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Institute Fellows

Cohort 1 RETI Fellows (2011 - 2013)

Michelle Broaddus, Ph.D.

Assistant Professor
Center for AIDS Intervention Research
Medical College of Wisconsin
Milwaukee, Wisconsin

Background
Michelle Broaddus's research has been guided by the study of gender roles, how individuals negotiate condom use within relationships, and contexts of sexual risk among high-risk young adults and adolescents. She obtained her PhD in social psychology at the University of Colorado at Boulder in Social Psychology in 2008, focusing on condom attitudes and gender and power in heterosexual relationships. She has published articles examining associations with consistent condom use and the effects of a HIV risk reduction randomized controlled trial among adolescents in detention, detailing gender specific models of condom use intentions and use among adolescents on probation, and perceptions of condom proposers among college students. She completed a NRSA postdoctoral fellowship at CAIR in 2010, and conducted a developmental project on the uses of social media technology, including Short Messaging Service (SMS, also known as “texting”) in sexual relationships among HIV and STD at-risk young adults. After being hired as an assistant professor at CAIR in 2010, Dr. Broaddus’s interests remain focused on the potential for mobile phone technologies in innovative HIV prevention interventions, both as a medium for intervention delivery, and as a tool for at-risk populations to increase safer sex communication.

Mentored Research Project (MRP) Title
Participant perspectives of risks and benefits of participating in a text message-delivered intervention for safer sex communication

Abstract
This project aims to identify relevant risks and benefits of participating in a text messaged-delivered sexual health intervention compared to a traditional small-groups intervention for at-risk, young, African American women. Focus groups were used to discuss the dimensions of risks and benefits inherent in these two modalities ofintervention delivery. Results indicated that benefits were driven by practical considerations such as travel, childcare, and convenience, while risks were driven by privacy and fear of social judgment. The texting intervention was overall seen as more preferable, mainly due to the benefit of convenience. The main benefit of the face-to-face intervention delivery was the ability to share stories and learn from the other participants’ experiences. Surprisingly, participants cited more privacy concerns regarding the face-to-face, small-groups intervention due to the potential for judgment by the other participants in the group and the inability to guarantee that private information would not be shared outside the group. Quantitative data collection is in progress, with ACASI surveys being conducted in the same population using scales developed from the qualitative results. Results will provide evidence for participants’ clear understanding of risks and benefits inherent in new intervention delivery technologies, suggesting that participants can provide informed consent regarding the use of new technologies inresearch. Results may also provide the basis for decision aids for participants and researchers regarding whether or not new technologies are appropriate for intervention use in different populations.

MRP Publications
Broaddus, M. R. & Marsch, L. (2015). "Comparing risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American young women in the Midwestern U.S." Ethics & Behavior, 25(2): 146-168. Ethics Behav.

Peter Davidson, Ph.D.

Peter Davidson

Assistant Adjunct Professor
Division of Global Public Health
University of California, San Diego

Background
Peter Davidson received his PhD in medical sociology from the University of California, San Francisco in 2009. Dr. Davidson has been conducting research and harm-reduction based intervention development around heroin-related overdose and the transmission of HIV, hepatitis C, and sexually transmitted infections among drug users in Australia and the United States since 1997. Dr. Davidson's dissertation project explored the influence of policing practices on the movements and economic activities of a highly mobile group of homeless young injecting drug uses in San Francisco, and how these in turn affect the willingness and ability of young injectors to utilize needle exchange services. His work also involves explorations of how injecting drug users and other economically marginalized populations ‘make sense’ of research participation, and the ethical implications of these understandings.

Mentored Research Project (MRP Title)
Disjuncts in understanding: An exploration of differences in the ways drug users, researchers, and federal code understand research participation

Abstract
The research will utilize a grounded theory / situational analysis approach to explore how a specific population of young people who inject drugs understand and experience participation in epidemiologic research, and will compare these understandings with those embedded in US Federal Code regulating research with human subjects, as well as with perspectives provided by researchers and IRB members. The research is expected to offer insight into disjuncts in understanding which have the potential to inadvertently leave research participants feeling mistreated.

Jennifer Hettema, Ph.D.

RETI, fellow

Assistant Professor
Department of Family and Community Medicine
University of New Mexico
Albuquerque, New Mexico

Background
Jennifer Hettema is an Associate Research Professor in the Department of Family and Community Medicine at UNM. She is a clinical psychologist and conducts behavioral health research. Her research focuses on the development and evaluation of behavioral health interventions in primary care, meta-analysis, medical education, and implementation of effective interventions. She is particularly interested in interventions focused on risky alcohol use, prevention of alcohol exposed pregnancy, and HIV medication adherence. Dr. Hettema is a member of the Motivational Interviewing Network of Trainers and incorporates this treatment modality into much of her research.

Mentored Research Project (MRP) Title
Physician attitudes and behavior towards HIV+ IDUs

Abstract
While adherence to HAART may be affected among IDUs, due to the instable lifestyle associated with drug seeking and use (Wood et al., 2008), the risk of development of antiretroviral resistance among IDUs has not been found to be higher than their non-IDU counterparts (Werb et al., 2010). Despite this, IDU status has been found effect access to care for HIV (WHO, 2006; Wood et al., 2008), with evidence that physician reluctance to prescribe HIV may play contribute to this disparity (Bassetti, 1999; Ding et al., 2005). To determine the impact of IDU status on physician prescribing behavior, a national sample of community-based HIV prescribing providers completed an online survey in which they were presented with two case vignettes describing a patient with previous adherence issues presenting for treatment and requesting reinstatement on antiretroviral medications. The vignettes were identical with the exception of the IDU status of the patient. Participants were randomly assigned to see either the IDU or non-IDU (NIDU) vignette first. To date 156 participants have consented to participate in the study and 112 of these submitted complete responses. Participants were predominately female (55.8%), White (77.9%), and practicing in Urban settings (80.5%). Participants were well distributed by state. Most participants were physicians (47.8%) or nurse practitioners (45.1%), with a smaller samples of physician assistants (7.1%). Independent samples t-tests revealed that neither IDU prescribing behavior (t(118)=-.258, p=.797) nor NIDU prescribing behavior (t(117)=-.693) differed significantly by condition (order of presentation). Consequently, conditions were collapsed for future analyses. A paired samples t-test was conducted to evaluate the impact of patient IDU status on prescribing behavior. There was a statistically significant difference between reported likelihood of prescribing for NIDU (M=3.51, SD=1.37) versus IDU patients (M=3.03, SD=1.37), t(115) = -5.03, p < .001. Attitudes towards shared decision making and concerns about adherence are both predictive of less willingness to prescribe to IDUs.

Kristin Kostick, Ph.D.

Kristin Kostick

Research Associate
Baylor College of Medicine
Houston, Texas

Background
Kristin Kostick is a medical anthropologist with expertise in applied prevention/ intervention research, with specific experience in HIV/AIDS prevention and interdisciplinary research methods. She specializes in the design and implementation of culturally-specific and community-based health interventions, including those aimed at reducing sexual risk and promoting psychosocial health and gender equity. She has engaged in training and capacity-building among local non-governmental and community-based organizations in developing countries, particularly among impoverished urban slum communities in India and Mauritius. She has also conducted evaluation research on evidence-based research programs, including Supported Employment rehabilitation services for individuals with severe mental illness in the US, and malaria control interventions in West Africa.

Dr. Kostick has experience collaborating with both local and national entities, and coordinating research activities across academic and clinical settings. Her current research focuses on the role of MDMA (ecstasy) –use on sexual risk behaviors among urban young adults, as well as the use of ecstasy to improve intimacy, communication and sexual satisfaction in relationships characterized by significant intimate partner conflicts. In conjunction with her previous work in India, she continues to focus on culturally-based symptom markers that can help to identify women who are in relationships whose dynamics put them at greater risk for HIV and other sexually transmitted infections. Dr. Kostick has conducted research in India, Africa, Mauritius and the US.

Mentored Research Project (MRP) Title
Exploring participant experiences in a peer-delivered HIV intervention with IV drug users

Abstract
This study explores ethical issues faced by investigators as they conduct research aspart of a peer-delivered HIV/AIDS risk reduction program for injection drug users (IDUs).Staff and participant experiences in peer-delivered interventions among IDUs havecome under scrutiny by ethics researchers because of their potential to inadvertentlyand negatively impact participant rehabilitation due to continued engagement with drug-using networks during the course of outreach. This study explores whether enhancedcommunication of participant concerns and experiences with clinic and research staffhelps to reduce inadvertent malfeasance in peer-delivered drug treatment interventions. Results contribute to the development of patientsupport infrastructure in peer-deliveredrisk reduction programs involving IDUs.

MRP Publications
Kostick, K., Weeks, M., & Mosher, H. (2014). "Participant and Staff Experiences in a Peer-Delivered HIV Intervention with Injection Drug Users". Journal of Empirical Research on Human Research Ethics. 9(1), 6-18.

Purnima Madhivanan, M.B.B.S., M.P.H., Ph.D.

Associate Professor
Robert Stempel College of Public Health & Social Work
Florida International University
Miami, Florida

Background
Purnima Madhivanan received her medical degree from Mysore Medical College in India. She served as an HIV physician at the Y.R. Gaitonde Centre for AIDS Research and Education in Chennai, India, before going on to earn an MPH and PhD in Epidemiology at the University of California, Berkeley. Dr. Madhivanan is founder and Executive Director of Public Health Research Institute of India that is recognized by Government of India as a research organization carrying out basic and translational research on women’s health issues in India. She is also the guiding force behind Prerana Women’s Health Initiative which provides voluntary, comprehensive, and culturally sensitive services including HIV/STI management, family planning and cancer screening.

Prerana operates a free reproductive health clinic in an urban Mysore slum and mobile antenatal clinics serving 144 rural villages in Mysore Taluk, an area with a large concentration of low-income and farming communities. Dr. Madhivanan has an active research program on prevention of HIV/STIs, primary and secondary prevention of cervical cancer, and domestic violence. She has more than 30 peer-review manuscripts in journals including AIDS, BMJ, Sexually Transmitted Diseases, AIDS & Behavior, Global Public Health, Vaccine, BMC Public Health, and Human Resources for Health. She was the 2007 recipient of the prestigious Elizabeth Glaser Pediatric AIDS Foundation’s International Leadership Award for her work on prevention of pediatric AIDS in India. Currently, Dr. Madhivanan Associate Professor of Epidemiology at the Robert Stempel College of Public Health & Social Work at FIU. She continues her research and advocacy for HIV infected women in India.

