Stigma and HIV
Much of our work aims to understand and address stigma and health inequities across the HIV prevention and treatment cascade. Among people at risk for HIV, stigma associated with substance use disorders, race/ethnicity, gender identity, and other characteristics is related to behaviors that increase risk for HIV such as substance use and sex without condoms. Among people living with HIV, stigma associated with HIV is related to less engagement in treatment, less medication adherence, and worse wellbeing. We are collaborating on several projects related to HIV stigma.
Key populations at risk of HIV (including men who have sex with men, people who inject drugs, transgender women, and female sex workers) are often more likely to be infected with HIV but less likely than members of the general population to know of their HIV status, receive HIV prevention counseling, or be linked to HIV care services. Clinician stigma towards these groups remains a potent and persistent driver of these HIV disparities in many places of the world. We are incorporating evidence-based stigma reduction tools into a popular teletraining platform for clinicians and pilot testing our resulting intervention (Project ECHO® for HIV Prevention and Stigma Reduction) with clinicians in Malaysia, a context wherein clinician stigma and HIV disparities are substantial. This study is funded by the National Institute on Mental Health (R34MH124390).
We are working with Chanelle Howe and Akilah Dulin Keita to develop a reliable and valid measure of individual, interpersonal, and neighborhood resilience among African Americans living with HIV. This measure may ultimately inform the development and implementation of novel multilevel resilience-related interventions to reduce persistent racial disparities in HIV disease. This study is funded by the National Institute of Mental Health (R01MH112386).
Over half of HIV infections worldwide are undiagnosed. To increase HIV testing, the World Health Organization recommends that persons living with HIV receive health care provider assistance to notify their sex and needle-sharing partners of shared exposure so that they can be tested. Two key populations for assisted partner services are prisoners, who are at increased risk of HIV infection, and their partners in the community, who are also at risk. To increase the number of at-risk partners who know their HIV status, we worked with Gabriel Culbert to develop IMPART, a nurse-assisted partner notification intervention for criminal justice settings. If successful, IMPART would provide an important new approach to increase HIV testing among community dwelling partners of HIV-positive male prison inmates in global regions where HIV prevalence among prisoners is high. This study is funded by the National Institute of Mental Health (R34MH115779).
Engagement in HIV care is important for maintaining the health and wellbeing of people living with HIV. Yet, approximately 60% of PLWH in the United States and 20% of PLWH in Delaware are not engaged in care. We are working with the Christiana Care HIV Community Program to compare barriers to HIV care engagement in Wilmington, Smyrna, and Georgetown, Delaware via qualitative interviews with people living with HIV and healthcare providers. These sites are proximal to the locations with the highest concentrations of HIV in the state and differ geographically and socio-culturally. Research comparing barriers, including experiences of stigma, can inform the adaptation of interventions to enhance engagement in care throughout the state of Delaware.
Black men who have sex with men experience an alarmingly high rate of HIV and STIs in the US. We are working with Lisa Eaton, PhD to develop and conduct structural and stigma-focused interventions to increase HIV and STI testing uptake among Black men who have sex with men. This study is funded by the National Institute of Mental Health (R01MH109409).