Older immigrant Latino gay men and childhood sexual abuse: Findings from the Palabras Fuertes project

Abstract

Childhood Sexual Abuse (CSA) and maltreatment have long-term negative impacts on survivors, including older adults. Yet, limited qualitative examinations of how these experiences impact the lives of older adults exists and even fewer among older Latino gay men. We drew data from life-history narratives the first author conducted with five Spanish speaking older Latino gay men in New York City. Our analyses were guided by an Ecological Model, a Suffering lens, and our clinical social work experience with older adults, sexual minorities and people of color. All participants reported sexual experiences prior to the age of 15 and possible emotional and physical maltreatment. Yet, not all participants perceived these experiences as abuse. Our findings indicate how cultural, linguistic and contextual factors may affect disclosure and coping. Despite the fact that CSA and maltreatment occurred decades ago, these early experiences affected long-term psychosocial functioning. Our findings support a need for future research and clinical practice that considers the subjective perceptions of childhood sexual experiences and maltreatment and how these relate to psychosocial functioning in Latino gay men during older adulthood.

Introduction

Childhood sexual abuse (CSA) and maltreatment are associated with a number of negative health outcomes, yet little is known about these experiences among older Latino gay men in the US (Easton and Kong, 2017; Felitti et al., 1998; Raposo et al., 2014). We drew data from the Palabras Fuertes project in which the first author (DC) conducted life history narratives with immigrant older Latino gay men in New York city. All interviewees described early childhood sexual experiences. Given the scant literature that includes the voices of older Latino gay men, we present participants’ descriptions of childhood sexual experiences, illustrate how biopsychosocial factors contribute to disclosure, coping and ultimately long-term impacts of CSA and maltreatment, and discuss implications for clinical research and practice with older Latino gay men.

Literature review

Childhood sexual abuse and maltreatment: Rates and impact

Researchers, clinicians, policy and law makers have used a variety of definitions of CSA and maltreatment (Mathews and Collin-V ézina, 2019; Straus, 1994: 9). Regardless of definition, CSA and maltreatment rates are high among older adults and negatively impact the well-being of survivors across the lifespan. Studies with midlife and older adults (i.e., 50 years and above) indicate rates of CSA may range between five and 16% (Easton and Kong, 2017; Felitti et al., 1998, Raposo et al., 2014). Emotional and physical abuse histories among midlife and older adults are also common with documented rates of emotional abuse of approximately 11% (Felitti et al., 1998) and physical abuse between three and 20.6% (Felitti et al., 1998, Raposo et al., 2014). Unfortunately, studies show that CSA and other adverse childhood experiences (ACEs) may be more prevalent among sexual minority men and Latino populations than their heterosexual and White counterparts (Ai et al., 2016; Arreola et al., 2005, 2008; Dolezal and Carballo-Diéguez, 2002; Paul and Monahan, 2019; Rothman et al., 2011; Schneeberger et al., 2014). For example, one study found that 22% of their sample of US Latino men who have sex with men reported CSA (Arreola et al., 2005) and a recent review of CSA found that rates of CSA may be as high a 18% among children in some Latin American countries. Finally, one study of Latino men found that approximately 36% of their sample reported childhood physical abuse (Ai et al., 2016).

CSA is associated with multiple negative effects on psychological and physical well-being including symptoms of depression, hostility, suicide-attempts, posttraumatic stress disorder, anxiety, eating disorders, substance abuse, high-risk sexual behaviors, HIV, poor HIV treatment adherence and earlier mortality in child and adult survivors (Arreola et al., 2008; Lloyd and Operario, 2012; Raposo et al., 2014; Schneeberger et al., 2014). Studies among midlife and younger Latino men have also linked CSA to similar health outcomes but also found that they experience more frequent, anger, anxiety, hyper-vigilance, flashbacks and communication problems than their Black and White counterparts (Barrera et al., 2019; LaBrenz et al., 2020; Levine et al., 2018; Martinez et al., 2016; Payne et al., 2014; Sauceda et al., 2016). Interestingly, recent findings indicate that older age(i.e., aging into middle and older adulthood) may not moderate these effects of CSA (Easton and Kong, 2017; Raposo et al., 2014).

Child maltreatment is also associated with numerous negative outcomes in adulthood. For example, emotional abuse and physical abuse are associated with the presence of depression and anxiety symptoms, low self-esteem, anger, dissociation, and higher allostatic load (Cecil et al., 2017; Nelson et al., 2017; Widom et al., 2015). Survivors of CSA and/or maltreatment may also experience intrusive memories of the incident(s), low self-esteem and self-worth, lack of trust in others, shame, rage and anger that for some may contribute to homicidal or suicidal ideation and difficulty in engaging in intimate and successful relationships (Dorahy and Clearwater, 2012; Isely et al., 2008). Results from studies with Latino men have found positive associations between ACEs (including maltreatment) and depressive symptoms, smoking, alcohol use, cancer, coronary heart disease, and chronic obstructive pulmonary disease and more perceived stress (Llabre et al., 2017; Newcomb et al., 2009).