Mentored Research Project (MRP) Title
Ethical issues in the deliver of prevention of mother-to-child transmission of HIV interventions in South India

Abstract
Specific Aims: Aim 1 - Explore current practices of health care workers in Government of India facilities offering antenatal care, HIV testing and PMTCT services with regard to confidentiality, pre and post-test counseling, and provision of informed consent for HIV testing and treatment; and Aim 2 - Investigate women's experiences with maternal care and PMTCT in India including their perceptions about the information provided during the process; their understanding of the risks and benefits of HIV-testing and PMTCT; and their role in decision making around those issues.

Methods: This is aqualitative study examining experiences of delivered women undergoing HIV testing during ANC and healthcare workers who conduct HIV counseling testing in hospitals in Mysore. We will conduct focus group discussions (FGD) among recently delivered HIV negative women, in-depth interviews with HIV infected women to explore experiences with HIV counseling testing during ANC. FGDs with healthcare workers will also be conducted to assess knowledge, practices and attitudes around HIV testing of pregnant women.

Results: To date, all the data collection has been completed and we are in the process of data analysis. Preliminary results show the following: in the two FGDs with HIV negative women, only six recalled being informed about purpose of HIV testing. Majority of women reported only their doctor informing them to get tested for HIV if they wished to deliver at the hospital. Only 3 women recalled signing consent form for testing but a majority said they were given forms and told to sign. Majority of women said their husbands/relatives were informed of results either before or at the time they learned about their results. Healthcare workers had sufficient knowledge about HIV testing and maintained confidentiality. Many admitted other hospital employees occasionally find out about a women’s HIV status. Several expressed derogatory stigmatizing remarks about ‘uneducated rural women’ who don’t comprehend HIV counseling or reasons for giving consent.

Preliminary conclusion: Women are poorly informed about the risks and reasons for routine HIV testing. The level of information given during post-test counseling varies depending on the HIV status. HIV negative women get minimal to no information during post-test counseling. Healthcare workers should be further trained on confidentiality and informed consent in addition to sensitizing them about theneed for non-stigmatizing HIV testing.

MRP Publication
Madhivanan, P., Krupp, K., Kulkarni, V., Kulkarni, S., Vaidya, N., Shaheen, R., Philpott, S. & Fisher, C. B. (2014). "HIV testing among Pregnant Women Living with HIV in India: Are Private Providers Routinely Violating Women’s Human Rights?" BMC International Health and Human Rights. 14:7.

Cynthia Pearson, Ph.D.

RETI, fellow

Research Assistant Professor
Indigenous Wellness Research Institute
University of Washington
Seattle, Washington

Background
Cynthia Pearson directs the Research Methods and Policy Core at the Interdisciplinary Indigenous Wellness Research Institute where she collaborates with indigenous scholars in the development of research policies and directs iterative data analysis on historical and cultural determinants of physical and mental health among American Indians and Alaska Natives. Dr. Pearson expertise is in designing community-based health studies from an ecological perspective that emphasize social, economic, political, environmental, and historical determinants of health. Specifically, Dr. Pearson’s research focuses on the intersecting risk of substance use, historical and lifetime trauma, and HIV risk and how culture, place, and community serve as protective factors.

Dr. Pearson meets community members where they are and identifies community ways of knowing and resources to create innovative sustainable interventions. She is involved in several CBPR health and wellness projects across Pacific Northwest tribal communities identifying strengths and protective factors that support young women’s wellness, maternal health, cardiovascular disease, youth academic achievement, and suicide prevention.

Mentored Research Project (MRP) Title
Human subject research training for community researchers: A Pacific Northwest Native American cultural prospective

Abstract
Informed engagement of American Indian (AI) community partners in the review of research protocols helps ensure community-based research avoids cultural misunderstandings, stigmatization, or culturally inappropriate, irrelevant, and disrespectful science. However, available certified human subjects trainings fail to resonate with AI community members. Using participatory research processes, we adapted the Collaborative IRB Training Initiative (CITI) certified human subjects training module “Assessing risk and benefits”. Investigators prepared materials for panel review including mapping the modules’ corecomponents to the code of federal regulations. Three expert panels (AI communitymembers, scientific and ethicist; n = 11,) adapted the module to meet AI cultural perspectives and concerns. In a two-arm randomized controlled trial, followed by debriefing interviews, we evaluated module acceptability and feasibility (i.e. relevance ofmaterials, self-efficacy/confidence in applying concepts and satisfaction), understandability of module (test scores) among 40 AI reservation-based community members.Participates who took the adapted module, as compared to those who took the standard module reported higher scores on relevance of the material (82.7 versus 65.8, t= 3.06, p<0.01), overall satisfaction (81.4 versus 69.4, t= 2.10, p<0.05), module quiz scores(75.7 versus 62.9, t= 2.15, p<0.05) and a trend toward higher self-efficacy (76.3 vs. 68.1, t= 1.71, p<0.10). Culturally-relevant ethical training materials were preferred by AI community members and imperative to address AI health and wellness. Developing human subject research training materials and programs that are collaborative, community driven, and nationally supported offer the most promising potential for community acceptability, long-term success, and sustainability.

MRP Publications
Pearson, C. R., Parker, M., Fisher, C. B., & Moreno, C. (2014). "Capacity Building from the Inside Out: A Randomized Control Trial on Adapting the CITI Ethics Certification Training Course for American Indian Community Researchers". Journal of Empirical Research on Human Research Ethics, 9(1), 46.

Elizabeth Reed, M.P.H., Sc.D.

Assistant Professor
Division of Global Public Health
University of California San Diego

Background
Elizabeth Reed is an Assistant Professor at the University of California San Diego's Division of Global Public Health. Her research has focused on gender-based violence (GBV) and HIV prevention in multiple global settings, with particular attention to the influence of social, environmental, and structural factors on risk (e.g. economic position, gender inequities and norms, other challenges across individuals’ ‘life contexts’). Given the increasing recognition that such contextual-level factors are contributing significantly to these health burdens and thereby, the need for interventions that aim to alter such structures within communities, Dr. Reed’s research agenda focuses on the development, implementation, and evaluation of structural-level interventions to address GBV and HIV –particularly those that consider both social and economic aspects of women’s lives. Given the contribution of GBV to HIV risk across populations and contexts, her work related to GBV prevention is also central to HIV prevention.

Dr. Reed’s recent work in the US has involved investigation of social and environmental contexts in relation to GBV perpetration, as well as the mechanisms explaining the link between such perpetration and STI/HIV risk. Her most recent work abroad has involved the investigation of social and environmental factors (e.g. residential instability, economics, migration/mobility, forced migration) and relation to vulnerability for GBV and HIV risk among women working as sex workers in South India.

Mentored Research Project (MRP) Title
Perceptions of HIV prevention research participation among women working as sex workers in Andhra Pradesh, India

Abstract
Background: Recently, various HIV prevention research studies have been conducted among female sex workers (FSW) within Rajahmundry in Andhra Pradesh, India, as a resultof high rates of HIV among FSW in this region. Given the multitude of challenges across the lives of FSW as well as immense stigma associated with sex work in this region, it is especially important to ensure that research participation is not creating additional burdens among FSW. While studies investigating participant experiences in research have been useful for improving the ethical conduct of research among other types of vulnerable populations (e.g. drug using populations), to our knowledge, no work has investigated such critical aspects of research ethics among FSW in high HIV prevalence Indian states.

Methods: FSW (n=30) who participated in HIV prevention research recently (previous three years) were recruited from a local community-based organization for semi-structured qualitative interviews. Interviews focused on research ethics issues pertinent to respect for persons, beneficence, and justice. Interviews were audio-taped, translated, transcribed, and reviewed for common themes.

Results: Various themes emerged from preliminary interview data, including women’s motivations for research participation (sense of helping the community, gaining information), perceived motivations of study staff (e.g. reports of study staff being influenced by monetary incentives creating an environment that reduced respectful treatment of participants and interfered with valid study implementation), study benefits (e.g. self-realization, appreciation of one’s life challenges, increased sense that other women have had similar struggles) and negative experiences (e.g. long waiting times, reports of research staff making judgements based on survey responses). Women also reported that research findings were not made available to the FSW community.

Conclusion: Findings highlight strategies to ensure that HIV research studies among FSW in this region prevent negative consequences, foster a positive experience by the community, and ensure maximal community benefits and accessibility to the research findings.

MRP Publications
Reed, E., Khoshnood, K., Blankenship, K. & Fisher, C.B. (2014). "Confidentiality, Privacy, & Respect: Perspectives of Female Sex Workers Participating in HIV Prevention Research in Andhra Pradesh, India". Journal of Empirical Research on Human Research Ethics, 9(1), 19-28.

Reed, E., Fisher, C. B. Blankenship, K. & Brook, S. W. Khoshnood, K. (2016 online). Why Female Sex Workers Participate in HIV Research: The Illusion of Voluntariness. AIDS Care.

Lianne Urada, Ph.D., M.S.W., L.C.S.W.

RETI, fellow

Assistant Professor
MSW/MPH Program Advisor 

School of Social Work
San Diego State University 

Background
Lianne Urada is an assistant professor with a PhD in Social Welfare from UCLA (March, 2011), and a former doctoral training fellow in the Social and Behavioral Determinants of HIV/AIDS Prevention in the Department of Community Health Sciences, UCLA School of Public Health. She also worked with persons living with HIV/AIDS for eight years in Los Angeles, California. She served as a Field Education faculty member in Social Welfare at UCLA and holds a California license in clinical social work. For her dissertation, she conducted surveys of 498 female entertainment workers and 48 managers from 54 establishment venues (night clubs/bars, spa/saunas, karaoke bars) in the Philippines. She received grants to assess the socio-structural influences of risk behavior among the entertainers and to develop and evaluate a new intervention.

Specifically, she examined factors in the risk environment (at physical, social, economic, and policy levels) and their effects on behavioral outcomes. She used a mixed method, collaborative community-based research approach. She also interviewed 48 key informants (health officials, managers, NGOs) and held focus groups of entertainers prior to administering questionnaires. Dr. Urada wishes to examine the ethics surrounding research with sex workers in the Philippines who are concerned about their legal risks and human rights. The criminal contexts of substance use, sex work, and trafficking often pose perceived risks to participants. Interviews with policymakers, law enforcement, and establishment managers regarding police practices in relation to sex workers and substance users are necessary.

