The Impact of Environmental and Physiological Factors on Sexual Assault and HIV

环境和生理因素对性侵犯和艾滋病毒的影响

• 批准号: 8735640
• 负责人: Jamila Kinshasa Stockman
• 金额: $ 48.06万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-16 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8735640
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Adult; Affect; African American; Age; Anal Sex; Area; Baltimore; Behavioral; Behavioral Mechanisms; Biological; Characteristics; Chronic; Clinic; Cohort Studies; Complex; Crime; Cross-Sectional Studies; Data Collection; Development; Disease; Environmental Impact; Environmental Risk Factor; Epidemiology; Evaluation; Forcible intercourse; Goals; HIV; HIV Infections; HIV risk; Health; Heterosexuals; High Risk Woman; Hydrocortisone; Immune system; Incidence; Infection; Intervention; Interview; Life; Link; Low income; Measures; Methods; Nature; Neighborhoods; Participant; Pathway interactions; Pattern; Perception; Phase; Physiological; Populations at Risk; Poverty; Predisposition; Prevention strategy; Preventive Intervention; Recording of previous events; Recruitment Activity; Reporting; Research; Research Design; Risk; Risk Behaviors; Risk Factors; Role; Salivary; Sampling; Sexual Partners; Social Environment; Stress; Surveys; United States; Unsafe Sex; Vagina; Violence; Woman; Work; base; biological adaptation to stress; cohort; contextual factors; design; experience; high risk behavior; high risk sexual behavior; hypothalamic-pituitary-adrenal axis; inner city; meetings; mortality; psychosocial; public health relevance; resilience; response; sex; sex risk; sexual assault; sexual violence; social; violence against women

DESCRIPTION (provided by applicant): Among women in the US, African Americans (AA) continue to be disproportionately affected by HIV, having the highest HIV incidence and HIV-related mortality. AA women are also disproportionately affected by forced sex, with 44% of AA women reporting rape by a partner, compared to 35% of White women. Forced sex contributes significantly to women's risk for HIV, directly when occurring with an HIV-infected partner and indirectly through participation in high risk behaviors. Neighborhood-level characteristics of the built and social environment (e.g., neighborhood disorder, poverty) have been studied as contributors to violence and HIV risk behaviors, but no studies have examined potentially modifiable environmental characteristics as contributors to forced sex specifically. Additionally, these neighborhood-level factors and forced sex experiences may result in physiological changes of the hypothalamic-pituitary-adrenal (HPA) axis-based stress response for these women, in turn influencing their risk behaviors and STI infection. However, no study has examined the isolated effect of the stress-response resulting from a history of forced sex on HIV risk behaviors and STI infection, accounting for environmental factors. The specific aims of the proposed project are to: 1) examine the association between features of the built and social environment (e.g., neighborhood disorder, norms about violence against women) and forced sex experiences and HIV risk factors; 2) determine the physiological effect of a recent or chronic history of forced sex on the stress response within the HPA axis, represented by cortisol awakening response; and 3) assess whether features of the built and social environment and physiological factors moderate the relationship between forced sex and HIV risk factors. As our fourth aim, we will qualitatively provide context for 1) the built and social environment's role in increasing one's likelihood of experiencing forced sex and 2) a woman's perception of stress related to forced sex and its relationship to HIV risk behaviors. To this end, we will recruit 400 HIV-negative AA women at increased risk for HIV from low- income health clinics in inner-city Baltimore, MD into a retrospective cohort study. By study design, at least one-third of the sample will have experienced forced sex since the age of 18 and two-thirds will not have experienced any abuse. In Phase I, participants will complete a quantitative survey and biological data collection to measure salivary cortisol levels. In Phase II, a subset of women with a history of forced sex in adulthood (n=20) will participate in qualitative in-depth interviews. To our knowledge, the proposed study is the first to evaluate the independent and combined influence of environmental factors and physiological altered HPA-axis stress response that may contribute to increased vulnerability to HIV. Because the relationship between forced sex and HIV risk can be influenced by several potentially interconnected pathways, the long term goal of our work is to inform interventions that act on those pathways, and when combined together, will not only mitigate AA women's risk for HIV but also boost their level of resilience.

描述（由申请人提供）：在美国女性中，非洲裔美国人 (AA) 仍然不成比例地受到艾滋病毒的影响，其艾滋病毒发病率和艾滋病毒相关死亡率最高。 AA 女性也尤其容易受到强迫性行为的影响，44% 的 AA 女性报告曾被伴侣强奸，而白人女性中这一比例为 35%。强迫性行为会显着增加妇女感染艾滋病毒的风险，直接发生在与感染艾滋病毒的伴侣之间，间接发生在参与高危行为时。建筑和社会环境的邻里特征（例如，邻里混乱、贫困）已被研究为暴力和艾滋病毒危险行为的促成因素，但没有研究专门检验潜在可改变的环境特征作为强迫性行为的促成因素。此外，这些邻里因素和强迫性经历可能会导致这些女性下丘脑-垂体-肾上腺（HPA）轴应激反应发生生理变化，进而影响她们的危险行为和性传播感染。然而，还没有研究考虑到环境因素，检验强迫性行为史引起的压力反应对艾滋病毒危险行为和性传播感染感染的孤立影响。拟议项目的具体目标是：1）检查建筑和社会环境的特征（例如，邻里混乱、暴力侵害妇女行为规范）与强迫性经历和艾滋病毒危险因素之间的关联； 2) 确定近期或长期强迫性行为史对 HPA 轴内应激反应（以皮质醇觉醒反应为代表）的生理影响； 3) 评估建筑、社会环境和生理因素的特征是否调节强迫性行为和艾滋病毒危险因素之间的关系。作为我们的第四个目标，我们将为 1) 建筑和社会环境在以下方面的作用提供定性背景： 增加遭受强迫性行为的可能性；2) 女性对与强迫性行为相关的压力的感知及其与艾滋病毒危险行为的关系。为此，我们将从马里兰州巴尔的摩市中心的低收入卫生诊所招募 400 名 HIV 阴性 AA 女性，这些女性感染 HIV 的风险较高，参与一项回顾性队列研究。根据研究设计，至少三分之一的样本自 18 岁以来经历过强迫性行为，三分之二的人没有经历过任何虐待。在第一阶段，参与者将完成定量调查和生物数据收集，以测量唾液皮质醇水平。在第二阶段，一部分女性患有 有成年期强迫性行为史的人（n=20）将参加定性深入访谈。到 据我们所知，这项拟议的研究是第一个评估环境因素和生理改变的 HPA 轴应激反应的独立和综合影响的研究，这些影响可能会增加感染艾滋病毒的可能性。由于强迫性行为与艾滋病毒风险之间的关系可能受到几个潜在相互关联的途径的影响，因此我们工作的长期目标是为这些途径提供干预措施，并且将这些干预措施结合起来，不仅可以降低 AA 妇女感染艾滋病毒的风险，还可以提高她们的复原力水平。