A graduate student at the University of Hawaiʻi at Mānoa Office of Public Health Studies (OPHS) has won a national research award to showcase her work at the American Public Health Association (APHA) annual meeting that will be held virtually in October.
Amber Sophus, one of 28 winners nationwide, will present her systematic review about interventions aimed at preventing HIV/AIDS in Black women in the U.S.
“In my dissertation research with Black women, I focus on identifying their barriers and facilitators toward using pre-exposure prophylaxis [PrEP],” Sophus said. PrEP medications for HIV-negative individuals are important because they could help reduce Black women’s risk of becoming infected with HIV through sex with an infected partner.
Sophus was nominated for the award by the UH chapter of Delta Omega Honor Society, a prominent public health honor society. She has completed her master of public health degree and is now working toward earning her PhD at OPHS.
“Amber’s research is timely and vital to helping reduce HIV disparities that severely impact Black women in the U.S., particularly in the south,” said Jason W. Mitchell, an associate professor of OPHS who is her primary mentor and chair of her dissertation committee. “Winning this award reflects Amber’s hard work…she deserves this important national recognition.”
Most interventions aimed to prevent new HIV infections in Black women have been conducted in the Southern U.S., focused on adults, and have centered on women’s behaviors. Few studies have included teens or older women, while none have included the use of PrEP in preventing new infections, and none have included women’s sex partners in the interventions.
“This research reveals opportunities to improve current and future HIV prevention interventions for Black women, such as including PrEP,” Sophus said. “Although strides have been made to prevent HIV infections in Black women, more work is needed.”
Introduction of highly active antiretroviral therapy (HAART) has significantly decreased deaths in HIV-positive children, most of whom were infected from pregnancy or breastfeeding. Before, HIV-positive children rarely lived past their fifth birthday; today, they are living into their teenage years. As a result, parents and health care providers struggle to decide how and when to tell an adolescent that he/she is HIV-positive.
Researchers from the Office of Public Health Studies at the University of Hawaiʻi at Mānoa explore this dilemma in a paper published in the American Medical Association Journal of Ethics this month, “Should There Be a Disclosure Mandate for Physicians Caring for Perinatally Infected Adolescents Who Don’t Know Their HIV Serostatus?” First author Sabhyta Sabharwal wrote the paper during a class when she was an MPH student at the University of Hawaiʻi at Mānoa with her instructor and assistant professor Victoria Y. Fan, ScD, SM. Jason W. Mitchell, PhD, MPH, assistant professor, is also a co-author on the paper. Sabharwal is currently a medical student at Tufts University School of Medicine in Boston, Massachusetts.
This paper highlights current gaps in HIV disclosure policies for adolescents in America. Currently, the law does not require providers or caregivers to tell minors that they are HIV-positive. In some states, the physician needs parental consent before they can tell a minor that he/she is HIV-positive.
On the one hand, disclosure may cause psychological distress, social stigma, or social isolation to the minor. On the other hand, adolescence is a time when children are more likely to engage in risky behaviors and if a minor does not know they are HIV-positive, they can have unprotected sex and infect unknowing partners. Furthermore, adolescents living with HIV could face criminal penalties if they fail to tell sex partners about their HIV-status once they turn 18.
For these reasons, physicians should be legally allowed to tell adolescents of their HIV serostatus, even if parental consent is not granted.
In the wake of a devastating HIV outbreak in a rural Midwestern county, the tone of the news media toward people who use injection drugs changed significantly, according to a new analysis from a public health researcher at the University of Hawai‘i.
Moreover, this shift in the media's tone may have provided the momentum that was needed to change decades-old, outdated government policies, and allow public health agencies to start a syringe exchange program to prevent the further spread of HIV and other diseases, the analysis shows.
"The study showed that the media is really key to creating a frame around how populations are perceived by the public," said David Stupplebeen, the author of the study and a PhD student at the Office of Public Health Studies at the university.
The outbreak struck Scott County, Indiana, in 2015, and was linked to an increase in the use of opioids. In his analysis, Stupplebeen searched for news articles that focused on people who use injection drugs that were published up to 10 years before the outbreak was first reported to the Centers for Disease Control and Prevention. He compared those articles with articles that were published after the outbreak was reported. He examined a total of 372 articles, which were mainly from local newspapers' coverage of the outbreak.
Stupplebeen found that before the outbreak, news stories about people who use injection drugs tended to focus on the crimes that these people committed, painting a picture of them as immoral criminals. But during the outbreak, which ultimately resulted in nearly 200 new cases of HIV in the sparsely-populated county, the tone shifted. The news articles started to bring to light the heartbreaking effects that the opioid-use epidemic had on the people living in an area already plagued by high levels of unemployment and poverty.
"Negative framing of people who inject drugs helped reinforce a stable policy environment, which didn't support syringe exchange programs," Stupplebeen says. "The HIV crisis changed the framing." This change in framing opened the door to the state's decision to allow the county to begin a syringe exchange program, to offer clean needles to people who use injection drugs.
Much research has shown that syringe exchange programs reduce the impact of communicable diseases in the community. However, some policy makers are reluctant to allow such programs over misguided fears that the programs encourage drug use. (They don't.)
"After the outbreak became known, talk turned to getting people into treatment, preventing overdoses, and doing needle exchange," Stupplebeen says.
The analysis will appear in an upcoming issue of the International Journal of Drug Policy.
A mobile app aimed at lowering the HIV-transmission rate among men who have sex with men should include an HIV test location finder and should help men to track their sexual activities, new research from the University of Hawai‘i at Mānoa shows.
For the study, public health researchers conducted in-depth interviews with Spanish-speaking men who have sex with men (a group that includes men who are homosexual, bisexual, questioning their sexual identity or orientation, or heterosexual but having sexual encounters with other men). The researchers asked the men what features they look for in apps, and what aspects of an app would make them likely to use it.
"We know from previous research that there is a need to improve HIV prevention efforts for Latino men who have sex with men in the U.S., and to help these men get tested for HIV and other sexually transmitted infections," said Jason Mitchell, PhD, MPH, an assistant professor with the Office of Public Health Studies at UH. "Mobile apps are a great way to get information and resources out to people, but prior to our research, there weren't any studies that had asked these men what they wanted in an app, and what might motivate them to download an app and keep using it over time," said Mitchell, who is the lead author of the new study.
The researchers recruited men in the Miami area whose primary language was Spanish through Facebook ads and flyers. They interviewed 15 men and then analyzed the transcripts of the interviews, looking for common themes.
When asked what they looked for in apps in general, all of the men said that it was very important to them that apps keep their personal information secure and confidential. Most said they were willing to pay for apps that were useful to them. The men also said they tended to download apps that their friends had used and liked.
As for an HIV-prevention app, almost all of the men said they would like an app to send them reminders to get tested for HIV on certain dates and show them the nearest location where they could get tested. Most of the men also said they would like the app to send them information about HIV, either through text messages or alerts, and that they would want a feature in the app that would help them keep track of how many sexual partners and encounters they had.
"These findings could help guide future efforts to develop an HIV prevention app for Spanish-speaking men who have sex with men," Mitchell said.
The study will be published in a future issue of the Journal of Medical Internet Research: Public Health & Surveillance. Mitchell's co-authors included researchers Maria Beatriz Torres of Gustavus Adolphus College in Minnesota, Lucy Asmar of the University of Miami Miller School of Medicine in Florida, and Thu Danh and Keith Horvath, both of the University of Minnesota.
