The Impact of Environmental and Physiological Factors on Sexual Assault and HIV

环境和生理因素对性侵犯和艾滋病毒的影响

• 批准号: 8588256
• 负责人: Jamila Kinshasa Stockman
• 金额: $ 46.76万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-16 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8588256
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Adult; Affect; African American; Age; Anal Sex; Area; Baltimore; Behavioral; Behavioral Mechanisms; Biological; Characteristics; Chronic; Clinic; Cohort Studies; Complex; Crime; Cross-Sectional Studies; Data Collection; Development; Disease; Environmental Impact; Environmental Risk Factor; Epidemiology; Evaluation; Forcible intercourse; Goals; HIV; HIV Infections; HIV risk; Health; Heterosexuals; High Risk Woman; Hydrocortisone; Immune system; Incidence; Infection; Intervention; Interview; Life; Link; Low income; Measures; Methods; Nature; Neighborhoods; Participant; Pathway interactions; Pattern; Perception; Phase; Physiological; Populations at Risk; Poverty; Predisposition; Prevention strategy; Preventive Intervention; Recording of previous events; Recruitment Activity; Reporting; Research; Research Design; Risk; Risk Behaviors; Risk Factors; Role; Salivary; Sampling; Sexual Partners; Social Environment; Stress; Surveys; United States; Unsafe Sex; Vagina; Violence; Woman; Work; base; biological adaptation to stress; cohort; contextual factors; design; experience; high risk behavior; high risk sexual behavior; hypothalamic-pituitary-adrenal axis; inner city; meetings; mortality; psychosocial; public health relevance; resilience; response; sex; sex risk; sexual assault; sexual violence; social; violence against women

DESCRIPTION (provided by applicant): Among women in the US, African Americans (AA) continue to be disproportionately affected by HIV, having the highest HIV incidence and HIV-related mortality. AA women are also disproportionately affected by forced sex, with 44% of AA women reporting rape by a partner, compared to 35% of White women. Forced sex contributes significantly to women's risk for HIV, directly when occurring with an HIV-infected partner and indirectly through participation in high risk behaviors. Neighborhood-level characteristics of the built and social environment (e.g., neighborhood disorder, poverty) have been studied as contributors to violence and HIV risk behaviors, but no studies have examined potentially modifiable environmental characteristics as contributors to forced sex specifically. Additionally, these neighborhood-level factors and forced sex experiences may result in physiological changes of the hypothalamic-pituitary-adrenal (HPA) axis-based stress response for these women, in turn influencing their risk behaviors and STI infection. However, no study has examined the isolated effect of the stress-response resulting from a history of forced sex on HIV risk behaviors and STI infection, accounting for environmental factors. The specific aims of the proposed project are to: 1) examine the association between features of the built and social environment (e.g., neighborhood disorder, norms about violence against women) and forced sex experiences and HIV risk factors; 2) determine the physiological effect of a recent or chronic history of forced sex on the stress response within the HPA axis, represented by cortisol awakening response; and 3) assess whether features of the built and social environment and physiological factors moderate the relationship between forced sex and HIV risk factors. As our fourth aim, we will qualitatively provide context for 1) the built and social environment's role in increasing one's likelihood of experiencing forced sex and 2) a woman's perception of stress related to forced sex and its relationship to HIV risk behaviors. To this end, we will recruit 400 HIV-negative AA women at increased risk for HIV from low- income health clinics in inner-city Baltimore, MD into a retrospective cohort study. By study design, at least one-third of the sample will have experienced forced sex since the age of 18 and two-thirds will not have experienced any abuse. In Phase I, participants will complete a quantitative survey and biological data collection to measure salivary cortisol levels. In Phase II, a subset of women with a history of forced sex in adulthood (n=20) will participate in qualitative in-depth interviews. To our knowledge, the proposed study is the first to evaluate the independent and combined influence of environmental factors and physiological altered HPA-axis stress response that may contribute to increased vulnerability to HIV. Because the relationship between forced sex and HIV risk can be influenced by several potentially interconnected pathways, the long term goal of our work is to inform interventions that act on those pathways, and when combined together, will not only mitigate AA women's risk for HIV but also boost their level of resilience.

描述（由申请人提供）：在美国的妇女中，非裔美国人（AA）继续受HIV的影响不成比例，HIV发病率最高和与HIV相关的死亡率。 AA妇女也受到强迫性别的影响不成比例，有44％的AA妇女报告伴侣强奸，而白人妇女中有35％。当与艾滋病毒感染的伴侣发生并间接通过参与高风险行为时，强迫性行为会对妇女的艾滋病毒风险产生重大贡献。已经研究了建筑和社会环境的邻里水平特征（例如，邻里障碍，贫困）是暴力和艾滋病毒风险行为的贡献者，但是没有研究研究了可能经过强迫性别的贡献者的潜在可修改的环境特征。此外，这些邻里水平的因素和强迫性经历可能会导致下丘脑 - 垂体 - 肾上腺肾上腺（HPA）基于轴的压力反应的生理变化，进而影响其风险行为和STI感染。但是，尚无研究检查由强迫性行为对艾滋病毒风险行为和性病感染的史产生的应激反应的孤立作用，这是对环境因素的解释。拟议项目的具体目的是：1）检查建筑环境和社会环境的特征（例如，邻里障碍，有关妇女暴力行为的规范）与强迫性经历和HIV风险因素之间的关联； 2）确定强迫性别的近期或慢性历史对HPA轴内压力反应的生理影响，以皮质醇觉醒反应为代表； 3）评估建筑和社会环境的特征以及生理因素是否适应强迫性和艾滋病毒危险因素之间的关系。作为我们的第四个目标，我们将定性地为1）建筑和社会环境在 增加自己的强迫性生活的可能性以及2）女性对强迫性行为及其与艾滋病毒风险行为的关系的看法。为此，我们将招募400名HIV阴性AA妇女，即在马里兰州巴尔的摩市中心低收入健康诊所的HIV风险增加中，成为一项回顾性队列研究。根据研究设计，自18岁和三分之二以来，至少有三分之一的样本将经历强迫性行为。在第一阶段，参与者将完成定量调查和生物数据收集，以测量唾液皮质醇水平。在第二阶段，一部分女性 成年后强迫性的历史（n = 20）将参加定性的深入访谈。到 我们的知识，拟议的研究是第一个评估环境因素的独立和综合影响以及生理改变的HPA轴应激反应，这可能导致增加对HIV的脆弱性。由于强迫性和艾滋病毒风险之间的关系可能会受到几种潜在的相互联系的途径的影响，因此我们工作的长期目标是告知对这些途径作用的干预措施，并且在合并在一起时，不仅会减轻AA女性的HIV风险，而且还会提高其弹性水平。