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
Abstract
:1. Introduction
2. Materials and Methods
2.1. Background and Objectives of the Namibia VACS
2.2. Sampling of the Namibia VACS
2.3. Ethical Procedures
2.4. Study Sample
2.5. Outcomes
2.6. Demographics
2.7. Exposures—ACEs
- (a)
- Slapping, pushing, shoving, shaking, or intentionally throwing something at the participant;
- (b)
- Punching, kicking, whipping, or beating the participant with an object;
- (c)
- Strangling, smothering, intentionally burning, or trying to drown the participant;
- (d)
- Threatening or hurting the participant with a knife, a panga, a gun, or another weapon.
- (a)
- If a parent, an adult caregiver, or another adult relative (i) told the participant he or she was not loved or did not deserve to be loved; (ii) said that they wished the participant had never been born or were dead; or (iii) ridiculed or put the participant down;
- (b)
- If an intimate partner (i) insulted, humiliated, or made fun of the participant in front of others; (ii) kept the participant from having money; (iii) tried to keep the participant from seeing or talking to family or friends; (iv) kept track of the participant by demanding to know where he or she has been and what he or she has been doing; or (v) made threats to physically harm the participant;
- (c)
- If a peer (i) made participant get scared or feel really bad because peer was calling participant names, saying mean things, or saying they didn’t want participant around; (ii) told lies or spread rumors about participant; (ii) told lies or spread rumors about the participant; or (iii) kept the participant out of things on purpose, excluded the participant from their group of friends, or completely ignored the participant.
- (a)
- Being touched in a sexual way without the participant’s permission, including “fondling, pinching, groping, or touching” on or around his or her sexual body parts;
- (b)
- Being physically forced to have sex against his or her will, when sex did occur;
- (c)
- Being physically forced to have sex, when sex did not occur;
- (d)
- Being pressured to have sex through harassment and threats, when sex did occur.
2.8. Exposures—PCEs
2.9. Data Analysis
3. Results
3.1. Descriptive Analysis
3.2. Bivariate Association between ACEs, PCEs, and Sexual HIV Risk Factors
3.3. Multivariable Associations between Cumulative ACE Score, Individual PCEs, and Sexual HIV Risk Factors
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Indicator | Female | Male | Total | |||
---|---|---|---|---|---|---|
N | Weighted Prevalence % (95% CI) | N | Weighted Prevalence % (95% CI) | N | Weighted Prevalence % (95% CI) | |
Demographic | ||||||
Age | 2046 | 467 | 2513 | |||
19–21 | 55.0 (51.5–58.6) | 57.8 (51.8–63.8) | 56.5 (52.9–60.1) | |||
22–24 | 45.0 (41.4–48.5) | 42.2 (36.2–48.2) | 43.5 (39.9–47.1) | |||
Region of Residence | 2046 | 467 | 2513 | |||
Khomas | 21.6 (16.5–26.6) | 16.2 (6.7–25.8) | 18.7 (14.3–23.1) | |||
Oshikoto | 10.5 (7.9–13.1) | 9.2 (0.5–17.8) | 9.8 (5.5–14.1) | |||
Zambezi | 5.6 (4.3–7.0) | 4.8 (0.0–10.2) | 5.2 (2.5–7.9) | |||
Other | 62.3 (54.3–70.3) | 69.8 (57.5–82.1) | 66.3 (60.8–71.7) | |||
