Mapping the Spatial Variability of Adverse Childhood Experiences and Their Associations with HIV Vulnerabilities Among Adolescents in Uganda

Background: Adverse childhood experiences such as child sexual violence (CSV) is a global concern with harmful health consequences, including sexually transmitted infections, risky sexual behavior, and death. To date, few studies have explored the geographical patterning of exposure to CVS, from different perpetrators, particularly in low-income settings such as Uganda that have high HIV prevalence rates. Yet, such information might be critical in informing the development of targeted prevention interventions. Guided by the social norms theory, we assess potential geographical patterns of histories of childhood sexual violence across Uganda, and whether such patterns are associated with HIV vulnerabilities (i.e., transactional sex, multiple sex partners, condomless sex, HIV testing, STI symptoms).

Methods: Data were drawn from the Ugandan violence against children survey collected utilizing a multi-stage cluster sample design. We aggregated the data to the district level (N=136) and used Multivariate Clustering tool in ArcGIS Pro to assess the possibility that districts in Uganda can be differentiated based on their level of CSV, as measured by four proxies: experienced any unwanted sexual touching in childhood, experienced any unwanted attempted sex in childhood, experienced any physically forced sex in childhood and experienced any pressured sex in childhood. A non-spatial regression model was conducted to examine the association between the geographical patterns of histories of CSV on HIV vulnerabilities.

Results: We found three clusters of histories of CSV: 16.9% (n=23) of districts had severe histories of CSV, while 36.03% (n=49) had moderate histories of CSV and 47.06% (n=64) had low histories of CSV. Non-spatial regression analyses showed that compared to districts with low histories of CSV districts, districts with severe and moderate patterns of CSV histories were positively associated with multiple sexual partners, transactional sex engagement, condomless sex, STI symptoms, and suboptimal HIV testing.

Conclusion: Findings point to the need for multi-component interventions that screen and concurrently address adverse childhood experiences and HIV vulnerabilities. Specifically, there is a need for targeted interventions in districts with severe and moderate CSV histories.