Neighborhood Factors, Sexual Risk, and STIs in HIV-Infected and High-Risk Women

HIV 感染者和高危女性的邻里因素、性风险和性传播感染

• 批准号: 8788761
• 负责人: Danielle Frances Haley
• 金额: $ 4.27万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8788761
• 关键词: AIDS/HIV problem; Accounting; Address; Alabama; Anal Sex; Area; Biological; Censuses; Centers for Disease Control and Prevention (U.S.); Characteristics; Data; Development; Disadvantaged; Disease; Economics; Enrollment; Environment; Epidemic; Female; Florida; Funding; Future; HIV; HIV Infections; HIV Seropositivity; Healthy People 2020; High Risk Woman; Incidence; Individual; Infection; Knowledge; Life; Longitudinal Studies; Measures; Mediation; Mediator of activation protein; Mississippi; Morbidity - disease rate; Multiple Partners; Nature; Neighborhoods; North Carolina; Participant; Population; Poverty; Prevalence; Prevention; Principal Investigator; Probability; Recording of previous events; Research; Risk; Role; Sex Behavior; Sex Ratio; Sexual Dysfunction and Infertility; Sexual Health; Sexual Partners; Sexually Transmitted Diseases; Site; Source; Testing; Time; Trichomonas vaginalis; United States; United States National Institutes of Health; Universities; Ursidae Family; Vagina; Woman; clinical research site; cohort; design; disorder prevention; experience; high risk; improved; longitudinal design; male; mortality; public health relevance; sex risk; social; theories; therapy design; transmission process

DESCRIPTION (provided by applicant): The Southern United States (US) bears a disproportionate burden of HIV and sexually transmitted infections (STIs). HIV-infected women in this region experience higher rates of HIV-related morbidity and mortality. For HIV-infected women, STI infection may increase morbidity and facilitate HIV transmission to sex partners. Features of the social and built environment, such as high levels of poverty and low male:female sex ratios, are associated with HIV/STIs and sexual risk behaviors among HIV-uninfected populations. However, no multilevel studies have explored these relationships in a predominantly HIV-infected cohort. It is unclear how neighborhood characteristics influence sexual risk and create vulnerability to STI acquistion for people living with HIV. By integrating Women's Interagency HIV Study (WIHS) data with data from administrative sources (e.g., US Census), the proposed study will be the first to use a longitudinal, multilevel design to investigate relationships of neighborhood contexts to sexual risk behavior and STIs in a predominantly HIV-infected cohort of women living in the Southern US. The specific aims are: Aim 1. Examine cross-sectional associations between neighborhood characteristics (i.e., economic disadvantage, residential instability, male:female sex ratios, STI prevalence, social disorder) and sexual risk behaviors (i.e., HIV status of sex partner at most recent vaginal and anal sex, partner risk) among HIV-infected women screened for WIHS at the Southern Clinical Research Sites (CRSs), and investigate whether the associations between neighborhood characteristics and sexual risk behaviors that are found for HIV-positive women are similar for high-risk HIV-uninfected women. Subaim 1a. Explore the role of collective efficacy (e.g., mediator, moderator) in the relationships between social disorder and sexual risk behaviors. Aim 2. Assess the relationships between changes in neighborhood characteristics and changes in sexual risk behaviors (i.e., unprotected vaginal and anal sex, HIV status of partner at most recent vaginal and anal sex, number of sexual partners) over time among HIV-infected women enrolled in WIHS at the Southern CRSs, and investigate whether the associations between neighborhood characteristics and sexual risk behaviors that are found for HIV-positive women are similar for high-risk HIV-uninfected women. Aim 3. Assess the relationships between changes in neighborhood characteristics to changes in the probability of testing positive for trichomonas vaginalis over time among HIV-infected women enrolled in WIHS at the Southern CRSs, and investigate whether the associations between neighborhood characteristics and STIs that are found for HIV-positive women are similar are similar for high-risk HIV-uninfected women. The proposed analyses are informed by the Socioecological Framework and the Theories of Social Disorder and Collective Efficacy, and will advance our knowledge of how neighborhood-level characteristics influence sexual risk behavior and STIs over time among HIV-infected and high-risk uninfected women in the South.

描述（由申请人提供）：美国南部（US）承担着不成比例的艾滋病毒和性传播感染（STI）负担。该区域感染艾滋病毒的妇女与艾滋病毒有关的发病率和死亡率较高。对感染艾滋病毒的妇女来说，性传播感染可能会增加发病率，并促使艾滋病毒传染给性伴侣。社会和建筑环境的特点，如贫困程度高和男女性别比例低，与未感染艾滋病毒的人口中的艾滋病毒/性传播感染和危险性行为有关。然而，没有多层次的研究探讨了这些关系，主要是艾滋病毒感染的队列。目前还不清楚社区特征如何影响性风险，并使艾滋病毒感染者容易感染性传播感染。 通过将妇女机构间艾滋病毒研究（WIHS）数据与行政来源的数据（例如，美国人口普查），拟议的研究将是第一个使用纵向，多层次的设计，以调查邻里环境的关系，性风险行为和性传播感染的主要是艾滋病毒感染的妇女队列生活在美国南部。具体目标是：目标1。检查邻里特征之间的横截面关联（即，经济劣势、居住不稳定、男女性别比例、性传播感染流行率、社会混乱）和性风险行为（即，在南方临床研究中心（CRS）进行WIHS筛查的HIV感染妇女中，性伴侣在最近阴道和肛交时的HIV状态，伴侣风险），并调查HIV阳性妇女的邻里特征和性风险行为之间的关联是否与高风险HIV未感染妇女相似。Subaim 1a.探索集体效能的作用（例如，社会障碍与危险性行为之间的关系。目标二。评估邻里特征变化与性风险行为变化之间的关系（即，无保护的阴道和肛交，在最近的阴道和肛交的伴侣的艾滋病毒状态，性伴侣的数量）随着时间的推移，在南方CRS的WIHS登记的艾滋病毒感染的妇女，并调查邻里特征和性风险行为之间的关联，发现艾滋病毒阳性的妇女是类似的高风险艾滋病毒未感染的妇女。目标3.评估社区特征的变化与在南方CRS参加WIHS的HIV感染妇女中随着时间的推移阴道毛滴虫检测阳性概率变化之间的关系，并调查在HIV阳性妇女中发现的社区特征和性传播感染之间的关联是否与高风险HIV未感染妇女相似。 拟议的分析以社会生态框架以及社会障碍和集体效能理论为基础，将加深我们对社区层面的特征如何随着时间的推移影响艾滋病毒感染者和高风险未感染妇女的性风险行为和性传播感染的了解。在南方。