Relationship between high adverse childhood experience score, HIV risk behavior, and previous HIV testing in the South Carolina behavioral risk factor surveillance system

Identifying HIV risk factors is important for screening. High adverse childhood experience (ACE) scores (≥ 4) reflect childhood trauma and are associated with HIV risk behaviors. Studies examining ACE and HIV testing are limited, with mixed results. We performed a retrospective cross-sectional study examining ACE score, HIV risk behaviors, and previous HIV testing utilizing the S.C Behavioral Risk Factor Surveillance System over six years. We separately compared individuals <35/≥35 years old, with/without risk behaviors, and with/without previous testing. Using logistic regression, we determined factors associated with risk behaviors and previous testing. Of 55,087 surveyed, 15% reported high ACE. High ACE was associated with risk behaviors (aOR 2.652, 95% CI: 1.987-3.538) and previous testing (aOR 2.340, 95% CI: 2.031-2.696). Female respondents had lower odds of risk behaviors (aOR 0.442, 95% CI: 0.336-0.581) and previous testing (aOR 0.822, 95% CI: 0.736-0.919). Individuals <35 years old more often reported high ACE score (25% vs 14%, <i>p</i> < 0.001), risk behaviors (13% vs 2.5%, <i>p</i> < 0.001), and previous testing (46% vs 30%, <i>p</i> < 0.001). Women, who make up 20% of HIV diagnoses, were less likely to report risk behaviors and testing, suggesting traditional risk factors underestimate risk. ACE score could be evaluated prospectively to identify high-risk women.