By: Jennifer McMillen Smith, LISW-S, HIV Social Worker at MetroHealth Medical Center and medically reviewed by Ann K. Avery, MD, Infectious Disease Physician at MetroHealth Medical Center
A quick heads-up before you read: This post talks about childhood trauma, including abuse, neglect, violence, substance use, and suicide. Some of it may bring up difficult memories or feelings. Take care of yourself as you read; pause, step away, or skip this article if you need to.
So, what exactly is an ACE? It stands for an adverse childhood experience: something difficult or harmful you went through before age 18. That could mean experiencing abuse or neglect, witnessing violence, or growing up in a home that didn’t always feel safe or stable. Research has found that people with four or more ACEs have a higher risk of depression, substance use problems, and suicide later in life.
Those early experiences can also shape how we cope, the relationships we form, the risks we take, and how we care for our health later in life. For people with HIV, understanding that connection can be an important part of understanding your whole health story.
Think of this post as reading the library on your own past: knowing your story helps you take better care of yourself.
The ACE study
The CDC-Kaiser Permanente ACE Study, conducted in the mid-1990s, was the first large-scale study to link childhood trauma to adult health. More than 17,000 adults answered questions about their childhoods and their current health, and the results changed how doctors and researchers think about trauma.
The big takeaways:
- Childhood trauma is far more common than people assume. Roughly 1 in 4 participants reported physical abuse, and about 15% reported emotional neglect.
- The more ACEs someone had, the higher their risk of later health and life problems.
- ACEs showed up across all kinds of backgrounds.
One caveat worth noting: all participants had Kaiser health insurance, so the group was predominantly white, middle-class, and employed. Newer, more diverse data show that while ACEs can happen to anyone, they don't affect everyone equally.
What counts as an ACE?
The original study sorted ACEs into three categories: abuse, neglect, and household challenges.
Abuse
- Physical abuse: A parent or other adult in the home pushing, grabbing, slapping, hitting, or throwing something at you.
- Emotional abuse: Being sworn at, insulted, put down, or made to feel afraid you'd be hurt.
- Sexual abuse: An adult or someone at least five years older touching you sexually, making you touch them, or raping you. This can be a relative, family friend, another adult you know, or a stranger.
Neglect
- Physical neglect: Not having enough food, clean clothes, safe shelter, or protection, or being kicked out of the home.
- Emotional neglect: Not feeling loved, important, or supported, or having a family that didn't look out for each other.
Household challenges
- Mental illness or a suicide attempt in the home.
- Parental separation or divorce.
- Substance use in the home.
- Domestic violence.
- A family member in jail or prison.
The expanded list
Researchers now recognize that the original ten ACEs don't cover everything. Things like food insecurity, homelessness or unstable housing, witnessing violence in the community, and losing a family member to suicide are often considered ACEs, too. Others commonly studied include poverty, the death of a parent, bullying, discrimination, and being the victim of or witness to a crime.
A quick note on ACE scores: Online quizzes and surveys that count your ACEs are useful for reflection, but the score was built for population research. It can't diagnose you, predict your future, or measure how much a situation hurts.
How ACEs can show up later
ACEs can touch nearly every part of adult life: mental health, physical health, relationships, school, and money.
Your body and brain: Growing up with constant, heavy stress changes how your body reacts to tough situations. It affects how your brain grows and how your body fights off sickness. Over time, this can make it hard to focus, remember things, or stay calm when big feelings hit.
Your physical health: Long-term stress as a kid can hurt your body as you get older. It raises the chance of health problems like heart disease, diabetes, or lung trouble. Sometimes, people also turn to alcohol or drugs to help numb the emotional pain.
Your mental health: Heavy stress from childhood is strongly connected to feeling sad, worried, or hopeless as an adult. For kids and teens, carrying that pain without help makes big emotional struggles much harder to handle.
Your daily life: Early stress doesn't stay in the past. It can follow you to school and work, making it harder to finish school, keep a job, or save money.
Remember this: None of this means your future is set in stone. These are just patterns researchers see in large groups of people, not a rule for your life. Many people who go through tough times grow up to live happy, healthy lives, especially when they have supportive friends, family, and places to heal.
The past explains. It doesn’t define you
You can’t go back and rewrite your childhood. But you can understand how it shaped you, and start building more of what you may not have gotten then: safe relationships, people you can count on, healthy ways to cope, and a sense of belonging. That matters for people with HIV.
Taking care of yourself is about more than labs and medication. Your mental health, relationships, support system, and ability to ask for help are part of your health, too. Your past may help explain some things about you. It doesn’t get to decide what happens next.
You don’t have to unpack it alone. If this post has you thinking about your own childhood, or about patterns you’re noticing today, talk it through with someone who gets it. Connect with a peer in the Positive Peers app. Sometimes understanding where you’ve been is the first step toward deciding where you want to go next.
Join the app.