Adverse childhood experiences, HIV and sexual risk behaviors - Five sub-Saharan countries, 2018-2020.

BACKGROUND: Adverse childhood experiences (ACEs) have been shown to have negative, lasting effects on health including increasing the likelihood of engaging in sexual risk behaviors. OBJECTIVE: This study aimed to identify associations between exposures to ACEs and sexual risk behaviors and HIV service utilization among young people. PARTICIPANTS AND SETTING: A sample of 8023 sexually active young people (19-24 year olds) from five sub-Saharan African countries participated Violence Against Children and Youth Surveys (VACS). METHODS: Descriptive analysis of demographic variables, individual ACEs, cumulative ACEs, sexual risk behaviors, HIV testing, antiretroviral treatment (ART) and Antenatal Care (ANC) attendance were completed. Bivariate and multivariable logistic regression analyses were conducted to assess the associations between both individual and cumulative ACEs, sexual HIV risk behaviors, and service utilization while controlling for important covariates such as demographic, having ever been pregnant, had an STI, and used contraception. RESULTS: Exposure to three or more ACEs was higher among males (26.1 %) compared to females (21.3 %); p = 0.003. The most prominent sexual risk behavior for females was having sexual partners who were at least 5 years older (45.7 % compared to males 3.7 %; p < 0.0001) whereas in males it was no or infrequent condom use (45.3 % compared to females 30.1 %; p < 0.0001). Males and females exposed to childhood sexual violence had seven and four times the odds of engaging in transactional sex (aOR = 7.34, 95 % CI: [3.5-15.0]) and (aOR =3.75, 95 % CI: [2.3-6.2], respectively. Females exposed to three or more ACEs were four times more likely to engage in transactional sex (aOR = 4.85, 95 %, CI: [1.6-14.4]) compared to those who did not experience any ACEs. Males exposed to three or more ACEs were two times more likely to engage in early sexual debut (aOR = 2.2, 95 % CI: [1.3-3.4]),]) compared to those who did not experience any ACEs. Females who had witnessed IPV or violence in the community had significantly higher odds of getting tested for HIV (aOR = 2.16, 95 % CI: [1.63-2.87]) and (aOR = 1.36, 95 % CI: [1.03-1.81]), respectively. CONCLUSIONS: This study demonstrated that experiencing ACEs during childhood is associated with higher HIV risk behaviors in sub-Saharan Africa (SSA) with unique differences between males and females.

"Ganja Mamas": Online discussions about cannabis use in pregnancy.

BACKGROUND: Nearly 5 % of pregnant women in the United States use cannabis. However, expecting mothers often do not seek counsel from their healthcare providers about prenatal cannabis use due to stigma and legal ramifications. Instead, cannabis-using pregnant women turn to each other to learn. Online message boards have become a safe place for parents to seek answers anonymously in real-time. The objective of this study was to examine the information-seeking/giving behaviors of cannabis-using pregnant women on an online community forum. METHODS: We extracted 151 original messages and 1260 corresponding comments posted over a 7-day period from Whattoexpect.com's "Ganja Mamas" forum. We iteratively developed a codebook with 16 categories to reflect information-seeking behavior. N = 131 unique forum members posted questions for comment. RESULTS: Approximately half, 46.56 %, reported their geographic location (24 states), and 40.46 % reported gestational age. The top topics for which members sought out information were testing, state-specific questions, postpartum, child protective services (CPS), hospital-specific questions, birth announcements, methods of cannabis use, quitting, breastfeeding/pumping, pregnancy symptoms, mental health, general health and pregnancy, and quantity of cannabis use. The second phase of analysis was based on members' responses. Clustered codes indicated how the respondents were using the forum: (1) interviewing and geographic location, (2) knowledge, experience, and reassurance, (3) congratulations and relief, and (4) concealing cannabis use and symptoms. CONCLUSIONS: Our results demonstrate that mothers on an online cannabis forum are seeking information about location-specific experiences pertaining mostly to testing and child protective services. Additionally, mothers are responding by geographic-specific interviewing, and are expressing relief and reassurance in response to members' experiences.