Health Systems Strengthening Division, Foundation for Professional Development, Pretoria, South Africa.
School of Public Health, University of the Western Cape, Belville, South Africa.
PLoS One. 2019 Jan 4;14(1):e0198866. doi: 10.1371/journal.pone.0198866. eCollection 2019.
Sexual and physical abuse in childhood creates a great health burden including on mental and reproductive health. A possible link between child abuse and HIV infection has increasingly attracted attention. This paper investigated whether a history of child physical and sexual abuse is associated with HIV infection among adult women.
A cross sectional survey was conducted among 2042 postnatal women (mean age = 26y) attending six public primary health care clinics in Harare, Zimbabwe within 6 weeks post-delivery. Clinic records were reviewed for mother's antenatal HIV status. Participants were interviewed about childhood abuse including physical or sexual abuse before 15 years of age, forced first sex before 16, HIV risk factors such as age difference at first sex before age 16. Multivariate analyses assessed the associations between mother's HIV status and child physical and sexual abuse while controlling for confounding variables.
More than one in four (26.6%) reported abuse before the age of 15: 14.6% physical abuse and 9.1% sexual abuse,14.3% reported forced first sex and 9.0% first sex before 16 with someone 5+ years older. Fifteen percent of women tested HIV positive during the recent antenatal care visit. In multivariate analysis, childhood physical abuse (aOR 3.30 95%CI 1.58-6.90), sexual abuse (3.18 95%CI: 1.64-6.19), forced first sex (aOR 1.42, 95%CI: 1.00-2.02), and 5+ years age difference with first sex partner (aOR 1.66 95%CI 1.09-2.53) were independently associated with HIV infection.
This study highlights that child physical and/or sexual abuse may increase risk for HIV acquisition. Further research is needed to assess the pathways to HIV acquisition from childhood to adulthood. Prevention of child abuse must form part of the HIV prevention agenda in Sub-Saharan Africa.
儿童时期的性虐待和身体虐待会对包括精神和生殖健康在内的健康造成严重负担。儿童虐待与 HIV 感染之间的可能联系越来越受到关注。本文调查了儿童期身体和性虐待史是否与成年女性的 HIV 感染有关。
在津巴布韦哈拉雷的六家公立初级保健诊所，对 2042 名产后妇女（平均年龄=26 岁）进行了横断面调查，这些妇女在分娩后 6 周内接受了调查。对产妇产前 HIV 状况进行了诊所记录审查。对 15 岁以下的儿童期虐待（包括身体或性虐待）、16 岁以下的被迫初次性行为、年龄差异在 16 岁以下的首次性行为等 HIV 风险因素进行了采访。多变量分析评估了母亲的 HIV 状况与儿童期身体和性虐待之间的关联，同时控制了混杂变量。
超过四分之一（26.6%）的人报告在 15 岁之前遭受过虐待：14.6%的人遭受过身体虐待，9.1%的人遭受过性虐待，14.3%的人报告过被迫初次性行为，9.0%的人在 16 岁之前与年龄大 5 岁以上的人发生过初次性行为。在最近的产前保健就诊期间，有 15%的女性检测出 HIV 阳性。在多变量分析中，儿童期身体虐待（OR3.3095%CI1.58-6.90）、性虐待（OR3.1895%CI：1.64-6.19）、被迫初次性行为（OR1.4295%CI：1.00-2.02）以及与初次性行为伴侣相差 5 岁以上（OR1.6695%CI1.09-2.53）与 HIV 感染独立相关。
本研究强调了儿童期身体和/或性虐待可能会增加 HIV 感染的风险。需要进一步研究来评估从儿童期到成年期 HIV 感染的获得途径。在撒哈拉以南非洲，预防儿童虐待必须成为 HIV 预防议程的一部分。
