Adverse childhood experiences, sexual debut and HIV testing among adolescents in a low-income high HIV-prevalence context

AIDS. 2019 Nov 15;33(14):2245-2250. doi: 10.1097/QAD.0000000000002352.


Objectives: To investigate whether adverse childhood experiences are important determinants of sexual debut and HIV testing.

Design: Adolescents (age 10-16; N = 2089) from rural Malawi were interviewed in 2017-2018 for the baseline wave of a longitudinal study of childhood adversity and HIV risk.

Methods: Respondents were interviewed in their local language. Surveys captured 13 lifetime childhood adversities (using the Adverse Childhood Experience - International Questionnaire); sexual debut; and previous HIV testing. We used multivariate regression models to test whether adversity, measured both cumulatively and separately, predicted HIV risk.

Results: For each additional adversity, there was a significant rise in the odds of sexual debut (odds ratio 1.13, confidence interval 1.07-1.20) and HIV testing (odds ratio 1.10, confidence interval 1.04-1.16).

Conclusion: Preventing HIV among all young people necessitates a paradigm shift that recognizes the importance of early life social determinants in structuring HIV risk.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adolescent Behavior
  • Adverse Childhood Experiences*
  • Child
  • Female
  • HIV Infections / diagnosis*
  • HIV Infections / prevention & control
  • Humans
  • Longitudinal Studies
  • Malawi
  • Male
  • Multivariate Analysis
  • Poverty
  • Regression Analysis
  • Risk-Taking
  • Sexual Behavior / statistics & numerical data*