The Influence of Sexual Violence and Partner Dynamics of Women's HIV Risk

描述(由申请人提供)：性暴力和艾滋病毒感染已成为妇女面临的重大和相互关联的公共卫生问题。在美国，每六名女性中就有一名曾在生活中的某个时候受到威胁或被迫进行不受欢迎的性行为；然而，这一估计代表了不同类型的伴侣。此外，四分之一的艾滋病毒/艾滋病新诊断病例发生在妇女中，其中近70%是由于异性接触。许多研究发现，女性的性暴力和艾滋病毒风险之间存在一致的关系。此外，最近的研究表明，性暴力经历发生在药物滥用和抑郁之前，表明艾滋病毒风险的开始。然而，根据暴力性行为的严重程度和频率--压力或强迫的阴道、口腔和肛门性行为--以及性暴力伴侣的类型--主要的、临时的或交换的--描述HIV性风险的可能差异的数据有限。为了解决这一研究差距，申请者将在马里兰州巴尔的摩进行一项基于社区的调查，以检验性暴力、伴侣动态、受害者物质滥用、抑郁和性艾滋病毒风险之间的相互关系。调查具体的暴力性行为与艾滋病毒风险之间的关系，考虑到暴力伴侣的类型，对于修改处理性暴力与艾滋病毒之间联系的现有干预和预防努力至关重要。这项研究的具体目的是：(1)评估性暴力的频率和严重程度对暴力性伴类型对艾滋病毒风险的影响；(2)描述女性通过暴力阴道、口腔和肛门性行为或任何暴力性行为的组合而产生的艾滋病毒风险行为的流行率；以及(3)评估受害者滥用药物和抑郁症状的相互作用，作为性暴力和艾滋病毒风险之间关系的潜在中介。女性参与者目前将参加由NIMH赞助的马里兰州巴尔的摩的艾滋病毒预防干预研究。在为期12个月的访问中，一份使用音频计算机辅助自访技术的标准化问卷将从350名参与者那里收集有关性暴力经历、性活动、抑郁、药物滥用和其他行为特征的信息。性暴力行为将使用暴力侵害妇女行为严重程度量表的修订版进行评估，这是一个经过验证和确定的工具。将使用Logistic回归和结构方程模型来检验拟议的目标。国家研究优先事项支持致力于评估性暴力在一生中对健康造成的后果的研究。确认性暴力和暴力伴侣类型如何影响艾滋病毒感染率，将使预防计划能够改变中介行为，并最终改变个人艾滋病毒风险。

DESCRIPTION (provided by applicant): Sexual violence and HIV infection have emerged as significant and interrelated public health problems facing women. In the United States, one of every six women has been threatened or forced into an unwanted sex act sometime in her life; however, this estimate represents a spectrum of partner types. In addition, a quarter of new HIV/AIDS diagnoses occur among women, with almost 70% due to heterosexual contact. Numerous studies found a consistent relationship between sexual violence and HIV risk in women. Also, recent research showed that sexually violent experiences occur prior to substance abuse and depression indicating an initiation of HIV risk. However, limited data exist to delineate possible differences in HIV sexual risk based on the severity and frequency of violent sex acts - pressured or forced vaginal, oral, and anal sex - and type of sexually violent partner - main, casual, or exchange. To address this gap in research, the applicant will conduct a community-based survey in Baltimore, Maryland to examine the interrelationships of sexual violence, partner dynamics, victim substance abuse, depression, and sexual HIV risk. Investigating the relationship between specific violent sex acts and HIV risk, accounting for types of violent partners, is critical to modify existing intervention and prevention efforts addressing the linkage between sexual violence and HIV. Specific aims of the research are to: (1) assess the impact of frequency and severity of sexual violence on HIV risk by type of violent sex partner; (2) describe the prevalence of women's HIV risk behaviors by violent vaginal, oral, and anal sex acts or a combination of any violent sex acts; and (3) evaluate the interaction of victim substance abuse and depressive symptoms as potential mediators in the relationship between sexual violence and HIV risk. Female participants will be currently enrolled in an NIMH sponsored HIV prevention intervention study in Baltimore, Maryland. A standardized questionnaire using audio computer-assisted self-interview techniques will collect information from 350 participants about sexual violence experiences, sexual activity, depression, substance abuse, and other behavioral characteristics at the 12-month visit. Sexual violence will be assessed using a modified version of the Severity of Violence Against Women Scale, a validated and established instrument. Logistic regression and structural equation modeling will be used to examine the proposed aims. National research priorities support research dedicated to evaluating the health consequences of sexual violence across the lifespan. Identifying how sexual violence and violent partner type can impact HIV rates will allow for prevention programs that can alter mediating behaviors and ultimately individual HIV risk.