Pilot trial of an intervention to increase HIV engagement and reduce Intimate Partner Violence among Black women living with HIV

携带艾滋病毒(LWH)的黑人妇女在接触亲密伴侣暴力方面继续存在差异 (IPV)和次优的艾滋病毒护理参与度。黑人女性患IPV的可能性是LWH的两倍 未感染艾滋病毒的黑人妇女。黑人女性低体重中的IPV经历与下降有关 获得社会支持资源和精神和身体健康受损。许多黑人女性LWH 暴露在IPV中也会经历长期暴露于内在化和预期的耻辱。HIV相关污名 由于担心披露，艾滋病毒护理参与率较低。而与IPV相关的耻辱可以 防止妇女为安全进行规划或使用非正式或正式资源。一直以来都有限 注意IPV的作用或污名对黑人妇女从事艾滋病毒护理的障碍的影响。 认知行为方法(CBA)在减少污名、改善IPV安全策略、 以及增加艾滋病毒护理参与度，但针对黑人女性LWH和经历IPV的干预措施 都是缺乏的。此外，CBA的干预措施很少利用黑人妇女LWH现有的复原力 力量之源框架。这项研究的总体目标是：a)组件测试 对有艾滋病毒和IPV生活经历的黑人妇女进行干预；以及b)一项试点研究，以评估 以CBA为基础的7次小组干预的可接受性、可行性和初步效果 艾滋病毒和IPV耻辱，并随后增加IPV安全战略和艾滋病毒护理参与。这个 干预使用助记法(COPE)教授评估社会和环境应激源的技术 这包括真实的和感知的艾滋病毒和IPV污名，以及改变扭曲思维的战略，问题- 解决、支持积极的社会支持，并安排与奖励相关的安全策略。COPE是 由训练有素的社区卫生工作者提供，这允许可扩展性。我们将招募并随机抽取80名 暴露于IPV的黑人女性LWH进入实验CBA或对照状态。纳入标准是：(A)自我 报告女性出生时的性别，(B)自我报告黑人种族，(C)18至44岁(D)艾滋病毒阳性情况的文件 经OraQuick测试确认，(E)最近接触IPV(12个月)，以HARK评分=1衡量，(F)自我 报告&lt；=在过去12个月中有1次HIV护理预约。所有参与者将立即完成一份- 情况、3个月和6个月的随访评估。这一创新干预的总体影响是高的：IT 解决暴力暴露对黑人妇女LWH中艾滋病毒护理参与度的影响，这是 国家健康保险协会。这项拟议的研究与持续的艾滋病毒流行有关，这种流行病对 黑人女性LWH。研究干预是可扩展的，并且很容易通过基于社区的实施 组织和卫生部门。

Black women living with HIV (LWH) continue to experience disparities in exposure to intimate partner violence (IPV) and sub-optimal HIV care engagement. Black women LWH are twice as likely to experience IPV than non-HIV infected Black women. IPV experiences among Black women LWH are associated with decreased access to social support resources and impaired mental and physical health. Many Black women LWH and exposed to IPV also experience chronic exposure to internalized and anticipated stigmas. HIV-related stigma is associated with low rates of HIV care engagement due to fears of disclosure. While IPV-related stigma can prevent women from planning for safety or engaging informal or formal resources. There has been limited attention to the role of IPV or the effects of stigma as a barrier to Black women engaging in HIV care. Cognitive behavioral approaches (CBA) are efficacious to reducing stigma, improving IPV safety strategies, and increasing HIV care engagement, yet interventions designed for Black women LWH and experiencing IPV are lacking. Furthermore, few CBA interventions leverage the existing resilience of Black women LWH using a sources of strength framework. The overarching aim of this research is to conduct: a) component testing of an intervention among Black women with lived experiences of HIV and IPV; and b) a pilot study to evaluate acceptability, feasibility and preliminary efficacy of a 7-session small group-based CBA intervention to reduce HIV and IPV stigma and subsequently increase IPV safety strategies and HIV care engagement. The intervention uses a mnemonic (COPE) to teach techniques to appraise social and environmental stressors which includes real and perceived HIV and IPV stigma, and strategies for altering distorted thinking, problem- solving, bolstering positive social support, and scheduling safety strategies linked to rewards. COPE is delivered by a trained community health worker, which allows for scalability. We will enroll and randomize 80 IPV-exposed Black women LWH into the experimental CBA or control condition. Inclusion criteria are: (a) self- report female sex at birth, (b) self-report Black race, (c) aged 18 to 44 (d) documentation of HIV positive status confirmed with Oraquick test, (e) recent IPV exposure (12 months) as measured by HARK score >=1, (f) self- report <=1 HIV care appointment in previous 12 months. All participants will complete an immediate post- condition, 3 and 6-month follow-up assessments. The overall impact of this innovative intervention is high: it addresses the impact of violence exposure on HIV care engagement among Black women LWH, a priority of the NHAS. The proposed study is relevant to the persistent HIV epidemic that disproportionately impacts Black women LWH. The study intervention is scalable and easily implemented by community-based organizations and health departments.