Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA.
J Acquir Immune Defic Syndr. 2011 Aug 1;57(4):340-50. doi: 10.1097/QAI.0b013e31821d36b4.
Stressful life events in childhood during critical periods of development have long-term psychological and neurobiological sequelae, which may affect risk for HIV infection across the life course.
Data were from a nationally representative sample of 13,274 US men (National Epidemiologic Survey on Alcohol and Related Conditions, 2004-2005). Weighted multivariable logistic regression models examined (1) the association of childhood violent events before age 18 on 12-month incident HIV infection and (2) whether posttraumatic stress disorder (PTSD) diagnosis (clinical interview) mediated the association between early life events and HIV.
Overall, the 12-month HIV incidence was <1% (0.35%); 44% of new infections were among racial/ethnic minorities and 31% among men who have sex with men). One-third of the sample (33.5%) reported one or more early life stressors (physical abuse, sexual abuse, neglect, verbal violence, or witnessed violence). In a weighted multivariable logistic regression model adjusted for age, education, family's socioeconomic position, and sexual behaviors, each additional early life violent event was associated with an elevated odds of HIV infection [adjusted odds ratio (aOR) = 1.32; 95% confidence interval (CI): 1.16 to 1.50]. Adding PTSD to this adjusted model, PTSD was highly associated with incident HIV infection (aOR = 5.75; 95% CI: 4.76 to 6.95). There was evidence that PTSD partially mediated the relationship between early life events and HIV (aOR = 1.14; 95% CI: 1.02 to 1.28).
Experiencing early life violent family stressors was associated with HIV infection among men. Early life events and HIV infection were mediated by PTSD, which has implications for understanding disparities in HIV infection. Interventions are urgently needed that address the long-term sequelae of childhood violence.
儿童期在发育关键期经历的压力性生活事件会产生长期的心理和神经生物学后果，这可能会影响整个生命过程中 HIV 感染的风险。
数据来自于美国 13274 名男性的全国代表性样本（2004-2005 年全国酒精相关情况流行病学调查）。采用加权多变量逻辑回归模型检验了（1）18 岁前儿童期暴力事件与 12 个月内新发 HIV 感染之间的关系，以及（2）创伤后应激障碍（PTSD）诊断（临床访谈）是否在早期生活事件与 HIV 之间的关系中起中介作用。
总体而言，12 个月的 HIV 发病率<1%（0.35%）；新感染中 44%为少数族裔，31%为男男性行为者。三分之一的样本（33.5%）报告有一个或多个早期生活压力源（身体虐待、性虐待、忽视、言语暴力或目睹暴力）。在调整年龄、教育、家庭社会经济地位和性行为的加权多变量逻辑回归模型中，每增加一个早期生活中的暴力事件，HIV 感染的几率就会增加[调整后的优势比（aOR）=1.32；95%置信区间（CI）：1.16 至 1.50]。在这个调整后的模型中加入 PTSD，PTSD 与 HIV 感染的发生高度相关（aOR=5.75；95%CI：4.76 至 6.95）。有证据表明，PTSD 部分介导了早期生活事件与 HIV 之间的关系（aOR=1.14；95%CI：1.02 至 1.28）。
经历早期生活中暴力的家庭压力源与男性的 HIV 感染有关。早期生活事件和 HIV 感染是通过 PTSD 介导的，这对理解 HIV 感染的差异有影响。迫切需要采取干预措施，解决儿童期暴力的长期后果。
