Partner Violence and the Reproductive Health of LBT Women

描述（由申请人提供）：使用生殖健康诊所的16-29岁年轻妇女报告的亲密伴侣暴力（IPV）发生率明显高于一般人群的流行率估计值。很少有研究比较了性少数（SM）女性（广义上定义为具有同性吸引力，身份和/或行为的女性）与在生殖健康诊所寻求服务的异性恋女性之间暴露于IPV和性健康和生殖健康状况差的差异。基于人口的估计表明，SM妇女是显着更有可能比他们的异性恋同行的经验IPV和性侵犯（SA）在他们的一生中，但需要进一步的研究，以了解SM妇女的虐待关系的背景下，这如何影响他们的性和生殖健康。在这项拟议研究的母研究中（米勒，R 01 HD 064407），72%有男性和女性性伴侣史的女性经历过IPV，而只有男性性伴侣的女性经历过IPV的比例为44%。在解释了他们暴露于IPV之后，SM女性更有可能报告最近无保护的肛交，最近无保护的阴道性交，以及害怕拒绝性行为，终身性交易和终身性传播感染诊断。尽管明确需要 尽管我们需要为性行为者提供全面的性健康和生殖健康服务，但先前的研究表明，提供者在讨论同性行为时感到不适，或者缺乏对性行为者的医疗保健需求的了解，这可能会阻碍对IPV的评估，并为这一弱势群体提供适当的性健康和生殖健康服务。R 03扩大了原始母研究的影响，原始母研究不包括关于性行为女性性和生殖保健需求的具体培训。对参与父母研究的SM女性的访谈（目标1和2; n=40）将探讨1）IPV/SA的历史以及IPV如何影响性健康和生殖健康; 2）对性行为、性别、性取向和其他性风险行为的社会规范的态度和感知; 3）他们与计划生育提供者讨论IPV的反馈;（4）接受性与生殖保健的经历。简短的调查（n=50）和访谈（n=15）与供应商从诊所谁参加了家长的研究将探讨：1）关于性和生殖健康需求的SM妇女的看法，2）与培训的经验，提供医疗服务的SM客户，3）的舒适度和战略评估IPV/SA之间的SM客户。研究结果预计将直接转化为新的增强生殖健康干预措施，嵌入安全和减少伤害的战略，以减少IPV风险的SM妇女没有针对或进一步边缘化这一人群。

DESCRIPTION (provided by applicant): Young women ages 16-29 years using reproductive health clinics report significantly higher rates of intimate partner violence (IPV) compared to general population prevalence estimates. Few studies have compared differences in exposure to IPV and poor sexual and reproductive health among sexual minority (SM) women - broadly defined as women with same-sex attraction, identity, and/or behavior - and heterosexual women seeking services at reproductive health clinics. Population based estimates suggest that SM women are significantly more likely than their heterosexual counterparts to experience IPV and sexual assault (SA) over their lifetime, but further research is needed to understand the context of SM women's abusive relationships and how this impacts their sexual and reproductive health. In the parent study from which this proposed study emerges (Miller, R01HD064407), 72% of women with a history of male and female sexual partners had experienced IPV compared to 44% of women with male partners exclusively. After accounting for their exposure to IPV, SM women were more likely to report recent unprotected anal sex, recent unprotected vaginal sex, and fear of refusing sex, lifetime sex trade and lifetime STI diagnosis. Despite the clear need for comprehensive sexual and reproductive health services for SM women, previous research indicates there is provider discomfort discussing same-sex behavior or lack of knowledge regarding the health care needs of SM women, which may hinder assessment for IPV and provision of appropriate sexual and reproductive health services for this vulnerable population. This R03 expands the impact of the original parent study, which did not include specific training on the sexual and reproductive health care needs of SM women. Interviews with SM women who participated in the parent study (Aims 1 and 2; n=40) will explore 1) histories of IPV/SA and how IPV impacts sexual and reproductive health; 2) attitudes toward and perceived social norms regarding sexuality, gender, sexual orientation, and other risk behaviors with sex; 3) feedback on IPV discussion they've had with their family planning providers; and 4) experiences receiving sexual and reproductive health care. Brief surveys (n=50) and interviews (n=15) with providers from clinics who participated in the parent study will explore: 1) perceptions regarding the sexual and reproductive health needs of SM women, 2) experiences with training on health care provision for SM clients, 3) level of comfort and strategies for assessing for IPV/SA among SM clients. Findings are expected to translate directly into novel enhancements to reproductive health interventions that embed safety and harm reduction strategies to reduce IPV risk for SM women without targeting or further marginalizing this population.