Violence and viral suppression among gender diverse people

项目总结/摘要 越来越多的证据表明，跨女性个体（TF）经历艾滋病毒和亲密接触的双重流行。 性伙伴暴力（IPV），但对这两种流行病之间的协同作用的了解还不够充分。 在美国，变性人仍然是受艾滋病毒影响最严重的风险群体。 States.同时，TF中接受IPV的估计患病率范围为12%至62%。紧急证据 证明TF中IPV的经历与HIV感染风险之间存在关联，或 参与增加艾滋病毒风险的危险行为（即物质使用），但 艾滋病毒感染者TF的IPV经验和艾滋病毒临床护理了解较少。绝大多数 将IPV和次优艾滋病毒护理联系起来的证据来自对异性恋妇女的研究。最近的一个Meta- 分析显示，女性IPV的经验与自我报告的依从性降低55%相关， 病毒抑制几率降低了36%这些研究着眼于临床护理和 感染艾滋病毒的性和性别少数群体的IPV都受到方法上的阻碍， 局限性：基于临床人群的横断面研究设计限制了得出结论的能力 关于IPV如何影响艾滋病毒感染者的合作TF参与艾滋病毒护理。我们提出了一个创新的6- 一项为期一个月的HIV阳性TF队列研究-作为对现有HIV阳性男性队列研究的补充， 与男性发生性关系-以确定IPV和美国TF的艾滋病毒护理之间的途径和干预点。的 拟议的研究活动包括一个前瞻性的6个月队列的100艾滋病毒阳性的合作TF（>18岁） 从美国各地的网上招募。队列研究将采用专门开发的IPV测量方法， 捕获TF经历的IPV，并将考虑IPV的经验（受害，犯罪和 双向IPV），以及IPV的严重程度和频率作为参与艾滋病毒护理的驱动因素。病毒的生物标志物 将从所有参与者收集负载。拟议活动的总体目标是提供新的知识 IPV的受害或犯罪如何影响艾滋病毒护理的参与，并与以下能力有关： 实现并维持病毒抑制。

PROJECT SUMMARY/ABSTRACT There is increasing evidence that transfeminine individuals (TF) experience dual epidemics of HIV and intimate partner violence (IPV), yet understanding of the synergies between these two epidemics is underdeveloped. Transfeminine individuals continue to be of the the risk groups most severely affected by HIV in the United States. In parallel, estimated prevalence for receipt of IPV among TF range from 12% to 62%. Emergent evidence demonstrates associations between the experience of IPV among TF and the risk of HIV acquisition or participation in risk behaviors that heighten the risk of HIV (i.e. substance use), but the relationship between the experience of IPV for TF living with HIV and HIV clinical care is less understood. The overwhelming majority of evidence linking IPV and sub-optimal HIV care comes from studies of heterosexual women. A recent meta- analysis showed that women's experience of IPV was associated with 55% lower odds of self-reported adherence and 36% decreased odds of viral suppression. Studies that have looked at associations between clinical care and IPV for sexual and gender minority groups living with HIV have all been hampered by methodological limitations: cross-sectional study designs with clinic-based populations that limit the ability to draw conclusions as to how IPV affects engagement in HIV care for partnered TF living with HIV. We propose an innovative 6- month cohort study of HIV-positive TF – as a supplement to an existing cohort study of HIV positive men who have sex with men - to identify the pathways and points of intervention between IPV and HIV care for US TF. The proposed research activities include a prospective 6-month cohort of 100 HIV-positive partnered TF (>18 years) recruited online from across the US. The cohort study will employ a measure of IPV developed specifically to capture IPV as experienced by TF, and will consider the experience of IPV (victimization, perpetration and bidirectional IPV), and severity and frequency of IPV as drivers of engagement in HIV care. Biomarkers of viral load will be collected from all participants. The overall aim of the proposed activities is to provide new knowledge of how victimization or perpetration of IPV shapes engagement in HIV care and is associated with the ability to achieve and maintain viral suppression.