Childhood adversity increases the risk of onward transmission from perinatal HIV-infected adolescents and youth in South Africa |
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| Institution: | 1. Program in Public Health and Department of Family, Population & Preventative Medicine, Stony Brook University, Health Sciences Center, Level 3, Stony Brook, NY, 11794, USA;2. Department of Pediatrics, Stony Brook School of Medicine, Stony Brook, NY, USA;3. Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;1. Department of Psychology, University of Maryland, College Park, 4095 Campus Drive, College Park, MD, USA;2. Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA;3. Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, USA;4. Department of Psychiatry, University of California San Diego, La Jolla, CA, USA;5. Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa;6. Department of Medicine and the Institute of Infectious Disease and Molecular Medicine, Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, ZA, South Africa;7. Office of the President, South African Medical Research Council, Western Cape, ZA, South Africa;8. Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA;9. Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA;10. Massachusetts General Hospital Center for Global Health, Boston, MA, USA;11. Harvard Medical School, Boston, MA, USA;1. Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA;2. Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, VA, USA;1. Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;2. Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois;3. HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Columbia University Medical Center, New York, New York;4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;5. Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois;6. Department of Psychiatry, Drexel University College of Medicine and St. Christopher''s Hospital for Children, Philadelphia, Pennsylvania;7. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal and Pediatric Infectious Disease Branch, Bethesda, Maryland;8. Department of Pediatrics Infectious Diseases, Tulane School of Medicine, New Orleans, Louisiana;9. Children''s Diagnostic & Treatment Center, Fort Lauderdale, Florida;1. Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA;2. Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA;3. Health Services Branch, Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA;4. Malawi Ministry of Gender, Children, Disability and Social Welfare, Lilongwe, Malawi;5. Office of the Global AIDS Coordinator, Washington, DC;6. Centers for Disease Control and Prevention Malawi, Lilongwe, Malawi;1. Department of Surgery, University of Washington & Harborview Injury Prevention and Research Center, 325 Ninth Avenue, Box 359960, Seattle, WA 98104, USA;2. Department of Pediatrics, University of Washington & Harborview Injury Prevention and Research Center, 325 Ninth Avenue, Box 359960, Seattle, WA 98104, USA;3. Department of Epidemiology, University of Washington, 1959 NE Pacific St, Box 357236, Seattle, WA 98195, USA;4. Division of Violence Prevention, National Center for Injury Prevention and Control Centers for Disease Control and Prevention, 4770 Buford Highway, NE (F64), Atlanta, GA 30341-3724, USA;5. Department of Anthropology and Department of Health Sciences, University of Miami, Chancellor, Interuniversity Institute for Research and Development (INURED), 8 Rue Eucalyptus, Delmas 83, Port-au-Prince, Haiti;1. Departments of Pediatrics and Epidemiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA;2. Department of Paediatrics, Children''s Hospital of Philadelphia, Philadelphia, PA, USA;3. Botswana-UPenn Partnership, Gaborone, Botswana;4. Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda;5. Botswana-Baylor Children''s Clinical Centre of Excellence, Gaborone, Botswana;6. Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;7. Biomedical Research and Training Institute, Harare, Zimbabwe |
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| Abstract: | Repeated exposure to childhood adversity (abuse, neglect and other traumas experienced before age 18) can have lifelong impacts on health. For HIV-infected adolescents and youth, such impacts may include onward transmission of HIV. To evaluate this possibility, the current study measured the burden of childhood adversity and its influence on risky health behaviors among perinatally-infected adolescents and youth. We surveyed 250 perinatally-infected adolescents and youth (13–24 years) receiving care in Soweto, South Africa. Both male and female participants reported on childhood adversity (using the ACE-IQ), sexual behavior, and psychosocial state. Viral load was also abstracted from their charts. We used logistic regressions to test the association between cumulative adversity and behavioral outcomes. Half the sample reported eight or more adversities. Overall, 72% experienced emotional abuse, 59% experienced physical abuse, 34% experienced sexual abuse, 82% witnessed domestic violence, and 91% saw someone being attacked in their community. A clear gradient emerged between cumulative adversities and behavioral risk. Having experienced one additional childhood adversity raised the odds of risky sexual behavior by almost 30% (OR 1.27, 95% CI 1.09–1.48). Viral suppression was poor overall (31% had viral loads >400 copies/ml), but was not related to adversity. Adversity showed a robust relationship to depression and substance abuse. Childhood adversity is common, influences the current health of HIV-positive adolescents and youth, and puts their sexual partners at risk for HIV infection. Greater primary prevention of childhood adversity and increased access to support services (e.g., mental health) could reduce risk taking among HIV-positive adolescents and youth. |
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| Keywords: | HIV Adolescents Childhood adversity Adherence Sexual behavior |
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