Social and structural violence and HIV care continuum outcomes: Developing a trauma-informed HIV care intervention among WLWH

项目摘要/摘要 我们将使用创新的社会流行病学方法来纵向描述这些影响和 艾滋病毒护理连续体上基于性别的暴力机制，界定了区别对待的关键组成部分 艾滋病毒护理模式，缓解这些关系，并为创伤和暴力提供信息平台 艾滋病毒护理和实践(TVI-HCP)干预措施，生活在顺性(Cis)和跨性别者(跨性别者)妇女中 艾滋病毒携带者(WLWH)。新出现的证据表明，新冠肺炎大流行已导致 基于社会和结构性的基于性别的暴力行为，侵害独联体和跨性别妇女，她们肩负着不公平的责任 分享由此产生的限制、物理距离和经济市中心的影响。感受到的影响 被边缘化的顺式和跨性别妇女，包括世界妇女联合会，甚至更加严重，短期和长期 在创伤、暴力、安全和艾滋病毒护理方面的后果顺位和跨世界卫生组织的连续结果 将需要得到解决。甚至在新冠肺炎危机之前，尽管在方案上取得了实质性进展， 在许多情况下，世界卫生组织在所有全球艾滋病毒目标中都经历了相对于顺性男子的差距。尽管 世界卫生组织的社会和结构性暴力在全球的流行率高得令人震惊，缺乏研究 描述不同类型的暴力影响艾滋病毒护理连续结果的机制，以 通知干预目标。此外，尽管有人呼吁将了解创伤和暴力的护理方法应用于 艾滋病毒护理和实践(TVI-HCP)和WLWH的独特需求，令人惊讶的是，人们对此知之甚少 方法可以在艾滋病毒临床实践环境中量身定做。在拟议的研究中，我们将利用 加拿大现有以社区为基础的顺式和跨性WLWH队列(性健康和艾滋病毒/艾滋病： 妇女纵向需求评估)，并重新获得这一队列，并将其扩大到#市的300 WLWH 温哥华。这项量化研究将包括调查访谈、创新绘图和空间分析、艾滋病毒 疾病监测和机密管理链接，以填补关键研究空白并提供信息 多层次TVI-HCP规划的组成部分，通过以下方式优化艾滋病毒护理连续成果：(1) 前瞻性地描述不同类型的暴力经历(人际关系)之间的关系 情感、身体和性暴力；邻里暴力)和病毒载量抑制失败 确定在这些关系中要干预的关键调解人；(2)前瞻性地描述 与病毒载量有最强关联的差异化艾滋病毒护理模式的关键组成部分 抑制，在我们初步开发和验证WLWH的TVI-HCP量表的基础上进行扩展；以及(3) 建立创新的社会流行病学平台，为未来多层次提供信息和评估 了解创伤和暴力的艾滋病毒护理干预措施。在持续的新冠肺炎危机中，与 作为北美暴力、创伤和艾滋病毒的综合体，我们的研究提供了一个前所未有的机会 告知差异化的艾滋病毒护理模式，以优化边缘化妇女的艾滋病毒临床结果。

PROJECT SUMMARY/ABSTRACT We will use innovative social epidemiological methods to longitudinally characterize the impacts and mechanisms of gender-based violence on the HIV care continuum, define key components of differentiated HIV care models that mitigate these relationships and develop a platform for trauma- and violence-informed HIV care and practice (TVI-HCP) interventions, among cisgender (cis) and transgender (trans) women living with HIV (WLWH). Emerging evidence suggests that the COVID-19 pandemic has resulted in heightened social and structural gender-based violence against cis and trans women, who are shouldering an inequitable share of the resulting impact of restrictions, physical distancing and economic downtown. Impacts felt by marginalized cis and trans women, including WLWH, are even more severe and the short- and long-term consequences in terms of trauma, violence, safety and HIV care continuum outcomes of cis and trans WLWH will need to be addressed. Even prior to COVID-19 crisis, despite substantial programmatic advancements, WLWH experienced gaps relative to cisgender men in all global HIV targets in many settings. Although the global prevalence of social and structural violence by WLWH is alarmingly high, there is a lack of research delineating mechanisms through which different types of violence impact HIV care continuum outcomes, to inform intervention targets. Moreover, despite calls to apply a trauma-and violence-informed care approach to HIV care and practice (TVI-HCP) and the unique needs of WLWH, surprisingly little is known about how this approach can be tailored in HIV clinical practice environments. In the proposed study we will leverage an existing community-based cohort of cis and trans WLWH in a Canadian setting (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment) and recapture and expand this cohort to 300 WLWH in the City of Vancouver. This quantitative study will include survey interviews, innovative mapping and spatial analyses, HIV disease monitoring, and confidential administrative linkages to fill critical research gaps and inform components of multi-level TVI-HCP programming to optimize HIV care continuum outcomes by: (1) Prospectively characterizing relationships between different types of violence experiences (interpersonal emotional, physical and sexual violence; neighbourhood violence) and viral load suppression failure and identifying critical mediators in these relationships on which to intervene; (2) Prospectively characterizing the key components of differentiated HIV care models that have the strongest associations with viral load suppression, expanding on our preliminary development and validation of a TVI-HCP Scale for WLWH; and (3) Establishing an innovative social epidemiological platform for informing and evaluating future multi-level trauma- and violence-informed HIV care interventions. Amidst the ongoing COVID-19 crisis, in parallel with a syndemic of violence, trauma and HIV in North America, our study offers an unprecedented opportunity to inform differentiated HIV care models to optimize HIV clinical outcomes among marginalized women.