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

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 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 is designed to 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.

Comparison of Supportive Housing Models for HIV+ and At-risk Chronically HomelessComparison of Supportive Housing Models for HIV+ and At-risk Chronically Homeless
Funding Source: National Institute on Drug Abuse
Principal Investigators: Julia Dickson-Gomez, PhD, and Steven D. Pinkerton, PhD

The link between homelessness or housing instability and HIV is clear and indisputable, particularly among those with long or frequent episodes of homelessness who are also likely to suffer from substance use disorders and serious mental illness. Homelessness is both a cause and an effect of HIV infection. People who are homeless or unstably housed have as much as 16 times the rate of HIV infection as people who have a stable place to live. In turn, HIV increases the risk of homelessness with at least half of all people living with HIV/AIDS experiencing homelessness or housing instability. Supportive housing—permanent, subsidized housing with supportive services—has been offered as a structural intervention to reduce HIV infection rates and improve health outcomes of HIV-positive persons. The SHOP project uses qualitative and quantitative data to characterize and compare the effectiveness of different types of supportive housing programs on residents’ sexual and injection risk, substance use, ART/treatment adherence, and housing stability, and it evaluates the economic efficiency of at least 20 different supportive housing programs serving over 2000 chronically homeless individuals.


Community Intervention for HIV Testing & Care Linkage Among Young MSM in Bulgaria
Funding Source: National Institute for Child Health and Human Development
Principal Investigators: Jeffrey A. Kelly, PhD, and Yuri A. Amirkhanian, PhD

Throughout the world, young MSM are disproportionately burdened by HIV infection. Young MSM in low- and middle-income countries often do not seek out HIV testing, are unaware of their HIV+ status, and do not receive early medical care, compromising their health and contributing to downstream disease incidence. This situation is of great concern in post-socialist countries of Eastern Europe, with the stigma of HIV/AIDS and same-sex behavior, ever-increasing HIV epidemics, and the health needs of young MSM rarely acknowledged or addressed. This study, being conducted in Sofia, Bulgaria, seeks to conduct in-depth interviews with young MSM ages 16 to 20 and other key informants to gain an understanding of factors related to HIV testing and barriers and facilitators of testing and medical care. In a second phase of the study, a network intervention to increase regular HIV testing and care linkage among young MSM will be tested.


Structural and Social Contexts of Substance Use, Violence, and HIV Risk Among Adolescent GangsStructural 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.

Engagement in Care & Quality of Life among Older, Rural HIV-positive Adults
Funding Source: National Institute on Aging
Principal Investigator: Andrew E. Petroll, MD, MS

HIV-positive adults over the age of 50 who live in rural areas suffer from greater mortality than non-rural HIV-infected individuals and face unique challenges to maintaining good health. This disparity in health outcomes is not well understood, yet remains significant because a sizeable number of HIV-positive individuals live in rural areas. Services such as expert HIV care, case management, mental health care, and antiretroviral adherence support can improve health outcomes for HIV-infected individuals, but may be unavailable or more difficult to access for individuals living in rural areas. This project will determine the specific needs of this population and the factors that have the greatest effect on quality of life and engagement in medical care, and will serve as a basis from which to develop interventions to improve health outcomes and reduce health disparities for this population.


Regular HIV Testing among At-Risk Latino Men
Funding Source: National Institute of Mental Health
Principal Investigator: Laura R. Glasman, PhD

In the US, approximately 20% of the 1.1 million individuals living with HIV are unaware of their HIV status, and many are concentrated in clusters of individuals with high HIV prevalence and undiagnosed infections.  Encouraging regular HIV testing among individuals in these clusters and then providing treatment to those testing positive will not only improve the individuals’ health but also reduce HIV incidence. Latino men who have sex with men comprise many of these clusters. Despite the many strategies to encourage HIV testing, there are currently no strategies to promote regular HIV testing among any group at risk for HIV. This study will examine the feasibility of a strategy to promote regular HIV testing among Latino men at risk for HIV which, if successful, will help to identify Latino men unaware of their HIV status, benefiting them and the society.

