BACKGROUND:Youth trauma exposure is associated with syndemic HIV risk. We measured lifetime prevalence, type, and correlates of trauma experience by gender among adolescents living in the HIV hyper-endemic setting of Soweto, South Africa. METHODS:Using data from the Botsha Bophelo Adolescent Health Survey (BBAHS), prevalence of "ever" experiencing a traumatic event among adolescents (aged 14-19) was assessed using a modified Traumatic Event Screening Inventory-Child (TESI-C) scale (19 items, study alpha = 0.63). We assessed self-reported number of potentially traumatic events (PTEs) experienced overall and by gender. Gender-stratified multivariable logistic regression models assessed independent correlates of 'high PTE score' (≥7 PTEs). RESULTS:Overall, 767/830 (92%) participants were included (58% adolescent women). Nearly all (99.7%) reported experiencing at least one PTE. Median PTE was 7 [Q1,Q3: 5-9], with no gender differences (p = 0.19). Adolescent men reported more violent PTEs (e.g., "seen an act of violence in the community") whereas women reported more non-violent HIV/AIDS-related PTEs (e.g., "family member or someone close died of HIV/AIDS"). High PTE score was independently associated with high food insecurity among adolescent men and women (aOR = 2.63, 95%CI = 1.36-5.09; aOR = 2.57, 95%CI = 1.55-4.26, respectively). For men, high PTE score was also associated with older age (aOR = 1.40/year, 95%CI = 1.21-1.63); and recently moving to Soweto (aOR = 2.78, 95%CI = 1.14-6.76). Among women, high PTE score was associated with depression using the CES-D scale (aOR = 2.00, 95%CI = 1.31-3.03,) and inconsistent condom use vs. no sexual experience (aOR = 2.69, 95%CI = 1.66-4.37). CONCLUSION:Nearly all adolescents in this study experienced trauma, with gendered differences in PTE types and correlates, but not prevalence. Exposure to PTEs were distributed along social and gendered axes. Among adolescent women, associations with depression and inconsistent condom use suggest pathways for HIV risk. HIV prevention interventions targeting adolescents must address the syndemics of trauma and HIV through the scale-up of gender-transformative, youth-centred, trauma-informed integrated HIV and mental health services.

译文

背景:青年创伤暴露与艾滋病毒的综合症相关。我们测量了南非索韦托艾滋病毒高流行地区青少年的终生患病率,类型以及创伤经历的相关性(按性别)。
方法:使用Botsha Bophelo青少年健康调查(BBAHS)的数据,使用改良的创伤事件筛查儿童量表(TESI-C)评估青少年(14-19岁)经历过创伤事件的“曾经”发生率( 19个项目,研究alpha = 0.63)。我们根据性别和性别对自我报告的潜在创伤事件(PTE)的数量进行了评估。性别分层的多变量logistic回归模型评估了“高PTE得分”(≥7 PTE)的独立相关性。
结果:总体上包括767/830(92%)的参与者(58%的青少年女性)。几乎所有(99.7%)的人都经历过至少一种PTE。 PTE中位数为7 [Q1,Q3:5-9],无性别差异(p = 0.19)。青春期男性报告了更多暴力的PTE(例如,“在社区中看到暴力行为”),而女性报告了更多非暴力的与HIV / AIDS相关的PTE(例如,“家庭成员或亲密的人死于HIV / AIDS”)。高PTE分数与青少年男女的高食品安全性无关(aOR = 2.63,95%CI = 1.36-5.09; aOR = 2.57,95%CI = 1.55-4.26)。对于男性,较高的PTE分数也与年龄有关(aOR = 1.40 /年,95%CI = 1.21-1.63);并且最近转移到了Soweto(aOR = 2.78,95%CI = 1.14-6.76)。在女性中,高PTE评分与使用CES-D量表的抑郁症相关(aOR = 2.00,95%CI = 1.31-3.03),使用安全套的前后不一致与没有性经历(aOR = 2.69,95%CI = 1.66-) 4.37)。
结论:本研究中几乎所有青少年都经历过创伤,PTE类型和相关性存在性别差异,但没有患病率。 PTE的暴露沿社会和性别轴分布。在青春期妇女中,与抑郁症和避孕套使用不一致有关,这提示了感染艾滋病毒的途径。针对青少年的艾滋病毒预防干预措施必须通过扩大性别转变,以青年为中心,以创伤为先导的综合性艾滋病毒和精神卫生服务来应对创伤和艾滋病毒的综合症。

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