By Loretta Waldman
Professor Lisa Eaton is embarking on a new intervention aimed at reducing the impact of stigma and logistical barriers to HIV/STI testing.
Funding for the new study was finalized in September and is provided by the National Institute of Mental Health (NIMH), said Eaton, an InCHIP researcher and Associate Professor of Human Development and Family Studies. The goal of the study is to remove critical barriers well recognized by her and other researchers – emotional and logistical barriers to more frequent HIV/STI testing among Black men and transgender women who have male sex partners.
The need for the intervention is tremendous.
“I think most people don’t understand the urgency of addressing the HIV epidemic, particularly in the southern US among race-minority populations,” says Eaton. “In our work we typically see about 40 percent of our participants who say that they are HIV positive, which is a huge number and it’s really a public health crisis. Most people aren’t aware that this is occurring.”
Previous studies have shown that by the age of 40, an estimated 60 percent of black gay/bisexual men will be living with HIV, Eaton says. The prevalence of HIV is alarming and more has to be done, she says.
“This is why I do the work I do in this area,” says Eaton. “It’s just so compelling. We need more work on understanding the larger systems that are maintaining this really high rate of HIV transmission.”
“Our new study is built off a National Institutes of Health (NIH) Supplement that we received last year,” Eaton says of the study. “In that particular grant, we followed individuals who were recently diagnosed with HIV or an STI …through the first year of their treatment.”
Five hundred individuals aged 18 and older will be enrolled. The trial will run for five years and be delivered by peer counselors in the Atlanta metro area, Eaton says. “We’re testing whether addressing stigmas as an emotional barrier and providing HIV & STI testing online – providing individuals with test kits and providing counseling online – can increase HIV testing uptake and frequency,” Eaton says.
Counselors will make participants aware of pre-exposure prophylaxis (PrEP), a pill to prevent HIV infection, too. “PrEP is highly effective but the uptake of it is very low among this population,” says Eaton. “In addition to the focus on stigma and logistical barriers, [counselors will be] informing individuals about the availability of this as a form of prevention and providing them with the opportunity to get HIV tested as a first step to accessing PrEP. “
Regular testing for STIs and HIV is key to prevention, Eaton says. The Centers for Disease Control and Prevention (CDC) have recommended a testing frequency, but that frequency is not being achieved, she says.
“With the lack of routine testing, we thought, ‘maybe we need a different model to implement this’,” says Eaton. “The way routine HIV testing has been set up at this point, it’s clear that there are barriers that aren’t being addressed. Maybe we can create a new model, a system, where individuals can test frequently,’”
A compelling aspect of the work is that researchers are finding that communities with poorer healthcare access tend to have what is referred to as ‘a higher community viral load’, an indication that HIV transmission is more likely to occur. Eaton believes the reason for the higher viral load among black men and transgender women is because healthcare access tends to be inferior in largely race-minority communities.
“Healthcare inequity is a very strong system that needs to be addressed if we want to see reductions in HIV transmissions,” Eaton says. “I think the overall message is that it’s obvious to focus on what’s most proximal to HIV transmission, which is sexual risk taking, but if we’re going to halt the HIV epidemic among black gay/bisexual men living in the south, we have to focus on a much broader environment in which the epidemic is continuing to be fueled. Contributing factors could include how members of the community are treated in the healthcare system, healthcare coverage, and the competency of healthcare providers. Our intervention takes on parts of this challenge.”
Eaton’s work is focused in the southern US where the HIV epidemic has a stronghold.
In the south, in particular, one must consider the historical significance of racism; of how racism has permeated school systems, prison systems, in addition to the healthcare systems, Eaton says.
“When you take this broader perspective of race-related health inequities, what we observe regarding HIV rates is consistent given the larger backdrop,” she says. “High HIV incidence is part of this broader system of disparities being more prevalent among minority populations in the south.”
Eaton says that’s what motivated her and her team to switch gears in this new project and focus on getting into HIV testing services and on increasing HIV testing frequency. But if something isn’t done to address the larger system, the problem will remain, she says.
“In this environment, we will still see high rates of HIV transmission even if you can reduce individual sexual risk taking. That’s why we need to develop these broader interventions,” says Eaton.