Disclosure of childhood sexual abuse and maltreatment

Researchers have examined CSA disclosure primarily among clinical samples and found that disclosure during adulthood tends to be “purposeful” and “intentional” and may be prompted by therapists or be self-motivated (Alaggia, 2004; Donalek, 2001; Draucker and Martsolf, 2008). Adults may experience both barriers and facilitators to disclosure of CSA and/or maltreatment. Survivors may not disclose due to a lack awareness or feeling uncertain about the accuracy of their memory, shame, guilt, self-blame, anxiety, fear of their story not being believed, feel that the person listening does not want to hear or is uncomfortable or hostile (as perceived by survivor) and/or feeling that the abuse is not relevant in their current lives (Alaggia, 2004; Crowley and Seery, 2002; Deering and Mellor, 2011; Del Castillo and O’Dougherty Wright, 2009; Denov, 2003; Dorahy and Clearwater, 2012; Draucker and Martsolf, 2008; Harper et al., 2008; Sorsoli, 2010; Sorsoli et al., 2008; Tener and Murphy, 2015). On the other hand, several factors may facilitate disclosure. Adult survivors may disclose to a trusted professional (e.g., counselors, doctors, psychiatrists) in “safe and trusted spaces” (Chouliara et al., 2011; Deering and Mellor, 2011) and when the survivor perceives the listener’s responses to be positive (e.g., empathic, nonjudgmental, calm, supportive) may disclose their stories in more detail (Denov, 2003; Draucker and Marsolf, 2008: 1039).Limited literature has examined disclosure among Latino men. However, scholars have pointed out that Latino values may influence whether abuse is disclosed. For example, machismo encourages physical virility and sexual prowess with women and may contribute to feelings of guilt and shame that may prevent disclosure (Fontes, 2007; Vidas, 1999).

Coping mechanisms: Childhood sexual abuse and maltreatment

There are limited examinations of coping mechanisms employed by boys/men with a history of CSA (DiPalma, 1994; Klein and Janoff-Bulman, 1996; Sigmon et al., 1997; Walsh et al., 2010). Extant research on cognitive and behavioral coping mechanisms with samples of primarily girls/women indicate that cognitive coping may include focusing on positive aspects of a situation, cognitive reappraisal, reframing and minimization. Behavioral coping may include engaging in substance abuse or physically distancing from the source of stress. Interestingly, some researchers codify substance abuse and risky sex as coping mechanisms (Filipas and Ullman, 2006; Ullman et al., 2005) while others identify these as maladaptive outcomes (Merrill et al., 2003).

Methods

We acknowledge the importance of providing transparent descriptions of study methods (e.g., what, how and why things were done; Tuval-Mashiach, 2017). Thus, we described our methods in detail elsewhere (Camacho et al., under review). For this manuscript we first provide an overview of the Palabras Fuertes study methods and rationale, then describe trauma informed principals implemented by the first author (DC) during data collection, and third we focus on outlining the analyses we used to arrive at our findings for this article.

Ongoing reflexive process

Reflexivity was a vital component throughout this research project (Camacho et al., under review). DC considered his identities as a bilingual (English/Spanish), bicultural (Mexican-American) gay man and caregiver trained in clinical social work with older adults in developing recruitment, engagement and strategies in collecting life history narrative interviews (Camacho, 2016). Similarly, all authors engaged in reflexive processes throughout data analyses. We provide examples throughout our explanation of our methods.

Palabras Fuertes: Starting a larger conversation

Despite the growing interests in older LGBT adults in the US (Fredriksen-Goldsen et al., 2019), our literature review yielded no qualitative studies focused on exploring the lives of older Latino gay men. Hence, the primary purpose of this exploratory study was to gain an understanding of older Latino gay men’s life experiences, health needs and perceptions of the future. The main research questions were: 1) What do older Latino gay men identify as important experiences across the life course, and 2) What meaning do they attach to these experiences?

In order to answer these questions, DC chose to conduct life history narratives. A life history narrative approach provided participants an opportunity to present their biography spanning from birth to present, to make inferences about the future, and to tell their story in their own words including rich descriptive accounts of experiences they deemed important (Chase, 2011; Ponterotto, 2002; Riessman, 2008). In order to allow participants to openly describe their lives, life histories were not guided by any particular theoretical framework.

In terms of recruitment, older Latinos are a “hard to reach” population (Liljas et al., 2019). DC considered that older Latino gay men face multiple sources of discrimination (e.g., ageism, racism, homophobia etc.) and barriers to participating in research (e.g., low levels of education, lack of trust in researchers; Calderón et al., 2006). Thus, one important foundational question for our study was whether it was even feasible to recruit and engage older Latino gay men in our research study. Given the exploratory nature of this study, gaining a “representative sample” of older Latino gay men was not an objective of this project. Instead a general goal for this project was to begin a conversation about the needs of older Latino gay men in the US.

Collaborating with an agency with a concentration of older LGBT adults was a logical recruitment strategy to enhance feasibility of connecting with older Latino gay men. In the fall of 2015, DC began a collaboration with SAGE in New York to carry out life history interviews with older Latino gay men. SAGE is a unique organization dedicated to improving the lives of older adults who identify as LGBT. At the time of the study, DC was a doctoral student and had not received funding to support this project. Thus, limited resources did not permit for multiple recruitment attempts or a large number of incentivized participants.

Study eligibility and procedures

DC initially recruited participants from a social support group for Latino men run at SAGE. He presented the project and encouraged possible participants to partake in life history narratives. During recruitment sessions and interviews, DC disclosed that he was a Mexican-American gay man and a doctoral student at Columbia University, as well as the logic and plans for this study. DC openly answered and addressed all participant concerns (e.g., regarding confidentiality, researcher’s nativity, personal motivations for doing study etc.).

