{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:41:55Z","timestamp":1790800915324,"version":"4.1.0"},"reference-count":37,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2018,5,8]],"date-time":"2018-05-08T00:00:00Z","timestamp":1525737600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Interpers Violence"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:p>Adverse childhood experiences (ACEs) exhibit a dose\u2013response association with poor health outcomes in adulthood, including HIV. In this analysis, we explored the relationship between ACEs and HIV sexual risk-taking behaviors among young adults in Malawi. We analyzed responses from sexually active 19- to 24-year-old males and females ( n = 610) participating in the Malawi Violence Against Children Survey. We tested the association between respondents\u2019 exposure to six ACEs (having experienced emotional, physical, or sexual violence; witnessing intimate partner violence or an attack in the community; one or both parents died) and infrequent condom use in the past year and multiple sexual partners in the past year. We used logistic regression to test the association between ACEs and these sexual risk-taking behaviors. A majority (82%) of respondents reported at least 1 ACE, and 29% reported 3+ ACEs. We found positive unadjusted associations between the number of ACEs (1-2 and 3+ vs. none) and both outcomes. In adjusted models, we found positive associations between the number of ACEs and infrequent condom use (adjusted odds ratio [aOR]: 2.7, 95% confidence interval [CI]: [1.0, 7.8]; aOR: 3.7, CI: [1.3, 11.1]). Among young adults in Malawi, exposure to ACEs is positively associated, in a dose\u2013response fashion, with engaging in some sexual risk-taking behaviors. HIV prevention efforts in Malawi may benefit from prioritizing programs and policies aimed at preventing and responding to violence against children.<\/jats:p>","DOI":"10.1177\/0886260517752153","type":"journal-article","created":{"date-parts":[[2018,5,9]],"date-time":"2018-05-09T01:37:36Z","timestamp":1525829856000},"page":"1710-1730","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":66,"title":["Adverse Childhood Experiences and HIV Sexual Risk-Taking Behaviors Among Young Adults in Malawi"],"prefix":"10.1177","volume":"33","author":[{"given":"Kristin","family":"VanderEnde","sequence":"first","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Chiang","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Mercy","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Shawa","sequence":"additional","affiliation":[{"name":"Malawi Ministry of Gender, Children, Disability and Social Welfare, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Hamela","sequence":"additional","affiliation":[{"name":"Malawi Ministry of Gender, Children, Disability and Social Welfare, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nankali","family":"Maksud","sequence":"additional","affiliation":[{"name":"United Nations International Children\u2019s Emergency Fund, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sundeep","family":"Gupta","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nellie","family":"Wadonda-Kabondo","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Saul","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie","family":"Gleckel","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Kress","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Hillis","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,5,8]]},"reference":[{"key":"bibr1-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-005-0624-4"},{"key":"bibr2-0886260517752153","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.13.129247"},{"key":"bibr3-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdt038"},{"key":"bibr4-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2009.06.021"},{"key":"bibr5-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.07.022"},{"key":"bibr6-0886260517752153","unstructured":"Centers for Disease Control and Prevention. (2016). Summary Sheet: Preliminary findings: Malawi Population-Based HIV Impact Assessment: MPHIA 2015-2016. CDC Stacks Public Health. Retrieved from https:\/\/stacks.cdc.gov\/view\/cdc\/42894"},{"key":"bibr7-0886260517752153","unstructured":"Central Intelligence Agency. (2017). The World Fact book: Africa: Malawi. Retrieved from https:\/\/www.cia.gov\/library\/publications\/the-world-factbook\/geos\/mi.html"},{"issue":"1","key":"bibr8-0886260517752153","first-page":"1","volume":"68","author":"Chin J.","year":"1990","journal-title":"Bulletin of the World Health Organization"},{"key":"bibr9-0886260517752153","unstructured":"DREAMS Innovation Challenge. Retrieved from https:\/\/www.pepfar.gov\/documents\/organization\/247602.pdf"},{"key":"bibr10-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16098-4"},{"key":"bibr11-0886260517752153","unstructured":"End Violence: A Global Partnership to End Violence Against Children. Retrieved from http:\/\/www.end-violence.org\/ (accessed May 2017)."