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

项目摘要/摘要 亲密伴侣暴力(IPV)和艾滋病毒之间存在着重要的关系。感染IPV的女性 报告艾滋病毒感染的可能性几乎高出10倍。现有研究表明有多种直接性行为(如强迫性行为 将IPV经历与艾滋病毒风险联系起来的间接途径(例如，精神健康状况不佳)。 需要开发不依赖伴侣的方法来预防感染IPV的妇女中的艾滋病毒。Pre- 暴露预防(PrEP)，是一种日常口服药物，可能是最有效和最新的艾滋病毒预防方法 为感染IPV的女性提供的选择。然而，从事PrEP护理可能很困难，包括多个步骤(例如， 每天坚持，每季度就诊)。妇女参与PrEP护理连续体可能会中断 四个与艾滋病毒有关的风险因素(经济不稳定、性自主、滥用药物、抑郁 症状)。首先，经济不稳定可能会让女性在金钱上依赖她们的虐待伴侣，并 保险，这可能会阻碍PrEP的吸收和坚持。第二，性自主权较低的妇女(例如， 表达自己性自我的自由)如果她的伴侣不同意，她可能会感到无法或不舒服地使用PrEP 她希望使用PrEP，这可以阻止PrEP的摄取。最后，药物滥用和忧郁感可能 扰乱认知，使其难以从事日常功能，这可能会阻止PrEP的坚持。到目前为止， 很少有研究探讨IPV对妇女参与PrEP护理的影响 连续体，尽管与IPV相关的潜在障碍。这是令人担忧的，因为Trans-NIH HIV- 相关研究优先事项呼吁研究暴力如何影响艾滋病毒感染经历 预防连续体。F31旨在通过以下研究目标改善女性的性健康：(1A) 检查IPV对妇女参与PrEP护理连续体的影响(即兴趣、摄取、 依从性、随访)和艾滋病毒相关风险因素，使用来自妇女队列研究的数据(n=250)； (1B)探讨四个与艾滋病毒有关的风险因素，将IPV和PrEP护理连续体联系起来；及(2) 描述妇女在PrEP连续护理过程中的经历和过程(n=32)。拟议的研究 解决了解初级保健方案和妇女参与初级保健方案之间的关系的迫切需要 护理连续体，以安全有效的方式实施PrEP护理。这项研究将设计PrEP 参与战略，为干预措施的发展提供信息，并帮助妇女抗击艾滋病毒/艾滋病。 在为期两年的研究和培训奖学金期间，申请者将发展跨学科的社会科学。 技能，包括高级统计分析技能，获得混合方法研究设计和 定性数据分析，同时精炼学术和科学交流。这次综合培训 该计划将为申请者成为一名独立的暴力流行病学家和学者做好准备 导师在为妇女设计艾滋病毒预防干预措施的同时进行经验性的IPV研究。

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.