The Influence of Sexual Violence and Partner Dynamics of Women's HIV Risk

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DESCRIPTION (provided by applicant): Sexual violence and HIV infection have emerged as significant and interrelated public health problems facing women. In the United States, one of every six women has been threatened or forced into an unwanted sex act sometime in her life; however, this estimate represents a spectrum of partner types. In addition, a quarter of new HIV/AIDS diagnoses occur among women, with almost 70% due to heterosexual contact. Numerous studies found a consistent relationship between sexual violence and HIV risk in women. Also, recent research showed that sexually violent experiences occur prior to substance abuse and depression indicating an initiation of HIV risk. However, limited data exist to delineate possible differences in HIV sexual risk based on the severity and frequency of violent sex acts - pressured or forced vaginal, oral, and anal sex - and type of sexually violent partner - main, casual, or exchange. To address this gap in research, the applicant will conduct a community-based survey in Baltimore, Maryland to examine the interrelationships of sexual violence, partner dynamics, victim substance abuse, depression, and sexual HIV risk. Investigating the relationship between specific violent sex acts and HIV risk, accounting for types of violent partners, is critical to modify existing intervention and prevention efforts addressing the linkage between sexual violence and HIV. Specific aims of the research are to: (1) assess the impact of frequency and severity of sexual violence on HIV risk by type of violent sex partner; (2) describe the prevalence of women's HIV risk behaviors by violent vaginal, oral, and anal sex acts or a combination of any violent sex acts; and (3) evaluate the interaction of victim substance abuse and depressive symptoms as potential mediators in the relationship between sexual violence and HIV risk. Female participants will be currently enrolled in an NIMH sponsored HIV prevention intervention study in Baltimore, Maryland. A standardized questionnaire using audio computer-assisted self-interview techniques will collect information from 350 participants about sexual violence experiences, sexual activity, depression, substance abuse, and other behavioral characteristics at the 12-month visit. Sexual violence will be assessed using a modified version of the Severity of Violence Against Women Scale, a validated and established instrument. Logistic regression and structural equation modeling will be used to examine the proposed aims. National research priorities support research dedicated to evaluating the health consequences of sexual violence across the lifespan. Identifying how sexual violence and violent partner type can impact HIV rates will allow for prevention programs that can alter mediating behaviors and ultimately individual HIV risk.