DC invited individuals to participate in a brief survey and life history narratives if they identified as gay, male, Hispanic or Latino and were at least 60 years of age. All participants interviewed at either a private office at SAGE or the participants’ home (participant’s choice) and agreed to being either audio or video recorded. After participants granted consent, DC collected basic information regarding demographics, acculturation, health conditions and self-rated health (Bardage et al., 2005; Marin and Marin, 1991).

During the interviews DC queried participants about multiple areas across chronological intervals of ten years (from birth to near future) to elicit participants’ memories and help them identify key life events and experiences. For example, DC asked: In thinking about when you were a young child from birth to ten years of age: “What do you consider the most important event/memory during these years? What is your happiest memory during these years? Were there any challenges you experienced during these years?” Participants constructed their narratives in non-linear fashion (e.g., made connections between adult events and how these were influenced by childhood experiences). All communication was completed in Spanish. Interviews lasted between two and three hours. Upon completion of interviews, DC provided participants with $20 as a token of appreciation. The Columbia University Institutional Review Board approved all study procedures.

Applied trauma informed principles

In qualitative work (e.g., life history narratives), researchers could only anticipate where original interview questions may lead (Sandelowski and Barroso, 2003). In conceptualizing this project, DC reflected on his experiences as a clinical social worker and researcher working with primarily Latino midlife and older adults. He frequently listened to stories that included childhood challenges, immigration hardships, intrafamilial violence, health challenges and loss (Camacho, 2016; Camacho et al., 2018). The loss of loved ones and health challenges are common in aging (Carstensen et al., 2003). Plus, older gay men experience high rates of lifetime victimization (Fredriksen-Goldsen et al., 2011). Intersecting identities of older Latinos gay men may exacerbate challenges in connecting to and receiving appropriate mental health services (e.g., age, culturally, linguistic and LGBT sensitive care) (e.g., Aranda, 2015; Barrio et al., 2008; Fuentes and Aranda, 2012; Moore et al., 2020a, 2020b). Despite these stressors and need for mental health services, older Latinos have low rates of mental health service utilization (Benuto et al., 2018). Hence, DC acknowledged that participation in this study would offer a rare opportunity for participants to reflect and discuss their lives. DC anticipated that narratives may include disclosure and discussion of “sensitive topics” (e.g., trauma, loss, suicide ideation, etc.) To ensure participant safety, DC developed safety protocols that included connecting individuals to appropriate services as needed. As a trained clinical social worker, DC prepared mental, health and social service resources and collaborated with SAGE social workers to develop safety plans as necessary.

Given the challenges that older Latino gay men may have experienced across their life course, DC employed multiple trauma informed social work principles throughout the Palabras Fuertes project that would facilitate participants’ sharing of their stories (Levenson, 2017). For example, “transparency” was a critical approach to establish trust, a safe environment and provide participants with choices in developing and sharing their narratives (Tuval-Mashiach, 2017). DC disclosed his social positionality (Watts-Jones, 2010) and shared his motivations for conducting this study. For example, he shared that he was a social work doctoral student from Columbia University and a Mexican-American gay man. DC explained that he spoke English, Spanish and Spanglish, that he had the privilege of pursuing advanced degrees and that he was a clinical social worker by training. He further shared that he was born in Los Angeles to Mexican immigrants and that he was raised in the Boyle Heights and East Los Angeles neighborhoods where the majority of residents were low-income Latino immigrants and where poverty, gang related activity and violence were common (Tita, 2004). However, DC pointed out that despite shared identities (e.g., Latino, gay man), these did not necessarily translate to equal experiences.

Possible participants shared they were unsure what they were supposed to talk about during the interviews. In order to empower potential participants, DC purposely highlighted that they had unique insight and expert knowledge (Fredriksen-Goldsen et al., 2014, Levenson, 2017). He emphasized that there were no right or wrong answers and that they were all experts in their lived experiences and there-fore, were more than capable of adequately responding to all of the questions. DC reassured them that they were in control of the interview content and that they could share as little or as much as they wished and that he was most interested in learning about their views (Levenson, 2017). DC purposely offered to do interviews at home because he recognized that for some older adults, mobility and traveling can be barriers to participation (Webber et al., 2010). In addition, DC anticipated that interviewing participants in their homes would help them feel in control of their environments that in turn would facilitate comfort in sharing their story to a “stranger”.

Throughout interviews, DC intentionally made eye contact, asked directly if participants understood study prompts, and paid attention to participants’ body language for clues of possible uncertainty or misunderstanding of study procedures (e.g., delayed response, blank stares, attempts to interrupt). DC emphasized participants’ expert knowledge, invited questions and openly discussed their concerns regarding the study in order to help them feel comfortable in the “expert role”. Throughout the interview, DC actively listened to participants stories, asked probing questions, and periodically summarized and checked with participants to ensure he understood and interpreted their narratives correctly. Multiple participants wept as they described incidents of abuse, loss, or other difficult events. During these cases, DC validated participants emotional responses and provided participants time to self-regulate and encouraged them to share only what they felt comfortable sharing. Finally, in order to avoid participants feeling pressured or rushed when reflecting about their lives, gathering their thoughts or regulating their emotions, DC did not set an interview time limit.

