Behavioral, social, and biomedical strategies essential to end HIV epidemic in the US

Penn MedicineOct 30 2019

To end the HIV epidemic in the United States, the use of behavioral and social science research-;combined with biomedical strategies-;is essential, according to a series of new papers in the Journal of Acquired Immune Deficiency Syndromes (JAIDS).

The 15 article supplement was co-edited by two faculty members in the Perelman School of Medicine at the University of Pennsylvania, Michael B. Blank, PhD, co-director of the Penn Center for AIDS Research (CFAR) and the Penn Mental Health AIDS Research Center, and David S. Metzger, PhD, director of the HIV Prevention Research Division in the department of Psychiatry and co-director of the Penn Mental Health AIDS Research Center.

The 15 articles underlie the importance of behavioral strategies to improve HIV care and the actions required to end the HIV epidemic. The supplement is based on proceedings of the Annual Meeting of the Social and Behavioral Science Research Network (SBSRM) in 2017 and 2018, and it will be published in print on December 1, 2019 for World AIDS Day.

HIV has moved from a death sentence to a more manageable, chronic illness, but strategies for dealing with these chronic illnesses are increasingly all about behavioral health. In order to end HIV in our lifetime, we need to focus on mental health in every step of the way towards eradicating the disease."

Michael B. Blank

Articles in the supplement outlined several important findings. For example, one study led by Penn Nursing's José A. Bauermeister, PhD, MPH, Presidential Professor of Nursing, used a youth-driven mystery shopper methodology to assess testing experiences for young men who have sex with men (YMSM) in three metropolitan cities highly impacted by the HIV epidemic.

Results showed variable performance across cities and testing sites, underscoring the importance of improving HIV testing services for this highly HIV-affected demographic.

A second study lead by Cécile M. Denis, PhD, a research associate in department of Psychiatry at Penn, assessed the association between chronic non-cancer pain, substance use disorder, and HIV-related outcomes in people living with HIV. Results showed that opioids are still commonly prescribed for people living with HIV.

A diagnosis of chronic pain or substance use disorder worsened the HIV-related outcomes, emphasizing the potential risk for the HIV epidemic. The findings call for a better coordinated care program in HIV clinics.

Two additional papers in the supplement focus on the inaugural Mid-Atlantic CFAR Consortium (MACC) Scholars program, which Penn created with the CFARs at Johns Hopkins and the District of Columbia.

The first of these two papers outlines the intentions and design of the Scholars program from the perspective of the program developers, which involves Blank and Metzger in partnership with Johns Hopkins University and other MACC Scholars mentors.

The paper outlines a model for other inter-CFAR collaborations to support the next generation of scientists. The second MACC Scholars paper, authored by Lily Brown, PhD, an assistant professor of Psychology in the department of Psychiatry, provides recommendations from the MACC Scholars themselves.

Both papers emphasize the importance of continued opportunities to promote the development of diverse junior scientists in HIV research.

An additional study, which involved work from Metzger in partnership with George Washington University, the Baltimore City Health Department, and others, measured policy change impact allowing for syringe exchange programs on HIV diagnoses among people in inject drugs in two cities-;Philadelphia and Baltimore.

Syringe exchange programs reduce HIV incidence associated with injection drug use, but legislation often prohibits implementation. The results of the analysis point to policy change as an effective structural intervention, with substantial public health and societal benefits, including the reduced HIV diagnoses among people who inject drugs and significant cost savings to publically funded HIV care.

The models studied estimate a one year return on investment in syringe exchange programs of $243.4 million in Philadelphia and $62.4 million in Baltimore.