Exposure to violence ups HIV risk for girls

Link to high risk practices

African-American girls from low-income neighborhoods who have had childhood violence exposure are significantly more likely to engage in high-risk sexual activities, researchers found.1

"The girls who experienced violence before age 12 are more than twice as likely to be sexually experienced as the other girls," says Helen W. Wilson, PhD, assistant professor, Rosalind Franklin University of Medicine and Science in North Chicago, IL.

"Then you see the same pattern for other indicators of sexual risk: they also reported more partners; they reported less consistent condom use," Wilson adds.

The two-year longitudinal study focused on HIV risk behavior in adolescent girls from low-income communities on the Southside of Chicago.1

"We looked at things like an emphasis on family relationships, aspects of family functioning, and mental health functioning," Wilson says. "The girls, originally between the ages of 12 and 16, were followed for two years during which time they completed five different assessments."

The study found that 91% of the 177 young women had reported experiencing violence in their lives, including sexual violence, physical violence, or witnessing violence. Forty-four percent of the cohort had experienced one of these types of violence before the age 12. So investigators compared those who had experienced violence before age 12 with those who had not experienced violence or who had experienced it after age 12, Wilson explains.

"My hypothesis was there would be an increased level of risk over time, and I also thought there'd be a link to being sexually experienced and having riskier behavior," she adds.

The study's findings suggest there might be something important about childhood experience to violence, she adds.

"There are correlations between the extent of violence exposure and the extent of sexual risk," Wilson says. "Girls who have more exposure to violence are at greater risk."

Wilson became interested in doing this study after working in an emergency room as part of her clinical training. She saw children who had experienced trauma, including gunshot wounds and sexual assault.

"I was noticing that these same kids exposed to trauma couldn't tell me how many sexual partners they had," Wilson says. "I began to think about a connection between violence exposure and sexual risk."

HIV clinicians have long seen a high rate of domestic partner violence and sexual abuse among their HIV-infected female populations, and those are important risk factors, Wilson notes.

"But we need to think about broader forms of violence and how they might be putting young women at risk, as well," she says.

The study doesn't address why this link between violence in childhood and higher HIV risk appears, but it's likely that violence, which can be chronic, repetitive trauma has a profound impact on a child's development, Wilson explains.

"Sexual risk behavior could be one outcome," she adds.

HIV clinicians and HIV organizations could help prevent or mitigate this problem through several interventions, she suggests.

Wilson outlines three interventions, as follows:

• Put violence on the broader radar screen as a risk factor: "Violence should more broadly be on our radar as a risk factor for sexual risk," Wilson says. "Young women who are growing up in violent communities and are exposed to high levels of violence might benefit from efforts to prevent sexual risk."

• Help at-risk youths foster healthy sexual relationships: "Whether through health clinics or mental health clinics, kids who have histories of violence exposure through experiencing or witnessing violence should have their sexual health addressed," Wilson says. "We often think in terms of sexual behavior, and we may not naturally think about that link when young women have other forms of violence exposure."

But their exposure to violence should be considered and addressed in meetings with health care professionals, she adds.

"We need to look at the way violence impacts development in broad ways, including making healthy choices, impulse control, and all of those kinds of things," she says.

• Incorporate a focus on violence and trauma in interventions: "In our HIV prevention interventions, we need to incorporate a focus on violence and trauma, addressing the effects of violence," Wilson says.

"There are a lot of interventions out there that are trauma-focused," she says. "We also need to develop HIV interventions for adolescents with a history of psychiatric problems, targeting family relationships because these models also might be helpful for girls and youth who are exposed to trauma."

Both trauma-focused interventions and HIV interventions are needed, she adds.

"We need to develop a test to see if existing interventions will work, as well as develop new interventions that combine HIV prevention with a focus on trauma and violence," Wilson says.


  1. Wilson H, Donenberg GR. Effects of violence exposure on the development of sexual risk behavior in low-income African American girls. Abstract CDC259. Sixth International AIDS Society Conference on HIV Pathogenesis and Treatment and Prevention. July 17-20, 2011, Rome, Italy.