Sample description

Our sample was one of convenience as we considered that this project would only be the beginning of the conversation about older Latino gay men. Despite the “small” sample of five, we believe that participants provided critical insights into their intimate lives that will lay a foundation for future work. We emphasize that the name of the project “Palabras Fuertes” [literally “strong words”] highlights the strength in participants’ words and the fight to bring to the forefront the unique experiences of a largely silenced group.

Briefly, the five participants in this study ranged in ages between 60 and 78 years (born between 1937–1955) and lived in the Brooklyn, Queens and Washington Heights neighborhoods of New York City. Three had less than a high school education, one completed high school and one had some college experience. All men were immigrants¹ and lived in the US for 28 years or more. Most participants reported incomes of less than $15,000. However, only two worked part-time as the others were either retired or unable to work due to disability. DC recorded (video or audio) all interviews (4 at home, 1 at SAGE).

Analysis

Ecological model and suffering.

Upon completion of each interview, DC met with a social work colleague and/or co-author (EL) to debrief regarding interview content, to process his emotional reactions to the interviews, and discuss impressions about the meaning of the data collected (Camacho, 2016; Camacho et al., under review; Morse, 2015). DC completed initial transcriptions in Spanish language and created notes and memos (Spanish and English) to capture his thoughts and reactions as he listened and transcribed the interviews.

As the sole Spanish speaker in this research team, and because he conducted the interviews, DC reviewed all transcripts, notes, and memos. Given that emotions can provide important insight into participants experiences, he paid particular attention to not just what participants said, but also how participants (e.g., pauses, tones, speed etc.) voiced their perceptions (Camacho, 2016). DC also considered the Ecological model to identify biological, psychological, social and historical factors that may contribute to health and suffering (Bronfenbrenner, 1994). For example, DC considered available educational, child welfare, healthcare and religious systems as well as the lack of social acceptance of sexual minorities in Latin America during the 1940s thru 1970s when participants were children. He also considered understandings of suffering (Cassell, 1998). Suffering threatens an individual’s social and psychological entity. The construct includes the perception of impending personal destruction and continues until the threat of disintegration passes or a person’s integrity is restored. Suffering includes distress that results in part from the meaning attached to an event or factor (Cassell, 1998). Suffering is not an automatic result of similar experiences. Individuals suffer depending on their subjective assignment of meaning (e.g., positive or negative) to experiences. Thus, DC coded initially not only for important factors but also the meaning participants attached to these. For example, DC coded incidents related to sexual, emotional and physical abuse, as well as descriptions of loneliness, “coming out”, poverty and end of life planning (Saldaña, 2015). Next, DC identified multiple clinically relevant areas for more focused analyses. After this initial set of analyses, DC engaged in “member checking” by presenting his findings to a group of Latino members (including some study participants) at SAGE and discussing their perceptions of DC’s interpretations and ultimately the relevance of these to Latino gay men’s current well-being (Creswell and Poth, 2016).

DC felt an emotional responsibility to honor the participants’ childhood experiences (Camacho, 2016; Gilgun, 2005). Most research examining CSA and maltreatment has focused on clinical samples aimed at understanding experiences of abuse (Tener and Murphy, 2015). However, our participants were not recruited from a clinical setting, and our study did not focus on abuse. Yet, participants disclosed and described how deep-seated wounds related to childhood abuse continued to be relevant many decades later. Hence, we conducted a directed and deeper analysis of CSA and maltreatment. We used Mathews and Collin-Vézina’s (2019) conceptualization of CSA and identified individuals who disclosed they engaged in sexual behaviors as children under the age of 18; and/or were unable to provide “true consent” due to not being able to comprehend the proposed sexual act (e.g., anal penetration); and where the perpetrator was in a position of relative power. Maltreatment included physical (e.g., hitting, slapping, pushing) and/or emotional abuse (i.e., behaviors that may negatively impact a child’s self-worth or emotional well-being including: name calling, shaming, rejection etc.) (Centers for Disease Control and Prevention, 2020).

Examination of childhood experiences.

DC invited three colleagues to participate in the data analysis processes. Authors CVR, KM and EL engaged in their own reflexivity process prior to engaging in this wave of data analysis. CVR highlighted themself as a young queer non-binary Chicanx (Mexican-American) person with a Masters of Social Work degree in advanced clinical practice, and an interest in serving LGBTQ+ communities and communities of color. CVR’s subjective experiences with gender, sexuality, and biculturality informed their interpretative analysis and formed the basis for their interest in this particular community. KM identifies as a straight cisgender person of color and middle-aged adult (Moore, 2016). KM has extensive clinical and qualitative research experience with LGBTQ+ Latinx, in addition to expertise in child and adolescent development and trauma. EL identifies as a woman who is white, cisgender and an older adult. She is the mother of a daughter who identifies as queer, and has lengthy experience as a professional clinician and family caregiver. She has significant experience with a range of approaches to qualitative research.

As a leader in this effort, DC worked with the team to re-visit and build on his original analyses. First, DC identified, composed and provided the team with case summaries and key excerpts of transcripts (translated into English). We all reviewed and coded these data. We met on multiple occasions to: jointly review and analyze our case summaries and transcripts, discuss our codes and interpretations of participants’ recollections (e.g., how our own identities/experiences shaped our interpretations), examine key biological, psychological and historical factors, and explore how our findings related to clinical practice and extant literature. Based on iterative discussions (e.g., ideas, interpretation, questions, lack of clarity in narratives etc.), we developed themes. DC revisited original data to provide the team with further clarifying information, resolve disagreements and ultimately reach consensus on our findings. We present our findings next.