Mentored Research Project (MRP) Title
Social and structural constraints on disclosure and informed consent with female sex workers and their managers in the Philippines

Abstract
This qualitative research explored the experiences of female sex workers (FSWs) participating in behavioral HIV prevention research, including their process of consent to research, their knowledge of research ethics, barriers to disclosure of sensitive topics, and the necessary conditions for their involvement in HIV research prevention interventions. Individual interviews were conducted with 20 FSWs and 10 establishment managers working in night clubs, karaoke bars and spas/saunas in the Philippines, using semi-structured interview guides. In addition, three community advisory board meetings were conducted to collect feedback on the study design and assist with the interpretation of findings.Participants completed brief self-administered pre-and post-tests before and after the final CAB meetings with five groups of sex workers (n=98 participants), that measured a change in their self-perceived level of knowledge of research ethics. Forthe qualitative interviews with managers and FSWs, emergent themes included FSW issues with trust (e.g. research in general, project interviewers), intrusiveness of survey questions, sense of being forced by government to do surveys, and the belief that nothing would happen as a result of the research. FSWs expressed desire to actively participate in intervention design and implementation and to learn new skills and obtain job training. Both FSW and managers expressed dissatisfaction with government support and were frustrated with their inability to stop police raids and bribes. The results suggest the need to improve ethical HIV prevention research practices with FSWs by: 1) addressing barriers to respect, trust, and/or disclosure stemming from risks in thestructural environment and/or the research process itself;and by; 2) developing a moretransparent and participatory approach to HIV prevention research that engages participants/FSWs in the research process in order to reduce perceived and actual risks to participants.

MRP Publications
Urada, L. A., & Simmons, J. (2014). "Social and Structural Constraints on Disclosure and Informed Consent for HIV Survey Research Involving Female Sex Workers and Their Bar Managers in the Philippines". Journal of Empirical Research on Human Research Ethics, 9(1), 29-40.

Urada, L. A., & Simmons, J. (2014). "A Collaborative Methodology for Investigating the Ethical Conduct of Research on Female Sex Workers in the Philippines". Journal of Empirical Research on Human Research Ethics, 9(1), 41-45.

Cohort 2 RETI Fellows (2012 - 2014)

Tania Basta, Ph.D., M.P.H.

RETI, fellow

Associate Professor
Department of Social and Public Health
Ohio University
Athens, Ohio

Background
Dr. Tania Basta received a BS in Kinesiology and a Master of Public Health (MPH) in Community Health Education from Indiana University and a PhD in Health Promotion and Behavior from the University of Georgia. Currently, she is an Associate Professor in the Department of Social and Public Health in the College of Health Sciences and Professions at Ohio University and is also affiliated faculty in the Center for International Studies and the College of Communications. She is also the Associate Director of the Appalachian Rural Health Institute, an interdisciplinary health services and research institute, collaboratively run by the Colleges of Osteopathic Medicine and Health Sciences and Professions at Ohio University. Dr. Basta has over 13 years of combined public health research and professional experience. She started her public health career as a worksite health practitioner, but in the past 10 year has worked extensively with domestic community-based organizations focused on HIV/AIDS.

She is currently the Chair of the HIV/AIDS Section of the American Public Health Association. Dr. Basta’s research interests focus on increasing the quality of life among individuals living with HIV/AIDS. The majority of her publications are focused on the mental health status of low-income individuals living with HIV/AIDS in the United States. Now that she lives rural Appalachian Ohio, she has become interested in HIV prevention and treatment among individuals living in Appalachia. Recently, she was funded by the NIH Loan Repayment Plan to conduct rural Appalachian HIV research (2010-2012). Dr. Basta also has considerable experience with community-based participatory research (CBPR) and is a Co-Investigator on a Department of Energy Public Outreach Project that was funded to use CBPR methods to develop alternative uses for the Portsmouth Gaseous Diffusion Plant in Appalachian, Ohio.

Mentored Research Project (MRP) Title
Consent Preparedness for Home-Based HIV Testing Research in Rural Appalachia

Abstract

Background: Many rural Appalachians have high levels of HIV-related stigma, misconceptions about HIV transmission,and inadequate HIV risk perceptions; and as a result, they may be reluctant to get an HIV test or participate in an HIVtesting study.There is a growing body of literature about how to enhance consent processesin order to facilitate participation in HIV testing studies; however, no research has been conducted among rural Appalachian Ohioans.

Purpose: The study aimed to 1) explore service barriers related to obtaining HIV testing services among rural economically disadvantaged individuals in out-patient drug treatment, 2) examine the effect ofeducational intervention on pre/post HIV knowledge and HIV-related stigma, 3) examine the efficacy of intervention willingness to get an HIV test and 4) assess post HIV-test satisfaction with method of HIV testing delivery (self-test vs. traditional test).

Methods: This two-phase mixed methods study utilized data within subjects intervention design followed by a post-test only design.

Results: Data were collected from 60 participants, the majority of whomwere Caucasian, high school educated, and unemployed. Nearly 70% of the sample reported heavy drug use beforeentering treatment, including 18.6% who reported injection drug use. Nearly half the sample had received an HIV test and 81.4% indicated they would like to get tested in the future. Following the educational intervention, overall HIV knowledge significantly increased (t(52) =-4.51, p = .00) and HIV-related stigma significantly decreased (t(54) =2.04, p = .04) and all but one individual opted to take the HIV self-test. Post-HIV test results indicated thatindividuals who used the HIV self-test were “very satisfied” with the test and were “confident” they could get tested for HIV in Athens County in the future.

Discussion: These results are encouraging because they suggest that a brief educational intervention was successful at changing HIV knowledge and stigma, facilitating getting an HIV test, and increasing confidence that participants can get tested for HIV in the future.

MRP Publications
Basta, T. B., Stambaugh, T., & Fisher, C. B. (2015). "Efficacy of an Educational Intervention to Increase Consent for HIV Testing in Rural Appalachia". Ethics & Behavior, 25(2): 129-145.

Brandon Brown, Ph.D., M.P.H.

RETI, fellows

Undergraduate Director of Public Health
School of Medicine's Center for Healthy Communities
University of California, Irvine

Background
Dr. Brandon Brown is the Undergraduate Director of Public Health at University of California Irvine's Center for Healthy Communities, where his efforts are spent in both education and research. He teaches several courses, including ethics and responsible conduct of research in public health, international epidemiology, and advances in global health. He also serves as the director of undergraduate education, chair of the curriculum committee, director of the global health infrastructure development program, and is a clinical research ethicist. Brandon received his MPH from UCLA and his PhD in International Health from Johns Hopkins Bloomberg School of Public Health in the Global Disease Epidemiology and Control program. His dissertation titled ‘HPV prevalence and risk factors among female sex workers (FSWs) in Peru’ has yielded four peer review publications, with another five articles in preparation. Dr. Brown completed Postdoctoral studies at UCLA in the Global HIV/AIDS Prevention Research program, and in the UCSD Global Public Health program.

Brandon has worked on projects in Peru for over 7 years, and is currently Principal or Co-Investigator on 6 HIV focused or related studies in Peru and Mexico. These projects include vaccine acceptability, building clinic infrastructure, studies of comorbidity of HIV with HPV, examining behaviors related to HPV infection, estimating HPV prevalence in developing countries, conducting interventions for cervical cancer prevention, recruitment and retention of high risk groups in clinical trials, and studies of STIs affecting FSWs and MSM. Dr. Brown is very interested is the topic of international research ethics, and works closely with the University of Cayetano Heredia in Peru. He hopes to begin a program training international scholars in research ethics at UC Irvine. A topic of particular interest is undue inducement in clinical studies of HIV in developing countries with vulnerable populations.

Mentored Research Project (MRP) Title
Voluntary study participation in a clinical trial of HPV vaccine with Peruvian FSWs

Abstract

Aims:This qualitative study examined Peruvian female sex workers’ (FSWs) evaluation of socialand health risks/benefits, informed consent, incentives, fair treatment, and post-trial care following their participation in an HPV vaccine phase IV clinical trial (GIRASOL), in which allparticipants received quadrivalent HPV vaccine.

Methods: Sixteen FSWs aged 23-29 years from Lima, Peru who previously enrolled in the GIRASOL trial were administered semi-structured interviews to assess perceptions of studyparticipation. Interviews were conducted in Spanish, audio-recorded, transcribed, andtranslated into English. Transcripts were coded in Atlas.ti using open and axial coding. Codes were collapsed, combined, and developed into concepts and representative quotes.

Results: Broad themes emerging from content analysis included respect, privacy, absence ofstigma, access to healthcare, and abandonment. Most participants reported staff treated them with empathy, fairness, and dignity, that participation provided protection from cancer and an opportunity to privately receive quality sexual health care, they were well prepared by consent procedures, participation was voluntary, and incentives were appropriate. Of note, one participant responded, “If nothing else, they always treated me as a human”. Unexpectedly, some experienced desertion when the study ended.

Conclusions: Participants were generally content with all aspects of the study and emphasized its protective and non-coercive attributes. They expressed gratitude for the professional treatment despite normalized stigma regarding their FSW status. Further work may be neededto reduce feelings of abandonment. Researchers may also need to develop navigation plans to properly transition participants out of research projects once studies have ended.

MRP Publications
Brown, B., Blas, M. M., Heidari, O., Carcamo, C., & Halsey, N. A. (2013). Reported changes in sexual behavior and human papillomavirus knowledge in Peruvian female sex workers following participation in a human papillomavirus vaccine trial. International Journal of STD & AIDS, 24(7), 531-535.

Brown, B., Davtyan, M., & Fisher, C.B. (2015). "Peruvian female sex workers’ ethical perspectives on their participation in an HPV vaccine clinical trial". Ethics & Behavior, 25(2): 115-128.

Brown B, Galea JT, Davidson P, Khoshnood K. Transparency of participant incentives in HIV research. Lancet HIV 2016; 3(10): e456-7.

Brenda Curtis, Ph.D.

RETI, fellow

Chief, Technology and Translational Research Unit 
Real-world Assessment, Prediction, and Treatment Unit
National Institute on Drug Abuse

Background
Dr. Brenda Curtis is currently a an Investigator at the National Institute on Durge Abuse (NIDA). She received her Masters of Science in Public Health from the University of Illinois and her Doctoral degree from the Annenberg School for Communication at the University of Pennsylvania. Her principal research interests have been in the fields of Health Communication and Public Health. She is very interested in providing scientifically tailored health information that is evidence based. She attempts to translate research into programs that allow for the building of individual and community capacity. In her recent research, she developed a web-based smoking cessation intervention program and conducted a randomized controlled trial to assess the relative effectiveness of tailoring the intervention content to particular demographic (age, gender, ethnicity), and also functional behavioral attributes of the individuals in the target population. That is, the computer used particular presentations of the same message that were individually designed to attributes known to be important in gaining attention and shaping behavior. She found that this relatively simple and inexpensive procedure was able to improve intention to quit by over 19%.

Dr. Curtis is continuing to explore this line of research and recently deployed a substance use screening and brief intervention web-based interactive program she developed into a New York school district. Dr. Curtis is also working on innovative ways to increase enrollment and retention of hard to reach populations into HIV clinical trials. Her research has led her to examine the ethical implications raised by the use of the Internet and social media to recruit and retain subjects into HIV related studies. She is particularly interested in assessing how Institutional Review Boards are implementing new policies and procedures to deal with online recruitment.

