Associations between childhood adversity and depression, substance abuse and HIV and HSV2 incident infections in rural South African youth

ObjectivesTo describe prevalence of childhood experiences of adversity in rural South African youth and their associations with health outcomes.MethodsWe analyzed questionnaires and blood specimens collected during a baseline survey for a cluster randomized controlled trial of a behavioral intervention, and also tested blood HIV and herpes simplex type 2 virus at 12- and 24-month follow up; 1,367 male and 1,415 female volunteers were recruited from 70 rural villages.ResultsBoth women and men before 18 had experienced physical punishment (89.3% and 94.4%), physical hardship (65.8% and 46.8%), emotional abuse (54.7% and 56.4%), emotional neglect (41.6% and 39.6%), and sexual abuse (39.1% and 16.7%). Incident HIV infections were more common in women who experienced emotional abuse (IRR 1.96, 95% CI 1.25, 3.06, p = .003), sexual abuse (IRR 1.66 95% CI 1.04, 2.63, p = .03), and physical punishment (IRR 2.13 95% CI 1.04, 4.37, p = .04). Emotional neglect in women was associated with depression (aOR 1.82, 95% CI 1.15, 2.88, p = .01), suicidality (aOR 5.07, 95% CI 2.07, 12.45, p < .0001), alcohol abuse (aOR 2.17, 95% CI .99, 4.72, p = .05), and incident HSV2 infections (IRR 1.62, 95% CI 1.01, 2.59, p = .04). In men emotional neglect was associated with depression (aOR 3.41, 95% CI 1.87, 6.20, p < .0001) and drug use (aOR 1.98, 95% CI 1.37, 2.88, p < .0001). Sexual abuse was associated with alcohol abuse in men (aOR 3.68, 95% CI 2.00, 6.77, p < .0001) and depression (aOR 2.16, 95% CI 1.34, 3.48, p = .002) and alcohol abuse in women (aOR 3.94, 95% CI 1.90, 8.17, p < .0001).Practice implicationsChildhood exposure to adversity is very common and influences the health of women and men. All forms of adversity, emotional, physical and sexual, enhance the risk of adverse health outcomes in men and women. Prevention of child abuse need to be included as part of the HIV prevention agenda in sub-Saharan Africa. Interventions are needed to prevent emotional, sexual, and physical abuse and responses from health and social systems in Africa to psychologically support exposed children must be strengthened.