The Relationship Between Adverse Childhood Experiences and HIV Prevalence Among Adolescent Girls and Young Women in Mpumalanga: An HPTN068 Analysis (2017)

Abstract

Introduction: Adverse childhood experiences (ACEs) encompass various forms of childhood adversity, including neglect, sexual and physical abuse, and household dysfunction. In Sub- Saharan Africa, adolescent girls and young women (AGYW) face a high prevalence of both HIV infection and ACEs. These experiences have been linked to a range of negative health outcomes, including an elevated risk of HIV infection. Prior research has predominantly focused on the influence of ACEs on HIV related risk behaviours and often overlooks the broader spectrum of ACEs such as exposure to household and community violence. This study aimed to examine the relationship between ACEs and HIV prevalence among AGYW in rural South Africa, with a focus on both cumulative ACEs and individual categories of ACEs and their relationship with HIV infection. Methods: This cross-sectional study utilised existing data from HIV Prevention Trials Network (HPTN) 068 randomised controlled trial. HPTN 068 investigated the effectiveness of a monthly cash transfer intervention in reducing HIV incidence among AGYW. In this study, individual ACE categories were dichotomised and included physical abuse, emotional abuse, witnessing verbal violence at home, witnessing physical violence at home and witnessing community violence during childhood. Age of sexual debut of less than 14 years was used as a proxy for childhood sexual abuse. A cumulative ACEs score was created, ranging from 0 to 4 or more ACEs. Descriptive analysis was conducted to estimate the prevalence of ACEs and their association with HIV status. The study then used logistic regression models to examine the relationship between cumulative ACEs and HIV prevalence as well as individual ACE categories and HIV prevalence. In addition, mediation analysis was conducted to assess the potential mediating effects of various variables between childhood physical abuse and HIV status. Lastly, a sensitivity analysis was conducted to exclude AGYW living with HIV at enrolment of the primary study, as these individuals were likely to have been perinatally infected with HIV. Results: HIV prevalence was estimated at 11.48%. While 38% of participants reported no ACEs, 62% experienced at least one ACE. There was no significant association between cumulative ACEs and HIV prevalence. However, individual ACEs such as childhood physical abuse (aOR: 1.57, 95% CI: 1.03–2.41, p=0.038) and witnessing physical violence at home during childhood (aOR: 1.63, 95% CI: 1.07–2.49, p=0.022) were associated with higher odds of HIV infection. Witnessing community violence during childhood was associated with lower v odds of HIV infection (aOR: 0.69, 95% CI: 0.49–0.98, p=0.037). Early sexual debut (aOR: 0.68, 95% CI: 0.20–2.35, p=0.542), childhood emotional abuse (aOR: 1.44, 95% CI: 0.94– 2.22, p=0.096), and witnessing verbal violence during childhood (aOR: 0.65, 95% CI: 0.41– 1.05, p=0.077) were not significantly associated with HIV prevalence. Mediation analysis suggested that none of the examined mediators demonstrated statistically significant mediation between childhood physical abuse and HIV prevalence. Lastly, the sensitivity analysis suggested that findings remained fairly consistent between HIV prevalence and an approximation of HIV incidence over the course of the study, after removing AGYW with prevalence HIV at enrolment. Conclusion: Individual ACEs, particularly childhood physical abuse and witnessing physical violence at home, are significant factors associated with greater odds of HIV infection among AGYW in rural South Africa. These results underscore the need for targeted, trauma-related interventions, such as trauma informed care, community-based education programmes, counselling services, and the development of safe spaces for children, adolescents and women.