Mentored Research Project Title (MRP)
Online Recruiting for HIV Research: Ethical Issues and Concerns for Investigators and IRBs

Abstract
Objective: To assess the ethical dilemmas that have arisen during the design and conduct ofHIV/AIDSprevention researchprojects that used the internet for recruitment and to gain a betterunderstanding as to how these dilemmas were resolved.

Background: The internet provides HIV/AIDS researchers access to target populations, oftenreaching difficult-to-reach populations. However, this benefit to researchers raises many issues for the protections of prospective research participants.

Methods:Semi-structured telephone interviews were conducted with 8 IRB members and 15 principal investigators (PIs). All interviews were confidential,and data regarding general geographic location,size of institution and disciplineof PI and IRB were recorded.

Results: Recruiting participants online has challenged the adequacy of current and established procedures for participants’ protections. Five main categories of ethical dilemmas were encountered duringthe online recruitment of participants: consent, protection of minors, privacy/confidentiality, data storage and security, and data integrity.

Conclusions:The data presented provides IRBs and researchers with the ethical dilemmas that are most likely to occur and how others have addressed these dilemmas. These challenges will continue to evolve rapidly as the online technology evolves and as societal privacy concerns and researchregulatory structures change.In light of findings, it is recommended that IRBs continue to track and seek procedural solutions for the protection of the confidentiality and validity of data while protecting participant privacy.

MRP Publications
Curtis, B. (2014). "Social networking and online recruiting for HIV research: ethical challenges”. Journal of Empirical Research on Human Research Ethics. 9(1), 58-70.

Shira Goldenberg, Ph.D.

shira goldenberg

Assistant Professor
Department of Health Sciences
Simon Fraser University 

Background
Dr. Shira Goldenberg is a Spanish speaking global health investigator with seven years of experience conducting research on social and structural factors shaping HIV and sexually transmitted infection (STI) risk among vulnerable populations. After completing her MSc in Epidemiology at the University of British Columbia, she received a Canada-U.S. Fulbright award to pursue her PhD through the University of California San Diego (UCSD) and San Diego State University Joint Doctoral Program in Public Health (2008-2011). Dr. Goldenberg is currently a post-doctoral fellow in the UCSD Division of Global Public Health, where her work focuses on structural factors shaping HIV/STI risk, gender-based violence and sex trafficking among female sex workers along the Mexico-U.S. and Mexico-Guatemala borders. She has also worked with the Pan American Health Organization on issues related to mobility and HIV in Central America and Mexico. As data on social and structural factors, such as gender inequities, poverty, and laws/policies are necessary to better understand and prevent HIV/STI infection, Dr. Goldenberg’s short-term goal is to develop the methodological and ethical skills to investigate social and structural influences shaping HIV/STI infection among formerly trafficked women. Her long-term research plans are to develop and evaluate structural interventions to reduce the impacts of sex work among women at high risk of HIV infection in border settings, which is a pressing public health concern in the U.S., Latin America, and globally.

Mentored Research Project (MRP) Title
Barriers and Facilitators to Participation in HIV Research: Female Sex Workers’ Perspectives

Abstract
Globally, female sex workers remain disproportionately impacted by HIV. While research with sex workers is critical to inform HIV prevention, few studies have examined how sex workers perceive the benefits and risks of participating in HIV-related research. To explore perceived barriers and facilitators to participation in HIV research, we conducted in-depth interviews and focus groups with 33 female sex workers ≥18 years old in Tecun Uman, Guatemala from 2013-2014.Stigma associated with sex work and HIV was a critical barrier to research participation.Key benefits of participation included access to HIV/STI prevention and testing, as well as positive and trusting relationships between sex workers and research teams. Control exerted by managers had mixed influences on perceived research risks and benefits, with some women reporting managerial practices that promoted research engagement, whereas others described managers as restricting research participation. Participant narratives contextualized these themes as linked to broader inequities related to stigma, poor access to care, limited social and psychological support, the clandestine nature of sex work, and human rights violations.Results underscore the critical need for HIV investigators to develop population-tailored procedures to reduce stigma, engage managers, and reinforce trusting, reciprocal relationships between sex work communities and researchers. These efforts remain particularly crucial within resource-poorsettings where sex workers face pervasive barriers to health and social supports,and remain heavily criminalized and stigmatized.

MRP Publications
Collins, S. P., Goldenberg, S. M., Burke, N. J., Bojorquez-Chapela, I., Silverman, J. G., & Strathdee, S. A. (2013). Situating HIV risk in the lives of formerly trafficked female sex workers on the Mexico–US border. AIDS care, 25(4), 459-465.

Goldenberg SM, Brouwer KC, Rocha Jimenez T, Morales Miranda S, Rivera Mindt M. Enhancing the Ethical Conduct of HIV Research with Migrant Sex Workers: Human Rights, Policy, and Social Contextual Influences.’ PLOS One. PLoS One. 2016; 11(5): e0155048.Published online 2016 May 9.

Goldenberg, S., Rivera Mindt, M., Jimenez, T.R., Brouwer, K.C., Miranda, S.M., & Fisher, C.B. (2014). "Structural and interpersonal benefits and risks of participation in HIV research: perspectives of female sex workers in Guatemala”. Ethics & Behavior, 25(2): 97-114.

Thomas Guadamuz, Ph.D., M.H.S.

RETI, fellow

Assistant Professor
Medical Social Sciences and Public Health
Deputy Head, Center for Health Policy Studies
Mahidol University, Thailand

Background
Dr. Thomas Guadamuz completed graduate training in infectious disease epidemiology at Johns Hopkins Bloomberg School of Public Health and later completed postdoctoral training in behavioral and social sciences and health at the University of Pittsburgh and Mahidol University in Thailand. He is currently a recipient of a Mentored Research Scientist Development Award from NIMH to develop a community-level behavioral change intervention for high-risk young men who have sex with men in Thailand. He is also working with transgender populations in Thailand and the Philippines to understand HIV risk contexts that will inform intervention development.

Dr. Guadamuz has worked in partnership with numerous community-based organizations in the US and Asia and has collaborated with the U.S. CDC, the Thailand Ministry of Public Health, World Health Organization, International Labor Organization, and Family Health International. Dr. Guadamuz currently holds a joint appointment at the Center for Health Policy Studies in the Faculty of Social Sciences and Humanities at Mahidol University where he has close research collaborations and teaches on gender, sexuality and health. His current research interests are the social determinants of health among marginalized populations, recruitment of hard-to-reach populations and HIV risk contexts in online and offline spaces, including gender- and sexuality-based violence and cyber bullying.

Mentored Research Project (MRP) Title
Barriers and facilitators to YMSM participating in HIV-related research studies in Thailand: Perspectives of parents and teens

Abstract
Young men who have sex with men (YMSM) under 18 years are often excluded from HIV prevention research in Thailand due to cultural attitudes toward youth sexuality, social stigma, and difficulties obtaining guardian permission. Culturally sensitive focus group discussions and in-depth interviews were conducted with parents and YMSM in Bangkok, Thailand and identified barriers and facilitators related to minors’ participation in HIV prevention research. Although gender and class differences emerged, mothers and fathers were generally accepting of research to reduce HIV risk,but not in favor of waiver. Youth’s positive attitude toward parental permission wastempered by concerns about harms posed by disclosing same-sex attraction through permission forms.

MRP Publications
Guadamuz, T., Goldsamt, L.A., & Boonmongkon, P. (2014). "Consent challenges for participation of young men who have sex with men (YMSM) in HIV prevention research in Thailand". Ethics & Behavior, 25(2), 180-195

Charmaine Thokoane

RETI, fellow

Dean of Instruction
Nova Pioneer
Midrand, South Africa

Background
Charmaine Thokoane is the Dean of Instruction at Nova Pioneer, a a Pan-African independent school network offering preschool through secondary education for students from ages 3 through 18.  In addition to this, she has worked with governmental and non-governmental institutions in South Africa, as well as, non-governmental organizations and academic institutions in the Eastern and Southern African region on Human Rights and, Sexual and Reproductive Health. She has represented the Center for the Study of AIDS (CSA) in various forums in South African and other African countries.

Her areas of interest in Public Health and Human Rights developed after joining the CSA as a volunteer in 2005, while studying towards a degree in natural and agricultural sciences. In 2010, she was selected by the US Embassy, to be part of the US State Departments’ International Visitor Leadership Programme on Skills and Youth Development (February 2011). The knowledge and skills she gained through this experience, has helped shape her community work.

Mentored Research Project (MRP) Title
Knowledge of rights to sexual reproductive health services among 12-18 year olds in Hammanskraal

Abstract
Young people represent the majority of the population in South Africa and, they are also the most affected by the HIV epidemic. HIV prevention programmes have mainly targeted youth aged 15 -24, focusing largely on behaviour change and risk reduction. The main goal of this intervention is to increase knowledge and awareness of youth sexual reproductive health rights (SRHR) and health services, among healthcare workers and youth aged 12-18, in Hammanskraal.The intervention programme proposes to achieve this goal by using a three phase strategy, which will examine the attitudes and perceptions of young people and healthcareworkers through focus group discussions, interviews and rights based training. The expected outcomes of the intervention programme are increased knowledge of youth SRHR among youth and healthcare workers, greater awareness of local health services, facilitate the creation of youth friendly health services, as well as offering another alternative to youth targeted intervention programmes.

MRP Publications
Thokoane, C. (2014). "Ethical challenges for piloting sexual health programs for youth in Hammanskraal, South Africa: bridging the gap between rights and services". Ethics & Behavior, 25(2): 185.

Kristen Underhill, J.D., Ph.D.

Associate Professor of Law
Columbia Law School
New York, NY

Background
Dr. Kristen Underhill holds a DPhil in Evidence-Based Social Intervention from Oxford University, where she focused on behavioral HIV prevention, systematic reviewing, and research with vulnerable populations. She completed her postdoctoral training under an NIH T32 grant in the Department of Community Health at Brown University, where she focused on the behavioral implications of biomedical HIV prevention strategies. Dr. Underhill's published articles have included studies of abstinence-based HIV prevention approaches, HIV risk among transgender women and their male partners, and the implementation of pre-exposure prophylaxis (PrEP). She also holds a JD from Yale Law School, and her legal research focuses on law and public health, the use of behavioral science concepts in the law, and healthcare financing.

She is jointly affiliated with the Yale Center for Interdisciplinary Research on AIDS and Yale Law School. Dr. Underhill is currently PI of a K01 Mentored Research Scientist Development grant focusing on behavioral issues involved in the use of oral anti-retroviral PrEP by men who have sex with men (MSM). This research grant uses mixed methods to investigate willingness to use PrEP, attitudes towards risk compensation behavior, and perceptions of drug efficacy. Dr. Underhill's legal research aligns with her public health research interests; one of her recent legal projects examined legal doctrines and regulations applying to health insurance coverage of biomedical HIV prevention technologies.

