Adverse Childhood Experiences and HIV Risk Behaviors among Indigenous Americans Open Access

Abstract

Introduction: American Indians and Alaska Natives (AI/AN) consistently report the highest frequencies of Adverse Childhood Experiences (ACEs) of any population group in the United States (U.S) (Giano et al., 2021; University of Montana, 2021). Historical events and practices have contributed to a generational cycle of repeating trauma among AI/AN, resulting in an increased prevalence of ACEs and familial dysfunction (Roh et al., 2015; Richards et al., 2021). AI/AN populations also face an increased risk for contracting HIV, have an elevated mortality rate from HIV/AIDS, all while consistently reporting the highest prevalence of having experienced four or more ACEs. Informed by the Minority Stress Theory (MST) and the Social Ecological Model (SEM), the present study considers the association between ACES and HIV risk behaviors among American Indians and Alaska Natives in a nationwide sample (Frost & Ilan, 2023; Kilanowski, 2017).

Methods: This study applied a combination of the Minority Stress Theory and the Social Ecological model to a secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) data set collected in 2022 (n=445,123). Chi Square tests of independence and bivariate logistic regressions were conducted to assess both research aims of the study: (1) To analyze the relationship between personal demographics and ACEs and (2) To analyze the relationship between enacting HIV risk behaviors and ACEs.

Results: After cleaning and weighting the BRFSS data according to the CDC instructions, results for research aim 1 found that age, sexual orientation, education level, employment status, and urban and rural status were statistically significant predictors of experiencing ACES.  Research aim 2 found both HIV risk variables to be significant statistically significant predictors of experiencing ACES, however, HIV risk situations findings conflicted with previous research conducted on this topic. HIV test status was statistically significant predictor of experiencing ACES and was congruent with previous research.

Discussion: This study found that participants who were aged 65+, heterosexual, went to college for four years or more, and lived in rural counties were the most likely to report a low or high ACE score when compared to other demographic groups. In addition, this study found that participants who reported both a low or high ACE score were more likely to report not knowing their HIV test status. These findings reveal key differences with previous studies. Future studies exploring AI/AN populations should aim to collect data from specific tribes and nations.

Table of Contents

Table of Contents:

Chapter One:

Introduction

Theoretical Framework and Application:

Figure 1. The Minority Stress Theory

Figure 2. The Social Ecological Model

Research Question:

Research Aims:

Purpose Statement:

Definition of Key Terms:

Chapter Two: Review of the Literature

Historical Context:

Adverse Childhood Experiences Background:

Table 1. Common ACE Definitions:

ACEs and AI/ANs:

HIV Risk and ACEs:

Table 2. Social Ecological Model Constructs

Table 3. Minority Stress Theory Constructs

Conceptual Model:

Figure 3. Conceptual Model

Summary:

Chapter Three: Methods

Study Purpose:

Research Aims:

Human Subjects Approval:

Behavioral Risk Factor Surveillance System:

Sampling Methodology:

Data Collection, Processing, and Weighting:

Sample:

Measures:

Personal Demographic Characteristics:

Table 4. ACE Scoring

HIV Risk Behaviors:

Preliminary Analyses:

Chapter Four: Results

Introduction:

Research Aims:

Key Findings:

Table 5. Personal Demographic Characteristics of Study Sample (All respondents)

Table 6. Adverse Childhood Experiences (All Respondents)

Table 7. HIV Risk Situations (All Respondents)

Table 8. Research Aim 1. Chi square test for all demographic variables and ACE Sum variable.

Table 9. Research Aim 2. Chi square test for ACE Sum variable by HIV Risk Situations.

Table 10. Research Aim 2. Chi square test for ACE Sum variable by Ever tested for HIV.

Table 11. Frequencies of AI/AN responses for main variables of interest.

Table 12. Research Aim 1 Logistic Regression Output

Table 13. Research Aim 2 Logistic Regression Output for ACEs and HIV risk situations.

Table 14. Research Aim 2 Logistic Regression Output for ACEs and HIV Test Status.

Chapter Five: Discussion

Introduction

Summary of Study

Discussion of Key Results

Overall Findings

Strengths and Limitations

Implications and Recommendations

Conclusion

About this Master's Thesis

Rights statement

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Human Development Native American Studies Health Sciences, Public Health
Keyword	HIV risk behaviors Adverse Childhood Experiences American Indian and Alaska Native HIV
Committee Chair / Thesis Advisor	Dr. Lillian Madrigal, Emory University Dr. Eric Nehl, Emory University

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