A prospective study on adverse childhood experiences and HIV-related risk among adolescents in Malawi

Abstract

Objective:Adverse childhood experiences have been robustly associated with poor sexual health in later life. In low-income countries, there is growing evidence that children experience greater adversity than those in higher income countries. Research suggests this may contribute to later sexual risk taking and HIV infection, though most studies to date have been cross-sectional.Design:We use longitudinal data on adolescents to examine the temporal relationship between adversity and HIV-related behavioral and biological outcomes.Methods:We interviewed 1878 adolescents living in Malawi in 2017–2018 (age 10–16) and again in 2021 (age 13–20). Adolescents completed the Adverse Childhood Experience – International Questionnaire. HIV-risk was assessed through both behavioral (e.g. condom use) and biological (HIV and herpes simplex virus 2 [HSV2] infection) outcomes. ordinary least squares (OLS) and logistic multivariate regression models are used to explore associations between adversity and HIV risk.Results:In longitudinal analyses, adverse childhood experiences (ACEs) were significantly associated with intimate partner violence and girls’ behavioral risk scores only. HIV incidence was too low to model; there were no significant associations with HSV2. In cross-sectional analyses, ACEs were additionally associated with an early sexual debut, lack of condom use, a greater number of sexual partnerships, and sexually transmitted infection symptoms.Conclusions:Our findings emphasize the importance of collecting prospective data: results from longitudinal and cross-sectional analyses drew qualitatively different conclusions. Cross-sectional analyses may not be accurate representations of longitudinal processes. However, they suggest that recent adversity and distress drives HIV-related behavior, perhaps more than early adversity. Interventions that combat emotional abuse or peer violence during adolescence could potentially reduce HIV risk.

Cohort profile: the Adverse Childhood Experiences cohort of the Malawi Longitudinal Study of Families and Health

“…ACEs were also associated with early sexual debut, lack of condom use, a greater number of sexual partnerships and STI symptoms at wave 2. The discrepancy between longitudinal and cross-sectional analyses raises interesting questions both about measurement and about the relative influence of more recent versus distal adversities 20…”

“…The discrepancy between longitudinal and cross-sectional analyses raises interesting questions both about measurement and about the relative influence of more recent versus distal adversities. 20…”

The Association Between Adverse Childhood Experiences and Human Papillomavirus Vaccination Coverage in US Young Adults: A Cross-Sectional Study

“…[2][3][4][5] Adverse childhood experiences, including sexual, physical, and emotional abuse, and neglect and witnessing violence, have also been linked to HIV risk behavior and/or increased risk of sexually transmitted infections (STIs) in adulthood. [6][7][8][9][10] Furthermore, childhood sexual abuse has been linked to an increased risk of genital human papillomavirus (HPV) infection. 11,12 Human papillomavirus is the necessary causal agent in cervical cancer, and HPV infections are also linked to vaginal, anal, vulvar, penile, and oropharyngeal cancers.…”

“…Compared with the general population, individuals with adverse childhood experiences (ACEs) are more susceptible to depression and other adverse mental health outcomes, tobacco smoking and excessive alcohol use, chronic disease, disability, and obesity in adulthood 2–5 . Adverse childhood experiences, including sexual, physical, and emotional abuse, and neglect and witnessing violence, have also been linked to HIV risk behavior and/or increased risk of sexually transmitted infections (STIs) in adulthood 6–10 . Furthermore, childhood sexual abuse has been linked to an increased risk of genital human papillomavirus (HPV) infection 11,12 .…”