# Adverse childhood experiences and adolescent HIV risk: Causal inferences from a high HIV prevalence context

> **NIH NIH R01** · STATE UNIVERSITY NEW YORK STONY BROOK · 2021 · $538,419

## Abstract

Adverse childhood experiences (ACE) are potentially important and modifiable social determinants of
adolescent HIV risk. While the relationship between ACE and sexual health has been documented in the US
other high-income contexts with concentrated epidemics, evidence from lower-income high-HIV prevalence
contexts is largely missing. Moreover, no study has considered how adversities cluster and compound across
the life course, interact across ecological levels, and contribute to a common causal chain culminating in HIV
infection. The proposed project will create an adolescent cohort that has been traced since birth by building on
exceptional existing data provided by parents in the Malawi Longitudinal Study of Families and Health
(MLSFH; established in 1998). We propose collecting two new rounds of prospective data directly from the
MLSFH children as they reach adolescence; in doing so, we will establish a cohort that is currently entering a
critical age-range for HIV risk as they transition to adulthood. The aims are: Aim 1. To describe the
prevalence, co-occurrence and re-occurrence of Adverse Childhood Experiences among adolescents
in a HIV-endemic low-income country. We will construct indicators of ACE covering the period from infancy
to adolescence by linking 1) rich data captured through parental reporting in prior MLSFH waves and 2) new
data collected from adolescents (at age 11-15 and at 14-18) using the Adverse Childhood Experiences –
International Questionnaire (ACE-IQ) recently developed by the WHO. Aim 2. To estimate the causal impact
of ACE on the emergence of differentiated HIV risk trajectories during adolescence. By applying
sophisticated statistical methods, we will be able to examine the causal role of early and ongoing adversities
on the emergence of HIV risk, including 1) poor transitions to adulthood 2) behavioral risk and 3) HIV and
HSV2 incidence. Aim 3. To highlight potential intervention points by identifying causal mediators
between ACE and HIV risk. We focus on social, emotional, and cognitive impairments that may result from
frequent or chronic activation of the stress response and may also contribute to social or behavioral HIV risk.
Aim 4: To identify protective factors that moderate the impact of ACE on HIV risk. We will test potential
multi-level sources of resilience (e.g., family resources, peer support, government programs) that may
determine how children cope could be enhanced through intervention. A rigorous evaluation of the
consequences, mediators, and moderators of childhood adversity on adolescent HIV risk will greatly enhance
current HIV prevention strategies in low income countries by explaining why some adolescents engage in high
risk behaviors and contract HIV while others do not, and by identifying modifiable targets for intervention. By
integrating the project into an ongoing longitudinal study, we rapidly create a birth cohort, facilitate causal
inference, ensure timely findings, and add value to an...

## Key facts

- **NIH application ID:** 9963293
- **Project number:** 5R01HD090988-05
- **Recipient organization:** STATE UNIVERSITY NEW YORK STONY BROOK
- **Principal Investigator:** Rachel Kidman
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $538,419
- **Award type:** 5
- **Project period:** 2016-09-26 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9963293

## Citation

> US National Institutes of Health, RePORTER application 9963293, Adverse childhood experiences and adolescent HIV risk: Causal inferences from a high HIV prevalence context (5R01HD090988-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9963293. Licensed CC0.

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