***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Substantiated cases of child sexual abuse ( CSA ) in the United States have declined significantly over the past decade . This may , or may not , reflect change in the underlying rate in the general population . This study examines age-cohort differences in the prevalence of self-reported CSA experiences of men and women aged 18 - 59 years in a community-based sample from a comparable western nation . METHOD In April 2000 , we completed a cross-sectional , telephone-based survey of a r and omly selected national sample of men and women in Australia . Volunteers ( 876 males , 908 females ) answered a range of questions about health status and sexuality , including unwanted sexual experiences before the age of 16 years . Of selected adults with publicly-listed telephone numbers , 61 % agreed to participate . There were few differences between the volunteers and the Australian population on demographic variables and health indicators . RESULTS Non-penetrative CSA was twice as common among women ( 33.6 % ) than men ( 15.9 % ) . Approximately 12 % of women and 4 % of men reported unwanted penetrative experiences . CSA was reported significantly less often by younger males , with a linear decline from the oldest to youngest men . Among all females who had intercourse before age 16 , older women were much more likely than younger women to say they were an unwilling partner on the first occasion . If first intercourse occurred at age 16 or later , there were no age-cohort differences in risk of first-time abuse . Self-reported " openness " and " comfort " during the telephone interviews was not systematic ally related to prevalence of CSA . CONCLUSION These population -based findings provide evidence of a decline in the underlying rate of CSA in Australia . Although every measure of CSA inevitably is flawed to some extent , these trends in self-report complement official statistics that show substantial decline in recent years OBJECTIVES This study examined the extent to which being abused and /or neglected in childhood increases a person 's  risk for promiscuity , prostitution , and teenage pregnancy .  METHODS A prospect i ve cohorts design was used to match , on the basis of age , race , sex , and social class , cases of abused and /or neglected children from 1967 to 1971 with nonabused and nonneglected children ; subjects were followed into young adulthood . From 1989 to 1995 1196 subjects ( 676 abused and /or neglected and 520 control subjects were located and interviewed . RESULTS Early childhood abuse and /or neglect was a significant predictor of prostitution for females ( odds ratio [ OR ] = 2.96 ) . For females , sexual abuse ( OR = 2.54 ) and neglect ( OR = 2.58 ) were associated with prostitution , whereas physical abuse was only marginally associated . Childhood abuse and neglect were not associated with increased risk for promiscuity or teenage pregnancy . CONCLUSIONS These findings strongly support a relationship between childhood victimization and subsequent prostitution . The presumed causal sequence between childhood victimization and teenage pregnancy may need to be reevaluated Childhood sexual and physical abuse have been linked to adolescent and adult risky sexual behaviors , including early sexual debut , an increased number of sexual partners , unprotected sex , alcohol and drug use during sex and sexual violence . This paper explores these relationships among both men and women who report histories of childhood abuse from representative sample s of communities in three countries in southern and eastern Africa ( South Africa , Zimbabwe and Tanzania ) . Data were collected as part of a 3-year r and omized community trial to rapidly increase knowledge of HIV status and to promote community responses through mobilisation , mobile testing , provision of same-day HIV test results and post-test support for HIV . The results indicate that reported childhood sexual and physical abuse is high in all three setting s , also among men , and shows strong relationships with a range of sexual risk behaviors , including age at first sex ( OR −0.6 ( CI : −0.9 , −0.4 , p < 0.003)—among men , OR −0.7 ( CI : −0.9 , −0.5 , p < 0.001)—among women ) , alcohol ( OR 1.43 ( CI : 1.22 , 1.68 , p < 0.001)—men , OR 1.83 ( CI : 1.50 , 2.24 , p < 0.001)—women ) and drug use ( OR 1.65 ( CI : 1.38 , 1.97 , p < 0.001)—men , OR 3.14 ( CI : 1.95 , 5.05 , p < 