Childhood traumas as a risk factor for HIV-risk behaviours amongst young women and men living in urban informal settlements in South Africa: A cross-sectional study

Andrew Gibbs, Kristin Dunkle, Laura Washington, Samantha Willan, Nwabisa Shai, Rachel Jewkes, Andrew Gibbs, Kristin Dunkle, Laura Washington, Samantha Willan, Nwabisa Shai, Rachel Jewkes

Abstract

Childhood traumas, in the form of physical, sexual, and emotional abuse and neglect, are globally widespread and highly prevalent, and associated with a range of subsequent poor health outcomes. This study sought to understand the relationship between physical, sexual and emotional childhood abuse and subsequent HIV-risk behaviours amongst young people (18-30) living in urban informal settlements in Durban, South Africa. Data came from self-completed questionnaires amongst 680 women and 677 men comprising the baseline of the Stepping Stones and Creating Futures intervention trial. Men and women were analysed separately. Logistic regression models assessed the relationship between six HIV-risk behaviours and four measures of trauma: the form of trauma, the severity of each trauma, the range of traumas, and overall severity of childhood trauma. Childhood traumas were incredibly prevalent in this population. All childhood traumas were associated with a range of HIV-risk behaviours. This was for the ever/never trauma, as well as the severity of each type of trauma, the range of trauma, and overall severity of childhood trauma. Despite the wider harsh contexts of urban informal settlements, childhood traumas still play a significant role in shaping subsequent HIV-risk behaviours amongst young people. Interventions to reduce childhood traumas for populations in informal settlements need to be developed. In addition, trauma focused therapies need to be considered as part of wider HIV-prevention interventions for young adults.

