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

环境和生理因素对性侵犯和艾滋病毒的影响

• 批准号: 9321515
• 负责人: Jamila Kinshasa Stockman
• 金额: $ 9.84万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-16 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9321515
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Adult; Affect; African American; Age; Anal Sex; Area; Baltimore; Behavioral; Behavioral Mechanisms; Biological; Characteristics; Chronic; Clinic; Cohort Studies; Complex; Crime; Cross-Sectional Studies; Data Collection; Development; Disease; Environmental Impact; Environmental Risk Factor; Epidemiology; Evaluation; Forcible intercourse; Goals; HIV; HIV Infections; HIV risk; Health; Heterosexuals; High Risk Woman; Hydrocortisone; Immune system; Incidence; Infection; Intervention; Interview; Life; Link; Low income; Measures; Methods; Nature; Neighborhoods; Participant; Pathway interactions; Pattern; Perception; Phase; Physiological; Populations at Risk; Poverty; Predisposition; Prevention strategy; Preventive Intervention; Recording of previous events; Recruitment Activity; Reporting; Research; Research Design; Risk; Risk Behaviors; Risk Factors; Role; Salivary; Sampling; Sexual Partners; Social Environment; Stress; Surveys; United States; Vagina; Violence; Woman; Work; base; biological adaptation to stress; built environment; cohort; contextual factors; design; experience; high risk behavior; high risk sexual behavior; hypothalamic-pituitary-adrenal axis; inner city; meetings; mortality; psychosocial; resilience; response; sex; sex risk; sexual assault; sexual violence; social; violence against women

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.

描述(由申请人提供)：在美国女性中，非裔美国人(AA)继续不成比例地受到艾滋病毒的影响，他们的艾滋病毒发病率和艾滋病毒相关死亡率最高。再障女性也不成比例地受到强迫性行为的影响，44%的再障女性报告被伴侣强奸，相比之下，白人女性的这一比例为35%。强迫性行为极大地增加了妇女感染艾滋病毒的风险，在与感染艾滋病毒的伴侣发生性行为时直接发生，并通过参与高危行为间接造成。社区层面的建筑和社会环境特征(例如，社区混乱、贫困)已被作为暴力和艾滋病毒危险行为的贡献者进行了研究，但还没有研究考察潜在的可改变的环境特征作为强迫性行为的具体贡献者。此外，这些邻里水平的因素和强迫的性行为经历可能会导致这些女性基于下丘脑-垂体-肾上腺(HPA)轴的应激反应的生理变化，进而影响她们的危险行为和STI感染。然而，还没有研究考察强迫性行为史导致的压力反应对艾滋病毒危险行为和性传播感染的单独影响，考虑到环境因素。拟议项目的具体目标是：1)检查建筑和社会环境特征(例如，邻里混乱、对妇女的暴力行为规范)与强迫性行为经历和艾滋病毒风险因素之间的联系；2)确定近期或长期强迫性行为对HPA轴内的应激反应的生理影响，以皮质醇唤醒反应为代表；以及3)评估建筑和社会环境特征和生理因素是否调节了强迫性行为和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 增加一个人经历强迫性行为的可能性；2)女性对与强迫性行为有关的压力的感知及其与艾滋病毒危险行为的关系。为此，我们将从马里兰州巴尔的摩市中心的低收入医疗诊所招募400名艾滋病毒阴性、感染艾滋病毒风险增加的再生障碍性贫血妇女参加一项回溯性队列研究。根据研究设计，至少三分之一的样本将从18岁起经历过强迫性行为，三分之二的人将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，一部分患有 有成年强迫性史者(n=20)将参加定性的深度访谈。至 据我们所知，这项拟议的研究是第一次评估环境因素和生理变化的HPA轴应激反应的独立和联合影响，这些因素可能有助于增加对艾滋病毒的易感性。由于强迫性行为和艾滋病毒风险之间的关系可能会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作用于这些途径的干预措施提供信息，当这些干预措施结合在一起时，不仅将降低再生障碍性贫血妇女感染艾滋病毒的风险，还将提高她们的弹性水平。