Partner Violence and the Reproductive Health of LBT Women

描述（由申请人提供）：使用生殖健康诊所的16-29岁年轻妇女报告的亲密伴侣暴力（IPV）发生率明显高于一般人口流行率估计数。很少有研究比较在生殖健康诊所寻求服务的性少数群体（SM）妇女（广义上定义为具有同性吸引力、同性身份和/或同性行为的妇女）和异性恋妇女在暴露于IPV和不良性健康和生殖健康方面的差异。基于人口的估计表明，SM女性在其一生中比异性恋女性更有可能经历IPV和性侵犯（SA），但需要进一步研究以了解SM女性受虐待关系的背景以及这如何影响她们的性健康和生殖健康。在本研究提出的母体研究中（Miller, R01HD064407）， 72%有男性和女性性伴侣史的女性经历过IPV，而只有男性伴侣的女性则为44%。考虑到她们暴露于IPV后，SM妇女更有可能报告最近无保护的肛交、无保护的阴道性行为、害怕拒绝性行为、终生性交易和终生性传播感染诊断。尽管有明显的需求

DESCRIPTION (provided by applicant): Young women ages 16-29 years using reproductive health clinics report significantly higher rates of intimate partner violence (IPV) compared to general population prevalence estimates. Few studies have compared differences in exposure to IPV and poor sexual and reproductive health among sexual minority (SM) women - broadly defined as women with same-sex attraction, identity, and/or behavior - and heterosexual women seeking services at reproductive health clinics. Population based estimates suggest that SM women are significantly more likely than their heterosexual counterparts to experience IPV and sexual assault (SA) over their lifetime, but further research is needed to understand the context of SM women's abusive relationships and how this impacts their sexual and reproductive health. In the parent study from which this proposed study emerges (Miller, R01HD064407), 72% of women with a history of male and female sexual partners had experienced IPV compared to 44% of women with male partners exclusively. After accounting for their exposure to IPV, SM women were more likely to report recent unprotected anal sex, recent unprotected vaginal sex, and fear of refusing sex, lifetime sex trade and lifetime STI diagnosis. Despite the clear need for comprehensive sexual and reproductive health services for SM women, previous research indicates there is provider discomfort discussing same-sex behavior or lack of knowledge regarding the health care needs of SM women, which may hinder assessment for IPV and provision of appropriate sexual and reproductive health services for this vulnerable population. This R03 expands the impact of the original parent study, which did not include specific training on the sexual and reproductive health care needs of SM women. Interviews with SM women who participated in the parent study (Aims 1 and 2; n=40) will explore 1) histories of IPV/SA and how IPV impacts sexual and reproductive health; 2) attitudes toward and perceived social norms regarding sexuality, gender, sexual orientation, and other risk behaviors with sex; 3) feedback on IPV discussion they've had with their family planning providers; and 4) experiences receiving sexual and reproductive health care. Brief surveys (n=50) and interviews (n=15) with providers from clinics who participated in the parent study will explore: 1) perceptions regarding the sexual and reproductive health needs of SM women, 2) experiences with training on health care provision for SM clients, 3) level of comfort and strategies for assessing for IPV/SA among SM clients. Findings are expected to translate directly into novel enhancements to reproductive health interventions that embed safety and harm reduction strategies to reduce IPV risk for SM women without targeting or further marginalizing this population.