For more than two decades, PHMC has stood at the forefront of the battle against HIV/AIDS. Our work has sought to reduce infections, increase access to care and address persistent disparities experienced by marginalized groups infected with HIV—all through intensive research and evidence-based initiatives.
A Tradition of Groundbreaking HIV/AIDS Research
PHMC has a long-standing commitment to community-based HIV/AIDS research and policy analysis. For the past 23 years, PHMC’s Research and Evaluation Group has conducted and participated in a number of HIV prevention and intervention research studies that have influenced innovative outreach and education strategies across the country. “In 1987, we were among the first nonprofit organizations to get involved in HIV/AIDS prevention research,” says Lisa Bond, PhD, a senior researcher at PHMC and part of a multidisciplinary team of researchers whose backgrounds include psychology, sociology and social work.
From a National Institute on Drug Abuse research demonstration grant in 1987 focusing on HIV prevention among injection drug users, to a Centers for Disease Control and Prevention (CDC) project developing a new intervention for bisexual men that continues through 2012, PHMC’s studies have assessed prevalence, risk behaviors and testing factors, and they have evaluated interventions to reduce HIV risk among high-risk populations. The results of many of these have been published in national journals, such as American Journal of Public Health; Culture, Health & Sexuality: An International Journal for Research, Intervention and Care; and Archives of Sexual Behavior. Some studies serve as the framework for national models, such as the Women and Infants Demonstration Project led by Jennifer L. Lauby, PhD, senior research associate. The study led to the development of one of the CDC’s model evidence-based interventions known as Real AIDS Prevention, now carried out in cities across the United States.
“Our HIV/AIDS research is an important example of how our work consistently deals with larger public health issues related to population groups that are disproportionately at risk for multiple health problems and face challenges with access to health care and other services,” says PHMC’s Lynne Kotranski, PhD, vice president of research and evaluation.
PHMC is unique in the world of HIV/AIDS because programs and research are housed in the same place.”
Collaboration and community focus are hallmarks of PHMC’s research. “A strength of PHMC’s HIV prevention research has always been its strong ties to communities affected by HIV and its commitment to engaging community partners and community members in our research efforts,” says Bond.
Last year, “Black Men Who Have Sex with Men and the Association of Down-Low Identity with HIV Risk Behavior,” a study led by Bond and colleagues at PHMC, the CDC, and Hunter College of Social Work in New York City, was published in the American Journal of Public Health and received national print and broadcast coverage. The groundbreaking study analyzed interviews with more than 1,100 gay-, bisexual- and heterosexual-identified men of color who have sex with men. It found that down-low identification does not mean greater HIV risk—men who have sex with men and women and identify themselves as “on the down-low” engage in the same level of risk as men who do not identify themselves as on the down-low—and that such labeling undermines prevention and research efforts.
Consistently, PHMC carries out its HIV prevention research in partnership with other agencies and organizations in the region that serve HIV-affected communities. Most recently, the Research and Evaluation Group has partnered with Mazzoni Center, a local health and wellness center for lesbian, gay, bisexual and transgender communities and the oldest AIDS service organization in Pennsylvania. They collaborated on Get Real, a social marketing, community-level intervention program that uses the narratives of young, local men to facilitate frank discussions about safe sex, HIV/AIDS risk and general health and well-being. Get Real targets substance-using men who have sex with men through media communications and interpersonal networking. The program seeks to change risk behavior and social norms that contribute to HIV risk.
“We have a strong track record of partnering with community organizations,” says Lauby. Several Research and Evaluation Group staff members serve on PHMC’s Community Advisory Board (CAB) on LGBT research, which we created five years ago to ensure that the work of PHMC’s Research and Evaluation Group remains responsive to the needs and concerns of the diverse LGBT communities of Philadelphia. CAB provides input from community members at each stage of the research process: study design, recruitment, results dissemination and protection of study participants. “We need help from the community to plan and implement our research,” says Lauby. “We partner with the community; we don’t do our research isolated from community involvement,” says Bond. CAB helps to inform researchers of local issues or concerns that can affect the conduct and successful implementation of research studies, particularly in the area of HIV prevention.
Both Bond and Lauby agree that attitudes towards HIV/AIDS remain a barrier to an understanding of the epidemic. Says Bond, “People think that if we can get others to change their behavior we could end the epidemic. But effective HIV prevention is about much more than changing personal behaviors.” Lauby agrees. “Many factors influence HIV transmission,” she says, “such as relationships, community norms, access to health care and local laws. We know from research that an effective approach to the epidemic requires that we address it on multiple levels, including working with individuals, families, communities and larger systems like health care, housing and corrections. When these factors get addressed, we are more likely to see a positive, sustained impact.”
Taking It to the Streets: HIV/AIDS Outreach Work in the Community
In the 1980s, public health officials realized that the drug culture—with its frequent needle-sharing—was a contributing factor to the HIV/AIDS epidemic. In response, PHMC formed the Philadelphia HIV Prevention Street Outreach Project, recruiting people to go out on the streets in pairs to engage with active drug users and provide counsel, education and referral to services. PHMC community health outreach worker Sam Tiru says, “We’re just people from the community helping other people from the community.”
Outreach workers meet every morning and fill bags with HIV and HCV (hepatitis C virus) prevention materials, including bleach kits and condoms, and head out onto the streets. Bleach kits help reduce the risk of HIV transmission by cleaning needles. “We’re not about promoting drug use,” says Tiru, “but there can be as many as 10 to 15 people in a shooting gallery using the same syringe.”