0.001)—women ) and two forms of partner violence — recent forced sex ( OR 2.22 ( CI : 1.66 , 2.95 , p < 0.001)—men , OR 2.76 ( CI : 2.09 , 3.64 , p < 0.001)—women ) and ever being hurt by a partner ( OR 3.88 ( CI : 2.84 , 5.29 , p < 0.001)—men , OR 3.06 ( CI : 2.48 , 3.76 , p < 0.001)—women ) . Individuals abused in childhood comprise between 6 and 29 % of young adult men and women living in these African setting s and constitute a population at high risk of HIV infection Low self-esteem and depression are strongly correlated in cross-sectional studies , yet little is known about their prospect i ve effects on each other . The vulnerability model hypothesizes that low self-esteem serves as a risk factor for depression , whereas the scar model hypothesizes that low self-esteem is an outcome , not a cause , of depression . To test these models , the authors used 2 large longitudinal data sets , each with 4 repeated assessment s between the ages of 15 and 21 years and 18 and 21 years , respectively . Cross-lagged regression analyses indicated that low self-esteem predicted subsequent levels of depression , but depression did not predict subsequent levels of self-esteem . These findings held for both men and women and after controlling for content overlap between the self-esteem and depression scales . Thus , the results supported the vulnerability model , but not the scar model , of self-esteem and depression OBJECTIVE This article examined links between childhood maltreatment and risky sexual behavior ( early sexual contact , promiscuity , prostitution ) and HIV in adulthood . DESIGN Using a prospect i ve cohort design , physically and sexually abused and neglected children ( ages 0 - 11 ) with documented cases during 1967 - 1971 were matched with nonmaltreated children and followed into adulthood . MAIN OUTCOME MEASURES  Early sexual contact , promiscuity , and prostitution were assessed through in-person interviews and official records ( prostitution ) at approximate age 29 ( N=1196 ) .  HIV tests  were conducted at approximate age 41 ( N=631 ) . RESULTS Child maltreatment was associated with prostitution ( OR=2.47 , 95 % CI=1.35 - 4.50 ) and early sexual contact ( OR=1.73 , 95 % CI=1.24 - 2.40 ) . Prevalence of HIV in the abuse/neglect group was twice that in controls ( OR=2.35 , 95 % CI=.64 - 8.62 ) , although this difference did not reach conventional levels of statistical significance . SEM provided significant support for a model linking child abuse and neglect to prostitution through early sexual contact and a marginal link to HIV through prostitution . CONCLUSION These findings provide prospect i ve evidence that maltreated children are more likely to report sexual contact before age 15 , engage in prostitution by young adulthood , and test positive for HIV in middle adulthood BACKGROUND Cross-sectional studies have shown that intimate partner violence and gender inequity in relationships are associated with increased prevalence of HIV in women . Yet temporal sequence and causality have been question ed , and few HIV prevention programmes address these issues . We assessed whether intimate partner violence and relationship power inequity increase risk of incident  HIV infection in South African women . METHODS We did a longitudinal analysis of data from a previously published cluster-r and omised controlled trial undertaken in the Eastern Cape province of South Africa in 2002 - 06 . 1099 women aged 15 - 26 years who were HIV negative at baseline and had at least one additional HIV test over 2 years of follow-up were included in the analysis .  Gender power equity and intimate partner violence were measured by a sexual relationship power scale and the WHO violence against women instrument , respectively . Incidence rate ratios ( IRRs ) of HIV acquisition at 2 years were derived from Poisson models , adjusted for study design and herpes simplex virus type 2 infection , and used to calculate population attributable fractions . FINDINGS 128 women acquired HIV during 2076 person-years of follow-up ( incidence 6.2 per 100 person-years ) . 51 of 325 women with low relationship power equity at baseline acquired HIV ( 8.5 per 100 person-years ) compared with 73 of 704 women with medium or high relationship power equity ( 5.5 per 100 person-years ) ; adjusted multivariable Poisson model IRR 1.51 , 95 % CI 1.05 - 2.17 , p=0.027 . 