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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Prevalence, type, and correlates of trauma exposure among adolescent men and women in Soweto, South Africa: implications for HIV prevention

Authors: Kalysha Closson, Janan Janine Dietrich, Busi Nkala, Addy Musuku, Zishan Cui, Jason Chia, Glenda Gray, Nathan J. Lachowsky, Robert S. Hogg, Cari L. Miller, Angela Kaida

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

Youth trauma exposure is associated with syndemic HIV risk. We measured lifetime prevalence, type, and correlates of trauma experience by gender among adolescents living in the HIV hyper-endemic setting of Soweto, South Africa.

Methods

Using data from the Botsha Bophelo Adolescent Health Survey (BBAHS), prevalence of “ever” experiencing a traumatic event among adolescents (aged 14–19) was assessed using a modified Traumatic Event Screening Inventory-Child (TESI-C) scale (19 items, study alpha = 0.63). We assessed self-reported number of potentially traumatic events (PTEs) experienced overall and by gender. Gender-stratified multivariable logistic regression models assessed independent correlates of ‘high PTE score’ (≥7 PTEs).

Results

Overall, 767/830 (92%) participants were included (58% adolescent women). Nearly all (99.7%) reported experiencing at least one PTE. Median PTE was 7 [Q1,Q3: 5-9], with no gender differences (p = 0.19). Adolescent men reported more violent PTEs (e.g., “seen an act of violence in the community”) whereas women reported more non-violent HIV/AIDS-related PTEs (e.g., “family member or someone close died of HIV/AIDS”). High PTE score was independently associated with high food insecurity among adolescent men and women (aOR = 2.63, 95%CI = 1.36-5.09; aOR = 2.57, 95%CI = 1.55-4.26, respectively). For men, high PTE score was also associated with older age (aOR = 1.40/year, 95%CI = 1.21-1.63); and recently moving to Soweto (aOR = 2.78, 95%CI = 1.14-6.76). Among women, high PTE score was associated with depression using the CES-D scale (aOR = 2.00, 95%CI = 1.31-3.03,) and inconsistent condom use vs. no sexual experience (aOR = 2.69, 95%CI = 1.66-4.37).

