Association of Adverse Childhood Experiences and HIV Testing: A Cross-Sectional Analysis of the Behavioral Risk Factor Surveillance System

Background: It is estimated that nearly 15% of US adults and adolescents living with HIV are unaware of their seropositivity status and account for approximately 40% of HIV transmission in the US, presenting a major public health concern and stressing the importance of enhanced HIV screening. Adverse Childhood Experiences (ACEs) have been shown to be risk factors for HIV transmission in the US, but the relationship of ACEs and the likelihood of HIV screening in the US has yet to be elucidated.

Methods: Using data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) dataset, we constructed logistic regression models to determine the likelihood of men and women receiving HIV testing and their past history of ACEs, adjusting for age, sex, sexual orientation, HIV risk, race, education, and healthcare coverage.

Results: The binary logistic regression showed that women were more likely to be tested than men (OR: 1.16; 95%CI: 1.13-1.19) Compared to individuals reporting no ACES, individuals reporting 1 to 3 ACES were significantly more likely to be tested for HIV— the adjusted odds for women being 1.72 (95%CI: 1.63-1.83) and for men being 1.52 (95%CI: 1.35-1.71) controlling for sexual orientation, HIV risk, healthcare coverage, age, race, and education. The odds increased by nearly 100% among both sexes for those reporting 4 or more ACES. Compared to White individuals, Black, Hispanic, and ‘other’ of both sexes, and Native American women, were more likely to have been tested for HIV.

Conclusions: Our study suggests that US individuals with ACEs are more likely to report being screened for HIV, which may reflect clinical detection of ACEs as risk factors for HIV transmission precipitating enhanced screening. Black Americans were the most likely to report being screened by race, emphasizing the need to continue pursuing this population due to its disproportionate prevalence within the community. Understanding how ACEs relate to HIV screening behavior in the US is vital for increasing seropositivity awareness leading to positive HIV outcomes.