Last September, two professors of psychiatry and behavioral medicine—Jeffrey A. Kelly and Yuri A. Amirkhanian at the Center for AIDS Intervention Research (CAIR) of the Medical College of Wisconsin—received a five-year $3.4 million research grant from the National Institute of Health. The grant funds a project intended to remedy the lack of awareness of the anti-retroviral medication regimen known as PrEP (for Pre-Exposure Prophylaxis) among high-risk male populations in midsize Midwestern cities. Recommended by the Center for Disease Control to reduce the spread of HIV, PrEP can lower the rate of HIV infection by nearly 90%.
But, while PrEP awareness is established on the coasts, it is significantly lower in the Midwest—especially among racial minorities. According to Kelly, the research will be conducted in Milwaukee and Cleveland—cities chosen because they represent a common problem found in similar sized Midwestern cities: a greater likelihood that African American “MSM” (men having sex with men) will contract HIV.
“The PrEP medical regimen provides a high level of protection to those uninfected. Its use among white gay men has risen; among African Americans it lags far behind. In cities like Milwaukee, awareness of PrEP is much lower than locations on the coasts. People have not paid a lot of attention in cities in the mid section of the country,” Kelly says. The study will be conducted with the collaboration of the health departments of both cities: in Milwaukee with partners AIDS Resource Center of Wisconsin and Diverse & Resilient; and in Cleveland with the AIDS Task Force of Greater Cleveland.
‘Trust is Key’
CAIR’s five-year research consists of two phases. The first is listening and gathering input from African American gay and bisexual men to determine what they think about PrEP, what their concerns are and how a program needs to be delivered. “We need to spend a long time listening to learn why PrEP uptake is pretty low. Some people are not very aware of what it is. Others are aware but have concerns that it’s nothing they need because they’re not that sexually active,” Kelly says. “Others ask, why would I take a pill when I’m healthy? There’s also a legacy of medical mistrust in minority communities. Why are they trying to get me to take pills? It goes back to the Tuskegee days. We’re not trying to convince everyone but hoping to give them the ability to make informed choices.”
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Based on what the researchers hear, the second phase will consist of building the intervention and conducting a trial to educate the target community about PrEP. Kelly explains the process as a “social network” in which people connect with other people in the community. “It’s a friends-reaching-friends approach. If we can find people connected with others and invite them when they express interest, they’ll continue reaching out to more circles of friends. Sometimes, people don’t want to be out, but they are connected to other people and need to gain trust. Trust is key. Fortunately, thanks to previous programs, the CAIR staff is well known in the black MSM community. The process seeks to reach 500 subjects. We’ll be following everyone we enroll for 15 months to see if it changes views and attitudes towards PrEP and whether some have started the regimen. Finding out if it works is part of the research.”
Success will be measured by fundamental outcomes. “Do people start on PrEP? Do they choose to remain on the regimen? Sometimes, people tell you what they think you want to hear. So we’ll do verification by blood test to objectively corroborate reports of adherence. With such measures of awareness, concerns about compliance decrease,” Kelly says.
The CAIR team is optimistic about the study’s potential for success. According to Kelly, its last project with the African American community had around 85% follow up. Kelly cites another reason for their optimism: “We try to appeal to people’s altruism. People want to be able to help. When people volunteer, we emphasize it’s about developing plans for all over the world. If people understand what that meaning is, they are more likely to be involved, be honest and be willing to play a role in helping other people.”
