Impact of Violence and Power on a HIV Behavioral Intervention for Female MA Users

描述(由申请人提供)：拟议的科学家指导职业发展奖(K01)的目的是为候选人提供指导和研究经验，促进她作为一名独立研究人员的发展，特别是在吸毒人群中混合方法艾滋病毒干预研究领域。培训的目的是发展以下方面的知识和技能：1)药物滥用流行病学、评估和预防，了解亲密伴侣暴力如何影响吸毒人群和随后的艾滋病毒/性传播感染风险；2)理论驱动的行为艾滋病毒预防干预措施；3)混合方法研究，特别是与艾滋病毒干预措施有关的研究；以及4)结构方程模型等高级统计数据。培训活动将包括授课课程和具体的研讨会，定向阅读和与导师的一对一辅导，以及负责任的研究行为指导。候选人将接受一个培训委员会的指导，该委员会由加州大学圣地亚哥分校药物滥用、行为干预和混合方法研究领域的全国知名专家组成。这项拟议研究的具体目的是：1)评估最近IPV和性关系权力差异对HIV阴性异性甲基苯丙胺(MA)-使用艾滋病毒行为干预措施的女性-的性危险行为的影响；2)检查认知中介因素(例如避孕套使用自我效能和结果预期)是否中介最近IPV与性关系权力和性危险行为之间的关系；以及3)定性描述IPV和性关系权力差异如何影响在参与HIV行为干预期间和之后实施更安全的性行为。研究目的将通过进行混合方法的艾滋病毒干预研究来实现。定量数据将来自一项旨在减少性危险行为、MA使用和抑郁症状(FASTLANE2，PI：Patterson)的HIV预防干预研究干预组中登记的100名使用MA的女性的不同种族样本。定性数据将来自对FASTLANE2研究中使用MA的30名女性的深入访谈，报告IPV和不同的性关系权力差异。拟议研究的结果将使候选人能够提出R34或R01提案，以试点测试一种理论驱动的、混合方法的行为艾滋病毒预防干预措施，该干预措施在女性控制的障碍方法和赋权的背景下解决吸毒妇女的多种风险。此外，候选人的少数民族背景与拟议的培训和研究相结合，将支持专注于弱势、未得到充分服务的艾滋病毒风险人群的职业轨迹，同时成为代表性不足妇女的有影响力的导师。 与公共健康相关：女性甲基苯丙胺吸毒者往往面临多种风险，包括亲密伴侣暴力、关系权力差异、性伴侣之间因共享药物而发生冲突以及精神疾病；然而，没有关于同时解决基于性别的问题、艾滋病毒和药物使用的干预措施的最佳做法证据。拟议研究的结果将对开发、实施和评估理论驱动的混合方法艾滋病毒行为干预措施至关重要，这些干预措施在女性赋权的背景下解决吸毒妇女面临的多种风险。此外，培养混合方法艾滋病毒干预研究的技能将使候选人成为少数几位在性别暴力研究中具有将混合方法应用于以吸毒人群为重点的艾滋病毒干预措施的专门知识的流行病学家之一。

DESCRIPTION (provided by applicant): The purpose of the proposed Mentored Scientist Career Development Award (K01) is to provide the candidate with mentoring and research experiences that will promote her development as an independent researcher, with particular emphasis in the field of mixed methods HIV intervention research in drug-using populations. Objectives of the training are to develop knowledge and skills in: 1) substance abuse epidemiology, assessment and prevention, to understand how intimate partner violence (IPV) affects drug-using populations and the subsequent risk for HIV/STIs; 2) theoretically-driven behavioral HIV prevention interventions; 3) mixed methods research, specifically related to HIV interventions; and 4) advanced statistics such as structural equation modeling. Training activities will include didactic coursework and specific workshops, directed readings and one-on-one tutorials with mentors, and instruction in the responsible conduct of research. The candidate will receive mentorship from a Training Committee comprised of nationally renowned experts in the fields of substance abuse, behavioral interventions, and mixed methodology research at the University of California, San Diego. The specific aims of the proposed research are to: 1) assess the effect of recent IPV and sexual relationship power differentials on the sexual risk behaviors of HIV-negative heterosexual methamphetamine (MA)-using women enrolled in the intervention arm of an HIV behavioral intervention; 2) examine whether cognitive mediators (e.g., condom use self-efficacy and outcome expectancies) mediate the relationship between recent IPV and sexual relationship power and sexual risk behaviors; and 3) qualitatively characterize how the context of IPV and sexual relationship power differentials affect the implementation of safer sex behaviors during and after participation in the HIV behavioral intervention. The research aims will be accomplished by conducting a mixed methods HIV intervention study. Quantitative data will come from an ethnically diverse sample of 100 MA-using women enrolled in the intervention group of an HIV prevention intervention study designed to reduce sexual risk behaviors, MA use, and depressive symptoms (FASTLANE2, PI: Patterson). Qualitative data will come from in-depth interviews of a subsample of 30 MA-using women enrolled in the FASTLANE2 study, reporting IPV and varying sexual relationship power differentials. Findings from the proposed research will position the candidate to propose an R34 or R01 proposal to pilot test a theoretically-driven, mixed methods behavioral HIV prevention intervention that addresses the multiplicity of risks among drug-using women in the context of female-controlled barrier methods and empowerment. Moreover, the candidate's ethnic minority background combined with the proposed training and research will support a career trajectory focused on vulnerable, underserved populations at risk for HIV while becoming an influential mentor to underrepresented women. PUBLIC HEALTH RELEVANCE: Female methamphetamine users often experience a multiplicity of risks including, intimate partner violence, relationship power differentials, conflict between sex partners over sharing of drugs, and mental illness; yet, there is no best practice evidence on interventions that concurrently address gender-based issues, HIV and drug use. Findings from the proposed research will be critical to the development, implementation, and evaluation of theoretically-driven, mixed methods HIV behavioral interventions that address the multiplicity of risks faced by drug-using women, in the context of female empowerment. Further, developing skills in mixed methods HIV intervention research will uniquely position the candidate as one of only a handful of epidemiologists in gender-based violence research with expertise in applying mixed methodology to HIV interventions focused on drug-using populations.