Sanyukta Mathur is an assistant professor of Population and Family Health at Columbia University Mailman School of Public Health. Before her faculty appointment this past fall, she was an associate research scientist for the Department for two years. Dr. Mathur is the project director for PopFam’s Rakai Youth Project and a co-principal investigator on its Linkages study, two NIH-funded projects underway at the Rakai Health Sciences Program (RHSP) in Uganda. She previously spent seven years as a researcher for the International Center for Research on Women in Washington, D.C. Dr. Mathur recently developed and is teaching a new course focusing on global reproductive health. She earned her doctorate from the Mailman School’s Department of Sociomedical Sciences at Mailman in 2012.
I understand you played a key role in two NIH-funded research projects that have been conducted in Rakai, Uganda. Can you tell me a bit about that work?
The work is Rakai is really interesting. The Rakai Health Science Project is an incredible research station in southwestern Uganda. The core activity there is a community surveillance cohort in 50 communities with behavioral and bio-marker data. The project dates back to when they first found HIV in Uganda, before people knew what was going on. Rakai is located in a part of Uganda that borders Tanzania and there is a major highway route between the two countries so there are interesting disease transmission dynamics at play. I was a doctoral student at Mailman when Dr. Santelli developed a proposal to examine factors related to HIV risk for youth using this amazing dataset. He asked me to serve as the project director after [the Rakai Youth Project] was funded. Later, we developed [the Linkages study] to examine reproductive health issues within the context of a high and generalized HIV epidemic. The ideas [for that work] emerged in part from my dissertation work, in part from our colleagues at the RHSP, and from Dr. Santelli’s previous work in the U.S.
What are the goals of the Rakai Youth Project?
The Rakai Youth Project [has been underway for five years] and is wrapping up this May. The aim of the study was to understand the behavioral and social risk and protective factors for young people who are newly acquiring HIV. It has produced many important findings, some of which have been truly surprising. There are certain things you would expect would be likely to contribute to HIV, like having many sexual partners or not using condoms consistently, but this research has identified other things that contribute to HIV risk, such as a partner’s risk characteristics, and has found that school enrollment is protective against HIV acquisition.
I understand that you helped shape key aspects of the Linkages project to pursue some of your own research interests?
I helped develop the Linkages project. I am very interested in how young people think about reproductive health and fertility desire given the high prevalence of HIV in Uganda even today. The Linkages study is collecting new qualitative data and using existing RHSP data to examine the link between HIV and reproductive health in the community. It is looking at HIV sero-discordant couples, meaning that either the man or the woman is positive and the other is not, and HIV concordant couples, in which both people are either positive or negative, to explore a range of issues related to HIV, fertility desire, and the use of contraception. We are in the third year of this [five-year] project.
Can you share some of your findings and what, if anything, has surprised you?
Many things actually. From my own dissertation work looking at fertility desires, l expected young women to say they needed to have children regardless [of their HIV status] because being a mother is highly valued. But young women who found out their HIV positive status were much more willing to stop childbearing or have only one or two children—the norm is four to six per woman—while the young men were not. That was surprising to me. We don’t talk about this often in the family planning world—how important fatherhood is to young men. [But] young men in this community really saw becoming fathers as a way to become an adult in the community. Also, despite decades of reproductive health and HIV education, young people held many misconceptions about how contraceptives work, how they affected their potential fertility, and if HIV treatments could actually prevent HIV transmission to a baby. This signals to me the continued critical need to provide detailed and accurate sexual and reproductive health information to young women and young men. We need to provide young people with options to successfully fulfill their reproductive desires within the context of HIV risk.
I understand that you also did some interesting qualitative research in addition to managing the Rakai Youth Project. Can you tell me about that research?
For both of the projects, we have taken a mixed-methods approach because we did not feel that the questions we were asking could be answered by either quantitative or qualitative data alone. For the Rakai Youth Project, we worked with the qualitative research team at the RHSP to conduct a nest qualitative case-control study. We conducted one-one-one interviews with young people who had recently acquired HIV and their negative counterparts. We asked [them] the same questions about life transitions, aspirations, what they are doing now, and their relationship status, to see why some young people acquired HIV and some did not. You might have anticipated that those who acquired HIV would have had a fairly negative life trajectory… but the main difference was the relationship context. HIV positive young people found themselves in relationships with less power, less communication, less knowledge of their partners’ HIV status, and less awareness of the number of partners that their partner had—all things that put you at risk of HIV. Similarly in Linkages, we are collecting qualitative data from couples and from HIV-positive and HIV negative people over time to better understand their fertility intentions and contraceptive use behaviors.
I understand you are teaching a new course on global reproductive health and that you developed it. Can you tell me about it?
I developed and am now teaching a new, Global Perspectives on Reproductive Health. It builds on the Current Perspectives in Sexual and Reproductive Health course offered by the Department and offers a survey of key reproductive health topics from a global perspective. When I was designing the course, I took the main reproductive health indicators from the WHO and broke them down in corresponding class sessions focusing on things like maternal mortality, fertility and family planning, men and reproductive health, and violence against women. We started the course with broad theoretical frameworks—e.g. looking at gender and rights—and then moved to exploring specific reproductive health topics, for example, …abortion and post-abortion care.
How did you end up working as a social scientist in public health?
I did my undergrad at the University of Maryland at College Park in the Social Psychology department. During my last semester I took a couple of courses in public health and I became enamored with the population-level perspective on health and disease. I switched tracks and applied for my master’s in public health at Hopkins. After I graduated, I found a job as a research assistant with the International Center for Research on Women, an international NGO based in D.C. They work on variety of topics from food and nutrition to HIV to reproductive health with an emphasis on gender analysis. I worked on a variety of projects, including adolescent sexual and reproductive health initiatives in Nepal and India, assessments of integrated health and livelihoods programs for young people, and formative research in East Africa looking at HIV related stigma. As much as I enjoyed the work, I felt that I needed an advanced degree to do the more theoretically-oriented work and to methodologically update my skills. I applied to…Mailman and I have been here ever since….it has been a great fit for my background and interests.