DESCRIPTION (provided by applicant): The proposed mixed-methods study aims to examine the complex relationship between intimate partner violence (IPV) and reproductive coercion, mental health and HIV treatment adherence and disease progression. Pathways including substance abuse, depression and post-traumatic stress disorder will be examined. Women will be recruited from an urban HIV clinic that serves a primarily low income, African American population. African American women are disproportionally affected by the intertwined epidemics of HIV, violence and substance abuse. Phase 1 of the study will include quantitative data regarding past year, IPV, reproductive coercion, PTSD symptoms, depressive symptoms, substance abuse, and HIV medication adherence collected from eligible women. Participant's medical records will be reviewed to obtain biologic markers of disease progression and medication adherence (CD4 count and viral load) as well as covariates related to HIV disease progression (hospitalizations, opportunistic infections) and verification of mental health related diagnoses (PTSD, depression, substance abuse). Prevalence of IPV and reproductive coercion will be estimated, prior to examining the direct and mediated effects of IPV and reproductive coercion on HIV disease progression and treatment adherence (CD4 counts, viral load and missed clinic visits). Following analysis of Phase 1 data, a subsample of women will be purposefully selected for Phase 2 qualitative interviews. The aim of these qualitative interviews is to explore women's perceptions on IPV and reproductive coercion and the role in adherence and disease progression. The findings from the proposed study will be used to inform culturally competent interventions to reduce health disparities among urban, HIV positive women.

The overall career goal of the applicant is to contribute to the evidence needed to reduce disparities in health outcomes for urban women, with a specific focus on African American women who are HIV positive. This study proposes to build on existing evidence on HIV care and treatment adherence among urban, HIV positive women.