Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC.
Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT.
J Acquir Immune Defic Syndr. 2022 Jul 1;90(3):283-290. doi: 10.1097/QAI.0000000000002956.
HIV pre-exposure prophylaxis (PrEP) is an effective HIV prevention method for women experiencing intimate partner violence (IPV). This study aimed to examine (1) relationships between physical, sexual, and psychological IPV and women's PrEP communication with a health care provider and domestic violence advocate; and (2) how IPV-specific medical mistrust modifies the association between IPV and PrEP communication.
Data were from 2 studies conducted in Connecticut and Baltimore, MD on adult women experiencing IPV (N = 272). Logistic regressions examined associations between IPV, PrEP communication, and IPV-specific medical mistrust.
The average age was 25.7. The most common identity was non-Hispanic black (37.1%), followed by non-Hispanic white (33.8%), Hispanic (20.6%), and non-Hispanic another racial group (8.5%). Higher severity of psychological IPV was associated with more embarrassment to initiate a PrEP discussion with a health care provider (P = 0.009) or domestic violence advocate (P = 0.026). However, women with more severe psychological IPV were more willing to accept a PrEP recommendation from a health care provider (P = 0.033) or domestic violence advocate (P = 0.044). IPV-specific medical mistrust modified the association between physical IPV and willingness to accept a PrEP recommendation by a domestic violence advocate, such that women with physical IPV were significantly less likely to accept a PrEP recommendation by a domestic violence advocate, but only for women with high IPV-specific medical mistrust (P = 0.021).
PrEP initiation among women experiencing IPV may be strengthened by addressing and dismantling systems that perpetuate IPV-specific medical mistrust and stigma against IPV survivors.
艾滋病毒暴露前预防（PrEP）是一种针对经历亲密伴侣暴力（IPV）的女性的有效艾滋病毒预防方法。本研究旨在检验：（1）身体、性和心理 IPV 与妇女与医疗保健提供者和家庭暴力倡导者进行 PrEP 沟通之间的关系；以及（2）IPV 特定的医疗不信任如何改变 IPV 与 PrEP 沟通之间的关联。
数据来自康涅狄格州和马里兰州巴尔的摩市的两项针对经历 IPV 的成年女性的研究（N=272）。逻辑回归检验了 IPV、PrEP 沟通和 IPV 特定的医疗不信任之间的关联。
平均年龄为 25.7 岁。最常见的身份是非西班牙裔黑人（37.1%），其次是非西班牙裔白人（33.8%）、西班牙裔（20.6%）和非西班牙裔其他种族群体（8.5%）。更严重的心理 IPV 与更不愿意与医疗保健提供者（P=0.009）或家庭暴力倡导者（P=0.026）开始 PrEP 讨论有关。然而，心理 IPV 更严重的女性更愿意接受医疗保健提供者（P=0.033）或家庭暴力倡导者（P=0.044）的 PrEP 推荐。IPV 特定的医疗不信任改变了身体 IPV 与接受家庭暴力倡导者推荐 PrEP 的意愿之间的关联，以至于身体 IPV 的女性接受家庭暴力倡导者推荐 PrEP 的可能性显著降低，但仅在具有高度 IPV 特定医疗不信任的女性中（P=0.021）。
通过解决和消除加剧 IPV 特定医疗不信任和对 IPV 幸存者污名化的系统，可能会加强经历 IPV 的女性启动 PrEP。
