978    

Background:  Adverse childhood experiences are common and are associated with emotional and physical illness and high risk health behaviors. There has been very little research on the long-term effects of adverse childhood experiences in HIV-infected individuals. The objectives of this study were to determine the prevalence of adverse childhood experiences and to examine the association between adverse childhood experiences and health risk behaviors relevant to HIV disease including non-adherence to HIV medications, substance use, and high risk sexual behavior. We hypothesized a high prevalence (> 30%) of adverse childhood experiences and a strong positive association between adverse childhood experiences and health risk behaviors.

Methods:  This was a cross-sectional study of a convenience sample, from July 2003 to May 2004, in 506 HIV-infected patients in 2 urban New Mexico HIV clinics. Each participant completed a self-administered questionnaire after informed consent. To measure adverse childhood experiences, we used the Childhood Trauma Questionnaire, a validated instrument, which measures 5 types of maltreatment including sexual, emotional and physical abuse, and emotional and physical neglect. c² tests were used to test the association between adverse childhood experiences and health risk behaviors.

Results:  The majority of the participants were male (89%) and gay or bisexual (88%):  41% had experienced moderate to extreme sexual abuse; 38% moderate to extreme emotional abuse; 27% moderate to extreme emotional neglect; 30% moderate to extreme physical abuse; 50% moderate to severe physical neglect; 79% were taking ART of whom 36% were non-adherent; 30% considered themselves alcoholic and 25% had used 2 or more illicit drugs in the last 4 months. Of the men who engaged in anal sex, 35% reported sometimes, rarely, or never using condoms and sometimes, rarely, or never disclosed their HIV status prior to having sex. Adverse childhood experiences were associated with risk behaviors. Emotional abuse, the strongest predictor, was associated with medication non-adherence (p < 0.01; OR 2.0), alcoholism (p < 0.01; OR 2.2), and drug abuse (p < 0.01; OR 2.0).

Conclusions:  There is an unusually high prevalence of multiple types of adverse childhood experiences and health risk behaviors in this HIV-infected clinic population. Adverse childhood experiences and health risk behaviors are significantly associated with each other, although these data cannot be causally interpreted. Further research exploring the prevalence and effects of trauma in HIV populations is warranted.

Keywords: child abuse; health behaviors; adherence