For the past 21 years, Tiru has walked the city’s streets educating intravenous drug users on the ways they can reduce their risk of HIV transmission. He says the challenges of HIV/AIDS outreach have changed over the years. “A lot more people nowadays are educated about HIV/AIDS, but back then people were scared of dying. Back then, HIV/AIDS was a death sentence. Now people say, ‘Well, there are pills’ and continue to engage in risky behavior.” However, Tiru notes that other advancements in technology have helped move outreach work forward. “Having HIV/AIDS is still considered taboo. Many people still don’t want to get tested. But rapid testing helps. Back in the day, it would take three to six weeks to get results back. Now it’s a lot faster.”
Part of Tiru’s passion for outreach comes from seeing the affect of the epidemic firsthand. “I never thought when I got into this field that someone I knew would be infected,” he recalls. Then a family friend, a Vietnam War veteran who was also an active drug user, was diagnosed with AIDS. “We brought him home to die,” says Tiru. “It took six months.” Today, Tiru continues to fight against HIV/AIDS despite the risks of getting in the middle of a drug raid, shootout or fight. “Now drugs are more recreational,” says Tiru. “Drug culture has changed and gone underground. But the need for direct outreach remains.”
PHMC’s New Pathways and New Pathways for Women projects also serve active substance users in the Philadelphia community, in part through HIV/AIDS awareness, education and prevention resources. “It’s really important that an outreach program cater to the whole person,” says Eugenia Argires, program director with PHMC’s Health Promotion and Service Systems component. “We are working to expand our programs to be more holistic, including embedding HIV/AIDS prevention into a larger framework of project services promoting wellness.” New Pathways for Women responds to a growing need. “The face of the epidemic is changing, with HIV/AIDS now the third leading cause of death among African-American women ages 25 to 44,” says Argires. “The epidemic has shifted, and we’re here to meet that need.”
Providing Quality Primary Care
In addition to providing HIV/AIDS prevention and research, PHMC also offers direct care through the PHMC Care Clinic, formerly located at St. Joseph’s Hospital and managed by North Philadelphia Health System. Since 1992, the clinic has provided primary care, including medical treatment, case management, education and risk reduction, to the HIV/AIDS community in North Philadelphia. It was one of the first in the city to cater exclusively to the HIV/AIDS community in that area. “The population that we serve is at high risk for being lost to care and in the past ended up in the hospital with illnesses that could have been prevented,” says Anne Kelly, MSW, MEd, program director of the PHMC Care Clinic. “We provide services, such as support groups, outreach and nutrition counseling for our patients, many of whom may not go for such services in a traditional office setting.” PHMC Care Clinic staff routinely follow up with patients through phone calls and mailings to ensure they stay connected to care.
In March 2010, the clinic moved to a larger location at 1200 Callowhill Street, where they expanded their services to include family planning, pediatric care and much more. “We’re still doing outreach and specialized services here,” says Kelly. “In addition to adding services for our HIV patients, we provide primary care for other vulnerable populations such as homeless patients in our new setting.” HIV patients also have direct access to substance abuse treatment services at CHANCES, a PHMC outpatient and intensive outpatient substance abuse treatment program for women housed in the same building.
Prevention Programs for the Future
PHMC continues to implement programs to meet the needs of new and changing populations that require HIV/AIDS prevention services. According to a 2006 report by the Philadelphia Department of Public Health, while the overall rate of HIV infection in the US is estimated at 23 infections per 100,000, the rate of HIV infection in Philadelphia is estimated to be 114 infections for every 100,000—five times the national rate. Furthermore, the majority (89%) of all heterosexually acquired HIV infections in adolescents occur in girls and HIV/AIDS remains the leading cause of death for African-American women between the ages of 18 and 35. “Right now, the city of Philadelphia has no HIV prevention program specifically focused on reaching sexually active African-American adolescent girls,” says Akil Pierre, project coordinator of the Preventing AIDS through Live Movement and Sound (PALMS) Project. “The lack of targeted interventions designed to reach this vulnerable group highlights the urgent need for effective gender-specific, culturally relevant HIV prevention interventions geared toward this population.”
The PALMS (Preventing AIDS through Live Movement and Sound) Project, a community-based HIV prevention program, uses theater to teach young people the importance of HIV/AIDS prevention. Through multisession, group-level interventions, trained peer actors provide youth with HIV risk reduction education and strategies designed to increase their self-efficacy to practice safer sex behaviors.
Pierre recently applied for and received funding from the CDC to spearhead a new program at PHMC targeting African-American adolescent females. “The intervention is designed to celebrate the strengths of African-American women while building African-American girls’ capacities to consistently practice HIV risk reduction strategies in the context of race and gender-based inequalities,” says Pierre. The first component, called Sisters Informing Healing Living Empowering (SIHLE), uses peer-led group sessions to reduce HIV sexual risk behaviors among sexually active African-American girls ages 14 to 18, while also highlighting cultural and gender pride. SIHLE provides participants with free testing, referrals and counseling services. In addition, PHMC will partner with the Women’s Anonymous Test Site of the Health Federation of Philadelphia to provide on-site confidential rapid HIV counseling, testing and referral services to SIHLE participants. The second component, called Young Sisters Take Charge (YSTC), features a bi-monthly, multiservice, intergenerational program that reaches out to African-American women ages 14 and older and their female relatives. It provides counseling, testing and referral services for HIV. Both programs are scheduled to begin in February 2011.