Conclusion

Nearly all adolescents in this study experienced trauma, with gendered differences in PTE types and correlates, but not prevalence. Exposure to PTEs were distributed along social and gendered axes. Among adolescent women, associations with depression and inconsistent condom use suggest pathways for HIV risk. HIV prevention interventions targeting adolescents must address the syndemics of trauma and HIV through the scale-up of gender-transformative, youth-centred, trauma-informed integrated HIV and mental health services.
Appendix
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Literature
1.
2.
UNAIDS. Global AIDS response progress report 2012: Republic of South Africa. 2012
3.
Dellar RC, Dlamini S, Karim QA. Adolescent girls and young women: key populations for HIV epidemic control. J Int AIDS Soc. 2015;18(2 Suppl 1):19408.PubMedPubMedCentral
4.
Venter WD, Cowan F, Black V, Rebe K, Bekker LG. Pre-exposure prophylaxis in Southern Africa: feasible or not? J Int AIDS Soc. 2015;18(4 Suppl 3):19979.PubMedPubMedCentral
5.
6.
Meinck F, Cluver LD, Boyes ME, Mhlongo EL. Risk and protective factors for physical and sexual abuse of children and adolescents in Africa: a review and implications for practice. Trauma Violence Abuse. 2015;16(1):81–107.CrossRefPubMed
7.
Pence BW, Shirey K, Whetten K, Agala B, Itemba D, Adams J, Whetten R, Yao J, Shao J. Prevalence of psychological trauma and association with current health and functioning in a sample of HIV-infected and HIV-uninfected Tanzanian adults. PLoS One. 2012;7(5), e36304.CrossRefPubMedPubMedCentral
8.
Suliman S, Mkabile SG, Fincham DS, Ahmed R, Stein DJ, Seedat S. Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Compr Psychiatry. 2009;50(2):121–7.CrossRefPubMed
9.
Whetten K, Shirey K, Pence BW, Yao J, Thielman N, Whetten R, Adams J, Agala B, Ostermann J, O’Donnell K, et al. Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country. PLoS One. 2013;8(10), e74771.CrossRefPubMedPubMedCentral
10.
Brezing C, Ferrara M, Freudenreich O. The syndemic illness of HIV and trauma: implications for a trauma-informed model of care. Psychosomatics. 2015;56(2):107–18.CrossRefPubMed
11.
Neller DJ, Denney RL, Pietz CA, Thmlinson RP. Testing the Trauma Model of Violence. J Fam Viol. 2005;3
12.
Khan MR, Kaufman JS, Pence BW, Gaynes BN, Adimora AA, Weir SS, Miller WC. Depression, Sexually Transmitted Infection, and Sexual Risk Behavior Among Young Adults in the United States. Arch Pediatr Adolesc Med. 2009;163(7):644.CrossRefPubMedPubMedCentral
13.
Brawner BM, Gomes MM, Jemmott LS, Deatrick JA, Coleman CL. Clinical depression and HIV risk-related sexual behaviors among African-American adolescent females: unmasking the numbers. AIDS Care. 2012;24(5):618–25.CrossRefPubMedPubMedCentral
14.
Shrier LA, Harris SK, Sternberg M, Beardslee WR. Associations of depression, self-esteem, and substance use with sexual risk among adolescents. Prev Med. 2001;33(3):179–89.CrossRefPubMed
15.
Hutton HE, Lyketsos CG, Zenilman JM, Thompson RE, Erbelding EJ. Depression and HIV risk behaviors among patients in a sexually transmitted disease clinic. Am J Psychiatry. 2004;161(5):912–4.CrossRefPubMed
16.
Gibbs A, Willan S, Sikwyiya Y, Jama Shai N, Washington L. Experiences of childhood trauma increases HIV-risk behaviours in young women and men in urban informal settlements in South Africa. Durban: World AIDS Conference 2016; 2016.
17.
Nduna M, Jewkes RK, Dunkle KL, Shai NP, Colman I. Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape, South Africa. J Int AIDS Soc. 2010;13:44.CrossRefPubMedPubMedCentral
18.
Barhafumwa B, Dietrich J, Closson K, Samji H, Cescon A, Nkala B, Davis J, Hogg RS, Kaida A, Gray G, et al. High prevalence of depression symptomology among adolescents in Soweto, South Africa assocaited with being female and cofactors relating to HIV transmission. Vulnerable Child Youth Stud. 2016;11(3):263–73.
19.
20.
Batchelder AW, Gonzalez JS, Palma A, Schoenbaum E, Lounsbury DW. A Social Ecological Model of Syndemic Risk affecting Women with and At-Risk for HIV in Impoverished Urban Communities. Am J Community Psychol. 2015;56(3–4):229–40.CrossRefPubMed
21.
Kaminer D, Hardy A, Heath K, Mosdell J, Bawa U. Gender patterns in the contribution of different types of violence to posttraumatic stress symptoms among South African urban youth. Child Abuse Negl. 2013;37(5):320–30.CrossRefPubMed
22.
Abrahams N, Devries K, Watts C, Pallitto C, Petzold M, Shamu S, García-Moreno C. Worldwide prevalence of non-partner sexual violence: a systematic review. Lancet. 2014;383(9929):1648–54.CrossRefPubMed
23.