Findings

All participants disclosed sexual experiences before the age of 15 and possible emotional and physical maltreatment. Yet, participants’ narratives highlighted how subjective interpretations of these experiences were shaped by cultural, linguistic and contextual factors. Our findings focus on four general themes including: 1) Perceptions of Childhood Sexual Experiences: Not Always Abuse; 2) Descriptions of Childhood Sexual Abuse and Maltreatment; 3) Coping Mechanisms; and 4) Psychosocial Impact. We used pseudonyms and modified some original descriptions to enhance anonymity and confidentiality.

Perceptions of childhood sexual experiences: Not always abuse

All five participants disclosed childhood sexual experiences (i.e., prior to the age of 15). However, not all participants categorized their early sexual encounters with adults as sexual abuse. For example, Andres (60 years old) engaged in his first sexual experience as a 10-year-old boy. He explained that he physically developed early and that “nobody raped me, nobody forced me”. Sebastian (64 years old) described that at 15 years old, he was sexually involved with an older married woman who “seduced” him. He reasoned that as a teenager with raging hormones, he experienced a phase of “sexual desperation” and that his “[penis] would become erect and [he would] stick it in anywhere”.

As clinicians and researchers, we can argue (i.e., based on age, consent, power dynamics, etc.) that these incidents were sexual abuse (Mathews and Collin-Vézina, 2019). However, these examples support prior research that highlight the importance of subjective perceptions of early sexual experiences (Arreola et al., 2008; Dolezal and Carballo-Diéguez, 2002). For example, Arreola et al. (2008) study examined differential effects of forced, consensual, and no childhood sexual experiences among gay and bisexual men and found no differences in rates of depression and suicidal ideation between consensual and no-sex groups.

Descriptions of childhood sexual abuse and maltreatment

Diego’s (62 years old) early years were plagued by multiple challenges including CSA and maltreatment. He recalled the strained relationship he had with his mother. Diego never met his biological father who had abandoned his mother prior to his birth. He believed that the abandonment may have contributed to her unpredictable violent outbursts and emotional abuse. Diego explained: “She [mother] used to punish me so often … my childhood was a martyrdom … I do not even know how I am alive … she tried to kill me for anything … ” Diego recounted multiple incidents of her attacks. When a neighbor accused Diego of not paying for the arepas his mother instructed him to buy, without listening to his explanation, Diego’s mother took a rock and beat him severely. He described: “My mouth and nose were already busted [bleeding].” Community members attempted to intervene but she screamed “I prefer a dead son than a thief.” She then locked him in his bedroom for two weeks without food.

Diego’s recollections of abuse did not stop there. When he was 10 years old, his mother’s trusted neighbor lured him into his home. Diego remembered feeling unthreatened by his invitation until the visit took a violent turn. He recalled:

The man raped me … I did not know, he told me to accompany him, he was going to urinate and that, he began to caress me and to console me, I say, like he began to inspire trust in me, I knew nothing about sex … the next day I could not get out of bed, I had a fever, I never told this to anybody, the worst part was I could not go to school, then my grandmother said ‘let’s call the doctor’, I knew something had happened that I shouldn’t have done, so I told her not to call the doctor, they left me alone at home, when I went to the restroom, I sat on the chamber pot, and the hemorrhage was terrible …

The hemorrhage he describes alludes to a forceful penetration and tearing of the anal cavity. In addition, Diego’s recollection of “I knew something had happened that I shouldn’t have done” demonstrates feelings of confusion, shame, self-blame and wrongdoing. We consider Diego’s context (i.e., 1960s, Latin America, low-resource community, etc.) and realize that he had limited support to prevent/stop the abuse and limited access to social and mental health services to address the proximal and long-term effects of the abuse (Petersen et al., 2011; Ward et al., 2015). It is not surprising that this was the first time (after 50 years) he disclosed and named the incident as a “rape” (“me violo”).

José (60-year-old) described his childhood as profoundly unhappy with no happy memories during his early years. José’s childhood included multiple incidents of CSA and emotional abuse. For example, he recalled one morning when he was picked up by a 35-year-old man on his way to school:

We had some sexual contact, it seems ridiculous but I think I fell in love with him, and it was dysfunctional … [paused to contemplate] I am not a psychiatrist or psychologist, but he was the one who made the mistake of becoming [sexually] involved with someone who was a confused 15 year old … he had the choice not me … he was the one in control and not I …. and now that we are talking about this … I was also fondled by a priest during one of my classes when I was 10 years old …

José experienced multiple, repeated CSA incidents by different perpetrators. José did not only disclose his early sexual experiences but realized during the interview that he was sexually abused when he was 15 by a 35-year-old man. Although José previously received mental health services and disclosed his sexual history to a counselor, as he composed his narrative he identified for the first time that the perpetrator “had the power” and should not have engaged in a sexual relationship with him.

José also described the verbal aggression he received from his family for not fitting within gender expectations (e.g., clothing). He brought up his mother’s aggression as an important factor in his development as well.

