Gendered Risks, Substance Use, and HIV Outcomes among Urban Women

描述(申请人提供)：在美国和全球，被边缘化的城市妇女受到相辅相成的流行病“物质滥用、暴力和艾滋病毒/艾滋病(SAVA)综合征”的不成比例的影响。以亲密伴侣暴力(IPV)、性侵犯(SA)、在儿童期早期开始的性剥削(CSA)以及后来在交易性或性工作(SW)中开始的性剥削形式的性别风险可能会随着时间的推移积累和互动。然而，很少有研究描述这些性别风险星座中最常见、最危险的物质使用轨迹以及行为和生物艾滋病毒结果。拟议的二次分析旨在1)确定有意义的性别风险星座(例如，接触IPV和SA)及其随时间的流行率和稳定性，2)评估性别风险星座对药物使用行为和随时间变化的趋势的影响，以及3)前瞻性评估性别风险星座对大量处于危险和积极使用药物的边缘化城市妇女的艾滋病毒行为(无保护性行为)和治疗(病毒抑制)结果的影响。为了实现这些目标，拟议的二次分析利用了正在进行的纵向妇女机构间艾滋病毒研究(WIHS)，这是美国对妇女进行的最大和持续时间最长的艾滋病毒队列研究。调查小组带来了药物使用和艾滋病毒研究方面的长期专门知识，并对高危人群进行干预，以支持初级调查员过渡到与药物使用有关的艾滋病毒研究。调查结果将向 更好地了解城市妇女的生活现实，性别风险、药物使用和艾滋病毒一级和二级预防结果之间的交集，以及改进干预方法，以减少最边缘化妇女中药物使用和艾滋病毒的相互交织的负担。

DESCRIPTION (provided by applicant): In the US and globally, marginalized, urban women are disproportionately affected by the mutually reinforcing epidemics known as the "Substance Abuse, Violence and HIV/AIDS (SAVA) Syndemic". Gendered risk in the forms of intimate partner violence (IPV), sexual assault (SA), sexual exploitation that begins early in childhood sexual abuse (CSA), and later in transactional sex or sex work (SW) can accumulate and interact over time. Yet little research has characterized the most common, and the most hazardous, of these gendered risk constellations with respect to substance use trajectories, and behavioral and biologic HIV outcomes. The proposed secondary analysis seeks to 1) identify meaningful constellations of gendered risk (e.g., exposure to both IPV and SA) and their prevalence and stability over time, 2) evaluate the influence of gendered risk constellations on substance use behavior and trends over time, and 3) prospectively evaluate the influence of gendered risk constellations on HIV behavioral (unprotected sex) and treatment (viral suppression) outcomes in a large cohort of marginalized urban women at risk for and actively using drugs. To achieve these goals, the proposed secondary analysis leverages the ongoing, longitudinal Women's Interagency HIV Study (WIHS), the largest and longest-running HIV cohort study of women in the US. The investigative team brings long- standing expertise in substance use and HIV research and interventions with high-risk populations to support the transition of a junior investigator into substance use-related HIV research. Findings will inform a greater understanding of the lived realities of urban women, the intersections among gendered risk, substance use and primary and secondary HIV prevention outcomes, and refined intervention approaches to reduce the interwoven burdens of substance use and HIV among the most marginalized women.