Experiencing violence in childhood increases HIV risk for men

Experiencing stressful violent events in childhood is associated with an increased risk of infection with HIV for adult men, US investigators report in the advance online edition of the Journal of Acquired Immune Deficiency Syndromes.

The investigators calculated that experiencing violence accounts for 18% of new HIV infections, and they comment “experiencing early violence plays a particularly influential role in HIV infection for men…interventions are urgently needed to address the long-term sequelae of childhood and adolescent violent events.”

Stressful events in childhood are known to have long-term psychological and developmental consequences. Research conducted in women has also shown that childhood sexual or physical abuse is associated with sexual risk behaviour. There is also some evidence that gay men who were sexually abused as children are more likely to put themselves at risk of HIV.

Investigators wished to gain a clearer understanding of the prevalence of early violent experiences among men, and the role of these experiences in incident HIV infections.

Their study sample involved 13,274 white, black and Hispanic men who participated in the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

All the participants were aged 18 or over and were asked about their experience of physical abuse, sexual abuse, neglect, and emotional abuse.

The men were asked to report if they had sex with men, women, or both, and if they had been diagnosed with HIV within the last twelve months.

In addition, the participants were interviewed to see if they had post-traumatic stress disorder.

Overall, 24% of the sample were non-white (11% black, 13% Hispanic), 37% had had a college education, and 4% reported that they were gay or bisexual.

HIV incidence was 0.35%, similar to that seen in the general US population. However, HIV incidence was significantly higher among non-whites (p < 0.0001), and gay and bisexual men (p < 0.0001).

A third of men reported one or more violent childhood event. Physical abuse was reported by 3% of men, sexual abuse by 2%, neglect by 3%, verbal violence by 28%, and 13% witnessed parental violence against their mother.

One stressor was reported by 21% of men, two by 9%, and 3% reported three or more experiences of childhood violence.

Men who had been recently infected with HIV were more likely than HIV negative men to have experienced a range of violent events in early life. These included physical abuse (16% vs. 3%), sexual abuse (12% vs. 2%), neglect (11% vs. 3%), and the witnessing of violence directed towards their mother (23% vs. 13%). All these differences were highly significant (p < 0.0001).

Overall, 4% of men had post-traumatic stress disorder. A significantly higher proportion of men with incident HIV infection compared to HIV-negative men had been diagnosed with post-traumatic stress disorder in the past year (26% vs. 4%; p < 0.0001).

The investigators’ analysis showed that the number of violent experiences in childhood was a significant predictor of incident HIV infection (adjusted odds ratio [AOR] = 1.32; 95% CI, 1.16-1.50).

This association was especially strong for gay and bisexual men (AOR = 11.53; 95% CI, 9.45-1406).

Further analysis showed that gay and bisexual men reporting higher number of violent events were 65% more likely to have been recently infected with HIV than heterosexual men reporting the same number of stressful events (AOR = 1.65; 95% CI, 1.17-2.34).

HIV incidence among men who experienced at least one violent event in childhood was 0.39% compared to 0.32% for men who said they were not exposed to violence in early life. The investigators therefore calculated that 18% of “HIV incident cases in the sample would have been averted if early childhood violent events were eliminated.”

Post-traumatic stress disorder was also associated with recent infection with HIV (AOR = 5.75; 95% CI, 4.76-6.95). There was also evidence that this partially mediated the relationship between early life events and acquisition of HIV (AOR = 1.14; 95% CI, 1.02-1.28).

“The current study demonstrates the patterning of incident HIV infection by early experienced of violence and mediated through post-traumatic stress disorder diagnosis,” comment the investigators.

Although the investigators acknowledge that their research has some limitations, especially its reliance on self-report of experiences and HIV diagnosis, they nevertheless believe its findings have public health significance. In particular, the findings could help inform HIV prevention efforts.

Psychological interventions such as cognitive behavioural therapy have been shown to be effective treatments for mood and anxiety disorders.

“Incorporating HIV prevention into these evidence-based psychotherapeutic treatments for youth, or adapting these validated treatments as part of HIV prevention interventions that target young adult men, represents an important area of intervention development research, especially given that mental health concerns not only contribute to HIV risk but also likely interfere with the uptake of behavioral interventions for men.”