analysis investigates the relationship between psychological factors (PTSD and substance use), structural factors (government benefits, unstable housing and neighborhood crime), unprotected sex and STI incidence and also investigates possible moderation effects of race/ethnicity. MSM from Boston and Miami (N= 296) were recruited for a larger RCT testing the effect of Cognitive Processing Therapy (CPT) adapted for sexual risk on improving PTSD symptoms and decreasing unprotected sex. Participants completed psychosocial questionnaires and clinician-administered assessments and were followed for one year. A subset of 108 participants provided information on structural barriers. Cross-sectionally, higher PTSD symptoms, crystal meth use, unstable housing, and use of government benefits at baseline were associated with a higher number of unprotected sex encounters. Higher PTSD symptomology was also associated with lower odds of incident STI for Black (OR = 0.957, p = .007, 95%CI = 0.928 – 0.988) and Latino (OR = 0.965, p = .014, 95%CI = 0.937 – 0.993) MSM only. No other evidence of racial moderation was found. Longitudinally, cocaine use at baseline predicted decreased condom use and use of government benefits predicted increased condom use. Though underpowered in some structural variable tests, the study provides plausible intervention targets for a population at high risk for HIV infection whose risk reduction needs have been challenging to address. Future work should continue to address mechanisms for the effects found here, particularly those which are structural in nature. This work might also investigate other theoretically-guided variables and their relation to structural barriers and unprotected sex.


HIV; Structural; PTSD; Substance Use