HIV research and prevention is an ever-changing field, and Miriam Hospital is helping lead a new grant to develop innovative ways to deliver HIV-fighting drugs to women. The hospital announced last week that it has received a portion of a $20 million National Institutes of Health grant to develop and test an intravaginal ring as a method of delivering antiretroviral drugs to women to prevent the spread of sexually transmitted HIV. The ring will deliver tailored, timed dosages of ARV medications.
Associate Professor of Psychiatry and Human Behavior Kathleen Morrow has received $1.2 million of the grant to study the social and behavioral implications of this intravaginal ring, according to a Lifespan press release. Morrow’s role is to come in and assess whether the product is being received well by potential users, said Sara Vargas, a postdoctoral fellow working with Morrow.
Morrow works to bridge the gap between product developers and the users who actually receive their products, Vargas said. “Dr. Morrow’s main goal is to hear from people as early as she possibly can, so (developers) are not going down the wrong road.”
User feedback is especially critical in HIV treatment because “you can have the best drug in the world that delivers perfectly and has a really high protection rate, but if it makes sex feel terrible, people won’t want to use it,” Vargas said.
The trend of effective drug delivery for HIV treatment and prevention has been on the rise recently, Vargas said. In recent years, this line of work has increased, but Morrow’s work on this grant is still only “one piece of the puzzle,” she added.
Opening dialogue
The area of HIV research has grown in prevalence and has spread across disciplines, and current University research on HIV extends far beyond the development of intravaginal rings for women. A wide array of departments often collaborate to focus on both treatment and prevention measures for particular at-risk groups. Kristi Gamarel, a postdoctoral fellow at the Alpert Medical School, recently published two papers about HIV implications and prevention. The first was on the administration of Pre-Exposure Prophylaxis — a preventative drug combination — to men in relationships with other men, and the second focused on how social perceptions affect HIV treatment and prevention in transgender women.
Gamarel said she was interested in the social implications that make certain individuals within these groups more likely to seek PrEP over others. For men in same-sex relationships, she found that those most likely to seek PrEP were those with long-term partners in relationships where both individuals were self-reported as HIV negative.
“We did find over half of the men who are in relationships were interested in taking PrEP,” Gamarel said. “And the desires for intimacy around condom-less sex were a deciding factor in these men wanting to take PrEP to protect themselves.”
In the second study, Gamarel looked at discrimination’s effect on transgender women’s sexual health with their biologically male partners. Social disdain, alienation and discrimination had an effect on the quality of their sexual relationships, which led to a higher risk of HIV infection, she said. “Mental health is a pathway of HIV transmission, and poor relationship quality could also indicate difficulties with communication or not being on the same page.”
Social practices
Other societal factors can also play a large role in the likelihood of effective HIV treatment. Christopher Kahler, professor of behavioral and social sciences, looks at alcohol use and its effect on people living with HIV. Kahler said in recent studies, he has explored alcohol use in the context of the question of what living a healthy lifestyle means for those with HIV.
One of the primary effects of heavy alcohol use is that it reduces the likelihood that people will take their medication on time and in the correct manner, Kahler said. Another is that HIV-positive people with high levels of alcohol consumption may see their brain function detriorate more rapidly than heavy alcohol users without HIV, he added.
As treatment methods have evolved, Kahler said, part of HIV research has switched from being focused on “prevention and palliative care” and expanded to monitoring the effects of practices of HIV-positive people.
Across departments, across continents
HIV research has always been an important and widely-tackled topic, said Caroline Kuo, assistant professor of behavioral and social sciences. But the past decade has seen a significant increase in the interdisciplinary methods being used to improve treatment and prevention.
“More and more, we’re realizing that we should approach it as bio-behavioral prevention,” Kuo said.
Kuo, whose research focuses on adolescent, gay and transgender populations in South Africa that are at risk for HIV, said interdisciplinary collaboration at the University extends through departments and across continents to universities in South Africa. Interaction between medical developers and behavioral scientists is key for developing accessible products, Kuo said.
“If there is any disease that I would call an interdisciplinary science, HIV really exemplifies that,” she added.
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