Center for AIDS Intervention Research (CAIR)

Current Research Projects at CAIR

CAIR researchers investigate a wide variety of issues related to HIV/AIDS. Currently, investigators are conducting studies with a number of different populations, in different locations, with different intervention approaches. The following summaries describe several of CAIR's current research projects. 

Prevention of HIV Infection in High-Risk Social Networks of African American MSM Funding Source: National Institute of Mental Health Principal Investigator: Jeffrey A. Kelly, PhD

HIV infection has always taken a heavy toll on men who have sex with men (MSM) and also on African Americans. However, HIV incidence disparity is most striking of all for MSM who are also African American. Most existing HIV prevention interventions designed for African American MSM have relied on individual or small-group risk reduction counseling. In contrast to individual counseling models, HIV prevention interventions that are directed to social networks of Black MSM in the community and that work through natural influence channels within these networks hold the potential for reaching deeply into hidden and vulnerable populations of African American MSM. This study will determine the comparative effectiveness of a social network intervention on sexual risk, substance use, and STD/HIV incidence assessed with laboratory measures. The study aims to develop and determine the efficacy of an intervention modality capable of reaching and preventing HIV among high-risk African American MSM in the community.

Structural and Social Contexts of Substance Use, Violence, and HIV Risk Among Adolescent Gangs Funding Source: National Institute on Drug Abuse Principal Investigator: Julia Dickson-Gomez, PhD

Adolescent gang members are involved in a number of risky behaviors including drug use and sales, violence, and high risk sex and victimization. Many of these behaviors also increase gang members' risk of contracting and transmitting HIV. Understanding the social context in which HIV risk and substance abuse occurs, and structural features of gangs that may impact these, are essential to developing effective interventions with this population. This study is designed to address gaps in our knowledge regarding differences in structural characteristics among gangs and the influence of these on the social context of risk behavior and individual member's sexual risk.

Ukrainian-American HIV Prevention Exchange of Models, Theory, and Practice Funding Source: National Institute on Drug Abuse Principal Investigator: Jill Owczarzak, PhD

Ukraine has one of the most severe HIV epidemics in Eastern Europe, with an estimated 1.6% of the adult population living with the virus, and an estimated 33% prevalence among drug users in certain regions. Injection drug users (IDUs) account for 36% of new HIV cases in Ukraine. Recent collaborative efforts between international, governmental, and nongovernmental organizations (NGOs) have been made to expand access to substitution therapies and needle/syringe exchange programs in Ukraine. However, systematic and legislative barriers remain for these IDU-specific programs. In addition, while provision of sterile injection equipment is important, such programs alone do not address sexual HIV risk among drug users. This study seeks to understand how best to promote the use of evidence-based HIV prevention strategies among Ukrainian NGOs working with drug users.

A Multi-State Analysis of HIV Exposure Laws Funding Source: National Institute of Mental Health Principal Investigator: Carol L. Galletly, JD, PhD

The effectiveness of HIV disclosure laws as a public health HIV prevention intervention has not been firmly established, and it is not clear whether the laws increase seropositive status disclosure to prospective sex partners and whether disclosure increases abstinence or safer sex. There are also lingering concerns that the laws may have unintended negative effects on HIV transmission prevention efforts and on the life quality of persons living with HIV or at risk for HIV.  For persons living with HIV, there are concerns that the laws may increase HIV-related stigma and ultimately deter persons living with HIV from disclosing by increasing the nature and severity of consequences of being known as someone who has HIV. For persons at risk for HIV infection but who are seronegative or serostatus-unknown, concerns range from deterring individual from being tested to undermining central HIV prevention messages and fostering false confidence that infected persons are aware of their HIV-positive status and can and will disclose. This study examines the impact of an HIV disclosure law on at-risk (HIV negative or serostatus unknown) persons, as well as the law's impact on HIV-positive persons.

Implementation, Effectiveness, and Cost-Effectiveness of an HIV Intervention Funding Source: National Institute of Mental Health Principal Investigators: Jill Owczarzak, PhD, and Steve Pinkerton, PhD

Two decades of carefully controlled randomized trials have established that sexual behavior change interventions can significantly reduce intervention participants' risk of acquiring HIV. There is abundant scientific evidence of the efficacy of these interventions when conducted in research settings with well-trained staff, sometimes substantial participant incentives, and the economic, human, and organizational resources that typify NIH-funded intervention research centers. However, the effectiveness of these interventions when implemented by frontline HIV prevention service providers is largely unknown. When implementing an evidence-based intervention, frontline service providers are apt to modify the original intervention in ways that best suit the organization's available resources, goals, and limitations. How these various factors influence the effectiveness of research-based interventions when implemented in the "real world" has received very limited attention. This study will evaluate the effectiveness and cost-effectiveness of the SISTA intervention for African American women, as implemented by eight HIV prevention service providers that have completed the CDC's DEBI training for the SISTA intervention. 
 

