Prevalence of Adverse Childhood Experiences (ACEs) Among Adolescent and Young Women in Kenya and Behaviors and Experiences Associated with HIV Acquisition

Abstract

Adverse Childhood Experiences (ACEs) are significant stressors linked to negative health outcomes, yet their relationship with factors associated with HIV acquisition among adolescent girls and young women (AGYW) is poorly understood, especially in high HIV burden settings. This study characterized ACE prevalence and its association with HIV-related characteristics among AGYW in Kenya. A cross-sectional analysis using data from an ongoing cluster-randomized trial (NCT0467306) involving AGYW seeking contraception at 20 retail pharmacies in Kisumu. Using the World Health Organization (WHO) ACE-International Questionnaire, participants were categorized by high (≥4) or low (<3) ACE scores, while HIV risk indicators were assessed via standardized questionnaires. The analysis included 1636 AGYW (88% of all participants) ≥18 (median age 21 years), 37% attending school, 51% reported prior pregnancy and most (85%) were using contraception, currently. Overall, 92% reported at least 1 ACE and 37% had high ACE scores. AGYW with high ACE scores were more likely to report transactional sex (PR 2.71, 95% CI: 1.91-3.89), experiencing sex against their will (PR 3.82, 95% CI: 2.40_6.28), intimate partner violence (PR 7.33 95% CI: 2.80-19.19), high self-perceived HIV risk (PR 1.24, 95% CI: 1.08-1.43) and having a partner with other sexual partners (PR 1.53, 95% CI: 1.25-1.87), compared to those with low ACE scores. These findings highlight that ACEs are common among Kenyan AGYW and are linked to behaviors and experiences associated with HIV acquisition and violence, emphasizing the need for trauma-informed HIV prevention in this setting.