A Gender-Specific Analysis of Adverse Childhood Experiences and HIV Risk Behaviors

Background: Recent HIV research suggests assessing adverse childhood experiences (ACEs) as contributing factors of HIV risk behaviors. However, past studies often focused on a single type of ACE and very few examined population-representative data. To address these limitations, we used a population-based data and conducted gender-specific analyses. We hypothesized that: 1) individual ACE is associated with increased HIV risk behaviors; and 2) increasing number of ACEs is positively linked to HIV risks.

Methods: We analyzed the 2012 Behavioral Risk Factor Surveillance Survey (BRFSS) data from five states (Iowa, North Carolina, Oklahoma, Tennessee, and Wisconsin) that included ACE modules in their BRSFF. The study sample consisted of 15,583 males and 23,851 females. Data were weighted based on the population weights and sampling units provided by CDC. Two sets of hierarchical logistic regression analysis estimated of the association between ACEs and HIV risk behaviors using odds ratio (OR) with 95% confidence intervals (CIs) for males and females separately – The first set examined the association between each of nine ACEs that happened before the participants were 18 years old and their adult HIV risk behaviors (hypothesis 1), and the second assessed the association between accumulative ACE scores and HIV risk behaviors (hypothesis 2). Demographic variables, current alcohol use and smoking, and history depression were controlled. Bonferroni correction (Bland & Altman, 1995) was applied to correct for multiple testing.

Results: For hypothesis 1, the odds of engaging in HIV risk behavior among females are positively associated with childhood exposure to household mental health issues, substance abuse, and incarceration as well as childhood physical, verbal, and sexual abuse (all p’s<.0001). Parental separation or divorce is not associated with increased HIV risk behaviors among females. For males, those who experienced childhood household substance abuse, parental separation or divorce, interpersonal violence, and physical, verbal and sexual abuse have significant increased odds to engage in HIV risk behaviors in adulthood (all p’s<.0001) compared to those who did not. Household mental health issue and incarceration are not associated with HIV risk behaviors among males.

For hypothesis 2, a graded relationship between ACE scores and HIV risk behaviors is found, and the relationship varies by gender. Among males, compared to those with no ACE, those with one ACE have 1.94 times the odds of engaging in HIV risk behaviors, those with two ACEs have 2.29 times the odds, those with three ACEs have 3.30 times the odds, and those with four or more ACEs have close to 4 times the odds (all p’s<.0001). Among females, the odds of engaging HIV risk behaviors do not elevate until the individual experienced three or more ACEs, with those who experienced three ACEs having 2.26 times the odds, and four or more ACEs having 3.27 times the odds (all p’s<.0001).

Conclusions: Future research should investigate ACEs and gender-specific HIV risk pathways. As childhood adversities are prevalent among general population, and such experiences are associated with increased risk behaviors for HIV transmission, principles of trauma-informed practice may benefit and strengthen current HIV prevention programming.