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

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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.