A Mixed-Methods Study of Socio-Ecological Resilience Among Young ACE-Exposed Women in South Africa

摘要 年轻的南非（SA）妇女，受艾滋病毒影响不成比例的人口，通常遭受不利的影响， 童年经历（ACE）这些童年创伤与艾滋病毒风险行为呈正相关。 研究表明，ACE在青年中同时发生，并创造了累积风险暴露的生活轨迹。尽管 ACE在SA妇女中的普遍性，广泛研究ACE影响的数据有限， 如何影响南非妇女的艾滋病毒预防行为。社会-生态服从-概念化为重新- 在个人、人际和社区各级促进积极适应的资源， 创伤-提供了一种基于优势的方法来检查这些保护性决定因素如何缓冲负面影响 ACE的影响，恶化年轻女性的性风险行为和参与艾滋病毒预防亲， 影响艾滋病发病率的因素。这项研究符合NIH的艾滋病毒和艾滋病毒相关疾病战略计划。 研究优先领域使用行为和社会科学，以获得有关个人行为的见解， 影响艾滋病毒和艾滋病毒预防干预措施的环境。该研究将应用社会生态学 探索对抗ACE对HIV的负面累积效应的保护性弹性因素的框架 预防行为的年轻SA妇女，因为他们从青春期过渡到成年。亲- 提出的混合方法研究将使用来自共同发起人的NIMH R 01，HIV的多层次机制的数据 在年轻的SA女性中获得。本研究的具体目标是：1）确定社会生态的影响， 在交易性行为中经历过ACE的年轻SA女性的逻辑弹性，以及 利用艾滋病毒预防和避孕保健服务; 2）了解南非年轻妇女如何从 ACE了解并体验跨多个社会生态层面的复原力， 谈判性伙伴关系，并利用避孕和艾滋病毒预防服务，通过使用Pho- tovoice，一种参与式的定性研究方法; 3）探索趋同和分歧的发现 目标是制定基于创伤的复原力干预措施，以加强艾滋病毒综合预防 通过整合目标1和目标2的数据，编制了方案。拟议的奖学金将建立在申请人的先前重新- 搜索经验，支持他们的培训作为一个混合方法的全球卫生研究人员。具体的火车- 该奖学金的目标是：1）发展申请人在社会生态恢复力方面的理论基础 和创伤知情护理适用于年轻的ACE暴露的妇女; 2）增加申请人的定量 掌握数据管理、分析、解释和展示统计模型结果的技能; 3）深化应用 cant在定性和参与性研究技能方面的专业知识; 4）扩大申请人的整合能力 定量和定性数据，并提出混合方法的研究结果;和5）推进申请人的 手稿开发和排版技能。这些活动将支持申请人的目标- 即将成为一名专门从事青少年妇女健康的终身制艾滋病毒预防混合方法调查员。

ABSTRACT Young South African (SA) women, a population disproportionately impacted by HIV, commonly suffer adverse childhood experiences (ACEs). These childhood traumas are positively associated with HIV risk behaviors. Studies show that ACEs co-occur in youth and create life trajectories of cumulative risk exposures. Despite the pervasiveness of ACEs among SA women, there is limited data examining the effects of ACEs broadly and how they impact SA women’s HIV prevention behaviors. Socio-ecological resilience—conceptualized as re- sources at the individual, interpersonal and community levels that facilitate positive adaptation in response to trauma—offers a strengths-based approach to examine how these protective determinants buffer the negative impacts of ACEs that worsen young women’s sexual risk behaviors and engagement with HIV prevention pro- grams that impact HIV incidence. This research aligns with the NIH’s Strategic Plan for HIV and HIV-Related Research priority area to use behavioral and social science to gain insights about individuals’ behaviors and their contexts that influence HIV and HIV prevention interventions. The study will apply a social ecological framework to explore protective resilience factors that counter the negative cumulative effects of ACEs on HIV prevention behaviors among young SA women as they transition from adolescence to adulthood. The pro- posed mixed methods research will use data from the co-sponsor’s NIMH R01, Multilevel Mechanisms of HIV Acquisition in Young SA Women. The specific aims of this study are to: 1) Determine the effects of socio-eco- logical resilience in young SA women who have experienced ACEs on their transactional sex behaviors, and utilization of HIV prevention and contraceptive health services; 2) Contextualize how young SA women ex- posed to ACEs understand and experience resilience across multiple socio-ecological levels to navigate and negotiate sexual partnerships, and utilization of contraceptive and HIV prevention services, by using Pho- tovoice, a participatory qualitative research methodology; and 3) Explore convergent and divergent findings with the goal of developing trauma-informed resilience interventions to reinforce combination HIV prevention programs by integrating data from Aims 1 and 2. The proposed fellowship will build on the applicant’s prior re- search experience by supporting their training as a mixed methods global health researcher. The specific train- ing goals of this fellowship are to: 1) Develop the applicant’s theoretical grounding in socio-ecological resilience and trauma-informed care as applied to young ACE-exposed women; 2) Increase the applicant’s quantitative skills to manage data, and analyze, interpret, and present results of statistical models; 3) Deepen the appli- cant’s expertise in qualitative and participatory research skills; 4) Expand the applicant’s capacity to integrate quantitative and qualitative data and present mixed methods research findings; and 5) Advance the applicant’s skills in manuscript development and grantsmanship. These activities will support the applicant’s goal of be- coming a tenure-track HIV prevention mixed methods investigator specializing in adolescent women’s health.