Decker MR, Peitzmeier S, Olumide A, Acharya R, Ojengbede O, Covarrubias L, Gao E, Cheng Y, Delany-Moretlwe S, Brahmbhatt H. Prevalence and Health Impact of Intimate Partner Violence and Non-partner Sexual Violence Among Female Adolescents Aged 15–19 Years in Vulnerable Urban Environments: A Multi-Country Study. J Adolesc Health. 2014;55(6 Suppl):S58–67.CrossRefPubMed
24.
Jewkes R, Sikweyiya Y, Morrell R, Dunkle K. Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: findings of a cross-sectional study. PLoS One. 2011;6(12):e29590.CrossRefPubMedPubMedCentral
25.
Jewkes R, Abrahams N. The epidemiology of rape and sexual coercion in South Africa: an overview. Soc Sci Med. 2002;55:1231–44.CrossRefPubMed
26.
Dunkle KL, Jewkes RK, Brown HC, Yoshihama M, Gray GE, McIntyre JA, Harlow SD. Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa. Am J Epidemiol. 2004;160(3):230–9.CrossRefPubMed
27.
Dhaffala A, Longo-Mbenza B, Kingu JH, Peden M, Kafuko-Bwoye A, Clarke M, Mazwai EL. Demographic profile and epidemiology of injury in Mthatha, South Africa. Afr Health Sci. 2013;13(4):1144–8.CrossRefPubMedPubMedCentral
28.
Otwombe KN, Dietrich J, Sikkema KJ, Coetzee J, Hopkins KL, Laher F, Gray GE. Exposure to and experiences of violence among adolescents in lower socio-economic groups in Johannesburg, South Africa. BMC Public Health. 2015;15:450.CrossRefPubMedPubMedCentral
29.
Norris FH. Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clin Psychol. 1992;60(3):409–18.CrossRefPubMed
30.
Pitpitan EV, Kalichman SC, Eaton LA, Cain D, Sikkema KJ, Watt MH, Skinner D, Pieterse D. Co-occurring psychosocial problems and HIV risk among women attending drinking venues in a South African township: a syndemic approach. Ann Behav Med. 2013;45(2):153–62.CrossRefPubMedPubMedCentral
31.
Amir M, Sol O. Psychological impact and prevalence of traumatic events in a student sample in Israel: the effect of multiple traumatic events and physical injury. J Trauma Stress. 1999;12(1):139–54.CrossRefPubMed
32.
33.
Nkala B, Khunwane M, Dietrich J, Otwombe K, Sekoane I, Sonqishe B, Gray G. Kganya Motsha Adolescent Centre: a model for adolescent friendly HIV management and reproductive health for adolescents in Soweto, South Africa. AIDS Care. 2015;27(6):697–702.CrossRefPubMed
34.
Dietrich J, Khunwane M, Laher F, de Bruyn G, Sikkema KJ, Gray G. “Group sex” parties and other risk patterns: A qualitative study about the perceptions of sexual behaviors and attitudes of adolescents in Soweto, South Africa. Vulnerable Child Youth Stud. 2011;6(3):244–54.CrossRefPubMedPubMedCentral
35.
Dietrich J, Sikkema K, Otwombe KN, Sanchez A, Nkala B, de Bruyn G, Van Der Watt M, Gray GE. Multiple levels of influence in predicting sexual activity and condom use among adolescents in Soweto, Johannesburg, South Africa. J HIV AIDS Soc Serv. 2013;12(3–4):404–23.CrossRefPubMedPubMedCentral
36.
Otwombe KN, Sikkema KJ, Dietrich J, de Bruyn G, van der Watt M, Gray GE. Willingness to participate in biomedical HIV prevention studies after the HVTN 503/Phambili trial: a survey conducted among adolescents in Soweto, South Africa. J Acquir Immune Defic Syndr. 2011;58(2):211–8.CrossRefPubMedPubMedCentral
37.
Miller CL, Nkala B, Closson K, Chia J, Cui Z, Palmer A, Hogg RS, Gray G, Dietrich J. The Botsha Bophelo Adolescent Health Study (BBAHS): a profile of a South African - Canadian research collaboration. PLoS One. 2016. In Press
38.
Gray MJ, Slagle DM. Selecting a Potentially Traumatic Event Screening Measure. J Trauma Pract. 2006;5(2):1–19.CrossRef
39.
Kendall A, Olson CM, Edward A, Frongillo J. Validation of the Radimer/Cornell Measures of HUnger and Food Security. J Nutr. 1995;125:2793–801.PubMed
40.
Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRef
41.
Lewinsohn PM, Seeley JR, Roberts RE, Allen NB. Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging. 1997;12(2):277–87.CrossRefPubMed
42.
Chabrol H, Montovany A, Chouicha K, Duconge E. Study of the CES-D on a sample of 1,953 adolescent students. L’Encéphale. 2002;28(5 Pt 1):429–32.PubMed
43.
Bamidele JO, Asekun-Olarinmoye EO, Odu OO, Amusan OA, Egbewale BE. Sociodemographic characteristics and health risk behaviours among students of a tertiary institution in south western Nigeria. Afr J Med Med Sci. 2007;36(2):129–36.PubMed
44.
van Heerden MS, Grimsrud AT, Seedat S, Myer L, Williams DR, Stein DJ. Patterns of substance use in South Africa: results from the South African Stress and Health study. S Afr Med J. 2009;99(5 Pt 2):358–66.PubMedPubMedCentral
45.
Peltzer K. Predictors of positive health among a sample of South African adolescents. Psychol Rep. 2007;100(3 Pt 2):1186–8.PubMed
46.
McLaughlin KA, Koenen KC, Hill ED, Petukhova M, Sampson NA, Zaslavsky AM, Kessler RC. Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. J Am Acad Child Adolesc Psychiatry. 2013;52(8):815–30. e814.CrossRefPubMedPubMedCentral
47.
