One of the participants in powerful new research into how clinicians can better serve highly marginalized individuals with HIV gave NYU researchers a sense of their everyday struggles: He punctures the foil top on his medication bottle as soon as he gets it, making it worthless in the black market for pharmaceuticals. While he could have used the $125 or so that he could get from a disreputable pharmacy, he was determined not to impede his goal of achieving an undetectable HIV viral load level.
“Most of those who enrolled in our research projects live on the razor’s edge of poverty,” explains Professor Marya Gwadz associate dean for research at NYU Silver and director of the school’s Intervention Innovations Team who led the study—called Heart to Heart—aimed at increasing overall HIV medication uptake among those living with HIV who face serious impediments to doing so. “They are not always in a place where HIV can be their priority.”
Gwadz, a psychologist, and her team of master’s-level mental health professionals and researchers were still able to recruit hundreds Black and Latino persons of low socioeconomic status and unsuppressed HIV viral levels into the research study, conducted from a clinic in Manhattan’s Union Square. The goal was to determine the best behavioral-therapeutic components for increasing rates of HIV viral suppression in this population, with the knowledge that not all persons living with HIV are able or may even wish to do so.
Six different intervention components were tested, based on existing evidenced-based strategies; they were modified using a conceptual model Gwadz’s team developed, tailored to this hard-to-reach and understudied cohort’s particular impediments to HIV care and medication use. The model, called the Intervention Innovations Team Integrated Conceptual Model—or the IIT-ICM, for short—blends critical race theory and harm reduction and self-determination approaches, showing that a person’s health issues, such as falling short of HIV viral suppression, are the downstream effects of upstream structural factors such as poverty, according to Gwadz. That is a fundamentally de-stigmatizing message, she says, along with being more accurate than placing the source of health problems at the feet of the individual.
The results of Heart to Heart are so far encouraging, according to Gwadz, with 40% of the 512 study participants showing suppressed HIV viral loads during the course of their approximately one-year enrollment in the study. The team does not expect that all the components are needed to increase the rates of HIV viral suppression. So, compatible studies are planned to uncover the most cost-effective combination of intervention components for clinicians to use in clinical and social service settings.
“The US public health system wants to end the HIV epidemic by 2030,” noted Gwadz. “We can’t do that without bringing these people who face the greatest barriers onto the HIV care continuum.”
NYU News spoke with her about her research with respect to the national goal:
Why did you focus on this particular subpopulation?
Experts have shown that HIV travels along the “fault lines” of society—mainly related to poverty, racial and other forms of discrimination, and stigma. So, currently most people living with HIV or who contract HIV are Black and Latino, with sexual minorities overrepresented compared to their numbers in the general population. The reasons for this are not due to risky individual behavior, but rather to societal factors. I’m interested in understanding and disrupting that glaring problem.