Examining stress, sexual experiences and neighborhood correlates of HIV risk among African American women

Eunice Kennedy Shriver National Institute on Child Health and Human Development (#R01HD077891)

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 and STI infection, accounting for environmental factors.

Meet the Investigators

?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.

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