Official CHIP Lecture Series Podcast

Dr. Rietmeijer will discuss recent advances in biomedical interventions for HIV prevention, specifically HIV treatment as prevention (TasP). The key concept of TasP is to decrease the viral load in the HIV-infected community to levels that will result in rates of HIV transmission that are sufficiently low to extinguish the HIV epidemic. Central to the effectiveness of TasP is the concept of the spectrum (“cascade”) of engagement into HIV care that will ultimately affect the community viral load. Dr. Rietmeijer will then discuss the resurgence of syphilis and other sexually transmitted infections (STI) among men who have sex with men in the U.S. that occur despite decreasing rates of HIV in certain U.S. jurisdictions. He concludes that a sole focus on biomedical approaches for HIV prevention may be accompanied by increasing risk behaviors and that the gains in HIV prevention may come at a price of rising rates of other STI in the absence of a continued commitment to behavioral risk reduction interventions.

New realities in the prevention of HIV among MSM: the trials and tribulation of risk-reduction strategies other than condom use

Dr. Trask provides a definition of adherence and then examines where across the cancer continuum adherence is a problem. He quantifies how big a problem adherence is among individuals prior to a diagnosis, while on treatment, and then in short and long-term survivors. These factors are identified in relation to a conceptual model of adherence. Dr. Trask concludes the talk by identifying some potential interventions that could improve adherence.

Dr. Wilson reports on findings from related studies to highlight the importance of conceptualizing health behaviors, well-being, and resilience within a situational framework. In this sense, health and risk need to be explored as states that change over time, and not necessarily as traits of people that are static. Wilson reports on findings from studies of ethnic minority men who have sex with men that show within-person variations in mood are linked to HIV risk behaviors. He also describes ways in which diary methods can be used to capture situational variability in mood and risk behavior, and explores how diaries can potentially be leveraged for use in behavioral interventions.

Dr. Bauermeister first provides an overview of a community-academic partnership (United for HIV/AIDS Prevention and Policy – UHIP) developed in the Detroit Metro Area. Dr. Bauermeister then presents a multilevel theoretical framework that may inform the persistent HIV/AIDS disparity experienced by Black and Latino young men who have sex with men (YMSM) in the Detroit Metro Area, using qualitative and quantitative data to exemplify how the proposed linkages in the theoretical framework manifest in YMSM’s lives.

Beverage Choice of U.S. Households: Determinants and Obesity Consequences

The clinical manifestations of venereal syphilis reflect the propensity of the syphilis bacterium to disseminate and induce chronic inflammation. The appearance of the syphilitic chancre during primary syphilis typically only emerges 4 weeks after initial contact. By this time, organisms have disseminated to other organs and tissues, setting the stage for what is classically known as secondary syphilis. Paradoxically, despite the robust nature of the immune response it takes weeks to months for host defenses to gain control of the invading pathogen. Why this occurs in individuals and populations is the principal scientific objective of our global health research program.

Professors Couch, Furtado and Ross will each provide short presentations on their recent research. Professor Couch will present results from several studies relating the impact of discrete life course events such as Job Loss and Divorce on long-term indicators of health such as receipt of Disability or Supplemental Security Income and Mortality. In general, these results show that common life occurrences have large impacts on long-term likelihoods of experiencing poor health. Professor Furtado will examine the impact of ethnic networks on immigrants’ take-up of disability programs (SSDI and SSI). After providing evidence that they do, she explores whether they operate via information sharing about the programs, social norms related to exaggerating disabilities, or the benefits of sharing leisure time with co-ethnics. Professor Ross will discuss his research on the effects of school peers and friends on smoking and drinking by high school students. While Professor Ross has found little evidence of an effect of the demographic composition of peers, he finds substantial evidence of spillovers in health related behaviors with students being more likely to drink and smoke when their friends are involved with such behavior.

