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Background: Youth living with HIV (YLWH) are more likely than youth not living with HIV to experience adverse childhood experiences (ACEs). These experiences can increase risk for mental health disorders and hinder coping, potentially affecting HIV treatment adherence and long-term health. This study sought to determine the prevalence of ACEs and their association with symptoms of depression and anxiety in a cohort of YLWH.
Methods: This cross-sectional analysis uses baseline data from 690 YLWH aged 11-24 years enrolled in the Sauti ya Vijana (SYV) clinical trial between March 2023 and July 2024 in Tanzania. ACEs were assessed using the World Health Organization (WHO) Adverse Childhood Experiences International Questionnaire (ACE-IQ) tool. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder-7 (GAD-7) tools. Associations between ACEs and symptoms of depression and anxiety were examined using linear regression, with sociodemographic factors, social support, and HIV stigma included in the models as potential moderators.
Results: The mean age of our sample was 17.5 years and 64% reported having an ACE score of 4 or more. Emotional neglect (89%), community violence (87%), and parental separation (79%) were the most commonly reported ACEs. ACEs were significantly associated with symptoms of depression and anxiety in regression analyses. Having a secondary education level or higher was associated with a larger increase in GAD-7 score per unit increase in ACE score.
Conclusion: ACEs are prevalent among YLWH and have a strong relationship with mental health symptoms. Screening for both ACEs and common mental disorders should be prioritized among YLWH, followed by integrated, brief interventions and linkage to mental health treatment as needed. Interventions must address early trauma and HIV-related stigma to ease the burden of living with HIV and promote long-term HIV care engagement.