Date of Award
Summer 2025
Document Type
Open Access Dissertation
Department
Epidemiology and Biostatistics
First Advisor
Monique J. Brown
Abstract
Background: Adverse Childhood Experiences (ACEs) have been shown to be associated with cardiometabolic disorders (CMDs) and poor CVH; however, in Africa, this has not been well studied. Cardiovascular health (CVH) is an important measure of risk for cardiovascular diseases (CVD) developed by the American Heart Association (AHA). With the increasing prevalence of CVD in Africa, CVH is a potential upstream prevention approach. Africa also has the highest prevalence of HIV, and an increasing prevalence of comorbidities associated with it. Various mechanisms have been investigated to explain the relationship between CVD and chronic HIV infection. This study explores the potential relationship between ACEs and HIV with outcomes of CMDs and CVH in an African population. Methods: Data from the HAALSI study in rural Mpumalanga province in South Africa was analyzed for ACEs, HIV, CVH and CMDs. Seven ACEs were operationalized using CDC classification of ACEs. Statistical analysis was done using marginal structural modeling (MSM) logistic regression for ACEs and CMDs, and MSM multinomial logistic regression for ACEs and CVH, and HIV and CVH Results: Experiencing natural disasters resulted in lower odds for diabetes mellitus in adulthood (adjusted odds ratio (aOR)=0.78; 95% Confidence Interval (CI)=0.63; 0.96). Among males, lower odds for diabetes were observed among those who experienced natural disasters than those who did not (aOR=0.66; 95% CI=0.48; 0.91). Among participants without HIV, lower odds for diabetes were observed among those who experienced natural disasters compared to those who did not (aOR=0.79; 95% CI=0.63; 0.99). Participants who experienced parental drug and alcohol abuse ACE had lower odds for obesity (aOR=0.66; 95% CI=0.45; 0.97) compared to those who did not experience any ACEs. Participants who experienced physical abuse were less likely to have moderate CVH compared to those who did not experience any ACEs. The aOR of moderate CVH (as compared to low CVH) among those who experienced physical assault ACE was 0.59 times lower than that of participants who had no ACEs (aOR=0.59; 95% CI=0.47; 0.73), and good CVH was 0.54 times lower among those who experienced physical assault (a=0.54; 95% CI=0.36; 0.82). In the study population, PWH were more likely to have good CVH compared to HIV-negative participants (aOR=2.16; 95% CI=1.64; 2.83). Among males, participants with HIV had good CVH than those without HIV (aOR=2.57; 95% CI=1.75; 3.79); similar trends were observed among female participants (aOR=1.70; 95% CI=1.14; 2.54). Conclusions: In an African population, specific ACEs may be associated with lower odds of CMDs like diabetes and obesity, and higher odds for hypertension; however these may differ by specific characteristics like sex and HIV status. In an aging population with high prevalence of HIV, this reduced risk for some CMDs may be associated with gains from the management of HIV. In an African population, specific ACEs may be associated with less likelihood of good CVH, however this still needs investigation on a larger scale and in different settings. There is a strong relationship between HIV status and CVH in the population; PWH have better CVH than those without HIV. This could be a result of good nutrition and better health behaviors in contrast to those without HIV. It also points to success of HIV treatment programs in South Africa.
Rights
© 2025, Samuel Gavi
Recommended Citation
Gavi, S.(2025). The Impact of Adverse Childhood Experiences and Living with HIV on Cardiovascular Health and Cardiometabolic Disorders in an African Population: An Analysis of the Indepth Community in Rural South Africa. (Doctoral dissertation). Retrieved from https://scholarcommons.sc.edu/etd/8565