Women living in poor, urban communities are doubly disadvantaged with regard to increased risk for two major public health problems -- violence and HIV/AlDS. These two problems have become linked recently, as anecdotal evidence suggests that women infected with HlV are at increased risk for violence when others learn they are infected. Also, HlV prevention research suggests that violence and fear of violence may be significant barriers to women's ability to practice safer sex. This proposed research will provide the first empirical study comparing the frequency and severity of interpersonal violence between HlV-positive and HlV-negative women, most of whom are African-American and living in poor communities in Baltimore City. Violence will include measures of verbal, physical, and sexual violence perpetrated by male partners and others as well as reported injuries that result. Experiences with, and fears about violence will be described in relation to: HlV infection; disclosure of HlV seropositivity; and using condoms. Risk factors for violence being investigated, in addition to HlV status, are psychosocial characteristics of the women, the perpetrators, and the family, including drug and alcohol use and a history of family violence. Outcomes of interest, in addition to violence, include indicators of women's physical health and quality of life; posttraumatic stress disorder; mental health status; and homelessness. A total of 300 HlV-positive women will be sampled from treatment sites and a comparison group of 300 HlV-negative women will be sampled from a women's health clinic, low income housing projects, homeless shelters, and a drug-treatment program. Both quantitative and qualitative interview methods will be used. Analyses will include multiple regression modeling for quantitative data and descriptive thematic analysis of the qualitative data. Findings will contribute to the development of a more adequate theoretical understanding of the complex determinants of violence against women generally and in relation to HlV infection and prevention specifically. Results will have important implications for violence prevention interventions as well as HlV testing and prevention programs for women living in poor, urban communities.