Financial Insecurity | 2012 | 63.7 (57.9–69.5) | 464 | 71.8 (65.4–78.3) | 2476 | 68.0 (63.8–72.3) |
Outcomes | ||||||
Did Not Know HIV Status of at Least One Sexual Partner in the past 12 Months * | 1972 | 18.1 (14.9–21.3) | 445 | 29.3 (23.7–34.9) | 2417 | 24.0 (20.6–27.5) |
Ever Had Transactional Sex | 1999 | 3.4 (2.1–4.7) | 462 | 2.6 (1.2–4.1) | 2461 | 3.0 (2.0–4.0) |
Multiple Sexual Partners in the past 12 Months * | 1975 | 7.1 (5.1–9.2) | 445 | 24.6 (20.2–29.1) | 2420 | 16.4 (13.2–19.6) |
Infrequent or no Condom Use in the Past 12 Months * | 1961 | 38.2 (34.1–42.3) | 442 | 21.2 (17.0–25.5) | 2403 | 29.2 (25.6–32.8) |
Sexual Partner in the Past 12 Months Who Was Older by ≥10 years * | 1889 | 3.7 (2.2–5.3) | 435 | 0.4 (0.0–0.8) | 2324 | 1.9 (1.1–2.8) |
History of STI in Lifetime | 2034 | 7.2 (5.2–9.2) | 467 | 9.0 (5.6–12.4) | 2501 | 8.1 (5.9–10.4) |
Experienced Sexual Violence in Adulthood (18 Years Old to Present) | 2027 | 9.6 (7.2–12.0) | 464 | 7.3 (3.5–11.0) | 2491 | 8.3 (6.0–10.7) |
Indicator | Female | Male | Total | |||
---|---|---|---|---|---|---|
N | Weighted Prevalence % (95% CI) | N | Weighted Prevalence % (95% CI) | N | Weighted Prevalence % (95% CI) | |
ACEs (Before Age of 18 Years) | ||||||
Experienced Physical Violence * | 2015 | 30.6 (26.4–34.8) | 453 | 39.4 (32.7–46) | 2468 | 35.3 (31.6–39) |
Experienced Sexual Violence * | 2032 | 10.9 (8.3–13.5) | 467 | 6.1 (3.3–9.0) | 2499 | 8.3 (6.4–10.3) |
Experienced Emotional Violence | 1977 | 10.6 (7.8–13.4) | 458 | 7.0 (4.6–9.3) | 2435 | 8.7 (7.0–10.3) |
Witnessed Physical Violence in the Community * | 1997 | 49.1 (44.7–53.5) | 451 | 60.2 (52.5–67.9) | 2448 | 55 (50.2–59.8) |
Witnessed Physical Violence at Home | 1991 | 35.9 (31.5–40.3) | 449 | 38.8 (31.8–45.8) | 2440 | 37.4 (33.5–41.4) |
Orphan Status | 1915 | 32.5 (27.7–37.4) | 446 | 26.4 (21.3–31.5) | 2361 | 29.3 (25.7–32.8) |
≥1 ACEs | 2037 | 77.2 (73.3–81.1) | 467 | 81.0 (75.3–86.7) | 2504 | 79.2 (75.7–82.7) |
≥3 ACEs | 2037 | 25.5 (21.4–29.5) | 467 | 26 (19.9–32) | 2504 | 25.7 (22.4–29.1) |
PCEs (Before Age of 18 Years) | ||||||
Education Status: Completed or Attended Secondary School ** | 2032 | 90.6 (87.7–93.5) | 467 | 81.8 (76–87.7) | 2499 | 85.9 (82.4–89.4) |
Strong Mother–Child Relationship (Before 18 Years) | 1950 | 68.0 (64.0–72.1) | 461 | 74.7 (69.0–80.5) | 2411 | 71.7 (67.9–75.5) |
Strong Father–Child Relationship (Before 18 Years) ** | 1864 | 42.5 (37.0–48) | 447 | 55.3 (49.6–61.0) | 2311 | 49.6 (45.7–53.4) |
Caregiver Monitoring and Supervision (Before 18 Years) | 2002 | 64.0 (59.5–68.4) | 459 | 67.3 (60.4–74.1) | 2461 | 65.7 (61.5–70.0) |
Adjusted OR (CI 95%) | |||||||
---|---|---|---|---|---|---|---|
Did Not Know Partner’s HIV Status in the Past 12 Months | Lifetime Transactional Sex | Multiple Sexual Partners in the Past 12 Months | Infrequent Condom Use in the Past 12 Months | Lifetime STI | SV at 18 Years or Older | Sexual Partner in the Past 12 Months Who Was Older by ≥10 Years | |
Exposure | |||||||
ACEs 3 or More (ref: <3 ACEs) 1 | 1.1 (0.8–1.5) | 4.2 (2.0–8.7) *** | 2.2 (1.2–4.0) * | 1.0 (0.6–1.7) | 1.5 (0.8–2.8) | 2.9 (1.7–5.1) *** | 2.0 (1.2–3.3) ** |
