African-American women are the fastest growing population contracting Human Immunodeficiency Virus (HIV). Infection is commonly in the context of heterosexual intercourse with unsafe sexual practices and is independent of psychiatric diagnosis or substance dependence co-morbidity. A history of childhood sexual abuse (CSA) has been linked to increased risk of. HIV infection, with increasing intensity and chronicity of abuse associated with increasing risk. Imaging studies examining effects of stress have identified the medial prefrental cortex, hippocampus, and amygdala (medial temporal lobe) as brain regions that are particularly' vulnerable. Importantly, these are areas associated with emotion, memory or decision processing. The goal of the proposed studies is to test the hypothesis that childhood sexual abuse, especially in African-American women, leads to sustained changes in neural circuits even as adults and that these changes predispose sexually abused women to impaired decision making when making choices regarding unsafe sexual behaviors. This hypothesis will be tested by: 1) rigorous clinical description of adult African American and Caucasian women self reported to have experienced CSA;2) psychological assessment of executive decision making with the Stroop Test, the Emotional Stroop Test, and the Iowa Gambling Task;3) functional magnetic resonance imaging (fMRI) of the decision-making and behavioral inhibition neural circuits activated by provocation with the Stroop Test, Emotional Stroop, Iowa Gambling Task;and 4) correlation of the objective CSA data with the neuropsychological and functional imaging data. If, as we postulate, women with CSA have significant alterations in thought processes that increase risk of dangerous sexual behavior then defining the brain circuits altered may suggest therapeutic strategies in the future. Comparison of both CSA+ African American and Caucasian women with age-, education, and socio-economically matched control subjects without CSA histories will also reveal possible racial differences in CSA-provoked changes.
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