What Will It Take to End the HIV Epidemic? Focus, Collaboration — and the Internet
Brian Mustanski, PhD, knows that sexual education in the United States is often severely lacking. As a psychologist specializing in sexuality and adolescent health, his research focuses on HIV among gay and bisexual men ages 13-18 — young people who don’t always understand that condoms aren’t just used to prevent unwanted pregnancies.
Mustanski, director of the Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH) and co-director of the Third Coast Center for AIDS Research (CFAR), spoke about HIV prevention programs for young gay and bisexual men during a recent Translational Applications in Public Health presentation. The lecture series is a collaboration between the Northwestern University Clinical and Translational Sciences (NUCATS) Institute and Institute for Public Health and Medicine (IPHAM).
Mustanski, a professor of Medical Social Sciences and Psychiatry and Behavioral Sciences, is a fierce advocate for LGBTQ+ rights both in and out of the lab. He focused his talk on two hybrid effectiveness-implementation trials of HIV prevention programs as well as the translational research involved in ending the HIV epidemic.
He explained that the majority of HIV infections in the United States over the past decade stem from male-to-male sexual contact, a disparity that continues to grow over time as the number of HIV transmissions between heterosexual-identifying people decrease. Despite recent discoveries of HIV prevention options including Pre-exposure Prophylaxis (PrEP), there has not been a decline in HIV infections in the past 10 years. Mustanski noted that there has even been an increase in the number of HIV cases among 25- to 34-year-old men who have sex with men.
If you’re passionate about a health issue, you have to move it along the translational spectrum yourself, which for me has been incredibly rewarding.”
Beyond age and sexual orientation, race and ethnicity also play a factor into HIV positivity rates. Mustanski’s research focuses on HIV prevention across populations of sexual, gender and racial minority groups. He explains that young Black and Hispanic/Latinx men who have sex with men have been disproportionately likely to contract HIV.
Mustanski described how scientific inequities can drive health inequities: There are no evidence-based HIV risk-reduction programs classified by the Center for Disease Control and Prevention for men below the age of 18. This lack of available research leads to a lack of evidence for the disease, which means that the HIV epidemic will continue to grow until there is more funding and access to prevention programs for young men.
Mustanski also explained the benefits of maintaining research projects across the translational spectrum, from the biological basis of health to interventions like PrEP that benefit the health of both individuals and communities.
“Many of us were trained to take a slice of this spectrum and expect someone else along the line to figure out how to use our research to benefit others. But we’ve found that there isn’t anyone else necessarily waiting to pick up the next step of the work, and so important research falls through the cracks,” he says. “If you’re passionate about a health issue, you have to move it along the translational spectrum yourself, which for me has been incredibly rewarding.”
SMART (Sequential, Multiple Assignment, Randomized Trial)
SMART, a stepped-care suite of three online interventions, focused on a diverse sample of more than 1,200 adolescent men who have sex with men and aimed to establish efficacy and inform future implementation of HIV prevention techniques. Mustanski worked with a large team of researchers to create an accessible, mixed-methods eHealth approach to HIV prevention, including condom use, PrEP, and HIV testing.
All of the study’s participants started with a sexual education program called Queer Sex Ed. Those who did not respond positively to this program were then randomly placed into a more intensive educational program.
Mustanski’s challenge was to use research in the most cost-effective way in order to encourage health behavior changes among young men. Each of the three online interventions were youth-centered and science-based.
Keep It Up! & RE-AIM
Mustanski also discussed another eHealth intervention program that focused on comparing two national implementation strategies of the Keep It Up! HIV Prevention Program. One strategy funds local community organizations to integrate the program into their HIV testing initiatives. The other strategy delivers all of the services centrally from Northwestern.
Ending the HIV Epidemic
Mustanski’s efforts to end the HIV epidemic don’t end with these studies. He continues to connect with community organizations through his work leading the Implementation Science Coordination, Consultation, & Collaboration (ISCI) Initiative, where he seeks to take local knowledge on best practices for implementing effective HIV programs and make it generalizable to other organizations and settings.
He also continues to seek out experts within the Northwestern community who specialize in a health issue that can be applied to the LGBTQ+ community. “Important cancer prevention methods like the HPV vaccination require experts from across fields,” Mustanski says. “If we’re going to solve a community problem, we need to solve it as a community.”
Written by Morgan Frost
