Strong father-child relationships and other positive childhood experiences, adverse childhood experiences, and sexual risk factors for HIV among young adults aged 19-24 years, Namibia, 2019: A Cross-sectional Study.

AbstractBackground Understanding what childhood factors influence HIV acquisition risk among young adults, especially young women, is critical as they are disproportionately affected by the global HIV epidemic. Adverse and positive childhood experiences (ACEs and PCEs, respectively), including strong parent-child relationships, may influence HIV acquisition risk among youth (19–24 years) living in sub-Saharan African countries. Methods Using cross-sectional data from the 2019 Namibia Violence Against Children and Youth Survey, we assessed the associations between each of 4 PCEs (including having a strong father-child relationship, strong mother-child relationship, or strong caregiver monitoring and supervision, and ever attending secondary school) and ≥ 3 ACEs with 7 individual sexual HIV risk factors, through sex-stratified multivariable hierarchical models. Interaction terms between ≥ 3 ACEs and the relevant PCE were included in each model. For significant interaction terms, multivariable analyses were done stratifying among those with and without the PCE. Results Strong father-child relationships were inversely associated with 2 HIV risk factors among women (lifetime transactional sex [OR 0.4, 95% CI 0.2–0.7] and recent age-disparate sexual relationship [OR 0.3, CI 95% 0.2–0.5]) and significantly interacted with having ≥ 3 ACEs for 3 HIV risk factors among women and 1 among men. Among women without strong father-child relationships, having ≥ 3 ACEs was positively associated with not knowing a partner’s HIV status (OR 1.7, 95% CI 1.7–2.4) or infrequently using condoms (OR 1.4, 95% CI 1.0-2.1) in the past year, and ever having an STI (OR 2.3, 95% CI 1.2–4.6); among men without strong father-child relationships, ≥ 3 ACEs was positively associated with having multiple sexual partners in the past year (OR 3.5, 95% CI 1.9–6.4). Conversely, among women and men with strong father-child relationships, experiencing ≥ 3 ACEs was either not significantly, or inversely, associated with those risk factors. The other PCEs were significantly associated with ≤ 1 HIV risk factor and had no significant interaction terms. Conclusion Among youth in Namibia, strong child-father relationships may reduce HIV acquisition risk and mitigate the effect of childhood adversity on this risk. Improving parent and caregiver support may be an important strategy to reduce the impact of childhood adversity and aid global HIV epidemic control.