Sound Public Health Approaches to Knowing Exposure to HIV
Funding Source: National Institute for Child Health and Human Development
Principal Investigator: Carol L. Galletly, JD, PhD

Approximately half of all new HIV infections in the US arise from persons who are aware of their HIV-positive status. In some cases, these individuals have informed their partners of their positive serostatus and their partners have consented to sex assuming the risk of infection. In other cases, the partners have not been informed. That some people living with HIV (PLH) are unable or unwilling to disclose their HIV status to sex partners is an exceptionally difficult topic to broach, but health departments in high-HIV prevalence areas regularly respond to cases of knowing exposure. This study will explore how US health departments identify, verify, and intervene with PLH who are, or are believed to be, engaging in behaviors that risk forward HIV transmission with partners to whom they have not disclosed their HIV-positive status.


Social Network Intervention to Engage Out-of-Care PLH Into TreatmentSocial Network Intervention to Engage Out-of-Care PLH Into Treatment
Funding Source: National Institute of Mental Health
Principal Investigators: Yuri A. Amirkhanian, PhD, and Jeffrey A. Kelly, PhD

Most current approaches for improving care linkage are based on case management, and most adherence interventions studied to date rely on clinic-based counseling.  Although these individual-level interventions are necessary, the field needs new approaches that can also reach PLH who are not in care and that can strengthen norms among PLH in the community to enter or re-enter, remain, and adhere to treatment.  Prior research—including pilot data collected by our research team in Russia—establishes that PLH in the community have close social networks that include other HIV-positive persons.  Decisions by PLH to enter, re-enter, and adhere to care are based on the attitudes, views, and experiences of their social network members also known to be PLH. This project aims to develop an intervention that extends beyond current counseling paradigms by intervening to strengthen treatment-related norms, motivations, and collective self-efficacy within social networks of PLH in the community.  The intervention will also train leaders of the PLH social networks to encourage their personally-known HIV+ friends to enter and adhere to care.

Increasing Social Support to Improve HIV Care Engagement and AdherenceIncreasing Social Support to Improve HIV Care Engagement and Adherence
Funding Source: National Institute of Mental Health
Principal Investigators: Yuri A. Amirkhanian, PhD, and Jeffrey A. Kelly, PhD

Substance use, life chaos, mental health distress, poverty, and inaccessible care systems, complex regimens, and unsympathetic care have all been shown to predict poor HIV care engagement. However, social support very consistently and strongly predicts high HIV care attendance and high medication adherence, even among HIV+ drug users, a population with many barriers to treatment engagement. Social support may function to improve HIV treatment adherence directly through its informational, emotional, and concrete help-giving components. In addition, social support may alleviate mental distress and improve coping as mediators of care adherence. The intervention being pilot tested in this research directly builds peer social supports for medical care attendance and adherence. Most prior adherence interventions have involved only clinic-based counseling provided to individual patients. The present approach is unique because it extends beyond individual patient counseling to also strengthen social supports for care in the daily lives of PLH.

High-Impact Integrated Behavioral and Biomedical Interventions to Eradicate AIDSHigh-Impact Integrated Behavioral and Biomedical Interventions to Eradicate AIDS
Funding Source: Advancing a Healthier Wisconsin
Principal Investigator: Jeffrey A. Kelly, PhD

For the first time in the three decades since AIDS was identified, it is now possible to realistically envision how to end the HIV epidemic in Wisconsin, in the country, and the world. HIV prevention through risk reduction behavior change has limited the growth of the epidemic, but alone has not stopped it. Early initiation of antiretroviral treatment (ART) prevents illness in HIV-infected persons and also dramatically reduces their HIV viral load, infectivity, and likelihood of transmitting the disease on to others. Clinical trials have unequivocally demonstrated that HIV-infected persons who are in treatment, who adhere to ART regimens, and who achieve viral suppression are up to 90% less likely to transmit the virus to their partners. Thus, treatment of HIV disease is now also a potentially powerful approach to prevention. This project seeks to develop a new integrated research agenda that brings together behavioral, biomedical, and community expertise to rapidly translate new biomedical HIV prevention advances from clinical trials to interventions that can be implemented on a public health scale.