Mentored Research Project (MRP) Title
Exploring IRB Responses to Participant Complaints: Processes, Values, and Resources

Abstract
The goal of this project was to provide an initial characterization of IRBs' dispute procedures for handling complaints, injuries, and disputes involving individual research participants. The population for this study was IRB chairs, directors, and other IRB personnel designated to address research-related complaints. Included institutions were hospitals and academic institutions that had received funding from any source to implement research on biomedical HIV prevention strategies in the past 5 years. Individuals from these institutions were recruitedby email and participated in a semi-structured qualitative interview by phone. Interviews explored frequency and types of participant complaints, institutional practices for resolving complaints and injuries, experiences with HIV/AIDS research complaints, and predicted institutional responses to 4 complaint vignettes from a hypothetical trial of pre-exposure prophylaxis (PrEP) for HIV prevention. Institutions reported receiving 0 to 43 complaints annually per 1,000 protocols in all research areas, and 0 to 5annual complaints from HIV-related protocols. HIV/AIDS-related research complaints included concerns about compensation, eligibility, breach of confidentiality, reportability of HIV infection, advertisements, post-trial access to treatment, and obtaining individual results. IRBs provided internal processes for resolving complaints, and interviewees often discussed processes using procedural justice themes like voice, neutrality, voluntariness, respect, and transparency. Institutional insurance for research-related injuries was rare. By identifying common practices for responding to complaints and injuries, this study can provide a blueprint for IRBs, researchers,and research funders seeking to respond more comprehensively to participantswho make complaints or report injuries, both in HIV-related and other protocols.

MRP Publications
Underhill, K. (2014). "Legal and Ethical Values in the Resolution of Research-Related Disputes: How Can IRBs Respond to Participant Complaints?". Journal of Empirical Research on Human Research Ethics. 9(1), 71-82

Cohort 3 RETI Fellows (2013 - 2015)

Stella Njuguna, B.Pharm., M.P.H.

Stella Njuguna, HIV Fellow

Research Officer
Kenya Medical Research Institute

Background
Dr. Stella Njuguna is a Research Officer at Kenya Medical Research Institute (KEMRI). She earned her pharmacy degree from the University of Nairobi, Kenya and a MPH in Epidemiology from the University of California, Berkeley. Her main research interests include: HIV prevention care and treatment as well as socio-behavioral research especially within HIV discordant couples.

Stella has participated in several studies in various capacities. Currently, she is a Co-Investigator for the HIV- Neurology in Kenya Study 2 (THINK-2) and a pharmacist and epidemiologist for Sustainable East Africa in Community Health (SEARCH) study. THINK-2 is a longitudinal study that aims to assess the impact of cognitive impairment on adherence to anti-retroviral therapy (ART). SEARCH project is a cluster-randomized multi-site clinical trial which aims to quantify the health, economic and education impact of early diagnosis and immediate ART treatment using a streamlined care delivery system in rural communities in East Africa. Furthermore, she has keen interest in research ethics and currently provides technical support to KEMRI’s Ethics Review Committee. Dr. Njuguna is also a member of the ADILI Taskforce Secretariat which has been mandated by the Director of KEMRI to restructure the Institute’s research and regulatory review system. She is also a production editor for the quarterly bioethics newsletter in KEMRI.

Mentored Research Project (MRP) Title
Post-trial access of Truvada® amongst HIV-1 discordant couples enrolled in the PrEP study in Kisumu, Kenya

Abstract
Purpose: Recent studies have shown that Truvada is effective in preventing HIV infections in most at risk populations. However, Truvada has not been provided to the participants who were enrolled in the Pre-Exposure Prophylaxis (PrEP) study in Kisumu, Kenya. Who is responsible for post-trial access (PTA) in this population? This is a critical ethical issue that needs to be addressed. The main goal of this study was to examine attitudes regarding post-trial access to Truvada amongst a random sample of sero-discordant couples previously enrolled in the PrEP study in Kisumu, Kenya as well as the principal investigators of the study.

Study population: HIV uninfected participants in discordant relationships formerly enrolledin PrEP study, investigators of the study, and head of HIV preventative services for the Ministry of Health, Kenya.

Method: Mixed methods cross-sectional study. Focus group discussions and in-depth interviews were conducted. A brief questionnaire was administered to capture data on socio-demographics and trial experiences.

Results and Conclusion:A total of 40 participants were enrolled into the study, with 95% currently living with their partners. The majority of participants (60%) are inpolygamous relationships. Over half the participants (57%) fear-getting HIV infected since they are not receiving TRUVADA. From the FGD, most of the participants strongly felt that they should be receiving TRUVADA as they “risked their lives during study participation”. The government of Kenya and the sponsors should dialogue on how these drugs will be made available to the study population. Local investigators felt that the government should take up the responsibility of PrEP provision to high risk populations such as MSM, FSW and sero-discordant couples who are trying to conceive.

Nicole Overstreet, Ph.D.

RETI, fellow

Assistant Professor
Clark University
Department of Psychology
Worcester, Massachusetts

Background
Dr. Nicole Overstreet received her PhD in social psychology from the University of Connecticut, where she was a NIMH-funded T32 pre-doctoral fellow in the Social Processes of HIV/AIDS Training Program. Currently, she is an Assistant Professor in the Department of Psychology at Clark University. Previously, she was a NIMH-funded T32 post-doctoral fellow at the Center for Interdisciplinary Research on AIDS, Yale University. Her program of research examines the intersection of intimate partner violence (IPV) and HIV risk in marginalized groups, with a particular focus on social factors that influence risk (e.g., stigma, prejudice, discrimination).

Dr. Overstreet’s recent work considers how stigmatizing experiences with IPV victimization influence HIV risk factors, negative self-appraisals, and negative affect. Her work also examines mechanisms linking IPV and HIV risk, including substance use and psychological distress (e.g., PTSD, depression). Dr. Overstreet’s short-term goal is to establish a strong methodological and ethical foundation to investigate the effect of IPV and stigma on HIV risk behavior, mental health, and utilization of support networks. Her long-term research plans include developing interventions to address IPV, stigma, and HIV risk among groups disproportionately affected by HIV and other STIs.

Mentored Research Project (MRP) Title
Assessing the role of stigma on women’s participation in and perceptions of intimate partner violence research

Abstract

Background: African American women living with HIV may experiencemultiple forms of stigma and discrimination related to their HIV status, experiences of intimate partner violence (IPV), race, and gender. Despite these experiences of intersectional stigma, few studies have explored whether living with multiple marginalized social identities elicits ethical concerns and benefits when women choose to participate in HIV research. The purpose of the current study is to understand the role of intersectional stigma on ethics-relevant benefits and risks for women who participate in HIV research.

Specific Aims: This study examines: 1) Perceived benefits of research participation; 2) Perceived risks of research participation; 3) The extent to which women’s experiences of stigma and discrimination are associated with negative emotional reactions to research participation; 4) The extent to which experiences of stigma are associated with participant distress during research process.

Study Population: 90 HIV-infected African American women in the Baltimore area.

Research Design: Retrospective quantitative online survey.

Preliminary Results: Overall, participants expressed more positive than negative attitudes and reactions toward their research experience. However, internalized HIV stigma andstudy experience were significantly related to these reactions. Our results suggest that African American sero-positive women do not find responding to socially sensitive questions related to HIV and other risk behaviors stressful. However, the data also indicate that HIV stigma and lack of research experience can heighten negative reactions, which in turn may create barriers to recruitment and jeopardize the validity of participant responses.

Alexis Roth, Ph.D., M.P.H.

RETI, fellow

Assistant Professor

Drexel University
Dornsife School of Public Health
Philadelphia, Pennsylvania

Background
Dr. Alexis Roth pursued a PhD to address how individual and neighborhood-level factors contributing to disproportional rates of STI/HIV in urban settings. Over time, she became increasing interested in “mHealth research” as a mechanism for measuring event-level behavioral phenomenon and capturing information about high- and low-risk activity spaces. She completed a Predoctoral Research Fellowship sponsored by the Indiana University Purdue University Center for Urban Health to use smartphone-delivered digital diaries to measure how situational factors (e.g. drug craving; mood; relationship to sexual partner; day, time or location of sex) impact HIV risk among female sex workers.

In 2012, Dr. Roth began a NIDA-funded postdoctoral fellowship (T32 DA 023356) in the Division of Global Public Health (GPH) at the University of California San Diego (UCSD). At UCSD, her interest in mHealth research intensified as she began to consider how polydrug use impacts adherence to antiretroviral treatment (ART) among persons who inject drugs (PWID). In September 2014, she joined the Department of Community Health and Prevention at Drexel University as an Associate Professor. There her research will use daily diaries to unpack how drug use impacts HIV risk behaviors and anti-retroviral medication adherence over time. Findings will contribute to subsequent text messaging interventions that respond in real-time to identified antecedents of risk and non-adherence that may be amenable to intervention.

Mentored Research Project (MRP) Title

Ethical considerations for mHealth research with persons who inject drugs

Abstract
"mHealth” research refers to an emerging discipline that leverages the increasingly sophisticated capabilities of mobile communications technology for both measurement and intervention in health behavior research. mHealth is a new but growing field, it’s been approximately 5 years since the first mHealth randomized controlled trial, thus, a set of commonly agreed upon ethical standards for the use of these tools has yet to be established. Improving our understanding of the benefits and harms associated with involvement in mHealth studies, as well as concerns participants might have about privacy and data security, will be critical if mHealth research is to move forward. This project aims to draw upon participant perspectives to investigate ethical considerations for conducting one type of mHealth research, event-level monitoring of drug use via digital diaries entered on smartphones, to establish best-practice guidelines for researchers interested in using mHealth tools with drug using populations.

MRP Publications

AM Roth, J Rossi, JL Goldshear, Q Truong, RF Armenta, SE Lankenau, RS Garfein, & Janie Simmons. Potential Risks of mHealth Research: An exploration of perceptions among persons who inject drugs. Substance Use and Misuse. In Press.

Darpun Sachdev, M.D.

Clinical Prevention Specialist
Disease Prevention and Control
San Francisco Department of Public Health

Background
Darpun Sachdev, MD is a Clinical Prevention Specialist at the San Francisco Department of Public Health. After receiving her MD at Brown University, she was a resident and Chief Resident in Internal Medicine at Mount Sinai Hospital in New York and completed her Infectious Disease Fellowship at Columbia University. She is a board certified internist and completed her specialty training in Infectious Disease. 

