Research Brief: Adverse Childhood Experiences increase risk for HIV sexual risk taking behaviors in Malawi young adults


Adverse childhood experiences (ACEs) have negative impacts on health, including problems with mental health, infectious and chronic diseases, and reproductive health problems. The more ACEs people are exposed to in childhood the more likely they are to experience one or more negative health outcomes. Most research comes from upper-income countries. Understanding the prevalence of ACEs and their impact on health using data from low- and middle-income countries is important to inform efforts to prevent and control disease. In sub-Saharan Africa, it is particularly important to understand whether and how ACEs increase risk for HIV, which is a major health problem in the region. Researchers used data from the Violence Against Children Survey (VACS) in Malawi to look at whether there was a relationship between ACEs and later behaviors that expose people to risk for HIV.

ACEs and later behaviors that expose people to risk for HIV
Infrequent Condom Use Multiple Sexual Partners in Past 12 Months
Exposure to ACEs
None 5.3% 4.4%
1-2 17% 5.6%
3+ 25% 18.1%

Key Findings

  • 82% of youth in Malawi experienced 1 or more ACEs, and 29% reported two or more ACEs.
  • Exposure to ACEs in Malawi was higher than in non-African settings.
  • ACEs were associated with using condoms never or infrequently as young adults.
  • The more ACEs people had, the more likely they were to never or rarely use condoms as young adults.

What is added by this report?

This study establishes a critical link between HIV risk behaviors and ACEs. It was one of the first studies to examine the prevalence and outcomes related to ACEs in an African country. As the HIV epidemic in Malawi is mainly from heterosexual transmission, reducing sexual risk behaviors among young people is key to interrupting HIV transmission. For that reason, the results from this study highlight the importance of preventing violence against all children as a key HIV prevention strategy in Malawi.


VandeEnde K, Chiang L, Mercy J, Shawa M, Hamela J, Maksud N, Gupta S, Wadonda-Kabondo N, Saul J, Gleckel J, Kress H, Hillis S. Adverse childhood experiences and HIV sexual risk-taking behaviors among young adults in MalawiExternal. Journal of Interpersonal Violence 2018; 33(11): 1710-1730.

Footnote: some variation between prevalence estimates from published papers and country reports may exist. This variation reflects slight differences in the subsamples and variables used in the analyses.

Page last reviewed: March 14, 2019