title: Prevalence, type, and correlates of trauma exposure among adolescent men and women in Soweto, South Africa: implications for HIV prevention.
abstract: 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.
  
  
  
  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).
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University (SFU), Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
authors.forename: Kalysha
authors.initials: K
authors.lastname: Closson
authors.affiliation: Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Janan Janine
authors.initials: JJ
authors.lastname: Dietrich
authors.affiliation: Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Busi
authors.initials: B
authors.lastname: Nkala
authors.affiliation: Faculty of Health Sciences, Simon Fraser University (SFU), Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
authors.forename: Addy
authors.initials: A
authors.lastname: Musuku
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
authors.forename: Zishan
authors.initials: Z
authors.lastname: Cui
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Chia
authors.affiliation: Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Glenda
authors.initials: G
authors.lastname: Gray
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.|School of Public Health and Social Policy, University of Victoria, Victoria, Canada.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Lachowsky
authors.affiliation: Faculty of Health Sciences, Simon Fraser University (SFU), Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.affiliation: Faculty of Health Sciences, Simon Fraser University (SFU), Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
authors.forename: Cari L
authors.initials: CL
authors.lastname: Miller
authors.affiliation: Faculty of Health Sciences, Simon Fraser University (SFU), Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC V5A 1S6, Canada. Kangela@sfu.ca.
authors.forename: Angela
authors.initials: A
authors.lastname: Kaida
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D015995:Prevalence; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Adolescent; HIV; Potentially traumatic events; Prevention; Sexual and reproductive health; South Africa; Trauma; Young adult; Youth