Another memory that comes to mind, I am not sure if I was 10 years or less, my mother was very harsh, and one time she punched me in the face with her ring on [sortija] and she tore into my flesh …

In addition to being physically abused by his mother, José also recalled her saying on multiple occasions “she would have preferred to have had a dead son or a son in prison than a homosexual.” He also highlighted tv and radio shows where gay men were portrayed as socially deviant, of low class and as the laughingstock of society. In line with this accepted homophobia, José recalled his family’s verbal attacks and interrogation of his romantic life.

I never ever saw a positive character who was gay, it was always las locas [flamboyant gay men], they were always from a low social economic status … there used to be a comedy show, [it was] very very negative towards homosexuals … and it was always society judging … everyone, families, my mother, my father would judge a loca … my uncles would ask me why I did not have a girlfriend, why I wore pants without front pockets … why this or why that. I wanted to escape from all that …

We consider that in Latin America, the combination of Roman Catholic beliefs, socially accepted homophobia, and a medical view of homosexuality as a disease prior to 1973 all restricted the availability of resources and support to those “coming out” and their families (Chaux and León, 2016; Pachón, 2007; Spitzer, 1981). As a result of his environment and its pressure to conform to social norms, we believe that he suffered psychological and physical attacks that dehumanized and “othered” him, ultimately leading to his yearning to “escape from all that” (Cassell, 1998).

Coping mechanisms

Diego described his use of multiple coping mechanisms. In order to cope with his mother’s abuse, he created an “alternative” story to establish hope for an end to the abuse.

My first years were let’s say not so happy and I had to use mechanisms to compensate and not fall into depression or into a painful anguish and no longer have that rancor … based on a novella … called ‘Lejos Del Nido’, [in which] a young girl is stolen from her biological family and raised by an indigenous [couple] … in my mind, my mechanism was ‘this woman is not my mother’ … I firmly believed I had another family … I said someday my true parents are going to come for me, they will give me a better life, they will give me love ….

Diego created an alternative reality in order to cope with the emotional and physical abuse. For him, such approaches provided an avenue of hope that would lead him to having loving parents who would eventually rescue him from his torture. Interestingly, this coping approach was congruent with the Latino cultural value of “familism” which emphasizes obligation, filial piety and family support (Stein et al., 2014). When Diego was born, Roman Catholic beliefs guided an idealized family composed of a father, mother and children (Levine et al., 1981; Pachón, 2007). Although in some countries the law included protections for children born out of wedlock (i.e., Diego was raised by single mother), these laws did not protect against the social repercussions of being identified as illegitimate and as social nuisance or criminal (e.g., Pachón, 2007; Ramírez and Téllez, 2006).

Diego resorted to available resources to cope with his abuse and to meet his basic needs. As a teenager, he discovered a financial avenue that allowed him to gain some financial independence from his mother. He explained:

At the movie theater men, back then there were films starring Libertad Lamarque, Maria Felix and Sophia Loren, I found that there, men would approach you and I would jack them off and they would give you a bill … I no longer had to beg that she [his mother] give anything to me because she was always going to reproach me …

Some researchers may identify Diego sexual engagements as a maladaptive outcome of CSA and maltreatment (Merrill et al., 2003; Ullman et al., 2005). We believe Diego’s participation in sex work was a coping mechanism. We argue that underlying social and psychological factors may have driven him toward this behavior to survive.

For one, we consider the lack of a healthy reciprocal loving relationship with his mother, no father figure, and the “othering” he experienced as a “bastard” child and “gay” teenager (Pachón, 2007; Ramírez and Téllez, 2006). However, via sex-work, men provided him with attention. Albeit, this attention was not an appropriate substitution for parental love and affection. We also consider the importance of identity formation (Erikson, 1968), particularly around sexual orientation (Toomey et al., 2016) during teenage years. Unlike his general social context that ostracized him, Diego’s engagement with other men may have served as much needed affirmation. Additionally, we consider that he had limited, if any, employment opportunities (i.e., given his training and living location), and therefore engagement in transactional sex may have easily been financially lucrative (compared to low wage unskilled child labor). Finally, this informal employment provided him with both flexibility and the financial resources to take control of his life (i.e., stand up to his mother).

Despite the years of abuse and the “rancor” that Diego felt towards his mother, he found the strength to sit with and listen to his mother’s explanations and try to understand her behaviors. Diego explained: “with time she asked me for forgiveness … I sat with her one day to talk about everything that happened … then I understood her … I began to develop affection toward her and was able to love her a lot”. Although it is unclear how Diego rationalized this (i.e., cognitive restructuring) as there is no justification for child abuse, we highlight Diego’s remarkable strength to forgive his mother.

José immigrated to the US and gained financial independence. As a result, he freed himself from the gendered and sexual role prescriptions his community had set out for him, and the emotional abuse from family members. As a gay man living in the US, he developed a career in advertising, established a long-term relationship and developed a home in New York City. As an independent, gay man with a social position that did not fit the stereotypes of his early context (i.e., “las locas”), he successfully returned to his home country. His acquired a social standing that compensated and protected him from overt aggressive comments. He explained:

It was very different because they[family] respected me a bit more because I had some financial power … it is absurd to think that I did not face intensive questioning like before … [Eventually] The entire family learned that I was living with my partner … my mother came to visit on several occasions …

Similar to Diego, we highlight José’s resilience and ability to overcome an oppressive childhood to develop a life in the US and to forgive his mother. Despite the years of abuse, José explained:

I do not want to be unjust with my mother … my mother was very harsh … her comments were, I do not want to say not intelligent, she had few resources and little information … maybe she was trying to persuade me, divert me from being homosexual …

Interestingly, he reshaped (i.e., cognitively) her verbal aggression as an attempt to protect him from being “othered” and to guide him down a socially acceptable path (i.e., heterosexuality) (Walsh et al., 2010).

