Coercive sexual experiences and subsequent human papillomavirus infection and squamous intraepithelial lesions in adolescent and young adult women

Purpose: The purpose of this study was to examine the associations between coercive sexual experiences and subsequent human papillomavirus (HPV) infection and/or squamous intraepithelial lesion (SIL) in adolescent and young adult women, and to determine whether risk behaviors mediate and sociodemographic factors moderate any observed associations. Methods: Data were obtained from a longitudinal cohort study of female university students (N = 608). χ² and Wilcoxon rank-sum tests were used to determine associations between history of a coercive sexual experience and subsequent risk behaviors, and between risk behaviors and HPV or SIL. Logistic regression models were used to determine whether a coercive sexual experience was associated with HPV or SIL and whether the association was mediated by risk behaviors and/or moderated by sociodemographic factors. Results: Twenty-two percent of participants reported a prior coercive sexual experience. Report of a prior coercive sexual experience was associated with a higher lifetime number of sexual partners (p < .0001), which in turn was associated with subsequent HPV infection (p < .0001) and SIL (p < .0001). In logistic regression models, coercive sexual experience was associated significantly with HPV (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.19-2.84) and at a marginal significance level with SIL (OR, 1.90; 95% CI,. 97-3.70). When the number of sexual partners was included in the first model, the association between coercive sexual experience and HPV infection became nonsignificant and the β coefficient decreased by 49%. Race and age did not appear to moderate the association between coercive sexual experience and HPV. Conclusions: The number of sexual partners is an important mechanism through which adolescent and young adult women who report a coercive sexual experience acquire HPV.