Intimate Partner Violence and HIV Prevention Continuum Engagement Among Transgender and Nonbinary Populations

摘要/摘要 变性人和非双性人(TGNB)经历亲密伴侣暴力(IPV)的比率是 他们的顺性同龄人。先前的研究已经将IPV与性危险行为和增加艾滋病毒血清转换的风险联系起来 在TGNB中，但对IPV对艾滋病毒和性传播感染(STI)检测的影响知之甚少 暴露预防(PrEP)在TGNB中的吸收和持久性。虽然过去的研究结果表明IPV有可能 对艾滋病毒预防的持续参与、IPV经验和影响产生强烈的有害影响 艾滋病毒/性传播感染的风险和预防行为尚未在不同的TGNB人群中进行研究。其他内容 目前需要研究来为跨性女性亚群(Tf)、TRAN亚群的IPV和HIV风险之间的途径建模 男性(TM)和性别非二进制(GNB)者。由一个结合了Syndemic和 少数应激理论，拟议的创新观察队列研究将检查特定形式的IPV (例如，身体、性、情感、控制性别表达和/或转变)在稳定或随意的背景下 亲密关系对TGNB人群中HIV/STI风险和防护行为的影响 24个月的时间框架。具体地说，我们的目标是：1.使用定性方法，探索感知到的关联 不同性别间IPV、关系特征和动态与HIV风险和预防行为的关系 不同的TGNB人。2.审查IPV与艾滋病毒检测之间纵向联系的性别差异， PREP摄取、PrEP持续、性传播感染诊断(主要结果)、无避孕套性行为和HIV血清转换 (次要结果)在不同种族和族裔的TGNB人群中(TF、TM和GNB群体)。3. 确定个人、人际、网络、社区和结构级别的风险和复原力因素 调解(或缓和)IPV与HIV风险之间的关联以及每个群体的保护行为。4.制作 根据定量数据，对中断IPV和HIV/STI风险之间的途径的干预措施提出建议 来自队列的数据和定性数据，由技术专家指导。我们将评估性风险行为、行为 HIV和STI检测，并在24个月的随访中评估PrEP的摄取和持久性。我们假设 IPV对HIV/STI风险的频率、严重性和总体影响在不同的亚组之间将有所不同 TGNB人员。我们还怀疑IPV的更高频率将与儿童期虐待、精神虐待、 健康问题、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持久率。 我们预计，参与者及其伴侣之间的酒精和物质使用将与 有IPV和HIV危险行为的发作。我们还假设，性别肯定的经历、应对技能 社会支持将在IPV对危险行为、HIV检测、PrEP感染和PrEP持久性的影响中起中介作用。 拟议的研究将增进我们对与预防和恢复能力有关的风险和复原力因素的了解 降低IPV，减少IPV相关危险行为，增加不同TGNB的HIV保护行为 人。这项研究将为IPV、艾滋病毒和药物滥用干预措施的发展和适应提供信息 适用于TGNB人员。

SUMMARY/ABSTRACT Transgender and non-binary (TGNB) persons experience intimate partner violence (IPV) at alarming rates twice that of their cisgender peers. Prior work has linked IPV to sexual risk behavior and increased risk for HIV seroconversion among TGNB, but less is known about the impact of IPV on HIV and sexually transmitted infection (STI) testing, pre- exposure prophylaxis (PrEP) uptake, and persistence among TGNB. While past findings suggest the potential for IPV to have a strong deleterious effect on HIV prevention continuum engagement, IPV experiences and impacts on HIV/STI risk and prevention behaviors have yet to studied among a diverse group of TGNB persons. Additional research is currently needed to model pathways between IPV and HIV risk for subgroups of trans feminine (TF), trans masculine (TM), and gender non-binary (GNB) persons. Guided by a framework that combines Syndemic and Minority Stress Theory, the proposed innovative observational cohort study will examine how specific forms of IPV (e.g., physical, sexual, emotional, controlling gender expression and/or transition) in the context of steady or casual intimate relationships contribute to HIV/STI risk and protective behaviors among subgroups of TGNB persons over a 24-month timeframe. Specifically, we aim to: 1. Using qualitative methodologies, explore the perceived associations between IPV, relationship characteristics and dynamics, and HIV risk and prevention behaviors among gender diverse TGNB persons. 2. Examine gender-based differences in the longitudinal associations of IPV with HIV testing, PrEP uptake, PrEP persistence, STI diagnosis (primary outcomes), condomless sex, and HIV seroconversion (secondary outcomes) among a racially and ethnically diverse cohort of TGNB persons (TF, TM, and GNB groups). 3. Determine the individual-, interpersonal-, network-, community-, and structural-level risk and resilience factors that mediate (or moderate) the associations between IPV and HIV risk and protective behaviors for each group. 4. Make recommendations for interventions that interrupt the pathways between IPV and HIV/STI 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 there will be differences in the frequency, severity, and overall impact of IPV on HIV/STI risk among subgroups of TGNB persons. We also suspect 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 and with HIV risk behavior. We also hypothesize that experiences of gender affirmation, coping skills and social support will mediate 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 diverse TGNB persons. This research will inform the development and adaptation of IPV, HIV, and substance abuse interventions for TGNB persons.