Understanding the linkages between intimate partner violence and postpartum sexual risk: A longitudinal study of HIV-positive and HIV-negative pregnant South African women

项目总结 非洲地区的孕妇和产后妇女获得可治愈性行为的风险很高 传播感染(STI)可能造成破坏性的健康后果，包括增加感染艾滋病毒的风险 感染和传播。理论和经验证据表明，亲密伴侣暴力是一种 可能导致女性性行为风险的重要风险因素。然而，相对较少的研究表明， 研究了IPV与孕期和产后性风险的关系，产后是生命中的关键阶段 妇女和她们的新生儿。此外，几乎所有现有的关于IPV和IPV之间联系的研究 女性中的性风险受到严重的方法学限制，限制了对 协会的特定性质。例如，大多数关于IPV和性传播感染或性传播感染风险之间关系的研究 行为使用物理和/或二进制测量在某个时间点检查了全局关联 性虐待。这种方法排除了确定关联的暂时性和/或检查的能力 女性IPV经历的类型、水平和慢性化的异质性可以不同地预测 性传播感染的风险。在控制的同时经历过慢性多种形式虐待的孕妇 与女性相比，产后性传播感染的风险更大。 体验其他类型的暴力档案。此外，据我们所知，没有研究检查过 可以解释IPV与产后性风险和/或确定的关系的理论机制 与艾滋病毒阴性妇女相比，艾滋病毒阳性妇女的途径是否不同。该计划的目标是 建议的研究是确定是否、为什么以及对谁来说经历了特定类型或模式的IPV 怀孕前或怀孕期间与产后性风险有关(STI感染事件，不一致 使用避孕套)。数据将来自对HIV阳性和HIV阴性孕妇的纵向队列研究 在南非德班初级卫生诊所寻求产前服务的妇女(N=1480；39% HIV阳性)。研究参与者在第一次产前完成了怀孕期间的行为评估 分别在产后14周(T2)和产后9个月(T3)就诊；在T1和T2时评估和治疗性传播感染。 将使用潜在阶层、调解和有节制的调解分析：(1)确定妇女的亚群 T1基于他们在心理、身体和性方面的经验模式，以及他们关于 控制其当前合作伙伴的行为(IPV配置文件)，并检查预期的关联 这些IPV概况和产后性风险(STI感染事件、安全套使用不一致)；(2)确定 情绪困扰和/或低性关系权力是否会调节联系，以及(3)检查 艾滋病毒阳性妇女和艾滋病毒阴性妇女之间的关联是否以及如何不同。调查结果将提供一个 对IPV和产后性风险之间关系的细微和全面的看法，将使 制定有针对性的预防战略，以在这一关键的生命阶段减少性风险。

PROJECT SUMMARY Pregnant and postpartum women in the Africa region are at high risk for acquiring curable sexually transmitted infections (STIs) that can have in devastating health consequences, including increased risk of HIV infection and transmission. Theory and empirical evidence suggest that intimate partner violence (IPV) is an important risk factor that may contribute to sexual risk among women. Relatively few studies, however, have examined relations between IPV and sexual risk during pregnancy and postpartum, a critical phase in the life of women and their newborn babies. Further, nearly all of the extant research on the link between IPV and sexual risk among women suffers from serious methodological limitations that constrain understanding of the specific nature of the association. For example, most studies of relations between IPV and STIs or STI-risk behaviors have examined global associations at one point in time using binary measures of physical and/or sexual abuse. This approach precludes the ability to determine temporality of associations and/or to examine heterogeneity in the types, levels, and chronicity of women's experiences of IPV that may differentially predict risk of STI. Pregnant women who have experienced chronic multiform abuse in conjunction with controlling behavior may be more at greater risk for STI during the postpartum period, compared to women who experience other types of violence profiles. In addition, no research, to our knowledge, has examined theoretical mechanisms that may explain relations between IPV and postpartum sexual risk and/or determined whether pathways may differ for HIV-positive compared to HIV-negative women. The objective of the proposed study is to determine whether, why, and for whom experiencing a particular type or pattern of IPV prior to or during pregnancy is associated with postpartum sexual risk (incident STI infection, inconsistent condom use). Data will come from a longitudinal cohort study of HIV-positive and HIV-negative pregnant women who sought antenatal services from a primary health clinic in Durban, South Africa (N=1480; 39% HIV-positive). Study participants completed behavioral assessments during pregnancy at the first antenatal visit (T1) and at 14 weeks (T2) and 9 months postpartum (T3); STIs were assessed and treated at T1 and T2. Latent class, mediation, and moderated mediation analyses will be used to: (1) identify subgroups of women at T1 based on their patterns of experience with psychological, physical, and sexual IPV, as well as their reports of controlling behavior by their current partner (IPV profiles), and examine prospective associations between these IPV profiles and postpartum sexual risk (incident STI infection, inconsistent condom use); (2) determine whether emotional distress and/or low sexual relationship power mediate associations, and (3) examine whether and how associations differ for HIV-positive and HIV-negative women. Findings will provide a nuanced and comprehensive view of relations between IPV and postpartum sexual risk that will inform the development of targeted prevention strategies to reduce sexual risk during this critical life phase.