Research shows that the Human Papillomavirus (HPV) is a precursor of 70% of cervical cancers and 90% of genital warts. In 2006, the U.S. Food and Drug Administration licensed a vaccine to protect against these strains of HPV; however, recent estimates indicate that only 18% of teenage girls have received the three-dose series in the U.S. Cervical cancer affects ethnic minorities disproportionately. It is two to fourfold higher in Latina women when compared to non-Latina white women.  Research also suggests the prevalence of HPV is greater in ethnic minority women. This study will identify format and communication source to provide information to mothers and daughters about HPV and the vaccine while considering health literacy and numeracy; deterrents and motivators of vaccine acceptance while considering cultural factors; and the skills and resources that mothers and daughters perceive they need to be self-efficacious in communicating effectively with one another regarding sexuality and the adoption of sexuality-related health preventive measures such as vaccination.

Exploring Peer Referral Strategy to Link Recent Latino Immigrants to HIV Testing Funding Source: National Institute of Mental Health Principal Investigator: Laura R. Glasman, PhD

The vulnerability to HIV among recent Latino immigrant men (RLIM) has been attributed to structural and motivational factors, including uncertain immigration status, lack of resources, disconnection from services, high levels of stigma, and unawareness of HIV risk, factors that also hamper RLIM's access to venue-based and outreach HIV prevention efforts. Whereas RLIM are not reached by traditional HIV prevention approaches, they form associations with other RLIM to obtain information and referrals to cope with barriers associated with language, skills, and legal status in the U.S. Social network approaches use these associations to penetrate hidden groups and link them to services and research. This project will explore the feasibility of peer chain referral to link RLIM to voluntary counseling and testing, an essential tool to prevent HIV and the cornerstone of test and treat strategies.

Repeat STI Patients: Tailored Socio-Contextual Intervention to Reduce HIV Risk Funding Source: National Institute of Mental Health Principal Investigator: Lance S. Weinhardt, PhD

Repeat sexually transmitted infections (STI)--such as chlamydia, gonorrhea, trichomoniasis, and syphilis--indicate persistent elevated risk activity for HIV, and repeated STIs increase the likelihood of HIV transmission during exposure. Patients who seek treatment for repeat STIs, by definition, are not adequately served by the prevention services currently provided by STI clinics, and may benefit from additional clinic-based services to reduce their risk of future infections of STI and HIV. This study addresses the limitations of previous research by developing and testing an individually-tailored strengths-based prevention case management intervention strategy that addresses repeat STI patients' social context and other factors that heighten STI and HIV risk among these patients.

A Systemic Approach to Seek, Test, and Treat Strategies for Correctional Populations Funding Source: National Institute on Drug Abuse Principal Investigator: David W. Seal, PhD

It is estimated that 25% of all HIV-positive people in the U.S. pass through a correctional facility each year. Yet, many correctional systems and facilities do not provide a comprehensive and systemically coordinated approach to HIV testing, treatment, and transitional referral, resulting in many missed opportunities to identify previously undiagnosed cases of HIV and link individuals to treatment and prevention services. To address this gap, this study will comprehensively test people in a state correctional facility being released to a major metropolitan area; (re)link these HIV-positive people into low- or no-cost treatment and case management services; evaluate an innovative network method of HIV testing referral; and conduct cost and cost-effectiveness analyses to assess various aspects of the process.

Communication Technology to Disseminate Evidence-Based HIV Interventions to NGOs Funding Source: National Institute of Mental Health Principal Investigator: Jeffrey A. Kelly, PhD

Research on HIV prevention interventions can benefit public health only when those approaches shown effective in research studies are transferred to public health service providers and are successfully used. Such dissemination efforts are necessary on a global scale. This study (GAIN2) examines the relative impact of distance training (Internet-based) versus traditional face-to-face training methods in transferring an HIV prevention intervention to nearly 100 non-governmental organizations in Eastern Europe, Central Asia, and Russia.

Fostering an AIDS Research and Training Center Infrastructure in Russia Funding Source: National Institute of Mental Health Principal Investigator: Yuri A. Amirkhanian, PhD

This research infrastructure development grant award establishes the "Interdisciplinary Center for AIDS Research and Training" (ICART) in a collaboration between CAIR and Botkin Hospital for Infectious Diseases in St. Petersburg, Russia. ICART brings together a team of Russian behavioral, social, and medical scientists to work together in the conduct of HIV primary and secondary prevention projects, and to train new Russian investigators in the field. ICART's scientific leadership is linked with CAIR investigators and core resources to support their research and training initiatives.

High Risk Crack Use Settings and HIV in El Salvador Funding Source: National Institute on Drug Abuse Principal Investigator: Julia B. Dickson-Gomez, PhD

This project conducts formative research on the social context of crack use and sexual risk-taking in targeted communities in the San Salvador, El Salvador, metropolitan area.  Investigators hope to identify and describe structural differences within and across three types of low-income communities; examine the relationships among drug distribution systems, drug use settings, drug user networks, and HIV risk; and estimate HIV prevalence among crack users in the San Salvador metropolitan area.

HIV Prevention with High-Risk Social Networks in Eastern Europe Funding Source: National Institute on Drug Abuse Principal Investigators: Jeffrey A. Kelly, PhD, and Yuri A. Amirkhanian, PhD

Communities vulnerable to HIV/AIDS are often hard-to-reach and distrustful of outside authorities, especially in former communist countries. This project--undertaken in Russia, Bulgaria, and Hungary--uses social structural analysis to identify highly-interconnected influence leaders of social networks and then trains these network leaders to function as risk reduction behavior change advisors to other network members.