A Mixed Methods Evaluation of Violence, Substance Use, and HIV Risk Among a Vulnerable Population of Male Couples

项目摘要： 很大一部分新的艾滋病毒感染发生在有性行为的男子之间的主要伙伴关系中 男男性行为者（MSM），他们本身就不成比例地容易感染艾滋病毒，这表明有必要研究各种因素， 造成了这种差异。亲密伴侣攻击（IPA）和物质使用（SU）是两个这样的因素 与主要伴侣关系中的艾滋病毒风险行为密切相关（例如，无避孕套肛交， 一夫一妻制/非一夫一妻制关系协定的中断），但尽管有强有力的证据表明， IPA和SU在对艾滋病毒风险的影响方面可能重叠，IPA和SU如何预测艾滋病毒的形成知识 串联风险仍然缺失。文献中的这一空白严重限制了基础知识库， 哪些以夫妇为基础的干预措施（已显示出在MSM中预防艾滋病毒的希望）可以 开发、测试和优化。本文提出的混合方法研究将：（1）进行复杂的、多层次的 分析，以解开个人，互动，和二元效应的IPA和SU之间的大样本， 男性夫妇（目标1; N=728对夫妇），和B）通过深入访谈收集定性数据，以了解 使用男性与其他男性（N=35）的关系中的生活经验的定量效应， IPA/SU（目标2）。来自定量、二级数据分析（目标1）和定性、 将主要数据分析（目标2）与现有干预措施进行比较，以确定预防差距， 未来发展的目标。目前提议的研究部门非常适合NIH 这是一项使命，因为它将记录男男性行为者面临艾滋病毒风险的新途径，并支持未来的提案， 将目前的研究结果转化为新的艾滋病毒预防目标-这是关键的下一步。虽然申请人 拥有现有的基础能力，在夫妇研究，心理社会健康的决定因素， 先进的定量方法，这些技能已经通过研究与顺性和异性 夫妻。因此，该奖学金将支持她在艾滋病毒研究方面获得关键的新能力， 定性方法，granitarian/publication，以及性和性别少数群体（SGM）的健康， 目前资助她的博士后任命。这些培训和经验 研究活动将使申请人获得在男性夫妇中发展其研究计划的工具 并作为NIH资助的独立临床科学家的职业生涯。西北大学 性和性别少数群体健康和福祉研究所（ISGMH）是一个理想的环境， 奖学金，因为它提供了一套技术，指导，智力和工具资源， 早期职业研究者因此，ISGMH和本提案将相互作用，以支持申请人， 通过提供途径，使她能够获得关键技能，从而朝着长期职业目标前进， 建立合作，寻求额外的资金，并传播研究结果。

Project Summary: A large proportion of new HIV infections occur in the context of primary partnerships among men who have sex with men (MSM), who are themselves disproportionately vulnerable to HIV, suggesting a need to study factors that contribute to this disparity. Intimate partner aggression (IPA) and substance use (SU) are two such factors that are strongly associated with HIV risk behaviors within primary partnerships (e.g., condomless anal sex, breaks in monogamy/non-monogamy relationship agreements), but despite robust evidence that the effects of IPA and SU likely overlap in their influence on HIV risk, formative knowledge on how IPA and SU predict HIV risk in tandem remains missing. This gap in the literature critically limits the foundational knowledge base by which couple-based interventions (which have shown promise in preventing HIV among MSM) can be developed, tested, and optimized. The proposed mixed methods research will: a) conduct complex, multi-level analyses to disentangle the individual, interactive, and dyadic effects of IPA and SU among a large sample of male couples (Aim 1; N=728 couples), and b) collect qualitative data via in-depth interviews to contextualize quantitative effects using the lived experience of men in relationships with other men (N=35) experiencing IPA/SU (Aim 2). Key determinants of risk from quantitative, secondary data analyses (Aim 1) and qualitative, primary data analyses (Aim 2) will be compared to existing interventions to identify prevention gaps and formative targets for future development. The research arm of the present proposal is an ideal fit for the NIH mission since it will document novel pathways to HIV risk among MSM and support future proposals aimed at translating present findings into novel HIV prevention targets -- a critical next step. Although the applicant possesses existing foundational competencies in couple research, psychosocial determinants of health, and advanced quantitative methods, these skills have been accrued via research with cisgender and heterosexual couples. This fellowship will therefore support her in gaining critical new competencies in HIV research, qualitative methods, grantsmanship/publication, and sexual and gender minority (SGM) health by releasing her from grant-related responsibilities currently funding her post-doc appointment. These training and experiential research activities will imbue the applicant with the tools to grow her program of research among male couples and advance towards a career as a NIH-funded independent clinical scientist. Northwestern University’s Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH) is an ideal environment for this fellowship because of the suite of technical, mentorship, intellectual, and instrumental resources it affords to early career researchers. Thus, ISGMH and the present proposal will interact to support the applicant in progressing towards her long-term career goals by providing avenues through which she can gain critical skills, forge collaborations, seek additional funding, and disseminate findings.