Violence and onward HIV transmission in perinatally-infected adolescents

项目摘要（30行） 全球有200多万青少年感染艾滋病毒，其中大多数是由于围产期感染。 传输作为艾滋病毒呈阳性的青少年，他们的选择-例如不一致的医疗保健- 坚持和无保护的性行为-有可能改变艾滋病毒的流行。南非， 作为艾滋病毒感染青少年人口最多的国家， 暴力的流行。这些流行病一起造成了一个毁灭性的循环。亲密伴侣 暴力（IPV）被广泛认为是艾滋病毒传播的一个关键驱动因素，但这只是故事的一部分。 暴力受害（在家庭、人际关系和社区中）也可能同样增加 行为风险为了更好地了解暴力如何影响艾滋病毒传播风险，我们将 在南部索韦托招募300名艾滋病毒阳性和300名艾滋病毒阴性男性青少年（15-19岁） 非洲在基线和随访时，参与者将完成全面的调查和医疗检查。 检测（性病，病毒载量）。在观察年期间，他们将完成每两周一次的移动的电话 调查，产生生态瞬时评估（EMA）数据，了解 暴力会在真实的时间里影响行为。深入访谈将帮助我们更好地- 了解青少年在日常生活中如何实施这些行为。目标 目的1：测量PHIV的IPV犯罪，并测试它是否超过 艾滋病毒阴性的同龄人。大多数预防IPV的干预措施只关注女孩，但男孩 越来越多地被认为是重要的参与者。在南非城市， 据报告，青少年男孩实施了身体或性IPV。没有关于IPV犯罪的数据 男性PHIV -最有可能在青春期传播艾滋病毒的人群。 目的2：评估暴力受害对与下列行为相关的行为的影响： 在PHIV和HIV阴性的同伴中继续传播HIV。暴露于暴力可能 1）减少艾滋病毒治疗依从性， 病毒抑制，2）减少避孕套的使用，3）增加IPV的犯罪。使用 纵向数据和EMA，我们将能够建立暴力之间的时间顺序 受害和这三种结果。目标3：突出潜在的干预点， 确定将暴力与艾滋病毒传播行为联系起来的最突出的媒介。我们 将使用结构方程模型来测试潜在的介质（例如，抑郁症，性别 意识形态）之间的多层次暴力和行为风险。结合上述目标， 大量证据将指导我们采取有效的、适合发展的干预措施， 预防艾滋病毒的进一步传播。

Project Summary (30 lines) Over two million adolescents are infected with HIV globally, the majority due to perinatal transmission. As HIV-positive adolescents, their choices – such as inconsistent medical adherence and unprotected sex - have the potential to alter the HIV epidemic. South Africa, home to the largest population of HIV-infected adolescents, is also experiencing a second epidemic of violence. Together, these epidemics create a devastating cycle. Intimate partner violence (IPV) is widely viewed as a key driver of HIV transmission, but is only part of the story. Violence victimization (at home, in relationships, and in the community) may similarly increase behavioral risk. To better understand how violence influences HIV transmission risk, we will enroll 300 HIV-positive and 300 HIV-negative male adolescents (aged 15-19) in Soweto, South Africa. At baseline and follow-up, participants will complete comprehensive surveys and medical testing (STIs, viral load). During the observation year, they will complete bi-weekly mobile phone surveys, yielding ecological momentary assessment (EMA) data on how daily experiences of violence affect behaviors in real time. In-depth interviews will be used to help us to better- understand how these behaviors are enacted by adolescents in their day-to-day lives. The aims are as follows: Aim 1: To measure IPV perpetration by PHIV, and test whether it exceeds that of HIV-negative peers. Most interventions to prevent IPV focus on girls only, but boys are increasingly recognized as essential participants. In urban South Africa, up to 40% of adolescent boys report perpetrating physical or sexual IPV. There is no data on IPV perpetration by male PHIV – the population with the greatest potential to transmit HIV during adolescence.. Aim 2: To estimate the impact of violence victimization on behaviors associated with onward HIV transmission in both PHIV and HIV-negative peers. Exposure to violence may heighten risk of onward transmission by 1) decreasing HIV treatment adherence necessary for viral suppression, 2) decreasing condom use, and 3) increasing perpetration of IPV. Using longitudinal data and EMA, we will be able to establish temporal order between violence victimization and these three outcomes. Aim 3: To highlight potential intervention points by identifying the most salient mediators linking violence to HIV transmission behaviors. We will use structural equation modelling to test potential mediators (e.g., depression, gender ideology) between multi-level violence and behavioral risk. Combined with the above aims, this body of evidence will guide us towards effective, developmentally-appropriate interventions that prevent onward HIV transmission.