Global Burden of Disease Pediatrics C, Kyu HH, Pinho C, Wagner JA, Brown JC, Bertozzi-Villa A, Charlson FJ, Coffeng LE, Dandona L, Erskine HE, et al. Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013: Findings From the Global Burden of Disease 2013 Study. JAMA Pediatrics. 2016.
48.
Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, Duvvury N. Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. BMJ. 2008;337:a506.CrossRefPubMedPubMedCentral
49.
Hinsberger M, Sommer J, Kaminer D, Holtzhausen L, Weierstall R, Seedat S, Madikane S, Elbert T. Perpetuating the cycle of violence in South African low-income communities: attraction to violence in young men exposed to continuous threat. Eur J psychotraumatol. 2016;7:29099.CrossRefPubMed
50.
Jewkes R, Nduna M, Jama-Shai N, Chirwa E, Dunkle K. Understanding the Relationships between Gender Inequitable Behaviours, Childhood Trauma and Socio-Economic Status in Single and Multiple Perpetrator Rape in Rural South Africa: Structural Equation Modelling. PLoS One. 2016;11(5):e0154903.CrossRefPubMedPubMedCentral
51.
Jewkes RK, Dunkle K, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010;376:41–8.CrossRefPubMed
52.
Jewkes R, Morrell R. Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. J Int AIDS Soc. 2010;13:6.PubMedPubMedCentral
53.
Sherr L, Nagra N, Kulubya G, Catalan J, Clucas C, Harding R. HIV infection associated post-traumatic stress disorder and post-traumatic growth--a systematic review. Psychol Health Med. 2011;16(5):612–29.CrossRefPubMed
54.
Murray LK, Skavenski S, Kane JC, Mayeya J, Dorsey S, Cohen JA, Michalopoulos LT, Imasiku M, Bolton PA. Effectiveness of Trauma-Focused Cognitive Behavioral Therapy Among Trauma-Affected Children in Lusaka, Zambia: A Randomized Clinical Trial. JAMA Pediatr. 2015;169(8):761–9.CrossRefPubMed
55.
Pronyk PM, Hargreaves JR, Kim JC, Morison LA, Phetla G, Watts C, Busza J, Porter JDH. Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet. 2006;368(9551):1973–83.CrossRefPubMed
56.
Harrison A, Colvin CJ, Kuo C, Swartz A, Lurie M. Sustained High HIV Incidence in Young Women in Southern Africa: Social, Behavioral, and Structural Factors and Emerging Intervention Approaches. Curr HIV/AIDS Rep. 2015;12(2):207–15.CrossRefPubMedPubMedCentral
57.
Pettifor A, Nguyen NL, Celum C, Cowan FM, Go V, Hightow-Weidman L. Tailored combination prevention packages and PrEP for young key populations. J Int AIDS Soc. 2015;18(2 Suppl 1):19434.PubMedPubMedCentral
58.
Jewkes RK, Levin JB, Penn-Kekana LA. Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Soc Sci Med. 2003;56(1):125–34.CrossRefPubMed
59.
Petersen I, Bhana A, McKay M. Sexual violence and youth in South Africa: the need for community-based prevention interventions. Child Abuse Negl. 2005;29(11):1233–48.CrossRefPubMed
60.
Schuyler AC, Masvawure TB, Smit JA, Beksinska M, Mabude Z, Ngoloyi C, Mantell JE. Building young women’s knowledge and skills in female condom use: lessons learned from a South African intervention. Health Educ Res. 2016;31(2):260–72.CrossRefPubMed
61.
Bhana A, Zimmerman R, Cupp P. Gender role attitudes and sexual risk among adolescents in South Africa. Vulnerable Child Youth Stud. 2008;3:112–9.CrossRef
62.
Swan H, O’Connell DJ. The impact of intimate partner violence on women's condom negotiation efficacy. J Interpers Violence. 2012;27(4):775–92.CrossRefPubMed
63.
Hien DA, Campbell AN, Killeen T, Hu MC, Hansen C, Jiang H, Hatch-Maillette M, Miele GM, Cohen LR, Gan W, et al. The impact of trauma-focused group therapy upon HIV sexual risk behaviors in the NIDA Clinical Trials Network “Women and trauma” multi-site study. AIDS Behav. 2010;14(2):421–30.CrossRefPubMed
64.
van der Walt L, Suliman S, Martin L, Lammers K, Seedat S. Resilience and post-traumatic stress disorder in the acute aftermath of rape: a comparative analysis of adolescents versus adults. J Child Adolesc Mental health. 2014;26(3):239–49.CrossRef
65.
Igras SM, Macieira M, Murphy E, Lundgren R. Investing in very young adolescents’ sexual and reproductive health. Glob Public Health. 2014;9(5):555–69.CrossRefPubMedPubMedCentral
66.
Johansson EE, Alex L, Christianson M. Gendered discourses of youth sexualities--an exploration of PubMed articles on prevention of sexually transmissible infections. Sex Reprod Healthc. 2014;5(3):81–9.CrossRefPubMed
Metadata
Title
Prevalence, type, and correlates of trauma exposure among adolescent men and women in Soweto, South Africa: implications for HIV prevention
Authors
Kalysha Closson
Janan Janine Dietrich
Busi Nkala
Addy Musuku
Zishan Cui
Jason Chia
Glenda Gray
Nathan J. Lachowsky
Robert S. Hogg
Cari L. Miller
Angela Kaida
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3832-0

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