Adverse Childhood Experiences and HIV Sexual Risk-Taking Behaviors Among Young Adults in Malawi

Abstract

Adverse childhood experiences (ACEs) exhibit a dose–response association with poor health outcomes in adulthood, including HIV. In this analysis, we explored the relationship between ACEs and HIV sexual risk-taking behaviors among young adults in Malawi. We analyzed responses from sexually active 19- to 24-year-old males and females (n = 610) participating in the Malawi Violence Against Children Survey. We tested the association between respondents’ exposure to six ACEs (having experienced emotional, physical, or sexual violence; witnessing intimate partner violence or an attack in the community; one or both parents died) and infrequent condom use in the past year and multiple sexual partners in the past year. We used logistic regression to test the association between ACEs and these sexual risk-taking behaviors. A majority (82%) of respondents reported at least 1 ACE, and 29% reported 3+ ACEs. We found positive unadjusted associations between the number of ACEs (1–2 and 3+ vs. none) and both outcomes. In adjusted models, we found positive associations between the number of ACEs and infrequent condom use (adjusted odds ratio [aOR]: 2.7, 95% confidence interval [CI]: [1.0, 7.8]; aOR: 3.7, CI: [1.3, 11.1]). Among young adults in Malawi, exposure to ACEs is positively associated, in a dose–response fashion, with engaging in some sexual risk-taking behaviors. HIV prevention efforts in Malawi may benefit from prioritizing programs and policies aimed at preventing and responding to violence against children.

Complex trauma and its relation to hope and hopelessness among young people in KwaZulu-Natal, South Africa

“…Other studies have shown a relationship between adverse childhood experiences (ACEs) and HIV risk behaviours and These adverse experiences caused an increase in activities such as smoking, consistent with research that shows how ACEs contribute to as many as one in six individuals smoking (Kessler et al, 2010). These data on the relationship between childhood adversities and risky behaviours may help identify individuals that are predisposed to HIV risk and suggest that in high prevalence settings, HIV prevention strategies should target ways of reducing ACEs (Fang et al, 2016;VanderEnde et al, 2018).…”

The Relationship Between Adverse Childhood Experiences and Utilization of Different HIV Testing Strategies Among Young Men Who Have Sex with Men in Texas

“…The body of research on the topic shows that sexual minority (e.g., lesbian, gay, bisexual, queer) adults, including MSM [ 15 ] have greater overall ACEs exposure, [ 21 , 22 ] are more likely to report specific ACEs compared to heterosexuals, [ 18 , 23 , 24 ] and report frequent exposure to ACEs [ 25 ], all of which are linked to increased HIV risk behavior. [ 26 – 28 ].…”

Adverse Childhood Experiences: Prevalence and Association With Adolescent Health in Malawi

“…[52][53][54] More direct evidence that ACEs drive HIV risk behaviors and incidence comes from recent studies in Malawi, South Africa, and Tanzania. 21,55,56 Thus, addressing the extraordinarily high burden of ACEs should be part of our HIV response. To the authors' knowledge, this represents one of the first studies using the ACE-IQ in a low-income country.…”