Psychosocial impact

For Diego, despite his forgiveness, he has not forgotten the physical and emotional pain he experienced even after more than 40 years. Diego explained he hated listening to news reports that referenced child abuse. He acknowledged that those news reports “pick at his emotional scabs.” In his opinion, “abortion was preferable” to a child enduring a lack of love and years of abuse. He pointed out that:

Sometimes I do remember and it is painful because it was not hours, not days, not weeks, not months … it was years of suffering with this person [mother] and it was her who was supposed to care for me, she was my mother, I had no support …

Diego did not provide any evidence that he had forgiven or “overcome” the sexual abuse he experienced as a 10-year-old child. Rather he disclosed for the first time that he was raped and for more than fifty years he “had to hide the pain.” Considering the physically violent nature of the sexual attack (i.e., anal hemorrhage), that he had not openly discussed it with anybody, that news reports trigger his memories, and that CSA alone and in combination with physical and emotional abuse is associated with strong and cumulative health effects in middle and older adulthood (e.g., depressive symptoms, anxiety, hostility, etc.) (Easton and Kong, 2017; Felitti et al., 1998; Raposo et al., 2014), he may benefit from services to assess and potentially address the current impact of these experiences.

José’s narrative also included multiple indicators of unhealed wounds that continue to impact his emotional and social wellbeing. He connected his experiences of emotional and sexual abuse to his current psychological, social and sexual functioning. For example, José connected his long-term history of depressive symptoms to his childhood experiences and explained that “being told [by parents] that I was a zero because I was homosexual … I knew that I was a zero, I thought that deep inside”. He also drew connections between his sexual and emotional abuse history and what he described as dysfunctional sexual preferences. He rationalized:

This [early sexual experiences] could have triggered my sexual preferences … these have not helped me throughout my life in finding a stable and loving relationship … now I am certain that I am completely sexually passive [bottom], I never wanted to be a woman, I never felt like a woman, nevertheless I am passive to the point that my fantasies are derogatory, my dysfunction affected my relationship with my ex-partner. I could have been more versatile and it would have more pleasurable for him …

José’s views are supported by literature linking CSA and maltreatment having low self-esteem, shame, guilt and a lack of trust and other negative outcomes in adulthood (Cecil et al., 2017; Isely et al., 2008; Nelson et al., 2017; Widom et al., 2015). Yet, we point out that he maintained a romantic relationship for 20 years despite blaming himself for being sexually “dysfunctional” because his preference was to be a passive partner. Similar to literature that documents the stigmatization of receptive partners due to their feminization compared to “active” gay men (Zea, 2003), gendered norms continue to negatively impact José’s self-esteem. Interestingly, José hinted at having an interest in a sexual fetish (i.e., “fantasies are derogatory”). Although the sexuality spectrum is vast and sexual sub cultures (e.g., sub/slave) are common, he pathologized his sexual desires. Older adults have a right to experience a healthy, sexually satisfying life yet it is quite possible that José’s early sexual experiences and emotional abuse continue to act as barriers to feeling comfortable with his sexuality (i.e., identity, bottom, submissiveness) and ultimately developing a successful relationship.

Discussion: Implications for research and practice

Our study is one of a handful that explore the early lives of older Latino gay men now living in the US. Participants in the Palabras Fuertes project reported early childhood sexual experiences and/or maltreatment. However, we note that not all participants considered their early childhood sexual experiences as abuse. Among those who chose to disclose histories of sexual abuse, they shared important culturally and contextually feasible cognitive and behavioral coping mechanisms (i.e., sex-work, migration and forgiveness). Despite the decades since these men’s experiences of abuse, their narratives indicate that time does not heal all wounds. Our findings provide unique insight and have multiple implications for future research and practice with older Latino gay men.

Unlike prior studies focusing on CSA or maltreatment with primarily clinical samples of children and younger adults (Tener and Murphy, 2015), our participants were community dwelling older Latino men who volunteered for a study on general life experiences (Camacho et al., under review). We cannot point out for certain what triggered participants’ disclosure of CSA and maltreatment. However, we posit that DC’s clinical and research experience with primarily monolingual Spanish speakers in which participants disclosed sensitive data (i.e., rape, violence, death etc.) (Camacho, 2016; Camacho et al., 2018), formal clinical training (e.g., empathy and participants’ likely perception of a “positive” reaction; Alaggia, 2004; Del Castillo and O’Dougherty Wright, 2009; Dorahy and Clearwater, 2012; Draucker and Martsolf, 2008) and the provision of a “safe space” (e.g., participant home or LGBT friendly agency) may have contributed to disclosure. Prior research indicates that CSA survivors’ disclosure tends to be planned. However, because our study was not focused on CSA or maltreatment and not conducted in a clinical setting, we believe that neither Diego nor José came into our sessions with clear plans to disclose CSA (Tener and Murphy, 2015). Given the high rates of CSA and maltreatment among Latino gay men, researchers who plan to conduct studies with this immigrant Latinos, whether focused on childhood experiences or not, should employ “trauma informed principles” and prepare for possible unplanned disclosure of maltreatment and other adverse childhood experiences (Ai et al., 2016; Arreola et al., 2005; Sandelowski and Barroso, 2003; Levenson, 2017; Tener and Murphy, 2015; Thornton and Veenema, 2015).