},{"key":"bibr12-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1016\/s0749-3797(98)00017-8"},{"key":"bibr13-0886260517752153","volume-title":"WHO Multi-Country Study on women\u2019s health and domestic violence against women: Initial results on prevalence, health outcomes and women\u2019s responses","author":"Garcia-Moreno C.","year":"2005"},{"key":"bibr14-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1258\/095646203762869151"},{"key":"bibr15-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1542\/peds.113.2.320"},{"key":"bibr16-0886260517752153","doi-asserted-by":"publisher","DOI":"10.2307\/2673783"},{"key":"bibr17-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1542\/peds.106.1.e11"},{"key":"bibr18-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-4079"},{"key":"bibr19-0886260517752153","unstructured":"Institute of Health Metrics and Evaluation. (2010). Global burden of diseases, injuries, and risk factors study. Global burden of disease profile: Malawi. Retrieved from http:\/\/www.healthdata.org\/malawi"},{"key":"bibr20-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200107270-00009"},{"key":"bibr21-0886260517752153","unstructured":"Ministry of Gender, Children, Disability and Social Welfare of the Republic of Malawi, United Nations Children\u2019s Fund, The Center for Social Research at the University of Malawi, and the Centers for Disease Control and Prevention. (2014). Violence against children and young women Malawi: Findings from a National Survey in 2013. Lilongwe: Government of Malawi. Retrieved from http:\/\/www.togetherforgirls.org\/wp-content\/uploads\/2017\/09\/2013_Malawi_Findings-from-a-Violence-Against-Children-Survey.pdf"},{"key":"bibr22-0886260517752153","unstructured":"National Statistical Office & ICF Macro. (2011). Malawi: Demographic and Health Survey 2010. Zomba, Malawi: Author. Retrived from http:\/\/dhsprogram.com\/pubs\/pdf\/FR247\/FR247.pdf"},{"key":"bibr23-0886260517752153","author":"N\u2019Galy B. R. R.","year":"1988","journal-title":"Journal of Acquired Immune Deficiency Syndrome"},{"key":"bibr24-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.109.063677"},{"key":"bibr25-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2010.02.012"},{"key":"bibr26-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31821d36b4"},{"key":"bibr27-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(09)60247-6"},{"key":"bibr28-0886260517752153","unstructured":"SAS 9.3. (2011). Cary, NC: SAS Institute."},{"key":"bibr29-0886260517752153","volume-title":"South African National HIV Prevalence, Incidence and Behavior Survey, 2012","author":"Shisana O.","year":"2014"},{"key":"bibr30-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1002\/car.2353"},{"key":"bibr31-0886260517752153","unstructured":"UNICEF Tanzania, Centers for Disease Control and Prevention and Muhimbili University. (2012). Violence against children in Tanzania: Findings from a National Survey 2009. Dar es Salaam, Tanzania: UNICEF Tanzania. Retrieved from\u2009http:\/\/www.togetherforgirls.org\/wp-content\/uploads\/2017\/09\/2009_Tanzania_Findings-from-a-Violence-Against-Children-Survey.pdf"},{"key":"bibr32-0886260517752153","unstructured":"United Nations Development Programme. (2015). Human Development Report 2015. New York, NY. Retrieved from http:\/\/hdr.undp.org\/sites\/default\/files\/2015_human_development_report.pdf"},{"key":"bibr33-0886260517752153","unstructured":"United Nations Programme on HIV\/AIDS. (2012). Global report: UNAIDS report on the global AIDS epidemic. Washington, DC. Retrieved from http:\/\/files.unaids.org\/en\/media\/unaids\/contentassets\/documents\/epidemiology\/2012\/gr2012\/20121120_UNAIDS_Global_Report_2012_with_annexes_en.pdf"},{"key":"bibr34-0886260517752153","unstructured":"United Nations Programme on HIV\/AIDS. (2014). Social and behaviour change programming. Washington, DC. Retrieved from http:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/social_and_behaviour_change_programming_en.pdf"},{"key":"bibr35-0886260517752153","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2013.824540"},{"key":"bibr36-0886260517752153","unstructured":"World Health Organization. Adverse childhood experiences international questionnaire. Retrieved from http:\/\/www.who.int\/violence_injury_prevention\/violence\/activities\/adverse_childhood_experiences\/en\/ (accessed May 2017)"},{"key":"bibr37-0886260517752153","unstructured":"World Health Organization (WHO). (2016). INSPIRE: Seven strategies for ending violence against children. Geneva, Switzerland: WHO. Retrieved from http:\/\/apps.who.int\/iris\/bitstream\/10665\/207717\/1\/9789241565356-eng.pdf?ua=1"}],"container-title":["Journal of Interpersonal Violence"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0886260517752153","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0886260517752153","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0886260517752153","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T23:13:05Z","timestamp":1777504385000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0886260517752153"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,8]]},"references-count":37,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1177\/0886260517752153"],"URL":"https:\/\/doi.org\/10.1177\/0886260517752153","relation":{},"ISSN":["0886-2605","1552-6518"],"issn-type":[{"value":"0886-2605","type":"print"},{"value":"1552-6518","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,8]]}}}