Gender-Based Violence and HIV Risk: Mediating Pathways and Prevention Strategies

 说明(由申请人提供)：该提案涉及基于性别的暴力与几个被认为会增加非洲妇女感染艾滋病毒风险的中介因素之间的关系。前瞻性研究表明，暴露于GBV的妇女感染艾滋病毒的风险更高，但这种联系的机制尚不清楚。暴露于GBV的女性精神健康状况不佳和高危性行为的比例更高，这已知会增加艾滋病毒风险。此外，GBV可能导致对暴露前预防(PrEP)等艾滋病毒预防方法的依从性较低。不同的GBV经历模式可能会产生不同的心理或行为后果，并可能通过不同的机制影响艾滋病毒风险。因此，对这些机制的全面评估将需要有意义的GBV分类，其中考虑到暴力的类型、频率和严重程度的差异，以及妇女与犯罪者的关系。在这项研究中，我们将开发一个基于模式的暴露分类，基于详细的GBV历史。我们将使用这个分类来评估GBV对精神健康、性危险行为和PrEP依从性的影响。我们将检验以下假设：1)暴露于强烈GBV模式(以类型、严重程度、频率、持续时间和施暴者为特征)的女性更有可能经历不良的心理健康；2)暴露于强烈GBV模式的女性更有可能从事高风险的性行为；以及3)暴露于GBV的女性对PrEP的依从性较低。前两个假设将通过对肯尼亚蒙巴萨300名女性性工作者的横断面研究来验证。最后一个假设将通过一项前瞻性队列研究进行验证，该研究对1785名艾滋病毒血清不一致夫妇中未感染艾滋病毒的女性成员进行了研究，这些成员参加了在肯尼亚和乌干达进行的PrEP疗效的临床试验。我们将重点放在这两组高危妇女身上，以确保我们的结果与艾滋病毒预防具有最大的相关性。这将是第一个评估GBV与PrEP依从性的关联的研究，也是第一个表征GBV模式及其在女性性工作者中的后果的研究。我们的发现将为GBV对非洲妇女行为和心理艾滋病毒风险因素的影响提供新的证据。例如，有过严重暴力的经历，无论施暴者是谁，都可能与药物滥用有更强的关联，而有过亲密伴侣暴力的经历可能会增加无保护措施的性行为风险，直接增加艾滋病毒风险。积极的调查结果将有助于根据妇女的基于性别的暴力经历的个人模式，制定有针对性的干预措施，以解决关键的艾滋病毒风险因素。重要的是，负面的发现也将是有用的，因为这些将有助于将干预措施从不太可能降低风险的途径转向。

 DESCRIPTION (provided by applicant): This proposal addresses the relationship between gender-based violence (GBV) and several mediating factors thought to increase HIV acquisition risk among African women. Prospective studies indicate that women exposed to GBV have a higher risk of HIV infection, but the mechanisms for this association are not well understood. Women exposed to GBV have higher rates of poor mental health and high-risk sexual behavior, which are known to increase HIV risk. In addition, GBV may cause lower adherence to HIV prevention methods such as pre-exposure prophylaxis (PrEP). Different patterns of GBV experiences may have different psychological or behavioral consequences and may affect HIV risk through different mechanisms. Therefore, a full assessment of these mechanisms will require meaningful GBV classifications that consider variation in the type, frequency, and severity of violence, as well as women's relationship to the perpetrator. In this study, we will develop a pattern-based exposure classification based on detailed GBV histories. We will use this classification to evaluate the effect of GBV on mental health, sexual risk behavior, and PrEP adherence. We will test the following hypotheses: 1) Women exposed to patterns of intense GBV (characterized by type, severity, frequency, duration, and perpetrator) are more likely to experience poor mental health; 2) Women exposed to patterns of intense GBV are more likely to engage in high-risk sexual behavior; and 3) Women exposed to GBV have lower adherence to PrEP. The first two hypotheses will be tested with a cross-sectional study of 300 female sex workers in Mombasa, Kenya. The last hypothesis will be tested with a prospective cohort study of 1,785 HIV-uninfected female members of HIV serodiscordant couples participating in a clinical trial of PrEP efficacy in Kenya and Uganda. We focus on these two groups of high-risk women to ensure that our results have maximum relevance for HIV prevention. This will be the first study to evaluate the association of GBV with PrEP adherence, and the first to characterize GBV patterns and their consequences in female sex workers. Our findings will provide new evidence on the effect of GBV on behavioral and psychological HIV risk factors in African women. For example, experience of severe violence, regardless of perpetrator, may be more strongly associated with substance abuse, while experience of intimate partner violence may increase the risk of unprotected sex, directly increasing HIV risk. Positive findings will inform te development of targeted interventions to address key HIV risk factors based on women's individual patterns of GBV experience. Importantly, negative findings would also be useful, as these would help to redirect interventions away from pathways that are not likely to reduce risk.