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

项目总结/摘要 亲密伴侣暴力与艾滋病毒之间存在着重要关系。暴露于IPV的女性 报告感染艾滋病毒的可能性几乎高出10倍。现有的研究表明，多个直接（例如，强迫性行为 与风险伙伴）和间接（例如，精神健康状况不佳）将IPV经历与艾滋病毒风险联系起来的途径。 需要制定方法，在不依赖伴侣的IPV暴露妇女中预防艾滋病毒。预处理 暴露预防（PrEP）是一种每日口服药物，可能是最可行和最新颖的艾滋病毒预防方法 为暴露于IPV的女性提供选择。然而，参与PrEP护理可能很难，包括多个步骤（例如， 每日坚持，每季度进行一次医疗访视）。妇女参与PrEP护理连续体可能会中断 四个与艾滋病毒相关的风险因素（经济不稳定，性自主，药物滥用，抑郁 症状）。首先，经济不稳定可能使妇女依赖虐待她们的伴侣赚钱， 保险，这可能会阻碍PrEP的吸收和遵守。第二，性自主性低的女性（例如， 自由表达自己的性自我）可能会感到无法或不舒服使用准备，如果她的伴侣不同意 她希望使用PrEP，这可以防止PrEP吸收。最后，药物滥用和抑郁情绪可以 干扰认知，使其难以参与日常活动，这可能会阻止PrEP的坚持。到目前为止， 缺乏研究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。这是一个令人担忧的问题，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沿着经历。 预防连续体。F31旨在改善女性的性健康，研究目标如下：（1a） 检查IPV对妇女参与PrEP护理连续体（即，兴趣，吸收， 依从性、随访访视）和HIV相关风险因素，使用来自女性队列研究的数据（n=250）; (1b)探索四个艾滋病毒相关的风险因素作为中介联系IPV和PrEP护理连续体;和（2） 描述妇女的经验和过程沿着PrEP护理连续体（n=32）。拟议研究 解决了理解IPV与妇女参与PrEP之间关系的关键需求 为了以安全和有效的方式实施PrEP护理，我们需要提供持续的护理。这项研究将设计PrEP 妇女参与战略，为制定干预措施提供信息，并帮助妇女防治艾滋病毒/艾滋病。 在这2年的研究和培训奖学金，申请人将发展跨学科的社会科学 技能，包括提高统计分析技能，获得混合方法研究设计的经验， 定性数据分析，同时完善学术和科学交流。这种全面的训练 该计划将准备申请人的职业生涯作为一个独立的暴力流行病学家和学术 指导进行经验性的IPV研究，同时为妇女设计艾滋病毒预防干预措施。

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.