Trial registration: ClinicalTrials.gov NCT03022370.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Hillis S, Mercy J, Amobi A, Kress H. Global prevalence of past-year violence against children: a systematic review and minimum estimates. Pediatrics. 2016;137(3):1–13.
    1. Unicef. Hidden in plain sight: A statistical analysis of violence against children. 2014.
    1. Meinck F, Cluver LD, Boyes ME, Loening-Voysey H. Physical, emotional and sexual adolescent abuse victimisation in South Africa: prevalence, incidence, perpetrators and locations. Journal of epidemiology and community health. 2016;70(9):910–6.
    1. Jewkes RK, Dunkle K, Nduna M, Jama PN, Puren A. Associations between childhood adversity and depression, substance abuse and HIV and HSV2 incident infections in rural South African youth. Child abuse & neglect. 2010;34(11):833–41.
    1. Norman RE, Byambaa M, De R, Butchart A, Scott J, Vos T. The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Med. 2012;9(11):e1001349 doi:
    1. Arriola KR, Louden T, Doldren MA, Fortenberry RM. A meta-analysis of the relationship of child sexual abuse to HIV risk behavior among women. Child abuse & neglect. 2005;29(6):725–46.
    1. Fonseka RW, Minnis AM, Gomez AM. Impact of adverse childhood experiences on intimate partner violence perpetration among Sri Lankan men. Plos One. 2015;10(8):e0136321 doi:
    1. Fleming PJ, McCleary-Sills J, Morton M, Levtov R, Heilman B, Barker G. Risk Factors for Men’s Lifetime Perpetration of Physical Violence against Intimate Partners: Results from the International Men and Gender Equality Survey (IMAGES) in Eight Countries. Plos One. 2015;10(3):e0118639 doi:
    1. UN Habitat. Habitat III Issue Paper 22—Informal Settlements. New York: UN Habitat, 2015.
    1. UNAIDS, Habitat U. Ending the AIDS Epidemic: The advantage of cities. Geneva: UNAIDS, 2015.
    1. WHO, UN-Habitat. Hidden Cities: Unmasking and overcoming health inequities in urban settings. Geneva: WHO and UN-Habitat, 2010.
    1. Gibbs A. Tackling gender inequalities and intimate partner violence in the response to HIV: moving towards effective interventions in Southern and Eastern Africa. African Journal of AIDS Research. 2016;15(2):141–8. doi:
    1. Meinck F, Cluver LD, Boyes ME, Mhlongo EL. Risk and protective factors for physical and sexual abuse of children and adolescents in Africa: A review and implications for practice. Trauma, Violence, & Abuse. 2015;16(1):81–107.
    1. Gibbs A, Washington L, Willan S, Ntini N, Khumalo T, Mbatha N, et al. The Stepping Stones and Creating Futures intervention to prevent intimate partner violence and HIV-risk behaviours in Durban, South Africa: study protocol for a cluster randomized control trial, and baseline characteristics. BMC Public Health. 2017;17(1):336 doi:
    1. Dunkle K, Jewkes R, Brown HC, Gray GE, McIntryre JA, Harlow SD. Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med. 2004;59(8):1581–92. doi:
    1. Jewkes R, Morrell R, Sikweyiya Y, Dunkle K, Penn-Kekana L. Transactional relationships and sex with a woman in prostitution: prevalence and patterns in a representative sample of South African men. BMC public health. 2012;12(1):325.
    1. Garcia-Moreno C, Jansen HAFM, Ellsberg M, Heise L, Watts CH, Wo WM-CS. Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence. Lancet. 2006;368(9543):1260–9. doi:
    1. Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Khuzwayo N, et al. A cluster randomized-controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings. Trop Med Int Health. 2006;11(1):3–16. doi:
    1. Jewkes R, Nduna M, Jama Shai N, Dunkle K. Prospective study of rape perpetration by young South African men: incidence & risk factors. Plos One. 2012;7(5):e38210 doi:
    1. Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804.
    1. Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child abuse & neglect. 2003;27(2):169–90.
    1. Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Applied psychological measurement. 1977;1(3):385–401.
    1. Gibbs A, Govender K, Jewkes R. An exploratory analysis of factors associated with depression in a vulnerable group of young people living in informal settlements in South Africa. Global Public Health. Forthcoming:1–16.
    1. Nduna M, Jewkes RK, Dunkle KL, Shai NP, Colman I. Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape, South Africa. Journal of the International AIDS Society. 2010;13(1):44.
    1. Gibbs A, Willan S, Misselhorn A, Mangoma J. Combined structural interventions for gender equality and livelihood security: a critical review of the evidence from southern and eastern Africa and the implications for young people. Journal of the International AIDS Society. 2012;15(Supp. 1):17362.
    1. Dunkle KL, Jewkes RK, Murdock DW, Sikweyiya Y, Morrell R. Prevalence of consensual male–male sex and sexual violence, and associations with HIV in South Africa: A population-based cross-sectional study. PLoS medicine. 2013;10(6):e1001472 doi:
    1. Artz L, Burton P, Ward C, Leoschut L, Phyfer J, Kassanjee R, et al. Optimus Study South Africa: Technical Report. Sexual Victimisation of Children in South Africa. Final Report of the Optimus Foundation Study. South Africa. Zurich* UBS Optimus Foundation; 2016.
    1. Closson K, Dietrich JJ, Nkala B, Musuku A, Cui Z, Chia J, et al. Prevalence, type, and correlates of trauma exposure among adolescent men and women in Soweto, South Africa: implications for HIV prevention. BMC public health. 2016;16(1):1191 doi:
    1. Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, et al. The enduring effects of abuse and related adverse experiences in childhood. European archives of psychiatry and clinical neuroscience. 2006;256(3):174–86. doi:
    1. Suliman S, Mkabile SG, Fincham DS, Ahmed R, Stein DJ, Seedat S. Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Comprehensive psychiatry. 2009;50(2):121–7. doi:
    1. Fulu E, Miedema S, Roselli T, McCook S, Chan KL, Haardörfer R, et al. Pathways between childhood trauma, intimate partner violence, and harsh parenting: findings from the UN Multi-country Study on Men and Violence in Asia and the Pacific. The Lancet Global Health. 2017;5(5):e512–e22. doi:
    1. Maharaj P, Cleland J. Risk perception and condom use among married or cohabiting couples in KwaZulu-Natal, South Africa. International family planning perspectives. 2005:24–9.
    1. Cushman LF, Romero D, Kalmuss D, Davidson AR, Heartwell S, Rulin M. Condom use among women choosing long-term hormonal contraception. Family Planning Perspectives. 1998:240–3.
    1. Irish L, Kobayashi I, Delahanty DL. Long-term physical health consequences of childhood sexual abuse: A meta-analytic review. Journal of pediatric psychology. 2009: jsp118.
    1. Sikweyiya Y, Jewkes RK. Force and temptation: contrasting South African men’s accounts of coercion into sex by men and women. Culture, Health & Sexuality. 2009;11(5):529–41.
    1. Williams LM. Recall of childhood trauma: a prospective study of women’s memories of child sexual abuse. Journal of consulting and clinical psychology. 1994;62(6):1167
    1. Knerr W, Gardner F, Cluver L. Improving positive parenting skills and reducing harsh and abusive parenting in low-and middle-income countries: A systematic review. Prevention science. 2013;14(4):352–63. doi:
    1. Murray LK, Skavenski S, Kane JC, Mayeya J, Dorsey S, Cohen JA, et al. Effectiveness of trauma-focused cognitive behavioral therapy among trauma-affected children in lusaka, zambia: A randomized clinical trial. JAMA pediatrics. 2015;169(8):761–9. doi:
    1. de Arellano MAR, Lyman DR, Jobe-Shields L, George P, Dougherty RH, Daniels AS, et al. Trauma-focused cognitive-behavioral therapy for children and adolescents: Assessing the evidence. Psychiatric Services. 2014;65(5):591–602. doi:

Source: PubMed

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