Diego and José also described strategies to cope with CSA and maltreatment. Given that limited research related to coping mechanism has focused on male survivors, our participants’ narratives provide novel and critical insight into how Latino gay men may have faced early challenges with coping strategies that were feasible and congruent with their contexts. Researchers have tried to identify coping mechanisms that were specific to experiences of CSA, physical abuse or emotional abuse. In our participants’ narratives, we believe their coping mechanisms were employed to address CSA and maltreatment as well as contextual stressors (e.g., poverty). We suspect that engagement in behavioral coping mechanisms (i.e., sex work, immigration) and cognitive approaches (i.e., forgiveness, thought restructuring) were utilized individually and simultaneously to cope with the immediate and long-term impact of childhood experiences. We also note that José did not describe any coping mechanisms specific to the sexual abuse he experienced. However, we consider that it was only during our interview that he realized that the 35-year old man took advantage of his naiveté or confusion. Given this, we believe that at the time of his interview, he was not yet ready to move on to identify if and how he coped (or will cope) with this experience.

Findings from this study support prior research indicating long-term effects of CSA and maltreatment (as identified by clinicians or researchers as sexual abuse) (Easton and Kong, 2017; Felitti et al., 1998; Raposo et al., 2014). However, our findings indicate that not all older gay men who engaged in childhood sexual experiences may perceive these as “abuse.” We consider the importance of subjective perceptions (i.e., meaning making, suffering) in overall well-being among older adults and possibly in moderating the long-terms effects of CSA and maltreatment (Arreola et al., 2008; Bardage et al., 2005; Carstensen et al., 2003; Cassell, 1998; Dolezal and Carballo-Diéguez, 2002). Given this, clinicians should explore subjective interpretations of childhood sexual experiences (e.g., contributing social factors), coping mechanisms and how these experiences impact current well-being.

Our findings also have multiple additional implications for clinical research. Our exploratory study provided a glimpse into childhood experiences and how subjective interpretation may contribute to suffering (Cassell, 1998). However, our interviews are only a first step in understanding the experiences of older Latino gay men. To date, few studies have explored the lives of older Latino gay men (Fredriksen-Goldsen et al., 2019). For example, more research is needed to understand how other important factors, such as Latino diversity (e.g., acculturation, country of origin, social economic status, etc.), may shape subjective perceptions and ultimately the long-term impact of childhood experiences. Future research should also assess both objective and subjective reports of childhood sexual activities and how these influence the experiences of common problems (e.g., loneliness, chronic pain, cognitive decline) in older adulthood among diverse groups of aging Latinos (e.g., LGBT, various countries of origin, acculturation) (Ong et al., 2016; Simon, 2012).

Future work should also examine older Latino gay men’s narratives. Participants in this project provided extensive accounts of sensitive life experiences. Considering that personal values and experiences (e.g., identity, immigration, minority stressors) shape subjective interpretations of problems common in older age, it is important that clinicians and researchers provide older Latino gay men with safe spaces that will allow them to think about their lives and to develop their narratives (Forrester et al., 2019). One clinically relevant tool that may help in conducting these interviews is the Cultural Formulation Interview as it provides structured question modules that can help untangle how individual and intersecting identities may influence illness experiences (Lewis-Fernández et al., 2020).

It is also important to examine how and if the incorporation of promising clinical approaches may be used to facilitate disclosure, meaning making and exploration of CSA and maltreatment and current impact on the health of older Latinos in real-world settings (e.g., primary care, LGBT social services, community centers etc.). For example, psychoeducation has been successfully incorporated into interventions with older Latinos (Camacho et al., 2018) and may allow for an exchange of information (between provider and client) related to CSA and maltreatment on well-being in older adulthood (Lukens, 2015). For some older Latino gay men, CSA and/or maltreatment may be a treatment priority. Thus, more recent frameworks such as Patient Priorities Care may be helpful (PPC; Tinetti et al., 2016). PPC recognizes that older adults often experience comorbid conditions, receive fragmented and burdensome care, and that treatment rarely focuses on what matters most to patients. Older Latinos experience high rates of chronic conditions (Quiñones et al., 2016) and treatment may focus on managing these conditions. However, for some older Latino gay men, addressing undisclosed and subjective long-term impacts of childhood sexual experiences may be a healthcare priority. In such cases, clinicians may, for example, develop a care plan that incorporates psychoeducation (Lukens, 2015) about CSA, its long-term impacts, perceptions of mental health services and connect the older adult to mental health services with a Spanish speaking and LGBT affirmative mental health provider (Aranda, 2015; Barrio et al., 2008; Fuentes and Aranda, 2012; Moore et al., 2020a, 2020b). In the end, although gerontological care focuses on addressing current problems, we recognize that reducing suffering and enhancing the health of some older Latino gay man may require acknowledging and addressing hidden and unhealed childhood wounds.