Darpun’s research focuses on the epidemiologic and biologic risk factors for acquisition of HIV, and clinical trials of biomedical interventions to prevent HIV transmission. She is currently leading a quantitative study to evaluate preferences toward antiretroviral-based prevention strategies in Bronx, NY and a qualitative study to evaluate community and stakeholder perspectives toward standards of prevention care in HIV prevention trials. She recently completed a national survey to evaluate physicians’ willingness to prescribe oral and topical pre-exposure prophylaxis. At Bridge HIV, she provides scientific expertise and leadership to conduct Phase 1-3 HIV vaccine trials in San Francisco.

She plans to continue to focus on improving the design and delivery of HIV prevention modalities. Ultimately, she hopes to design combination HIV prevention trials that evaluate community-level impact and effectively utilize surrogate endpoints. 

Mentored Research Project (MRP) Title
Fair Access to effective Interventions in Research trials (FAIR study): A qualitative study

Abstract
Background: Given the efficacy of pre-exposure prophylaxis (PrEP), there is ongoing debate regarding whether future placebo-controlled biomedical HIV prevention trials are ethically justifiable. Several innovative trial designs are under consideration to test new biomedical HIV prevention modalities provide PrEP as part of the standard of prevention or use PrEP as an active control. However, little is known about the ethical considerations of these designs.

Methods: We purposively sampled and conducted in-depth interviews with 22 experts in clinical research methods and ethics. These experts included 6 principal investigators, 2 biostatisticians, 4bioethicists, 4 community advocates, 4 representatives of funding agencies, and 2 social scientists, each with experience in HIV prevention trials. We sought to understand potential trial designs for HIV vaccines or long-acting PrEP that have been under consideration, and identify preferences among these designs. We analyzed interview transcripts using constant comparative methods to inductively develop and refine themes.

Results: Respondents outlined tensions to providing oral PrEP, and generally agreed it should be offered as the standard prevention in future biomedical HIV prevention trials. Key tensions included practical challenges to providing PrEP as the standard of prevention. Respondents also outlined opportunities for addressing these challenges through adaptive trial designs.

Conclusions: Given the challenges and opportunities of incorporating oral PrEP as part of future clinical trials, adaptive trial designs, which allow for modification of a trial in response to study data, were highly acceptable to respondents. However, adaptive trials create new bioethical and biostatistical challenges. If adaptive HIV prevention trials are implemented, research ethics studies should focus on how to mitigate undue influence and enhance research literacy

Sean Young, Ph.D.

Sean Young, HIV Fellow

Executive Director
University of California Institute for Prediction Technology
Los Angeles, California

Background
Dr. Sean D. Young is an Assistant Professor in the Department of Family Medicine and Center for Behavior and Addiction Medicine at UCLA. Dr. Young studies HIV prevention decision-making and testing behavior in the U.S., Peru, and South Africa. He also has conducted extensive user experience research and development, designing and evaluating social media and health behavior change methods and social media “apps” for HIV prevention, addiction medicine, and general health. He has spent the past 7 years studying the relationship between social media and HIV prevention/sexual risk behaviors among Los Angeles homeless youth, African American and Latino MSM, Peruvian MSM, and American and Iranian college undergraduates. He is the Primary Investigator of the HOPE UCLA study, the first intervention trial to assess whether social networking technologies can be used to deliver peer-led HIV prevention information to increase HIV testing among African American and Latino MSM. He is currently replicating this study among Peruvian MSM, in Lima, Peru. Dr. Young’s clinical work is focused on designing and evaluating engaging electronic platforms and medical decision-making tools.

Mentored Research Project (MRP) Title
Ethics and Social Networking for HIV Research

Abstract
This study seeks to understand participants ethical experiences participating in social networking for HIV prevention research. Through 2 samples of men who have sex with men (MSM) participants (1 in Lima, Peru and another in Los Angeles, CA), we survey participants to better understand the impact that the intervention had on their lives in order to gain answers on how to improve the ethics of this research. Specifically, we seek to1) assess MSM participants’ ethics-related acceptance of using social networking technologies for HIV prevention research throughout recruitment, intervention, and follow-up, among MSM, and 2) determine whether participants’ reports of their research participation experiences can be generalized and standardized to inform future researchon social networking for HIV prevention. Results from the Peru surveys suggest that participants found the intervention to be safe, provide a positive experience where the benefits outweighed the risks, and found the consent process to be sufficient. Data from follow-up interviews with Peru participants as well as from the Los Angeles participants will provide additional data to address our aims.

MRP Publications
Chiu, C. J., Menacho, L., Fisher, C., & Young, S. D. (2015). Ethics Issues in Social Media–Based HIV Prevention in Low-and Middle-Income Countries. Cambridge Quarterly Health Care Ethics, 24(3) 303-310

Young, S., Chiu, C.J. & Menacho, L. (2015). "The Association Between Age and Ethics-Related Issues in Using Social Media for HIV Prevention in Peru". Ethics & Behavior.

Cohort 4 RETI Fellows (2014 - 2016)

Erin Bonar

RETI, fellow

Assistant Professor of Psychology
Addiction Research Center
University of Michigan
Ann Arbor, Michigan

Background
Dr. Erin E. Bonar received her PhD in Clinical Psychology at Bowling Green State University and completed an NIAAA T32 research fellowship at the University of Michigan Addiction Research Center. She is currently an Assistant Professor in the Department of Psychiatry at the University of Michigan. As a licensed clinical psychologist, she provides clinical care in the University of Michigan Addiction Treatment Service and teaches Motivational Interviewing to fellows in Addiction Psychiatry. Her research focuses on understanding and reducing substance use and concomitant risk behaviors (e.g., HIV risk behaviors) and related negative consequences for both individuals and communities. She received a NIDA K23 Career Development Award in 2013. Using mobile technologies, Dr. Bonar is studying the daily relationships between substance use and HIV-related sexual risk behaviors among at-risk emerging adults in a low resource community. The findings from this study will inform the development of an intervention for substance use and HIV risk behaviors in this population. Dr. Bonar also collaborates on a number of studies of adolescents and adults focused on improving care in substance abuse treatment centers as well as on identifying and screening for substance use among patients in a variety of healthcare settings.

Mentored Research Project (MRP) Title
Goals: We evaluated perceptions of risks and benefits among emerging adults who completed daily text message assessments of alcohol use, drug use, and sexual behavior in order to inform ethically sound procedures for future mHealth research with this population.

Method: Participants were emerging adults (18-25 years old) from an urban, low resource community who reported using drugs and engaging in risky sexual behavior and completed a 28-day longitudinal study employing daily text message assessments of substance use and HIV-related risky sexual behaviors. At one-month follow-up visits, participants completed survey items assessing domains of risks and benefits experienced during participation in the daily text message survey study.

Results: Data was collected from 54 participantswho were 53% female, 45% AfricanAmerican, 55%European American/Other. On average they were 22.0 years old. Participants reportedvery few perceived harms and were generally comfortable with the survey topics and questions. The majority reported several benefits of participation, such as having contributed to their community (79%) and helping other youth (83%). As a result of the surveys, some reported improvements in relationships (up to 32%) and engaging in sexual health-promoting behaviors (up to 35%).The majority (79-89%) said they would participate in the study again.

Discussion: Results from this sample from a vulnerable population of urban emerging adults who use drugs demonstrate that very few participants perceived experiencing actual harm from completing a text message-based study of socially sensitive behaviors. Findings from this study are important for informing future research procedures and IRB decisions.

MRP Publications
Erin E. Bonar, Gerald P. Koocher, Matthew F. Benoit, R. Lorraine Collins, James A. Cranford & Maureen A. Walton (2017): Perceived Risks and Benefits in a Text Message Study of Substance Abuse and Sexual Behavior, Ethics & Behavior

Faith Fletcher

Faith Fletcher

Assistant Professor
School of Public Health
University of Alabama

Background
Dr. Faith Fletcher is Assistant Professor at the University of Alabama. Dr. Fletcher’s research program broadly addresses reproductive and cancer-related disparities among disadvantaged women living with HIV/AIDS. Her undergraduate exposure to health inequities through Tuskegee University’s National Center for Bioethics in Research and Health Care influenced her decision to pursue a career in health disparities research and promote social justice among underserved populations. She obtained a MA through Michigan State University’s interdisciplinary program in Bioethics, Humanities, and Society (2006) and PhD in Health Promotion, Education, and Behavior from the University of South Carolina’s Arnold School of Public Health (2011).

Dr. Fletcher completed a Postdoctoral Fellowship in the Department of Behavioral Science at The University of Texas MD Anderson Cancer Center. Her National Cancer Institute R25T-funded study used combined qualitative and quantitative methods to explore barriers associated with cervical cancer screening utilization among HIV-positive women at an urban, comprehensive HIV clinic in Houston, Texas. Dr. Fletcher is a recent recipient of the Kaiser Permanent BURCH Minority Leadership Award Program which aims to enhance the voices and leadership development of minority researchers committed to improving service to the underserved and reducing health and healthcare inequalities. She is also a Building Interdisciplinary Careers in Women’s Health (BIRCWH) Associate and an Institute for Research on Race and Public Policy (IRRPP) Faculty Fellow at the University of Illinois at Chicago. Relevant training opportunities further position her to address health inequities among HIV-positive women through an enhanced interdisciplinary, translational research framework. Dr. Fletcher ultimately seeks to build a programmatic line of research that would engage innovative approaches to expand the provision of cancer preventive services in HIV clinic-based settings.

Mentored Research Project (MRP) Title
Perceptions of Facilitators and Barriers to Consenting Daughters Participation in HIV Prevention Research among African American Women Living with HIV/AIDS

Abstract
Background: Approved by the Food and Drug Administration in 2012, Pre-exposureprophylaxis, or PrEP is a new anti-HIV medication that prevents HIV in HIV-negative individuals. Currently, PrEP is not approved for adolescents, and data on adolescents and PrEP are lacking. Thus, PrEP’s potential as an HIV prevention strategy for adolescent populations is unknown.

Objectives: Given the social, behavioral, and ethical issues surrounding PrEP use foradolescents, the purpose of this study was to assess perceptions of barriers and benefitsrelated to African American girls' (ages 14-17) participation in PrEP clinical trials and potential utilization of various modes of PrEP delivery.

Methods: Fifteen African-American mother/daughter pairs (N=30) were recruited from atwo-armed, family-based randomized controlled trial to participate in a focus groupdiscussion and questionnaire related to adolescent PrEP utilization and clinical trial participation. The focus group discussion was guided by a fifteen-minute PrEP educational module, which included a hypothetical clinical trial informed by two local community advisory boards. 

Results: Overall, most mothers expressed a willingness to allow their daughters to take PrEP once approved for adolescents, but indicated concerns about clinical trial participation primarily due to a lack of available evidence related to the long-term side effects of PrEP for adolescents. Conversely, daughters expressed a willingness toparticipate in PrEP clinical trials, citing both individual and societal level benefits.

