Intimate Partner Violence and HIV Prevention among Sexual Minority Men

总结/摘要 性少数男性（SMM）经历亲密伴侣暴力（IPV）的速度令人震惊。之前的工作已经将IPV 性冒险行为和SMM中HIV血清转化的风险增加，但对 IPV对艾滋病毒和性传播感染（STI）检测/获得、暴露前预防（PrEP）的影响 吸收，以及SMM中PrEP使用的持续性。虽然这些发现揭示了IPV具有潜在的 对HIV预防的强烈有害作用，IPV的经历在SMM中如此不同（例如，频率， 严重性;稳定与偶然的伙伴关系;相互实施与仅仅实施或接受暴力;性与 身体暴力与心理暴力），需要更多的研究来揭示 IPV和艾滋病毒的风险之前，可以制定有效的干预措施。在一个框架的指导下， 综合征和少数民族压力理论，拟议的创新观察性队列研究将研究如何 实施和/或接收各种形式的IPV（例如，身体、性和心理;在 稳定或随意的亲密关系）有助于HIV阴性SMM中HIV风险和保护行为 在24个月的时间范围内，以便：1。检查IPV与HIV检测的纵向关联，PrEP 摄取、PrEP持续性、STI诊断、无避孕套肛交和HIV血清转化。2.确定 结构和个人层面以及弹性和风险因素，可能缓冲或放大IPV之间的关联 这些艾滋病风险和保护行为。3.确定SMM的特征，他们的亲密伙伴， 关系动态，用于调解或缓和IPV对HIV风险和保护行为的影响。4. 根据以下情况，提出干预措施的建议，中断IPV和艾滋病毒风险之间的途径 来自队列的定量数据和技术专家指导的定性数据。我们将评估性风险 行为，进行艾滋病毒和性传播感染检测，并评估在24个月的随访中PrEP的吸收和持续性。 我们假设IPV的发生频率更高与儿童期虐待史、心理健康、 问题，物质使用，性风险和较低水平的艾滋病毒检测，PrEP吸收和PrEP持久性。 我们预计，参与者及其伴侣的酒精和物质使用将与以下因素高度相关： IPV事件（受害和犯罪）和HIV风险行为。我们还假设应对 技能和社会支持将缓和IPV对风险行为、HIV检测、PrEP吸收和PrEP的影响 持久性。拟议的研究将促进我们对与以下方面相关的风险和弹性因素的理解： 预防和减少IPV，减少IPV相关的危险行为，增加HIV保护行为 在SMM中。这项研究将为IPV、艾滋病毒和药物滥用的发展和适应提供信息 对SMM的干预。

SUMMARY/ABSTRACT Sexual minority men (SMM) experience intimate partner violence (IPV) at alarming rates. Prior work has linked IPV to sexual risk-taking behavior and increased risk for HIV seroconversion among SMM, but less is known about the impact of IPV on HIV and sexually transmitted infection (STI) testing/acquisition, pre-exposure prophylaxis (PrEP) uptake, and the persistence of PrEP use among SMM. While these findings reveal the potential for IPV to have a strong deleterious effect on HIV prevention, experiences of IPV are so varied among SMM (e.g., frequency, severity; steady vs. casual partnerships; mutual perpetration vs. only perpetrating or receiving violence; sexual vs. physical vs. psychological violence) that additional research is needed to unpack the overall association between IPV and HIV risk before effective interventions can be developed. Guided by a framework that combines the Syndemics and Minority Stress theories, the proposed innovative observational cohort study will examine how perpetration and/or receipt of various forms of IPV (e.g., physical, sexual, and psychological; in the context of steady or casual intimate relationships) contribute to HIV risk and protective behaviors among HIV-negative SMM over a 24-month timeframe in order to: 1. Examine the longitudinal associations of IPV with HIV testing, PrEP uptake, PrEP persistence, STI diagnosis, condomless anal sex, and HIV seroconversion. 2. Determine the structural- and individual-level and resilience and risk factors that may buffer or amplify associations between IPV and these HIV risk and protective behaviors. 3. Identify the characteristics of SMM, their intimate partners, and the relationship dynamics that serve to mediate or moderate the impact of IPV on HIV risk and protective behaviors. 4. Make recommendations for interventions that interrupt the pathways between IPV and HIV risk based on quantitative data from the cohort, and qualitative data guided by technical experts. We will assess sexual risk behavior, conduct HIV and STI testing, and assess PrEP uptake and persistence over the 24 months of follow-up. We hypothesize that greater frequency of IPV will be associated with history of childhood abuse, mental health problems, substance use, sexual risk taking and lower levels of HIV testing, PrEP uptake, and PrEP persistence. We anticipate that alcohol and substance use among participants and their partners will be highly associated with episodes of IPV (both victimization and perpetration) and with HIV risk behavior. We also hypothesize that coping skills and social support will moderate the effects of IPV on risk behavior, HIV testing, PrEP uptake, and PrEP persistence. The proposed study will advance our understanding of both the risk and resiliency factors relevant to preventing and reducing IPV, reducing IPV-associated risk behaviors, and increasing HIV protective behaviors among SMM. This research will inform the development and adaptation of IPV, HIV, and substance abuse interventions for SMM.