A prospective study on adverse childhood experiences and HIV-related risk among adolescents in Malawi.
A prospective study on adverse childhood experiences and HIV-related risk among adolescents in Malawi.
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DOI：
10.1097/qad.0000000000003377
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发表时间：
2022-12-01
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不良的童年经历一直与晚年不良的性健康状况密切相关。在低收入国家，越来越多的证据表明，儿童经历的逆境比高收入国家的儿童更大。研究表明，这可能导致更晚的性行为风险和艾滋病毒感染，尽管到目前为止，大多数研究都是横断面的。我们使用青少年的纵向数据来检验逆境和艾滋病毒相关的行为和生物学结果之间的时间关系。我们在2017-18年(10-16岁)和2021年(13-20岁)采访了1878名居住在马拉维的青少年。青少年完成了不良童年经历--国际问卷。通过行为(例如，使用避孕套)和生物学(艾滋病毒和HSV2感染)结果来评估艾滋病毒风险。我们使用了OLS和Logistic多元回归模型来探索逆境和HIV风险之间的联系。在纵向分析中，ACE仅与亲密伴侣暴力和女孩的行为风险得分显著相关。HIV发病率太低，无法建模；与HSV2没有显著关联。在横断面分析中，ACEs还与早期首次性行为、不使用避孕套、更多的性伙伴关系和性传播感染症状有关。我们的发现强调了收集前瞻性数据的重要性：纵向和横向分析的结果得出了定性不同的结论。横截面分析可能不能准确地表示纵向过程。然而，他们表明，最近的逆境和痛苦可能比早期的逆境更能驱动与艾滋病毒相关的行为。在青春期打击情感虐待或同伴暴力的干预措施可能会降低艾滋病毒的风险。
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. We use longitudinal data on adolescents to examine the temporal relationship between adversity and HIV-related behavioral and biological outcomes. We interviewed 1,878 adolescents living in Malawi in 2017–18 (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 HSV2 infection) outcomes. OLS and logistic multivariate regression models are used to explore associations between adversity and HIV risk. In longitudinal analyses, 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 STI symptoms. 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.