The goal of the ESSENCE Project is to evaluate the impact of neighborhood-level characteristics of the built and social environment on sexual assault and, in turn, elucidate how sexual assault and physiological factors influence behavioral mechanisms that increase the risk for HIV acquisition. Although sexual assault has been shown to be associated with engaging in riskier sexual behaviors, no research has assessed how physiological changes of the stress response in the hypothalamic-pituitary-adrenal (HPA) axis following traumatic sexual encounter can weaken the immune system, thereby increasing women's susceptibility to HIV/STIs. Additionally, neighborhood-level factors such as neighborhood disorder and poverty have been studied as contributors to violence against women and HIV risk behaviors, but no studies have examined modifiable characteristics of the built and social environment as contributors to sexual assault incidence specifically. Our retrospective cohort mixed methods study will focus on African American women in Baltimore, MD, a city heavily impacted by HIV. This study is the first to evaluate the independent and combined influence of environmental factors and physiological HPA axis alterations that may contribute to increased vulnerability to HIV. Because the relationship between sexual assault and HIV risk can be influenced by several potentially interconnected pathways, the long term goal of our work is to inform multi-level interventions that act on those pathways, and when combined together, maximize reductions in incident HIV infections.
*Funded by the National Institutes of Health
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