Sexual violence, including nonconsensual sexual initiation and rape, remains pervasive, with impacts including adverse mental health and dysregulated stress response. Resilience is a promising interventional target. To advance the science, we examined the potential for resilience as an interventional tool by estimating associations between resilience, adverse mental health, and perceived stress among women by sexual violence history and partner perpetration. We analyzed 2018–2020 baseline survey data from 65 women enrolled in a prospective case-control study of sexual violence and HIV susceptibility in San Diego, CA. Multiple linear regressions were performed to examine associations, stratified by sexual violence history. About half of women experienced nonconsensual sexual initiation and/or rape; half of rapes were partner-perpetrated. Post-traumatic stress disorder (PTSD) was significantly associated with perceived stress among survivors (in regressions with depression and resilience, nonconsensual initiation: β = 6.514, p = 0.003, R2 = 0.616; rape: β = 5.075, p = 0.030, R2 = 0.611). Resilience was associated with lower perceived stress for all women; the effect appeared stronger among survivors of sexual violence (nonconsensual initiation: β = −0.599, p < 0.001 vs. β = −0.452, p = 0.019; rape: β = −0.624, p < 0.001 vs. β = −0.421, p = 0.027). Partner perpetration of rape was not associated with perceived stress. Our findings support leveraging resilience and addressing PTSD to reduce perceived stress among women with lifetime experiences of sexual violence.

Given the potential for retraumatization among survivors of sexual violence engaged in research, we aimed to provide pertinent knowledge and exemplification of the integration of trauma-informed practice to research with survivors. Grounded in trauma-informed care, we discuss the need for trauma-informed research, drawing upon experiences and data from a longitudinal case-control study on sexual violence. Through trauma-informed research settings, we can improve research experiences for survivors of sexual violence, as demonstrated by positive experiences of participants in The THRIVE Study. By meeting the needs of survivors, researchers can increase participation while maximizing the research quality and advancement of research.

BACKGROUND Black women continue to bear a disproportionate burden of HIV, accounting for nearly 60% of new diagnoses among U.S. women. Women living with HIV (WLHA), and in particular Black WLHA, often experience HIV with mutually reinforcing epidemics, known as syndemics, inclusive of interpersonal violence and substance use. Syndemic experiences are associated with decreased HIV care engagement and treatment adherence and worsening HIV outcomes. Compounding this, few HIV services and supportive resources are tailored to Black WLHA, including elements that are gender- and culturally-responsive and trauma-informed. Technology-based and psychoeducational programming, as well as peer navigation, offer promising pathways to Black WLHA-specific HIV support services, and improved HIV care outcomes. With this is mind, the web-based, trauma-informed intervention LinkPositively was developed in collaboration with Black WLHA to promote uptake of HIV care and ancillary support services. OBJECTIVE The primary aim is to determine the feasibility and acceptability of the gender-responsive, culturally-tailored, and trauma-informed LinkPositively intervention among Black WLHA affected by interpersonal violence. The secondary aim is to examine the preliminary impact of the LinkPositively intervention on retention in HIV care, ART adherence, and viral suppression, while evaluating the role of mechanism of change variables (i.e., social support, activation of social support networks, self-efficacy, and utilization of ancillary support services) in the associations. METHODS The LinkPositively trial is a pilot randomized controlled trial conducted in California, USA, among 80 adult Black WLHA who have experienced lifetime interpersonal violence. Core components of LinkPositively include: a) virtual peer navigation that includes phone and text check-ins and 4 weekly one-on-one video sessions to build skills to cope with barriers and navigate care; b) social networking platform to receive peer support; c) educational database with healthy living and self-care tips; d) GPS- enabled resource locator for HIV care and ancillary support agencies; and e) HIV medication self-monitoring and reminder system. Participants are randomly assigned to the intervention (n=40) or control (Ryan White standard of care, n=40) arm, with follow-up at 3- and 6- months. At each assessment, participants complete an interviewer-administered survey and submit hair samples for assessment of HIV medication adherence. All research staff and investigators adhere to ethical principles and guidelines in the conduct of research activities. Data will be analyzed utilizing generalized estimating equations. RESULTS Recruitment of participants is ongoing. We anticipate dissemination of preliminary results in 2024. CONCLUSIONS This trial will benefit the advancement of HIV prevention science by harnessing technology to promote engagement in HIV care, while improving social support through peers and social networking – all under the auspices of being trauma-informed for Black WLHA with experiences of interpersonal violence. If shown to be feasible and acceptable, LinkPositively has the potential to improve HIV care outcomes among Black WLHA, a socially marginalized, key population. CLINICALTRIAL NCT04199052

Background Black women bear a disproportionate burden of HIV, accounting for nearly 60% of new diagnoses among US women. Black women living with HIV often experience mutually reinforcing epidemics, known as syndemics, including interpersonal violence and substance use. Syndemics are associated with decreased HIV care engagement and treatment adherence and worsening HIV outcomes. Few HIV services and resources are tailored to be culturally and gender-responsive and trauma informed for Black women living with HIV. Technology-based, psychoeducational, and peer navigation programs offer promising pathways to tailored HIV support and improved HIV care outcomes. Therefore, the web-based, trauma-informed intervention LinkPositively was developed in collaboration with Black women living with HIV to promote uptake of HIV care and ancillary support services. Objective This study primarily determines the feasibility and acceptability of the LinkPositively intervention among Black women living with HIV affected by interpersonal violence. The secondary aim is to examine the preliminary impact of the LinkPositively intervention on retention in HIV care, antiretroviral therapy adherence, and viral suppression while evaluating the role of mechanism of change variables (eg, social support) in the associations. Methods The LinkPositively trial is a pilot randomized controlled trial conducted in California, United States, among 80 adult Black women living with HIV who have experienced interpersonal violence. Core components of LinkPositively include one-on-one peer navigation with phone and SMS text message check-ins; 5 weekly one-on-one video sessions to build coping and care navigation skills; and a mobile app that contains a peer support social networking platform, an educational database with healthy living and self-care tips, a GPS-enabled HIV and ancillary care resource locator, and a medication self-monitoring and reminder system. Participants are randomly assigned to the intervention (n=40) or control (Ryan White standard of care; n=40) arm, with follow-up at 3 and 6 months. At each assessment, participants complete an interviewer-administered survey and submit hair samples for the assessment of HIV medication adherence. All research staff and investigators adhere to ethical principles and guidelines for conducting research activities. Data will be analyzed using generalized estimating equations. Results Final development and testing of the LinkPositively app were completed in July 2021. As of May 2023, we have screened 97 women for eligibility. Of the 97 women screened, 27 (28%) were eligible and have been enrolled in the study. The dissemination of preliminary results will occur in 2024. Conclusions This trial will advance HIV prevention science by harnessing technology to promote engagement in HIV care while improving social support through peers and social networking—all while being trauma informed for Black women living with HIV with experiences of interpersonal violence. If shown to be feasible and acceptable, LinkPositively has the potential to improve HIV care outcomes among Black women, a marginalized key population. International Registered Report Identifier (IRRID) DERR1-10.2196/46325