Intimate Partner Violence and HIV Prevention among Sexual Minority Men

摘要/摘要 性少数男性(SMM)经历亲密伴侣暴力(IPV)的比率令人震惊。先前的工作已将IPV SMM中的性行为风险和艾滋病毒血清转换风险增加，但对 IPV对艾滋病毒和性传播感染(STI)检测/获取、暴露前预防(PrEP)的影响 在SMM中使用PrEP的持久性。虽然这些发现揭示了IPV具有潜在的 尽管IPV对预防艾滋病毒有很强的有害作用，但不同的SMM之间IPV的经历是如此不同(例如，频率， 严肃性；稳定的关系与临时的关系；相互实施与只实施或接受暴力；性与 身体暴力与心理暴力)，需要进一步的研究来揭示两者之间的总体联系 在制定有效的干预措施之前，应考虑到IPV和艾滋病毒的风险。由一个结合了 合并论和少数民族压力理论，拟议的创新观察队列研究将检验 实施和/或接受各种形式的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的HIV风险和保护行为 在24个月的时间范围内：1.检查IPV与艾滋病毒检测的纵向联系，PrEP 摄取、PrEP持续、性传播感染诊断、无套肛交和HIV血清转换。2.确定 结构和个人层面以及可能缓冲或放大IPV之间关联的弹性和风险因素 以及这些艾滋病毒风险和保护行为。3.确定SMM的特征、他们的亲密伴侣以及 用来调节或缓和IPV对艾滋病毒风险和保护行为的影响的关系动态。4. 根据以下数据为中断IPV和HIV风险之间的通路的干预措施提供建议 来自队列的定量数据，以及由技术专家指导的定性数据。我们将评估性风险 在24个月的随访中，进行艾滋病毒和性传播感染检测，并评估PrEP的摄入量和持久性。 我们假设，IPV的更高频率将与儿童虐待史、精神健康相关 问题、药物使用、性风险和较低水平的艾滋病毒检测、PrEP摄取率和PrEP持久度。 我们预计，参与者及其伴侣之间的酒精和物质使用将与 IPV事件(受害和实施)和艾滋病毒危险行为。我们还假设应对 技能和社会支持将缓和IPV对危险行为、艾滋病毒检测、PrEP感染和PrEP的影响 坚持不懈。拟议的研究将加深我们对以下相关风险和恢复能力因素的了解 预防和减少IPV，减少与IPV相关的危险行为，增加艾滋病毒防护行为 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.