Intimate Partner Violence and HIV Prevention Continuum Engagement Among Populations Most Affected by HIV in the United States

Populations most affected by intimate partner violence (IPV) and HIV experience disproportionately high rates of both, yet the relationship between IPV and engagement in HIV prevention remains poorly understood. Prior research has linked IPV to increased sexual risk behavior and heightened risk for HIV acquisition, but less is known about how IPV influences other points along the HIV prevention continuum, including HIV and sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) uptake, and continued PrEP use. This observational cohort study, guided by syndemics theory and stress process frameworks, will examine how specific forms of IPV—such as physical, sexual, emotional abuse, and partner interference with care—within steady or casual relationships contribute to HIV/STI risk and protective behaviors within populations most affected by IPV and HIV in the United States over a 24-month period. We will use qualitative methods to explore perceived links between IPV, relationship dynamics, and HIV-related behaviors; examine sociodemographic differences in the longitudinal effects of IPV on HIV testing, PrEP uptake and persistence, and STI diagnoses (primary outcomes), as well as condomless sex and HIV seroconversion (secondary outcomes); and multi-level factors that may mediate or moderate these associations. Findings from both cohort and qualitative data will inform recommendations for intervention strategies to reduce IPV-related barriers to HIV prevention engagement. Participants will complete behavioral assessments, biospecimen collection, and HIV/STI testing across five time points. We hypothesize that greater IPV exposure will be associated with trauma history, mental health and substance use challenges, and reduced HIV prevention engagement. Partner substance use is also expected to correlate with both IPV and HIV risk, while coping resources, social support, and access to healthcare and social services may buffer these effects. This study will improve understanding of how IPV influences HIV prevention and inform the development of targeted, evidence-based interventions to improve the health of persons in the United States.