Adverse Childhood Experiences and HIV Prevalence Among Adolescent Girls and Young Women in Rural South Africa: The Role of Household and Community Violence

Abstract Adverse childhood experiences (ACEs) are common among adolescent girls and young women (AGYW) in Sub-Saharan Africa, who also face a high burden of HIV. While prior research has focused on behavioural pathways linking ACEs and HIV, less attention has been given to the broader spectrum of adversities themselves, particularly household and community violence. This study examined the association between cumulative and individual ACEs and HIV prevalence among AGYW in rural South Africa. This cross-sectional study analysed data from the 2017 follow-up visit of the HIV Prevention Trials Network (HPTN) 068 randomised controlled trial. ACEs were dichotomised into physical abuse, emotional abuse, witnessing verbal violence at home, witnessing physical violence at home, and witnessing community violence. Early sexual debut (< 14 years) served as a proxy for childhood sexual abuse given the lack of a sexual abuse variable. A cumulative ACE score was created. Descriptive statistics assessed ACE prevalence, and logistic regression examined associations with HIV prevalence. HIV prevalence was 11.48%. While 38% of AGYW reported no ACEs, 62% experienced at least one. Cumulative ACEs were not significantly associated with HIV prevalence. However, physical abuse (aOR 1.57; 95% CI 1.03–2.41) and witnessing physical violence at home (aOR 1.63; 95% CI 1.07–2.49) were associated with higher odds of HIV infection. Specific ACEs, particularly childhood physical abuse and witnessing household violence, were associated with increased HIV risk among AGYW. Targeted, trauma-informed interventions are warranted to reduce vulnerability and support HIV prevention efforts.