Since the first case of HIV was diagnosed in the United States in 1981, 26 million people have died of AIDS worldwide and the epidemic shows no signs of weakening. There remains no vaccine or cure, and progress against the disease is uneven. UNAIDS, the United Nations’ AIDS fighting agency, estimates that for every 100 people put on treatment, 250 are newly infected.
Given the grim statistics, what can be done to curtail the spread of the disease?
On two different continents, Steinhardt faculty members are undertaking HIV prevention research and advocacy in an effort to help change the lives of South African youth and gay men in America.
A Hands-On Approach in South Africa
For the past 15 years, Professor Sally Guttmacher has been working to enact changes in health care delivery in South Africa. She directs Steinhardt’s master’s program in community public health, as well as Community Health: A Society in Transition in South Africa, an all-NYU graduate summer study abroad program she created.
Guttmacher studies the efficacy of publichealth interventions. The social upheaval of the 1960s and an activist father, Alan Guttmacher, a renowned leader in the reproductive rights movement (The Guttmacher Institute bears his name.), shaped her ‘hands-on’ approach to public health.
An anthropologist by training, Guttmacher, who lives part of the year in South Africa, will identify a pressing health problem and set out to change it. Her experience of the country’s staggering AIDS epidemic led her to study HIV and sexually transmitted disease prevention education in South African schools, as well as parental consent in students’ HIV prevention education.
But reducing the spread of AIDS in a country with one of the highest incidence rates in the world, can feel like a Sysiphusian task. When Guttmacher evaluated New York City’s plan for expanded HIV/AIDS education and condom availability program in 1997, she learned that city teenagers engage in sexual behavior whether or not condoms were readily available to prevent HIV transmission. Her experience in South Africa has borne a similar insight.
“Our whole emphasis on teaching kids doesn’t seem to be the panacea we thought it could be,” Guttmacher says. We thought that once people understood how HIV is spread they would desist in the kind of behaviors that spread HIV.”
A culture of poverty and fixed ideas about intimacy add to the direness of South Africa’s public health crisis. Guttmacher notes that young girls often will trade sex for items like lipstick, clothing, dinner, and young boys believe that sex has to be “skin to skin.”
This has led Guttmacher and her colleague South African professor Catherine Matthews to look for a way in enact small changes in policy to help teens who do seek out HIV prevention information and counseling into South Africa’s clinics.
Funded by the Medical Research Council in South Africa, a recent study looked at whether voluntary testing and counseling clinics in the Capetown metropolitan areas were adolescent friendly. Surveys administered by Guttmacher and her students, presented to South Africa’s Department of Health, revealed that nurses and receptionists were punitive to teens seeking services, and that they needed training to work with adolescents.
This might not seem like big news, but it is the kind of intervention that might change the future for one infected teen who needs to begin treatment.
“It’s an intervention that is so cheap so easy to do!” Guttmacher says. “Everyone is thinking about these very complicated changes you need to make in a clinic in order to get the youth to come in and get tested, and we discovered that maybe it’s as simple as spending one day teaching the receptionist to smile and not say to the kids, ‘Make your own chart! ‘ There are small interventions that can have a huge impact.”
In the United States Looking at the Whole Person
Working with gay men in the United States, Perry Halkitis Steinhardt associate dean and professor of applied psychology, has also found that prevention strategies aimed at altering behavior have had limited effectiveness in the HIV epidemic. Like Guttmacher in South Africa, Halkitis is aware that HIV prevention is an intractable problem. (In the United States, gay men constitute more than 50 percent of those infected with HIV.)
“Too long we have relied on simplistic policies of ‘use a condom every time,’” Halkitis says. “Our approaches for the last 30 years have envisioned HIV prevention strategies to alter behavior without taking into account that it is social context that mold these behaviors and fuels the risk of HIV infection.”
Halkitis is the director of Steinhardt’s Center for Health, Identity, and Behavior & Prevention Studies (CHIBPS) , where daily research is undertaken to explore the broad range of challenges that gay men face. CHIBPS projects look at the continuum of mens’ development in an effort to understand their prevention and health needs at all phases of the lifecycle. Since 1998, Halkitis has been involved in more than 20 research studies, which have received funding from a range of government and private sources, including the Center for Disease Control and Prevention, the New York City Department of Health, the New York Community Trust, and the United Way.
With a $2.9 million National Institute of Health grant, Halkitis and his team are working with the NYU School of Medicine to study the developmental pathways of young gay men in an attempt to pinpoint specific risk factors for HIV infection. The study called Project 18 (named for the age of the research subjects) follow 675 gay men for three years in order to understand their developmental trajectories and vulnerability to the epidemic. Data will look at sexual behavior, drug use, relationships, mental health status, as well as academic engagement and community service.
Halkitis hopes that the study will show the specific psychological burdens that young gay men face, and that this information will help service providers to create team approaches to HIV prevention to incorporate prevention, sexual health advocacy, addiction, and mental health services, into their counseling treatment.
“Our work consistently shows that for gay men, HIV exists within a larger framework,” Halkitis says. “HIV is not just a medical condition driven solely by sex, but a biological, psychological, and social disease driven by the health disparities and lack of equality and access that gay men face.”