The Impact of Environmental and Physiological Factors on Sexual Assault and HIV

描述（由申请人提供）：在美国女性中，非洲裔美国人（AA）继续受到艾滋病毒的不成比例的影响，具有最高的艾滋病毒发病率和艾滋病毒相关死亡率。匿名戒酒会妇女也不成比例地受到强迫性行为的影响，44%的匿名戒酒会妇女报告被伴侣强奸，而白色妇女的这一比例为35%。强迫的性行为大大增加了妇女感染艾滋病毒的风险，与感染艾滋病毒的伴侣发生性行为时直接增加，参与高风险行为则间接增加。建筑和社会环境的邻里水平特征（例如，邻里关系混乱、贫困）被研究为暴力和艾滋病毒风险行为的促成因素，但没有研究将潜在的可改变的环境特征作为强迫性行为的具体促成因素。此外，这些邻里水平的因素和强迫性行为的经验可能会导致下丘脑-垂体-肾上腺（HPA）轴为基础的应激反应的生理变化，这些妇女，反过来影响他们的危险行为和STI感染。然而，还没有研究探讨了强迫性行为史对艾滋病毒风险行为和性传播感染的压力反应的孤立影响，并考虑了环境因素。拟议项目的具体目标是：1）研究建筑和社会环境特征之间的联系（例如，（1）确定近期或长期强迫性行为史对HPA轴内应激反应的生理影响，以皮质醇觉醒反应为代表;（2）评估建筑和社会环境的特征以及生理因素是否调节强迫性行为与艾滋病毒风险因素之间的关系。作为我们的第四个目标，我们将定性地提供1）建筑和社会环境在以下方面的作用的背景： 增加一个人经历强迫性行为的可能性和2）妇女对与强迫性行为有关的压力的感知及其与艾滋病毒风险行为的关系。为此，我们将从马里兰州巴尔的摩市中心的低收入健康诊所招募400名HIV阴性AA女性，这些女性的HIV风险增加，进入一项回顾性队列研究。根据研究设计，至少三分之一的样本自18岁起经历过强迫性行为，三分之二的样本没有经历过任何虐待。在第一阶段，参与者将完成定量调查和生物数据收集，以测量唾液皮质醇水平。在第二阶段， 成年后有强迫性行为史的人（n=20）将参加定性深入访谈。到 据我们所知，这项研究首次评估了环境因素和生理改变的HPA轴应激反应的独立和综合影响，这些因素可能导致对HIV的易感性增加。由于强迫性行为和艾滋病毒风险之间的关系可能受到几个潜在的相互关联的途径的影响，我们工作的长期目标是为对这些途径采取行动的干预措施提供信息，当结合在一起时，不仅可以减轻AA妇女感染艾滋病毒的风险，而且还可以提高她们的韧性水平。

DESCRIPTION (provided by applicant): Among women in the US, African Americans (AA) continue to be disproportionately affected by HIV, having the highest HIV incidence and HIV-related mortality. AA women are also disproportionately affected by forced sex, with 44% of AA women reporting rape by a partner, compared to 35% of White women. Forced sex contributes significantly to women's risk for HIV, directly when occurring with an HIV-infected partner and indirectly through participation in high risk behaviors. Neighborhood-level characteristics of the built and social environment (e.g., neighborhood disorder, poverty) have been studied as contributors to violence and HIV risk behaviors, but no studies have examined potentially modifiable environmental characteristics as contributors to forced sex specifically. Additionally, these neighborhood-level factors and forced sex experiences may result in physiological changes of the hypothalamic-pituitary-adrenal (HPA) axis-based stress response for these women, in turn influencing their risk behaviors and STI infection. However, no study has examined the isolated effect of the stress-response resulting from a history of forced sex on HIV risk behaviors and STI infection, accounting for environmental factors. The specific aims of the proposed project are to: 1) examine the association between features of the built and social environment (e.g., neighborhood disorder, norms about violence against women) and forced sex experiences and HIV risk factors; 2) determine the physiological effect of a recent or chronic history of forced sex on the stress response within the HPA axis, represented by cortisol awakening response; and 3) assess whether features of the built and social environment and physiological factors moderate the relationship between forced sex and HIV risk factors. As our fourth aim, we will qualitatively provide context for 1) the built and social environment's role in increasing one's likelihood of experiencing forced sex and 2) a woman's perception of stress related to forced sex and its relationship to HIV risk behaviors. To this end, we will recruit 400 HIV-negative AA women at increased risk for HIV from low- income health clinics in inner-city Baltimore, MD into a retrospective cohort study. By study design, at least one-third of the sample will have experienced forced sex since the age of 18 and two-thirds will not have experienced any abuse. In Phase I, participants will complete a quantitative survey and biological data collection to measure salivary cortisol levels. In Phase II, a subset of women with a history of forced sex in adulthood (n=20) will participate in qualitative in-depth interviews. To our knowledge, the proposed study is the first to evaluate the independent and combined influence of environmental factors and physiological altered HPA-axis stress response that may contribute to increased vulnerability to HIV. Because the relationship between forced sex and HIV risk can be influenced by several potentially interconnected pathways, the long term goal of our work is to inform interventions that act on those pathways, and when combined together, will not only mitigate AA women's risk for HIV but also boost their level of resilience.