Attended or Completed Secondary School 2 | 0.6 (0.4–0.9) * | 0.6 (0.2–1.8) | 0.7 (0.2–2.1) | 0.8 (0.4–1.6) | 0.6 (0.2–1.5) | 0.6 (0.3–1.2) | 0.2 (0.1 0.5) *** |
Strong Relationship with Mother 2 | 0.9 (0.6–1.4) | 0.8 (0.4–1.6) | 0.5 (0.3–0.9) * | 0.9 (0.6–1.3) | 0.9 (0.6–1.5) | 0.8 (0.5–1.3) | 0.5 (0.2–1.4) |
Strong Relationship with Father 2 | n/a 3 | 0.4 (0.2–0.7) ** | 1.5 (1.0–2.2) | n/a 3 | n/a 3 | 0.9 (0.6–1.4) | 0.3 (0.2–0.5) *** |
Caregiver Monitoring and Supervision 2 | 1.2 (0.9–1.5) | 1.5 (0.5–4.0) | 1.4 (0.9–2.0) | 0.8 (0.6–1.0) * | 3.0 (1.6–5.7) ** | 2.3 (1.2–4.6) * | 0.8 (0.3–2.1) |
Adjusted OR (95% CI) | |||||||
---|---|---|---|---|---|---|---|
Did Not Know Partner’s HIV Status in Past 12 Months | Lifetime Transactional Sex | Multiple Sexual Partners in the Past 12 Months | Infrequent Condom Use in the Past 12 Months | Lifetime STI | SV at 18 Years or Older | Sexual Partner in the Past 12 Months Who Was Older by ≥10 Years | |
Exposure | |||||||
ACEs 3 or More (ref: <3 ACEs) 1 | 2.1 (1.4–3.1) ** | n/a 4 | 1.7 (1.0–2.8) | 2.2 (1.1–4.0) * | 1.7 (1.2–2.6) * | n/a 4 | n/a 4 |
Attended or Completed Secondary School 2 | 0.7 (0.5–1.0) | n/a 4 | 0.7 (0.3–1.6) | 0.2 (0.1–0.6) * | 0.8 (0.3–1.8) | n/a 4 | n/a 4 |
Strong Relationship with Mother 2 | 0.8 (0.4–1.5) | n/a 4 | 0.6 (0.4–1.1) | 0.7 (0.4–1.3) | 0.4 (0.2–0.8) ** | n/a 4 | n/a 4 |
Strong Relationship with Father 2 | 1.0 (0.7–1.3) | n/a 4 | n/a 3 | 1.0 (0.6–1.6) | 0.7 (0.4–1.2) | n/a 4 | n/a 4 |
Caregiver Monitoring and Supervision 2 | 0.6 (0.3–1.0) | n/a 4 | 1.1 (0.7–2.0) | 1.1 (0.6–2.2) | 1.1 (0.5–2.2) | n/a 4 | n/a 4 |
Experienced ≥3 ACEs | ||||
---|---|---|---|---|
OR and 95% CIs by Stratum 2 | ||||
Among Those Who Had Strong Relationships with Their Fathers | Among Those Who Did Not Have Strong Relationships with Their Fathers | |||
HIV Sexual Risk Factor | Sex | p-Value 1 | ||
Unknown HIV Status of at Least One Sexual Partner 3 | Female | 0.002 | 0.5 (0.3–1.0) | 1.5 (1.0–2.3) * |
Infrequent Condom Use 3 | Female | 0.005 | 0.6 (0.4–0.9) ** | 1.4 (1.0–2.1) |
STI in Lifetime | Female | 0.005 | 0.3 (0.1–1.0) | 2.3 (1.2–4.6) * |
Multiple Sexual Partners 3 | Male | 0.004 | 0.9 (0.4–1.9) | 3.5 (1.9–6.4) *** |
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Share and Cite
Agathis, N.T.; Annor, F.B.; Xu, L.; Swedo, E.; Chiang, L.; Coomer, R.; Hegle, J.; Patel, P.; Forster, N.; O’Malley, G.; et al. 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. Int. J. Environ. Res. Public Health 2023, 20, 6376. https://doi.org/10.3390/ijerph20146376
Agathis NT, Annor FB, Xu L, Swedo E, Chiang L, Coomer R, Hegle J, Patel P, Forster N, O’Malley G, et al. 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. International Journal of Environmental Research and Public Health. 2023; 20(14):6376. https://doi.org/10.3390/ijerph20146376
Chicago/Turabian StyleAgathis, Nickolas T., Francis B. Annor, Likang Xu, Elizabeth Swedo, Laura Chiang, Rachel Coomer, Jennifer Hegle, Pragna Patel, Norbert Forster, Gabrielle O’Malley, and et al. 2023. "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" International Journal of Environmental Research and Public Health 20, no. 14: 6376. https://doi.org/10.3390/ijerph20146376