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

项目摘要 非洲区域的孕妇和产后妇女感染可治愈性疾病的风险很高， 传播感染（STI）可能会对健康造成破坏性后果，包括增加艾滋病毒的风险 感染和传播。理论和经验证据表明，亲密伴侣暴力（IPV）是一种 可能导致妇女性风险重要风险因素。然而，相对较少的研究 研究了IPV与怀孕和产后性风险之间的关系，这是生命中的一个关键阶段 妇女和她们的新生儿。此外，几乎所有现存的关于IPV与 妇女的性风险受到严重的方法上的限制，限制了对妇女性风险的理解。 协会的具体性质。例如，大多数关于IPV与STI或STI风险之间关系的研究 行为研究了全球协会在一个时间点使用二元措施的物理和/或 性虐待这种方法排除了确定关联的时间性和/或检查 女性IPV经历的类型、水平和慢性程度的异质性可能差异预测 STI的风险。曾遭受慢性多种形式虐待并同时受到控制的孕妇 在产后期间，行为可能比那些 经历过其他类型的暴力。此外，据我们所知，还没有研究考察过 可能解释IPV和产后性风险之间关系的理论机制和/或确定 艾滋病毒阳性妇女与艾滋病毒阴性妇女的途径是否不同。的目的 建议的研究是确定是否，为什么，以及谁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（性病感染事件，不一致） 使用避孕套）。数据将来自一项对HIV阳性和HIV阴性孕妇的纵向队列研究。 在南非德班的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检查时完成了怀孕期间的行为评估。 随访（T1）、产后14周（T2）和产后9个月（T3）;在T1和T2评估和治疗STI。 潜在类别、中介和调节中介分析将用于：（1）确定年龄段的女性亚组， T1基于他们对心理、身体和性IPV的体验模式，以及他们对 通过他们当前的合作伙伴（IPV配置文件）控制行为，并检查 这些IPV概况和产后性风险（STI感染事件、避孕套使用不一致）;（2）确定 是否情绪困扰和/或低性关系权力调解协会，和（3）检查 艾滋病毒抗体阳性和阴性妇女的关联是否不同以及如何不同。调查结果将提供一个 IPV和产后性风险之间的关系的微妙和全面的观点，将告知 制定有针对性的预防战略，以减少这一关键生命阶段的性风险。

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.