# Violence and onward HIV transmission in perinatally-infected adolescents

> **NIH NIH R01** · STATE UNIVERSITY NEW YORK STONY BROOK · 2022 · $551,156

## Abstract

Project Summary (30 lines)
Over two million adolescents are infected with HIV globally, the majority due to perinatal
transmission. As HIV-positive adolescents, their choices – such as inconsistent medical
adherence and unprotected sex - have the potential to alter the HIV epidemic. South Africa,
home to the largest population of HIV-infected adolescents, is also experiencing a second
epidemic of violence. Together, these epidemics create a devastating cycle. Intimate partner
violence (IPV) is widely viewed as a key driver of HIV transmission, but is only part of the story.
Violence victimization (at home, in relationships, and in the community) may similarly increase
behavioral risk. To better understand how violence influences HIV transmission risk, we will
enroll 300 HIV-positive and 300 HIV-negative male adolescents (aged 15-19) in Soweto, South
Africa. At baseline and follow-up, participants will complete comprehensive surveys and medical
testing (STIs, viral load). During the observation year, they will complete bi-weekly mobile phone
surveys, yielding ecological momentary assessment (EMA) data on how daily experiences of
violence affect behaviors in real time. In-depth interviews will be used to help us to better-
understand how these behaviors are enacted by adolescents in their day-to-day lives. The aims
are as follows: Aim 1: To measure IPV perpetration by PHIV, and test whether it exceeds
that of HIV-negative peers. Most interventions to prevent IPV focus on girls only, but boys are
increasingly recognized as essential participants. In urban South Africa, up to 40% of
adolescent boys report perpetrating physical or sexual IPV. There is no data on IPV perpetration
by male PHIV – the population with the greatest potential to transmit HIV during adolescence..
Aim 2: To estimate the impact of violence victimization on behaviors associated with
onward HIV transmission in both PHIV and HIV-negative peers. Exposure to violence may
heighten risk of onward transmission by 1) decreasing HIV treatment adherence necessary for
viral suppression, 2) decreasing condom use, and 3) increasing perpetration of IPV. Using
longitudinal data and EMA, we will be able to establish temporal order between violence
victimization and these three outcomes. Aim 3: To highlight potential intervention points by
identifying the most salient mediators linking violence to HIV transmission behaviors. We
will use structural equation modelling to test potential mediators (e.g., depression, gender
ideology) between multi-level violence and behavioral risk. Combined with the above aims, this
body of evidence will guide us towards effective, developmentally-appropriate interventions that
prevent onward HIV transmission.

## Key facts

- **NIH application ID:** 10428472
- **Project number:** 5R01MH119878-04
- **Recipient organization:** STATE UNIVERSITY NEW YORK STONY BROOK
- **Principal Investigator:** Rachel Kidman
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $551,156
- **Award type:** 5
- **Project period:** 2019-08-15 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10428472

## Citation

> US National Institutes of Health, RePORTER application 10428472, Violence and onward HIV transmission in perinatally-infected adolescents (5R01MH119878-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10428472. Licensed CC0.

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