Associations between adverse childhood experiences and HIV risk behavior among adults in the United States toward the end of the COVID-19 Pandemic

Background: Adverse Childhood Experiences (ACEs) have been linked to HIV risk behaviors in adulthood and have not been explored after the start of the COVID-19 pandemic. Purpose: This study investigates the contemporary relationship between ACEs and HIV risk behaviors. Methods: This study used cross-sectional data from the 2022 Behavioral Risk Factor Surveillance System and included a sample of 51,168 individuals (26,769 females and 24,399 males). Analyses included multivariable logistic regressions using a 13-item, 8-item, and individual ACE exposure variables, and a test for interaction between ACEs and race/ethnicity on HIV risk behavior in adulthood. Results: In adjusted analyses and compared with no reported ACEs, increasing number of reported ACEs was associated with progressively higher odds of HIV risk behaviors: 1 (OR = 1.76, 95% CI: 1.26, 2.47), 2 (OR = 1.76, 95% CI: 1.28, 2.41), 3 (OR = 2.22, 95% CI: 1.62, 3.04), and 4 or more (OR = 3.82, 95% CI: 2.94, 4.97). Conclusion: This study reveals a significant association between ACEs and HIV risk behavior, with a marked increase in risk among individuals reporting three or more ACEs, underscoring the cumulative impact of trauma.