Understanding Pathways between Intimate Partner Violence and HIV risk for Men

项目摘要/摘要 越来越多的证据表明，男同性恋者、双性恋者和其他男男性行为者(GBMSM)会经历双重性行为 艾滋病毒流行和亲密伴侣暴力(IPV)，但了解两者之间的协同作用 流行病是不发达的。估计在GBMSM中感染IPV的流行率从12%到78%不等。 新出现的证据表明，GBMSM的IPV经历与参与之间存在关联 在增加艾滋病毒风险的危险行为中(即使用药物)。超越间接的行为关联 在IPV和HIV之间，人们对IPV可能增加HIV感染的直接途径知之甚少 GBGBMSM中的风险。根据谢弗的理论模型，IPV不仅会导致行为风险， 也与影响艾滋病毒风险的免疫变化有关，但所有这些证据都来自于 异性恋女性。随着与IPV相关的HIV特异性免疫功能障碍的确定，我们 能够进一步调查上游因素，包括可能导致这种情况的少数民族应激源 变化以及应对和复原力进程等保护性措施。我们假设这些经历 在少数群体压力的背景下，IPV(包括受害、实施和双向IPV)的增加 间接行为(性行为、物质使用)和直接生物学(STI)和免疫风险 GBMSM人群中HIV感染情况分析为了填补知识的关键缺口，我们提出了一个创新的24个月队列 密歇根州东南部结伴HIV阴性GBMSM的研究，以确定干预途径和要点 GBMSM的IPV和HIV风险之间的关系。先前的研究受到横断面设计的限制，不一致 暴力措施，以及对两者同时发生的重要心理社会和结构性因素的忽视 IPV和艾滋病毒，并可能缓和或调解关系。我们通过使用严格的 队列设计，针对GBMSM的IPV测量，考虑到IPV受害的作用， 实施和双向IPV，并考虑多个少数应激源和应激反应行为 这可能会影响IPV和HIV的危险行为，并测量HIV特异性免疫学指标 功能障碍、生物风险(STI)和行为风险。拟议的研究活动包括预期的24- 在密歇根州东南部招募了360名HIV阴性的GBMSM伴侣(18年)的月队列。的总体目标 拟议的活动是为了提供关于受害或实施IPV的新知识 参与艾滋病毒预防和危险行为。

PROJECT SUMMARY/ABSTRACT There is increasing evidence that gay, bisexual and other men who have sex with men (GBMSM) experience dual epidemics of HIV and intimate partner violence (IPV), yet understanding of the synergies between these two epidemics is underdeveloped. Estimated prevalence for receipt of IPV among GBMSM range from 12% to 78%. Emergent evidences demonstrates associations between the experience of IPV among GBMSM and participation in risk behaviors that heighten the risk of HIV (i.e. substance use). Beyond the indirect behavioral associations between IPV and HIV, less is known about direct pathways through which IPV may increase HIV acquisition risk among GBGBMSM. According to Schafer’s theoretical model, IPV not only contributes to behavioral risk, but also to immunologic change that impacts HIV risk – but all of this evidence comes from studies of heterosexual women. With the identification of HIV-specific immunologic dysfunction associated with IPV, we are able to further investigate upstream factors, including minority stressors that may contribute to such changes, as well as protective measures such as coping and resiliency processes. We hypothesize that experiences of IPV (including victimization, perpetration, and bi-directional IPV), in the context of minority stress, increases both indirect behavioral (sexual behavior, substance use), and direct biological (STI) and immunologic risks for HIV infection among GBMSM. To fill the critical gap in knowledge, we propose an innovative 24-month cohort study of partnered HIV-negative GBMSM in SE Michigan, to identify the pathways and points of intervention between IPV and HIV risk for GBMSM. Prior research is limited by cross-sectional designs, inconsistent measures of violence, and inattention to important psychosocial and structural factors that co-occur with both IPV and HIV, and may moderate or mediate relationships. We address these limitations by employing a rigorous cohort design, measures of IPV that are specific for GBMSM, considering the role of IPV victimization, perpetration and bi-directional IPV, and consider the multiple minority stressors and stress response behaviors that may shape both IPV and HIV risk behaviors, and measure indicators of HIV-specific immunologic dysfunction, biological risk (STI) and behavioral risk. The proposed research activities include a prospective 24- month cohort of 360 HIV-negative partnered GBMSM (>18 years) recruited in SE Michigan. The overall aim of the proposed activities is to provide new knowledge of how victimization or perpetration of IPV shapes engagement in HIV prevention and risk behaviors.