Childhood abuse and initial presentation for HIV care: An opportunity for early intervention

Abstract

An alarmingly high prevalence of childhood sexual and physical abuse has been observed in HIV-infected men and women, with rates several times higher than observed in the general population. Childhood abuse history has been associated with worse antiretroviral adherence and negative health behaviours in HIV-infected patients. This study evaluates the relationship between childhood abuse and the timing of presentation for HIV care. Participants in a multi-center prospective cohort study, who established initial HIV care after January 1996 and had a CD4 count available within six months of initial presentation, were included in this analysis. Bivariate contingency tables and multivariate logistic regression were used to evaluate the association of childhood abuse with early presentation for HIV care (initial CD4 count≥200/mm³). Among the 186 subjects included in this analysis, 33% had childhood abuse histories and 58% had an initial CD4 count≥200/mm³. Participants with a history of childhood abuse were more likely to present early for HIV care (AOR=2.12; p=0.03), perhaps because survivors of abuse tend to have higher utilization of health services. Because HIV-infected patients with childhood abuse histories have worse antiretroviral medication adherence and are more likely to engage in high-risk sexual and injection drug use behaviours, early presentation affords clinicians the opportunity for timely institution of interventions that may improve patient outcomes and prevent secondary HIV infections.

Acknowledgements

This study was supported in part by the National Institute of Mental Health (NIMH), the National Institute of Drug Abuse (NIDA), and the National Institute of Nursing Research (NINR), Grant# 5R01MH061687-05 of the National Institutes of Health. Nathan Thielman is supported in part by the Duke University HIV/AIDS Clinical Trials Unit (U01 AI069484) from the National Institutes of Allergy and Infectious Diseases. We thank the CHASE study subjects for their participation.