The advent of antiretroviral therapy (ART) as a treatment for people living with HIV and AIDS remains one of the most important advances in the response to this global epidemic. ART provided the first real hope that HIV/AIDS could transition from a near-certain death sentence to a chronic but manageable condition.
For public health researchers, however, ART’s monumental promise was coupled with a key concern: Would the knowledge that ART dramatically reduces the risk of HIV transmission lead to an increase in sexual risk taking, and thereby threaten the progress that had been made in controlling the epidemic?
While such questions have drawn significant attention among researchers in Western countries, less work has been done in developing nations. These circumstances prompted researchers at Uganda’s Rakai Health Sciences Program (RHSP), a major research and surveillance station focused on HIV, to conduct a study seeking to illuminate these questions.
This past summer, second-year PopFam student Laura Lazar spent her ten-week practicum helping analyze the findings from this research. She was one of five Mailman School students who participated in research underway at Rakai as a result of a collaboration between the RHSP and Mailman.
Specifically, Laura carried out a trend analysis that sought to illuminate whether being on ART is correlated with an increase in risky sexual behavior. The analysis used data collected through Rakai’s Community Cohort Study (RCCS), a longitudinal community-based survey that is the backbone for much of the research carried out by the RHSP.
“We looked at data from the four RCCS surveys that were collected from 2005 to 2011,” Laura explained. “We compared sexual risk-taking behavior for HIV-positive individuals who received ART along with basic healthcare and education, with that of HIV-positive individuals who received basic health care and education alone but did not take [ART] medication.”
The analysis showed that individuals on ART were less likely to engage in risky sexual behavior, Laura said. For example, 35 percent of men on ART reported consistent condom use, while only 12 percent of men who weren’t on ART reported this same consistency. Both male and female respondents on ART were proportionately less likely to have a non-marital sexual partner than were individuals who were not on ART. Finally, individuals on ART were more likely to disclose their HIV status to their partner.
At least one of these positive findings—increased consistent condom use—diminished over time for both groups of participants. This and the other study findings, Laura asserted, “have clear implications for safe sex messaging and content, and suggest the need to further explore motivations for safe sex.”
In addition to learning a great deal from the research process, Laura was deeply impressed by the accessibility of the program staff at the RHSP, especially on the part of her supervisors. “Both my direct supervisor, Gertrude Nakigozi, the deputy program director, and Joseph Ssekasanvu, who is the head of data analysis at Rakai, were extremely accessible throughout the summer, despite holding high-level positions and having multiple important demands on their time, including preparing for the 2014 International AIDS Conference that summer.”
Working at the RHSP also provided wonderful opportunities to learn about other aspects of this formidable research station, which has carried out research trials that have produced some of the most important advances in HIV prevention. The RHSP was one of the research centers that demonstrated that circumcision could dramatically reduce rates of HIV infection and could thus play a major role in controlling the epidemic in sub-Saharan African countries. Once this evidence was clear, the RHSP began providing this service, and Laura had the opportunity to observe some of the methods used for community outreach.
One such method is known as the “Stylish Man Campaign.” This multimedia community mobilization initiative works to promote safe male circumcision (SMC) and the utilization of HIV prevention services. It often combines educational outreach with mobile clinics offering SMC, delivered via the “Stylish Man Van,” a large bus with a formidable sound system.
“Singers would perform, host dance competitions for the kids in the
Stylish Man Van. Photo by: Laura Lazar
crowd, and pair their entertainment with outreach to young men around circumcision,” Laura recalled. “The campaign has been very effective and it was great to get to experience some of these innovative outreach activities.”
Perhaps most importantly, Laura’s practicum reinforced the fit between the PopFam program and her own public health interests. There was a lot of hard science underway at Rakai, but she also found a true appreciation of and respect for the community and a desire to be of service to them.
Laura decided to pursue her MPH at Mailman because of PopFam’s certificate in Sexuality, Sexual, and Reproductive Health. “It was one of the few programs that seemed to have the focus on sexuality as part of this work,” she said, while also being aligned with her interest in promoting reproductive health and justice for underserved populations.
Those interests, she acknowledged, stem from her childhood in Hong Kong. Raised by expatriate American parents, Laura grew up with opportunities to travel in Southeast Asia, where she was exposed to the realities and prevalence of the sex worker industry in countries such as Cambodia, Vietnam, and Thailand. Laura said that she realized from a young age that she was interested in the well-being of marginalized groups, and their access to health services.
While Laura isn’t sure where she will end up working after graduation this spring, this mission continues to guide her. She hopes to combine the passion that has fueled her interest in public health since childhood with the knowledge and skills she has acquired at PopFam to ensure greater access to sexual and reproductive health care for all.