45 of 253 women who reported more than one episode of intimate partner violence at baseline acquired HIV ( 9.6 per 100 person-years ) compared with 83 of 846 who reported one or no episodes ( 5.2 per 100 person-years ) ; adjusted multivariable Poisson model IRR 1.51 , 1.04 - 2.21 , p=0.032 . The population attributable fractions were 13.9 % ( 95 % CI 2.0 - 22.2 ) for relationship power equity and 11.9 % ( 1.4 - 19.3 ) for intimate partner violence . INTERPRETATION Relationship power inequity and intimate partner violence increase risk of incident HIV infection in young South African women . Policy , interventions , and programmes for HIV prevention must address both of these risk factors and allocate appropriate re sources . FUNDING National Institute of Mental Health and South African Medical Research Council Recent reports of sexually transmitted infection-rate increases among men indicate the need for renewed study of male sexual risk behavior to aid development of up date d and novel risk reduction interventions . Men who have childhood sexual abuse ( CSA ) histories consistently report frequent sexual risk behavior . The objective of this sturdy is to explore whether posttraumatic stress disorder ( PTSD ) and depression are moderators and /or mediators of the association between CSA and sexual risk in adult men . A cross-sectional survey study employing r and om digit dial recruitment was administered to men aged 18–49 years from Philadelphia County . Two bundred ninety eight men were recruited and screened for CSA history , administered items from the Posttraumatic Stress Diagnostic Scale ( PDS ) and Center for Epidemiologic Studies —Depression ( CES-D ) , and asked to estimate their number of  lifetime sexual partners  ( LSPs ) . Effects of sociodemographic characteristics , CSA , PTSD , and depression on the number of LSPs were modeled using Poisson regression . Results show that 197 ( 66 % ) men participated ; 43 ( 22 % ) had CSA histories . CSA was significantly associated with PTSD/depression ( P=.03 ) . Four sociodemographic variables ( age , race , sexual identity , and education ) , CSA ( incidence rate ratio , IRR=1.47 , P<.001 ) , PTSD ( IRR=1.19 , P=.04 ) , depression ( IRR=1.29 , P=.001 ) , all 2-way interactions , and the 3-way CSA/PTSD/depression interaction ( IRR=11.00 , P<.001 ) were associated with the number of LSPs ( R2=0.27 ) . In conclusion , sexual partnership patterns unique to men with CSA histories and comorbid PTSD/depression appear to lead to substantially higher numbers of LSPs . Estimates of this relationship may have been biased toward the null by underreporting that can occur with phone surveys . Cross-sectional studies do not support causal inferences ; however , the identification of a moderating and mediating influence of PTSD/depression on the relationship between CSA and sexual risk behavior is important and suggests the need for future studies with larger sample s that examine trajectories for CSA , psychiatric illness , and sexual partnerships This study examined the comparability and predictive validity of three approaches to the measurement of child maltreatment . Adolescents ( N = 160 , aged 11 - 17 ) were r and omly selected from the open caseload of a child protection agency . Global ratings of maltreatment severity were made by three reporting sources : research ers on the basis of protection agency case files , protection agency social workers , and the adolescents themselves . Ratings were made of five types of maltreatment : physical , sexual , emotional , neglect , and exposure to family violence . Self-reported ( YSR ) and caretaker-reported ( CBCL ) adjustment measures were also obtained for each subject . Results indicated that over 90 % of the sample had experienced more than one type of maltreatment . Comparison of ratings across sources indicated considerable disagreement with respect to judgments of maltreatment occurrence and severity . Relative to professional ratings , adolescent ratings were better predictors of externalizing and internalizing symptomatology in both univariate and multivariate analyses OBJECTIVE Two distinct 
    Output:
    
There was a similar association between childhood sexual abuse in general and subsequent risky sexual behaviors in both females and males .
There were nonsignificant overall and subgroup differences between males and females .
Childhood sexual abuse is a significant risk factor for a syndemic of risky sexual behaviors and the magnitude is similar both in females and males .