A Mixed-Methods Study of Socio-Ecological Resilience Among Young ACE-Exposed Women in South Africa

摘要 年轻的南非(SA)妇女，一个不成比例地受到艾滋病毒影响的人群，通常遭受不利的 童年经历(A)。这些童年创伤与艾滋病毒危险行为呈正相关。 研究表明，ACE在年轻人中共同出现，并创造了累积风险暴露的生活轨迹。尽管 ACEs在SA女性中的普遍存在，但检查ACEs影响的数据有限 它们如何影响SA妇女的艾滋病毒预防行为。社会生态复原力-概念化为重新- 在个人、人际和社区层面促进积极适应的来源 创伤-提供了一种基于强度的方法来检查这些保护性决定因素如何缓冲负面影响 ACEs恶化年轻女性性危险行为和参与艾滋病毒预防工作的影响 影响艾滋病毒发病率的克数。这项研究与美国国立卫生研究院的艾滋病毒和艾滋病毒相关战略计划相一致 研究优先领域，利用行为和社会科学来洞察个人的行为和 其影响艾滋病毒和艾滋病毒预防干预措施的背景。这项研究将应用社会生态学 探索抗击ACE对艾滋病毒的负面累积影响的保护性复原力因素框架 青年SA妇女从青春期过渡到成年期的预防行为。支持- 提出的混合方法研究将使用来自共同赞助者的NIMH R01，HIV的多水平机制的数据 在年轻的SA女性中的收购。这项研究的具体目的是：1)确定社会生态环境的影响 经历过A级交易性行为的年轻SA女性的逻辑弹性，以及 利用艾滋病毒预防和避孕保健服务；2)说明年轻的南非妇女如何 设置为王牌，了解并体验跨多个社会生态级别的恢复能力，以导航和 谈判性伙伴关系以及避孕和艾滋病毒预防服务的利用，通过使用Pho- TO VOICE，一种参与性的定性研究方法；以及3)探索趋同和分歧的结果 目标是开发创伤信息复原力干预措施，以加强艾滋病毒的联合预防 通过整合来自AIMS 1和AIMS 2的数据，计划。拟议的奖学金将建立在申请者之前的重新申请- 通过支持他们作为混合方法全球卫生研究人员的培训来获得搜索体验。特定的列车- 该奖学金的目标是：1)发展申请者在社会生态复原力方面的理论基础 和创伤知情护理适用于接触ACE的年轻女性；2)增加申请者的数量 管理数据，分析、解释和展示统计模型的结果的技能；3)深化统计模型的应用 Cant在定性和参与性研究技能方面的专业知识；4)扩大申请者的综合能力 提供定量和定性数据并提出混合方法研究结果；5)推进申请人的 手稿开发技能和文笔技巧。这些活动将支持申请者实现以下目标： 即将成为一名终身制艾滋病毒预防混合方法调查员，专门研究青春期妇女的健康。

ABSTRACT Young South African (SA) women, a population disproportionately impacted by HIV, commonly suffer adverse childhood experiences (ACEs). These childhood traumas are positively associated with HIV risk behaviors. Studies show that ACEs co-occur in youth and create life trajectories of cumulative risk exposures. Despite the pervasiveness of ACEs among SA women, there is limited data examining the effects of ACEs broadly and how they impact SA women’s HIV prevention behaviors. Socio-ecological resilience—conceptualized as re- sources at the individual, interpersonal and community levels that facilitate positive adaptation in response to trauma—offers a strengths-based approach to examine how these protective determinants buffer the negative impacts of ACEs that worsen young women’s sexual risk behaviors and engagement with HIV prevention pro- grams that impact HIV incidence. This research aligns with the NIH’s Strategic Plan for HIV and HIV-Related Research priority area to use behavioral and social science to gain insights about individuals’ behaviors and their contexts that influence HIV and HIV prevention interventions. The study will apply a social ecological framework to explore protective resilience factors that counter the negative cumulative effects of ACEs on HIV prevention behaviors among young SA women as they transition from adolescence to adulthood. The pro- posed mixed methods research will use data from the co-sponsor’s NIMH R01, Multilevel Mechanisms of HIV Acquisition in Young SA Women. The specific aims of this study are to: 1) Determine the effects of socio-eco- logical resilience in young SA women who have experienced ACEs on their transactional sex behaviors, and utilization of HIV prevention and contraceptive health services; 2) Contextualize how young SA women ex- posed to ACEs understand and experience resilience across multiple socio-ecological levels to navigate and negotiate sexual partnerships, and utilization of contraceptive and HIV prevention services, by using Pho- tovoice, a participatory qualitative research methodology; and 3) Explore convergent and divergent findings with the goal of developing trauma-informed resilience interventions to reinforce combination HIV prevention programs by integrating data from Aims 1 and 2. The proposed fellowship will build on the applicant’s prior re- search experience by supporting their training as a mixed methods global health researcher. The specific train- ing goals of this fellowship are to: 1) Develop the applicant’s theoretical grounding in socio-ecological resilience and trauma-informed care as applied to young ACE-exposed women; 2) Increase the applicant’s quantitative skills to manage data, and analyze, interpret, and present results of statistical models; 3) Deepen the appli- cant’s expertise in qualitative and participatory research skills; 4) Expand the applicant’s capacity to integrate quantitative and qualitative data and present mixed methods research findings; and 5) Advance the applicant’s skills in manuscript development and grantsmanship. These activities will support the applicant’s goal of be- coming a tenure-track HIV prevention mixed methods investigator specializing in adolescent women’s health.