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 MSMIncreasing PrEP Use in High-Risk Social Networks of African-American MSM in Underserved Low-Uptake Cities
Funding Source: National Institute of Nursing Research
Principal Investigators: Jeffrey Kelly, PhD, and Yuri Amirkhanian, PhD

PrEP use remains very low in mid-sized cities across the nation, especially among African American MSM who may be hidden in the community and hard to reach through conventional PrEP awareness campaigns. This research will employ a social network approach for both reaching racial minority MSM in the community and delivering an intervention in which peer network leaders are taught and enlisted to increase awareness, correct misconceptions, reduce stigma, and increase benefit perception and positive attitudes of their network members toward PrEP.

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 Investigator: Julia Dickson-Gomez, 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.

Structural and Social Contexts of Substance Use, Violence, and HIV Risk Among Adolescent GangsSocial Network Intervention to Engage Community PLH to Enter HIV Medical Care
Funding Source: National Institute of Mental Health
Principal Investigators: Yuri Amirkhanian, PhD, and Jeffrey 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. Social support may function to improve HIV treatment adherence directly through its informational, emotional, and concrete help-giving components. The intervention being pilot tested in this research undertaken in Russia directly builds peer social supports for medical care attendance and adherence. The present approach is unique because it extends beyond individual patient counseling to also strengthen social supports for care in the daily lives of persons living with HIV.

Structural and Social Contexts of Substance Use, Violence, and HIV Risk Among Adolescent GangsPerceived Immigration Laws' Impact on Hispanic Immigrants' HIV Health Behavior
Funding Source: National Institute on Minority Health and Health Disparities
Principal Investigator: Carol L. Galletly, JD, PhD

Along with disproportionate rates of HIV infection, Hispanic immigrants are affected by three important drivers of the US HIV epidemic: disordered alcohol and drug use, intimate partner violence, and reduced rates of HIV testing. This study addresses the knowledge gap. Law and policy scans, key informant interviews, and structured focus groups with Hispanic immigrants living in four US metropolitan areas will be conducted to explore immigrants' experiences with legal barriers and to identify the immigration-related concerns, beliefs, and misconceptions that influence their service utilization.

Community Intervention for HIV Testing and Care Linkage Among Young MSM in BulgariaCommunity 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.

Increasing Social Support to Improve HIV Care Engagement and AdherenceSocial 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, individual-level counseling. 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. This project develops an intervention that extends beyond current counseling paradigms by strengthening treatment-related norms, motivations, and collective self-efficacy within social networks of PLH in the community. It also trains leaders of the PLH social networks to encourage their personally-known HIV-positive friends to enter and adhere to care.

High-Impact Integrated Behavioral and Biomedical Interventions to Eradicate AIDSHealthier Wisconsin Strategic Initiative to Improve Behavioral Health
Funding Source: Advancing a Healthier Wisconsin (AHW) Endowment
Principal Investigator: Michelle R. Broaddus, PhD

The Healthier Wisconsin Partnership Program (HWPP) seeks to improve the behavioral health in Wisconsin communities--a person's mental well-being, their ability to function in everyday life, and their concept of self. An Academic Partner Team of CAIR faculty and staff works with 10 selected community coalitions spanning the state of Wisconsin to develop and implement strategies designed to improve some facet of each community's behavioral health. This collaborative effort also seeks sustainability by building the capacity of local communities to continue to serve and improve the behavioral health of their residents.

Regular HIV Testing among At-Risk Latino MenRegular 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.

Implementation, Effectiveness, and Cost-Effectiveness of an HIV InterventionReaching and Engaging Community PLH Into Care Through Social Networks
Funding Source: National Institute of Mental Health
Site Prinicipal Investigator: Jeffrey A. Kelly, PhD

Persons living with HIV (PLH) with viral load suppressed through antiretroviral therapy (ART) are less likely to transmit infection to their sexual partners. However, successful implementation of treatment-as-prevention on a public health scale can only be achieved when a high proportion of PLH living in the community are engaged into care. This project identifies reasons why PLH in the community are not in treatment and identifies how peer network supports can be used to improve care engagement. It will then pilot an intervention that trains influence leaders of social networks to encourage their HIV-positive friends to enter and remain in care.

High Risk Crack Use Settings and HIV in El SalvadorIntegrative Data Analysis of HIV Prevention Trials
Funding Source: NIH K01 Mentored Research Scientist Development Award
Prinicipal Investigator: Jennifer L. Walsh, PhD

Patients at sexually transmitted infection clinics report high rates of sexual risk behavior, are likely to experience repeat STIs, and are at increased risk of HIV relative to the general population. This research uses integrative data analysis (IDA), a technique for combining multiple, independent datasets to increase statistical power and sample diversity, to determine mechanisms of change in sexual risk and identify factors associated with differential response to intervention. Results will inform the development of more effective brief risk reduction interventions.

SPNS: System Linkages & Access to Care for Populations at High Risk for HIVThe Effect of Intersecting Stigmas on PrEP Outcomes for Young Black MSM
Funding Source: NIH K01 Mentored Research Scientist Development Award
Principal Investigator: Katherine G. Quinn, PhD

Young, Black men who have sex with men (YBMSM) continue to be disproportionately affected by HIV and pre-exposure prophylaxis (PrEP) may be an essential part of combination prevention strategies to curb these disparities Stigma may be a limiting factor in the success of PrEP for YBMSM and this research will examine how intersectional stigma experienced by YBMSM may influence PrEP knowledge and uptake. This study examines the factors that shape YBMSM's engagement with PrEP and findings from the study will inform a tailored PrEP intervention for YBMSM.

Sound Public Health Approaches to Knowing Exposure to HIVSound 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.

Engagement in Care and Quality of Life among Older, Rural HIV-positive AdultsEngagement 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.

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Center for AIDS Intervention Research (CAIR)
Department of Psychiatry and Behavioral Medicine
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