Neighborhood Factors, Sexual Risk, and STIs in HIV-Infected and High-Risk Women

描述(由申请人提供)：美国南部的艾滋病毒和性传播感染(STI)负担不成比例。该区域感染艾滋病毒的妇女与艾滋病毒有关的发病率和死亡率较高。对于感染艾滋病毒的妇女来说，性传播感染可能会增加发病率，并促进艾滋病毒向性伴侣传播。社会和建筑环境的特点，如贫困程度高和男女性别比低，与艾滋病毒/性传播感染和未感染艾滋病毒的人群中的性危险行为有关。然而，没有多水平的研究在以艾滋病毒感染为主的队列中探索这些关系。目前尚不清楚社区特征如何影响艾滋病毒携带者的性风险，并造成获得性传播疾病的脆弱性。 通过将女性机构间艾滋病毒研究(WIHS)数据与行政来源(如美国人口普查)的数据相结合，这项拟议的研究将首次使用纵向、多水平设计来调查居住在美国南部的以艾滋病毒感染为主的女性队列中社区环境与性危险行为和性传播感染的关系。具体目标是：1.在南方临床研究站点(CRSS)筛查WIHS的HIV感染妇女中，检查社区特征(即经济劣势、居住不稳定、男女性别比、性传播感染患病率、社交障碍)与性危险行为(即最近一次阴道和肛门性行为中性伴的HIV状况、性伴侣风险)之间的横断面关系，并调查在HIV阳性妇女中发现的邻居特征与性危险行为之间的关系是否类似于高危未感染HIV妇女。苏巴伊姆1a。探讨集体效能(如中介者、调和者)在社交障碍和性危险行为之间的关系中的作用。目的2.评估在南方CRSS WIHS登记的HIV感染女性中，社区特征的变化与性危险行为(即无保护的阴道和肛门性行为，最近一次阴道和肛门性行为的HIV状况，性伴侣数量)随时间的变化之间的关系，并调查在HIV阳性女性中发现的社区特征与性危险行为之间的关系是否与高危HIV感染女性相似。目的3.评估在南方CRSS WIHS登记的HIV感染妇女中，随着时间的推移，社区特征的变化与阴道毛滴虫检测阳性概率的变化之间的关系，并调查在HIV阳性妇女中发现的社区特征与STI之间的关系是否类似于高危HIV未感染妇女。 拟议的分析以社会生态学框架和社会混乱和集体效能理论为基础，将增进我们对社区特征如何随着时间的推移影响南部艾滋病毒感染和高危未感染妇女的性危险行为和性传播感染的了解。

DESCRIPTION (provided by applicant): The Southern United States (US) bears a disproportionate burden of HIV and sexually transmitted infections (STIs). HIV-infected women in this region experience higher rates of HIV-related morbidity and mortality. For HIV-infected women, STI infection may increase morbidity and facilitate HIV transmission to sex partners. Features of the social and built environment, such as high levels of poverty and low male:female sex ratios, are associated with HIV/STIs and sexual risk behaviors among HIV-uninfected populations. However, no multilevel studies have explored these relationships in a predominantly HIV-infected cohort. It is unclear how neighborhood characteristics influence sexual risk and create vulnerability to STI acquistion for people living with HIV. By integrating Women's Interagency HIV Study (WIHS) data with data from administrative sources (e.g., US Census), the proposed study will be the first to use a longitudinal, multilevel design to investigate relationships of neighborhood contexts to sexual risk behavior and STIs in a predominantly HIV-infected cohort of women living in the Southern US. The specific aims are: Aim 1. Examine cross-sectional associations between neighborhood characteristics (i.e., economic disadvantage, residential instability, male:female sex ratios, STI prevalence, social disorder) and sexual risk behaviors (i.e., HIV status of sex partner at most recent vaginal and anal sex, partner risk) among HIV-infected women screened for WIHS at the Southern Clinical Research Sites (CRSs), and investigate whether the associations between neighborhood characteristics and sexual risk behaviors that are found for HIV-positive women are similar for high-risk HIV-uninfected women. Subaim 1a. Explore the role of collective efficacy (e.g., mediator, moderator) in the relationships between social disorder and sexual risk behaviors. Aim 2. Assess the relationships between changes in neighborhood characteristics and changes in sexual risk behaviors (i.e., unprotected vaginal and anal sex, HIV status of partner at most recent vaginal and anal sex, number of sexual partners) over time among HIV-infected women enrolled in WIHS at the Southern CRSs, and investigate whether the associations between neighborhood characteristics and sexual risk behaviors that are found for HIV-positive women are similar for high-risk HIV-uninfected women. Aim 3. Assess the relationships between changes in neighborhood characteristics to changes in the probability of testing positive for trichomonas vaginalis over time among HIV-infected women enrolled in WIHS at the Southern CRSs, and investigate whether the associations between neighborhood characteristics and STIs that are found for HIV-positive women are similar are similar for high-risk HIV-uninfected women. The proposed analyses are informed by the Socioecological Framework and the Theories of Social Disorder and Collective Efficacy, and will advance our knowledge of how neighborhood-level characteristics influence sexual risk behavior and STIs over time among HIV-infected and high-risk uninfected women in the South.