Challenges in conducting research on sexual violence and HIV and methods to overcome them

Background: Studies have implicated sexual violence as a potential correlate of HIV acquisition in women. Characterizing how violence affects the female immune system may provide insight into the biological mechanisms of HIV transmission and ultimately improve global HIV prevention strategies. Little research has been done in this domain, and the obstacles to investigation can be daunting. We describe methodological challenges encountered and solutions.explored while implementing a study of dysregulation of immune biomarkers in pre- and postmenopausal women following sexual assault.Methods: We compared immune biomarkers indicative of HIV susceptibility between women who had experienced forced vaginal penetration during the preceding 12 weeks (cases) and women who had never experienced forced or coerced vaginal penetration (controls). Participants provided blood, cervicovaginal lavage and cervical swab samples for biomarker analysis at one or five visits, depending on study arm. In addition, some participants completed a computer self-administered interview at each visit.Results: From July 2014 to June 2016, we enrolled 24 cases (21 pre-menopausal and 3 postmenopausal) and 30 controls (25 pre-menopausal and 5 post-menopausal). Challenges included accessing and defining sexual assault survivors, ensuring participant well-being during research engagement, reducing selection and information bias, collecting and processing biological samples, and adjusting for confounders such as reproductive tract infections and emotional and physical abuse. Use of sensitive, mature, and highly trained research staff in conjunction with well-articulated community and medical partnerships were key methods to overcoming challenges while promoting the safety and welfare of vulnerable study participants.Conclusions: Research into the relationships between sexual assault, immune biomarkers and HIV is possible though not without challenges. Moreover, many survivors of sexual assault welcome the chance to help other women at risk for violence. This field of research would benefit from the development of multi-site consortia, which would allow for the combined accrual of larger study populations to clarify the individual and interacting effects of various causal factors.