Implementation, Effectiveness, and Cost-Effectiveness of an HIV InterventionImplementation, Effectiveness, and Cost-Effectiveness of an HIV Intervention
Funding Source: National Institute of Mental Health
Site Prinicipal Investigator: Steven D. 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.

High Risk Crack Use Settings and HIV in El SalvadorHigh Risk Crack Use Settings and HIV in El Salvador
Funding Source: National Institute on Drug Abuse
Prinicipal 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.

SPNS: System Linkages & Access to Care for Populations at High Risk for HIVSPNS: System Linkages & Access to Care for Populations at High Risk for HIV
Funding Source: State of Wisconsin and HHS Health Resources and Services Administration
Principal Investigator: Michelle R. Broaddus, PhD

In Wisconsin it is estimated that between 20% and 40% of HIV positive individuals are not in medical care and the proportion may be even higher among African Americans living with HIV in Milwaukee. African Americans may be more likely than other racial/ethnic groups in Wisconsin to never receive care or to fall out of care. As a result, persons with HIV who are not in medical care are more likely to have worse health outcomes and are more likely to transmit their HIV infection compared to those who are receiving care. The State of Wisconsin, with financial support from the federal Health Resources and Services Administration, has instituted a program to find HIV-infected individuals and link them to high quality health care and supportive services to reduce disease transmission and improve health outcomes within the community. This contract evaluates the provider and client satisfaction with that program.

Evaluating Providers’ Readiness to Enact PREP (HIV Pre-Exposure Prophylaxis)Evaluating Providers’ Readiness to Enact PREP (HIV Pre-Exposure Prophylaxis)
Funding Source: Gilead Health Sciences
Principal Investigator: Andrew E. Petroll, MD, MS

The FDA recently approved the use of Truvada© as pre-exposure prophylaxis (PrEP) to reduce the risk of HIV infection in HIV negative individuals. PrEP—using a combination of daily emtricitabine and tenofovir, or Truvada—was shown to reduce the risk of HIV acquisition by 44-73% in at-risk populations, with risk reductions of up to 92% among individuals who were most adherent to their PrEP drug regimen. Thus, using Truvada for PrEP has the potential to make a significant impact on the HIV epidemic if it can be prescribed to at-risk individuals. However, the feasibility of large-scale PrEP implementation that is accessible, safe, and cost-effective has yet to be determined. Some studies have focused on the awareness of PrEP among at-risk individuals, but little data exist regarding health care providers’ ability and willingness to prescribe PrEP, or clinic-level barriers and facilitators to support PrEP provision. This study examines these essential issues to facilitate increasing the availability of PrEP for at-risk individuals.

Promoting Healthy Relationships Among LGBT YouthPromoting Healthy Relationships Among LGBT Youth
Funding Source: Advancing a Healthier Wisconsin Partnership Program
Principal Investigator: Carol L. Galletly, JD, PhD

Data from the 2009 Youth Behavior Risk Survey indicated that LGBT youth in Wisconsin are at a significantly higher risk of experiencing intimate partner violence than their heterosexual peers. Continuing and expanding upon a long-standing collaboration, six LGBT community agencies will partner with academic researchers to implement a culturally competent, community level intervention focused on preventing intimate partner and dating violence among LGBT youth. The intervention focuses on increasing recognition of dating abuse in LGBT relationships, increasing knowledge about where to seek help if a target or perpetrator of violence, increasing awareness of healthy dating behaviors, increasing social support of targets of violence and confrontation of perpetrators, and shifting the dating norms of LGBT youth away from intimate partner and dating violence.


Repeat STI Patients: Tailored Socio-Contextual Intervention to Reduce HIV RiskRepeat STI Patients: Tailored Socio-Contextual Intervention to Reduce HIV Risk
Funding Source: National Institute of Mental Health
Site Prinicipal Investigator: Steven D. Pinkerton, 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.

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