She's PrEPared: The Impact of Intimate Partner Violence on Women's Engagement in the PrEP Care Continuum

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Project Summary/Abstract A significant relationship exists between intimate partner violence (IPV) and HIV. IPV-exposed women are almost 10 times more likely to report an HIV infection. Extant research indicates multiple direct (e.g., forced sex with risky partner) and indirect (e.g., poor mental health) pathways linking IPV experiences to HIV risk. Developing ways to prevent HIV among IPV-exposed women that is not partner-dependent is needed. Pre- exposure prophylaxis (PrEP), is a daily oral medication and may be the most viable and novel HIV prevention option for IPV-exposed women. However, engaging in PrEP care can be hard including multiple steps (e.g., daily adherence, quarterly medical visits). Women's engagement in the PrEP care continuum may be disrupted by four HIV-related risk factors (economic instability, sexual autonomy, substance abuse, depressive symptoms). First, economic instability can make women dependent on their abusive partner for money and insurance, which may hinder PrEP uptake and adherence. Second, women with low sexual autonomy (e.g., freedom to express one's sexual self) may feel unable or uncomfortable using PrEP if her partner disagree with her wish to use PrEP, which can prevent PrEP uptake. Lastly, substance abuse and feelings of depression can disrupt cognition, making it difficult to engage in daily functions, which may prevent PrEP adherence. To date, there is a dearth of studies examining the implications of IPV on women's engagement in the PrEP care continuum, despite the potential barriers associated with IPV. This is concerning since the Trans-NIH HIV- Related Research Priorities called for research addressing how violence influences experiences along the HIV prevention continuum. This F31 aims to improve the sexual health of women across these research aims: (1a) Examine the effects of IPV on women's engagement in the PrEP care continuum (i.e., interest, uptake, adherence, follow-up visits), and HIV-related risk factors using data from a cohort study of women (n=250); (1b) Explore four HIV-related risk factors as mediators linking IPV and the PrEP care continuum; and (2) Describe women's experiences and processes along the PrEP care continuum (n=32). The proposed research addresses a critical need to understand the relationship between IPV and women's engagement in the PrEP care continuum in order to implement PrEP care in a safe and effective way. This research will devise PrEP engagement strategies, inform intervention development, and help the fight against HIV/AIDS for women. During this 2-year research and training fellowship, the applicant will develop interdisciplinary social science skills including advancing statistical analysis skills, gaining experience in mixed-methods study design and qualitative data analysis, while refining academic and scientific communication. This comprehensive training program will prepare the applicant for a career as an independent violence epidemiologist and academic mentor conducting empirical IPV research while designing HIV prevention interventions with for women.