Dr. Krieger offers a brief overview of the health inequities in the Appalachian Mountain region regarding cervical cancer and how medical and relational uncertainty may influence conversations within the social network related to uptake of the HPV vaccine. This framework serves as the basis for a series of studies examining factors that predict communication among clinicians, parents, and young females about the HPV vaccine. Together, this research suggest that geographic differences in conversations about the HPV vaccine is likely to reinforce health inequities in the Appalachian region and that efforts to promote high- quality conversations about the HPV vaccine should focus on increasing parents’ and clinicians’ self-efficacy.

In this talk Dr Pettifor describes the epidemiology of HIV infection among young women in sub-Saharan Africa. She illustrates the disproportionate burden of infection faced by young women compared to young men. Dr Pettifor then discusses a number of determinants that may help explain why young women are at increased risk, focusing on structural factors, in particular education and gender power. Lastly, Dr Pettifor discusses the recent interest in the use of cash transfers as a mean to reduce risk of HIV infection. She discusses potential mechanisms through which such interventions may work and highlights the results of a few studies exploring cash transfers to reduce HIV risk. In particular, she describes a large randomized controlled trial of conditional cash transfers that she is conducting among young women in South Africa.

Dr. Copenhaver discusses his research over the past decade which has involved developing and testing behavioral HIV prevention interventions for high risk drug users. Using qualitative methods, he has adapted evidence-based interventions for optimal use in clinical settings. The adaptation process takes into to account both the characteristics and needs of intervention participants as well as the constraints and resources of the clinical settings in which the interventions are likely to be delivered. He describes a recently completed randomized trial targeting high risk HIV-negative drug users as well as a recently initiated randomized trial with HIV-infected drug users concurrently participating in an inner city methadone maintenance treatment program. If found to be efficacious in these trials, Dr. Copenhaver’s adapted interventions may be easily incorporated into routine treatment services within clinical settings where priority populations are most readily available.

Dr. Brownell will discuss how food and physical activity environments have changed in ways that make unhealthy conditions the default, with the predictable consequence of rising obesity in the U.S. and abroad. Public policies that address the environmental drivers of obesity, if approached with courage and determination, could create better defaults and therefore support rather than undermine personal responsibility in adults and help rather than hinder parents in their attempt to raise healthy children.

International Perspectives on Adherence to HIV Treatment and Prevention

Cost-effectiveness of the Insite Supervised Injection Facility

Adapting Mental Health Measures and Treatment for Very Different Settings: Adolescents in Nairobi Slums

Poverty Alleviation through Innovation: Crashing our Mental Models

Dr. Blissmer discusses the need for creating effective and efficient interventions that target multiple behavioral risk factors within individuals. He first discusses the phenomenon of behavioral clustering within individuals and current efforts at treating multiple behaviors within populations as well as within individuals. Examining outcomes across multiple behaviors leads to differential choices in outcome metrics and Dr. Blissmer discusses different options. There is some consideration of new findings that attempt to understand how individuals make changes in multiple health risk behaviors by examining common predictors and how behaviors interact and change over time. He finally discusses emerging research that suggests new approaches to efficiently target multiple risk behaviors.

Dr. Ghosh first briefly describes the development of Health and Medical Geography sub-discipline in the United States and how a health geographer could “collaborate” innovatively with a doctor to provide scientific evidences for effective health intervention policies. She further presents two current research projects highlighting the interdisciplinary techniques used in the projects. The projects and techniques used are as follows: 1) ‘Food Food Everywhere and Not a Healthy Bite to Eat: Understanding the disparities in healthy food access and its impact on obesity” – Geographic Information Science (GIS), cluster analysis, space-time paths, PhotoVoice, spatial food diaries, and 2) ‘Social Media, Geography, Health’ – topic modeling, sentiment analysis, GIS, and social network analysis.

Research on Drug Use and HIV in NYC: Historical Trends and Future Directions

Dr. Seacat begins by reviewing the status of the obesity epidemic in the United States with a particular emphasis on disparities and known bio-psychosocial consequences. He then discusses current research in the realm of obesity stigma assessment, the gaps and challenges faced in the field, and how changes in the obesity epidemic as well as in the nature of stigma have led to an evolution of stigma assessment strategies. The talk culminates with highlights from Dr. Seacat's daily diary and laboratory-based research projects and with discussion on strategies to triangulate stigma assessment tools.