Conclusion: Study findings uncover the need to implement ethically sound strategies tostrengthen the availability, accessibility and acceptability of new scientific advances in HIV for HIV-vulnerable adolescent populations.

Julia Lechuga

RETI, fellow

Assistant Professor of Education and Health, Medicine and Society
Leigh University College of Arts and Sciences
Bethlehem, Pennsylvania

Background
Dr. Julia Lechuga received her PhD from the University of Texas at El Paso in Health Psychology in 2008. In 2010, Dr. Lechuga was a finalist for the Harry and Pola Triandis Outstanding Dissertation Award from the International Association of Cross-Cultural Psychology (IACCP) and received an Honorable Mention. Dr. Lechuga completed a National Institutes of Health NRSA Ruth L. Kirschstein postdoctoral fellowship at the Medical College of Wisconsin in 2010. In 2010 she started a faculty position at MCW and in 2013 moved to The University of Texas at El Paso. She is now an Assistant Professor at Leigh University. Dr. Lechuga's research focuses on the development, cultural adaptation, and dissemination and implementation of behavioral interventions to reduce the risk of infectious disease in ethnic minorities and vulnerable populations such as injection and non-injection drug users. In 2012, Dr. Lechuga received an NIH R21 to design a sexual and reproductive health behavioral intervention for mother-daughter dyads.

Mentored Research Project (MRP) Title

Benefits and barriers to continued HIV treatment for drug using individuals (largely crack cocaine) who have participated in an HIV intervention study in El Salvador

Abstract
There is limited research on the effectiveness of social network-based community-level HIV risk reduction behavioral interventions in non-injection drug users in underdeveloped countriesand the risks and benefits encountered. In addition, there is a dearth of research on participants’ expectations and motivations to participate.The purpose of the study was to retrospectively assess the research experiences of crack users who took part in such an intervention. Seventy-eight surveys and 20 in-depth interviews were conducted to assess participants’ motivations to participate, perceived drawbacks of participation, and behavior change intentions and perceived sustainability of behavior change.Participants were recruited from a larger study assessing the effectiveness of an HIV risk reduction multi-level community based intervention. Findings indicated that participants were motivated to participate for a variety of reasons including a desire to help others (altruistic motive). Participants scored higher than the midpoint of the scale regarding perceived benefits of participating.Findings indicated that participants who felt trust towards research experienced greater benefits of participation and reduced drawbacks. Furthermore, measures of structural barriers to behavior change such as stigma towards crack use significantly influenced research trust. Approximately half of participants were motivated to participate in medical treatment, which points to the importance of utilizing alternative methods of teaching potential participants about the benefits of research participation. Findings will inform the development of guidelines to inform IRB decision-making regarding the risk/benefit ratio of participation in such interventions.

Abby Rudolph

RETI, fellow

Associate Professor
School of Public Health
Temple University
Philadelphia, Pennsylvania

Background
Dr. Abby E. Rudolph is an Associate Professor at Temple University. She received her PhD from Johns Hopkins University Bloomberg School of Public Health and her MPH from Columbia University Mailman School of Public Health. Her research focuses on understanding how individual, environmental, and network factors act together to shape disease transmission dynamics, risk behaviors, and health service utilization among populations disproportionately burdened with HIV. Dr. Rudolph's publications cover a variety of topics including HIV and drug use-related stigmas, recruitment strategies for hidden populations, network, neighborhood, and spatial correlates of HIV and risk behaviors, pharmacy syringe access for people who inject drugs (PWID), and community-based participatory interventions to connect marginalized populations with health services.

She is currently the recipient of a Mentored Research Scientist Development Award from the National Institute on Drug Abuse (K01 DA033879A) that aims to better understand the independent and combined influence of sociometric network, spatial, and neighborhood factors on health-seeking and risk behaviors among PWID in Baltimore, MD. She is also Co-investigator on 1) R01HD077891 (PI: Stockman, J), which aims to evaluate the impact of the built and social environment on forced sex and, in turn, elucidate how forced sex and physiological factors influence behavioral mechanisms that increase risk for HIV acquisition among at-risk, HIV-negative African American women in Baltimore, MD and 2) R01DA035098 (PI: Pollini, RA), which aims to assess the implementation of Senate Bill 41 (passed on January 1, 2012 and designed to expand sterile syringe access by allowing California pharmacies to sell up to 30 syringes without a prescription) in two inland counties of California’s Central Valley.

Mentored Research Project (MRP) Title
Ethical Considerations for the Collection of Spatial Data for HIV Prevention Research among Illicit Drug Users

Abstract
Background: Analyses with geographic data can be used to identify "hot spots" and "health service deserts", examine associations between proximity to services and their use, and link contextual factors with individual-level data to better understand how environmental factors influence behaviors. Technological advancements in methods for collecting this information can improve the accuracy of contextually-relevant information; however, they have outpaced the development of ethical standards and guidance, particularly for research involving populations engaging in illicit/stigmatized behaviors. Thematic analysis identified ethical considerations for collecting geographic data using different methods and the extent to which these concerns could influence study compliance and data validity.

Methods: In-depth interviews with 15 Baltimore residents (6 recruited via flyers and 9 via peer-referral) reporting recent drug use explored comfort with and ethics of three methods for collecting geographic information: (1) surveys collecting self-reported addresses/cross-streets, (2) surveys using web-based maps to find/confirm locations, and (3) geographical momentary assessments (GMA), which collect spatiotemporally referenced behavioral data.

Results: Survey methods for collecting geographic data (i.e., addresses/cross-streets and web-based maps) were generally acceptable; however, participants raised confidentiality concerns regarding exact addresses for illicit/stigmatized behaviors. Concerns specific to GMA included burden of carrying/safeguarding phones and responding to survey prompts, confidentiality, discomfort with being tracked, and noncompliance with study procedures. Overall, many felt that confidentiality concerns could influence the accuracy of location information collected for sensitive behaviors and study compliance

Conclusions: Concerns raised by participants could result in differential study participation and/or study compliance and questionable accuracy/validity of location data for sensitive behaviors.

MRP Publications
Rudolph AE, Bazzi AR, Fish S. (2016) Ethical considerations and potential threats to validity for three methods commonly used to collect geographic information in studies among people who use drugs. Addictive Behaviors. 61: 84-90.

Arunansu Talukdar

RETI, fellow

Associate Professor of Medicine
Medical College Kolkata, India

Background
Arunansu Talukdar started his professional career as physician and got involved in caring AIDS patients. Later he obtained his PhD in Epidemiology from School of Public Health at University of California Los Angeles in 2007, focusing on sexual risk behavior and STD/HIV scenario among homeless people in Kolkata, India. He has published several articles on association of circumcision and reduced HIV acquisition, inconsistent condom use and high prevalence of STDs among homeless people. He completed WHO Fellowship in 2011 and later published articles on coping strategy, quality of life among HIV infected people. After joining Medical College Kolkata, India, he conducted a course on research methodology in STD/HIV in collaboration with Washington University. He is now guiding five MD students who are conducting research on HIV prevention and care. He hopes to develop a training centre for health research for all categories of staff.

Mentored Research Project (MRP) Title
Study of voluntariness of consent to research for female participants in Clinic-Based Intervention Research in Kolkata, India

Abstract
A core ethical principal in research is voluntary participation. Voluntariness is ensured through the informed consent process, in which research participants receive detailed information about study procedures, risks, and benefits; are informed of their rights as research participants; and are given the opportunity to decide – without penalty or coercion – whether or not to participate in a research study. Unfortunately, there are at least two potentially significant barriers to this process, many of which are apparent in the developing world. First, literacy levels (both reading levels and levels of scientific literacy required to understand the research process) are often low among resource-limited groups, thus raising questions regarding the capacity of potential research participants to understand the informed consent process. Second, cultural barriers might impact the ability of an individual to provide informed consent. For example, the informed consent process assumes that an individual makes the decision of whether or not to participate in a research project. However, in many cultures important decisions are made by other family or community members, or are made collectively. While these decision-making processes reflect community norms, they are in direct conflict with the autonomy of potential research participants that is embedded in the informed consent process. These potential barriers to informed consent can be seen in the patient population at Medical College & Hospital, Kolkata, which is located in Kolkata, India. This hospital operates a large clinic for HIV+ patients, where clinical care (including antiretroviral medication, ART) is provided free of charge. Within the hospital, medical and social science research is regularly conducted, overseen by local and state internal review boards. A research project will be conducted soon on trial of cognitive behavior therapy (CBT) for non-ART adherent patients at ART centre in collaboration with Psychiatry department. Patients who enroll in this research project will first complete an informed consent process. This proposed study will assess the degree of voluntariness of this informed consent process prior to the initiation of CBT. A community advisory board will provide input on measures and research design. Semi-structured interviews will be conducted with 60 Bengali-speaking women who have provided informed consent but not yet begun therapy. Findings will be reviewed by focus groups of women, men and link workers to help contextualize results and make recommendations to improve the informed consent process for future research studies.

Thespina Yamanis

RETI, fellow

Assistant Professor
School of International Service
American University
Washington, D.C.

Background
Thespina "Nina" Yamanis' research interests lie in two primary areas: 1) understanding social and structural determinants of HIV risk for most at-risk populations; and 2) reaching these populations through place-based and social network approaches to sampling and intervention. She received her PhD in Health Behavior in 2009 from the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health. For her dissertation she lead qualitative and quantitative formative research studies on the social and sexual networks of high risk young men who socialize in "camps" in Dar es Salaam, Tanzania. Her published articles from this work demonstrate how characteristics of the social spaces and networks both protected and promoted HIV risk among the young men in Dar es Salaam, including engagement in concurrent sexual partnerships. This research was the basis for a current R01 trial in Tanzania on which she is a Co-Investigator.

The NIMH-funded trial is a multi-level intervention combining microfinance and health leadership with young men in camps to reduce their sexual risk behavior and perpetration of intimate partner violence. Dr. Yamanis' RETI project will add a study on the ethical dimensions of participation in this trial. Dr. Yamanis was a post-doctoral fellow at Duke University's Global Health Institute from 2009-2011 and published research empirically examining the recruitment bias in Respondent-Driven Sampling using data from female sex workers in China. She is currently an Assistant Professor in the School of International Service at American University (AU). Her new research work at AU involves exploring the dimensions of HIV risk for two highly vulnerable groups in Washington, DC: young Latino and adolescent Black men who have sex with men (MSM). She is broadly interested in how public health interventions for vulnerable populations can better address and harness social and structural factors to reduce risk.

