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

描述（由申请人提供）：在美国妇女中，非洲裔美国人（AA）继续不成比例地受到艾滋病毒的影响，其艾滋病发病率和艾滋病相关死亡率最高。互诫协会的女性也不成比例地受到强迫性行为的影响，44%的互诫协会女性报告被伴侣强奸，而白人女性的这一比例为35%。强迫性行为大大增加了妇女感染艾滋病毒的风险，直接发生在与感染艾滋病毒的伴侣发生时，间接发生在参与高风险行为时。已经研究了建筑和社会环境的邻里水平特征（例如，邻里混乱，贫困）作为暴力和艾滋病毒风险行为的贡献者，但没有研究专门检查潜在可改变的环境特征作为强迫性行为的贡献者。此外，这些社区水平的因素和强迫性经历可能导致这些妇女以下丘脑-垂体-肾上腺（HPA）轴为基础的应激反应的生理变化，进而影响其风险行为和性传播感染。然而，考虑到环境因素，目前还没有研究调查由强迫性行为史引起的压力反应对艾滋病毒风险行为和性传播感染的孤立影响。拟议项目的具体目标是：1)研究建筑和社会环境的特征（例如，邻里混乱，对妇女的暴力行为规范）与被迫的性经历和艾滋病毒风险因素之间的关系；2)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，以皮质醇唤醒反应为代表；3)评价建筑环境和社会环境特征以及生理因素是否调节了强迫性行为与HIV危险因素之间的关系。作为我们的第四个目标，我们将定性地为1)建筑和社会环境的作用提供背景

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.