Mentored Research Project (MRP) Title
Young men’s perspectives on the ethical issues of participating in a randomized controlled trial (RCT) to prevent HIV in Tanzania

Abstract 
Limited attention has been paid to ethical concerns of network HIV prevention interventions including: voluntariness; beneficence at the network level; and beneficence at the individuallevel. We explored these concerns using mixed methods during an ongoing HIV prevention trial combining health leadership and microfinance for young men. The trial was conducted in Tanzania with urban men who socialize in 59 networks known as “camps”.179 health leaders at 30 intervention camps were trained to deliver HIV prevention messages to members.We added ethics-related questions to the midpoint survey with intervention participants (n =588). 96% ofparticipants agreed that they respected their camp’s health leaders. 70% said their camp members had become closer since the start of the intervention and 86% attributed their greater closeness to the study. 213 out of 621intervention participants took microfinance loans.We hypothesized that camp leaders may have influenced members’decisions to take loans.We purposively selected 3 camps that took loans and 3 camps that did not and conducted semi-structured interviews with 2 leaders and 3 members per camp.Some leaders assessed members’ readiness for loan uptake and advised them accordingly. Reasons for members not taking loans included not trusting fellow camp members and not having business ideas. Ourresults suggest that there were several benefits of the intervention and that principals of voluntariness were largely upheld. However, there were challenges to engaging young men in microfinance.We provide concrete suggestions for involving men in microfinance and network interventions as a strategy for HIV prevention in sub-Saharan Africa.

Cohort 5 RETI Fellows (2016 - 2018)

Roberto Abadie, Ph.D.

Roberto Abadie

Postdoctoral Research Associate
University of Nebraska-Lincoln

Background
Dr. Roberto Abadie received his PhD from the Graduate Center (CUNY) in Anthropology in 2006. Dr Abadie has conducted research on a variety of topics related to health inequalities and risk, from the experiences of research subjects enrolled in Phase I and HIV clinical trials in Philadelphia, to the study of how breast cancer patients undergoing a non-diagnostic research biopsy understood the risks involved in the procedure. Currently, he is the senior ethnographer and fieldwork director of a multi-year NIH/HIDA R01 project “Injection Risk Networks in Rural Puerto Rico”. Before joining the University of Nebraska-Lincoln, he was a Postdoctoral Fellow at the Biomedical Ethics Program at the Mayo Clinic and a Research Associate at the Biomedical Ethics Unit at McGill University. He enjoyed his fifteen minutes of media attention from venues such as Times Magazine, BBC and The Guardian when his book “The Professional Guinea Pig: Big Pharma and the Risky World of Human Subjects” was published with Duke University Press.

Mentored Research Project (MRP) Title
Establishing Trust Among People Who Inject Drugs (PWID) Enrolled in a Community Health Study of Social Networks and Risk in Rural Puerto Rico

Abstract
Trust in Research is critical to advance HIV preventionparticularly among People Who Inject Drugs (PWID) and other vulnerable populations, yet, empirical research on how to establish and maintain trustin the course of community health research is lacking. This paper aims to document how PWID perceive and understand research trust within the context of HIV epidemiological studies, and to develop recommendations to inform best research ethics practices that enhance research trust. One of the strengths of this study is that it inquires about the social basis of trust but participants’ responses are rooted in their previous experience in a community health study. Research was conducted among a subset N=40 active PWID > 18 years of age, living in towns within rural Puerto Rico who had been previously enrolled in a much larger study involving N=360 participants. Findings suggests that trust in research is the result of a process where prospective participants continuously test researchers in order to assess whether they can trust them or not. Distrust, lack of financial compensation, stigma and lack of confidentiality or anonymity can compromise participation. Yet, these barriers can be overcome by a research staff knowledgeable about the targeted population and culturally sensitive to their needs. Furthermore, while each PWID makes their own assessment of the reliability of researchers taking intoconsideration their own experiences, prospective participants also rely on the opinion of those that had volunteered before them. The reputation of the research is built incrementally as participants join the study.

Suzanne Carlberg-Racich, MSPH, Ph.D.

Suzanne Carlberg-Racich

Assistant Professor
Master of Public Health Program at DePaul University in Chicago

Background
The primary aim of Dr. Suzanne Carlberg-Racich's scholarly work is to investigate access to quality services to improve the health of disenfranchised populations, from a social justice framework. Within this aim, populations of particular focus include persons who inject drugs, persons living with HIV and Hepatitis C, and pregnant women who use substances. More specifically, her work examines the lived experiences of individuals who are systematically isolated by the intersection of stigma and policy that permeates health systems, social services, and broader society. She is motivated by community-based participatory research practices that maximize participant voice, agency, and partnership in the research process, and the use of research findings to advocate for community-defined change. Dr. Carlberg-Racich teaches courses across the MPH curriculum, including: Public Health Concepts and Practice, Health Behavior Theory, Maternal & Child Health, Public Health Program Evaluation, Public Health & High Risk Behavior, Substance Use & Abuse, and the MPH Capstone Seminar. In addition to her University work, she has been volunteering for the Chicago Recovery Alliance, a comprehensive harm reduction program in Chicago, for the past fifteen years. Prior to her work at DePaul, Dr. Carlberg-Racich spent twenty years as a public health practitioner focused on improving health outcomes at the community level, engaging in community outreach, creating and implementing targeted interventions, training clinical providers and social service practitioners, and evaluating public health programs.

Mentored Research Project (MRP) Title
Agency in Photovoice Research: Exploring the lived experience of persons who inject drugs

Current Project Description
Photovoice (Wang & Burris, 1997) is a method used to prompt critical consciousness about community issues through photography. Participants become partners in the process, making the method particularly empowering for disenfranchised communities. Persons who inject drugs (PWIDs) are systematically silenced from community advocacy processes due to stigma or fear of legal repercussions, and Photovoice may provide a vehicle for safe participation, particularly with IRB protections that may prompt the use of anonymous photography. However, little is known about the lived experience of PWIDs who participate in Photovoice. This study will explore the ethical implications of using Photovoice with PWIDs, through a Self-Determination Theory lens, examining the potential to increase perceptions of autonomy, competence, and relatedness. Findings from this study may inform future efforts to engage PWIDs in research that informs local policy, while also illuminating how IRB protections of safety may affect participant experience in partnership-based research efforts.

Alana Janell Gunn, Ph.D.

gun

Assistant Professor
Department of Social Work in the College of Community and Public Affairs
Binghamton University
Binghamton, New York

Background
Before joining faculty in the fall of 2015, Dr. Alana Janell Gunn completed a NIDA funded T32 Postdoctoral Fellowship at the National Development and Research Institutes in New York City. Dr. Gunn has worked extensively with populations in jails and under correctional community-based supervision as well as with service agencies that support their community reintegration. Her program of research focuses on the ways in which multiple levels of stigmatization shape the health and well-being of women of color with intersecting experiences of incarceration and substance use disorders. She is currently a National Research Mentoring Network, Steps Towards Academic Research (STAR) Fellow, a grantsmanship and mentoring program administered through NIH’s National Institute on Minority Health and Health Disparities and a Faculty Affiliate at the NIAAA funded Developmental Alcohol Research Center. Dr. Gunn received a MPP from the Irving B. Harris School of Public Policy Studies, as well as an AM and PhD in Social Work from the School of Social Service Administration all from the University of Chicago. Dr. Gunn ultimately wants to develop a programmatic line of research that promotes culturally-responsive and trauma-sensitive interventions for marginalized women to reduce experiences of stigmatization and improve their sexual health.

Mentored Research Project (MRP) Title
Stigma and Ethical Concerns Related to Interviewing Women with Incarceration and Drug Use Experiences

Current Project Description
Ethics-specific research efforts have provided evidence of the risks and benefits of engaging vulnerable populationsin highly-sensitive research. Formerly incarcerated Black women with experiences of drug use represent a highly vulnerable population due to the several stigmas attached to their imprisonment, drug use and how they violate both gendered and racialized societal norms. Considering their heightened risks of stigmatization and consequent research harm, this study explores the research experiences of 28 formerly incarcerated Black women to understand these risks and benefits.

Methods: Grounded Theory was used to assure aniterative data collection process, and a Content-Based Thematic analysis is being used to analyzedata and identify common conceptualizations among the participants’ narratives.

Findings: Participants discussed benefits to participationsuch as raising awareness through disclosure,aswell asthe need to share their drug use paststo promote recovery. Participants also reported risks such as emotional distress, fears regarding researcher stigma and the misinterpretation of data. In addition, respondents discussed the ways in which their perceptions of stigma shaped theiremotional reactions to answering questions concerning their experiences marked by trauma, incarceration and addiction.

Conclusion: Findings speak to implications ofmorestigma-sensitive and empatheticinterviewing practicesthat considerpast traumatic experiences,the roleof the researcher, the research context and the ways that stigma can bemitigated.

Kimberly M. Nelson, M.P.H., Ph.D.

Nelson

Assistant Professor of Psychiatry and Human Behavior
The Warren Alpert Medical School of Brown University,
Research Scientist in the Centers for Behavioral and Preventive Medicine at The Miriam Hospital
Providence, Rhode Island

Background
Dr. Kimberly Nelson earned her MPH in epidemiology from the University of Washington (UW) and a PhD in clinical psychology also from UW. Following receipt of her doctoral degree in August 2014, she was awarded a NIMH-funded postdoctoral fellowship in child/adolescent bio-behavioral HIV research (PI: Brown, T32MH078788) at Rhode Island Hospital as a part of the Clinical Psychology Consortium Postdoctoral Training Program at Brown University. Having both a public health and psychology background, Dr. Nelson focuses on community- and population-level health implications while conducting individual-level behavioral research. Her research to date has primarily concentrated on psychological and structural factors associated with the transmission or acquisition of HIV among sexual and racial/ethnic minority populations, particularly among men who have sex with men (MSM). During her employment and graduate education she coordinated multiple NIH-funded HIV and substance use prevention trials targeting adult MSM (PI: Dilley, R01MH065138; PI: Dilley, R01MH073425; PI: Humfleet, P50DA009253) and conducted a two-phase, mixed-methods, NIMH-funded (F31MH088851) study on sexually explicit online media use and sexual risk-taking among adult MSM. Dr. Nelson’s current work focuses on media influences on risk behaviors among sexual minority adolescents. She is funded by a career development award from NIMH (K23MH109346) during which she will develop an online sexual health media literacy intervention to promote adolescent sexual minority males’ critical examination of online media and decrease their sexual risk-taking. Ultimately she hopes to develop HIV prevention interventions – using new and increasingly accessible and influential online media – to address disparities among sexual minority populations across key developmental periods.

Mentored Research Project (MRP) Title
Developing methods to promote the sexual health and protect the welfare of adolescent males who are interested in sex with males in the United States

Current Project Description
Young males who are interested in sex with males (YMSM) are in need of sexual health education programs that address male-male sexual behaviors and sexual health-related online media. Institutional review boards (IRBs) create barriers to YMSM-specific sexual health research when they overestimate the risks of participation and refuse to adequately consider the YMSM-unique risks surrounding guardian permission requirements. Two hundred 14-17 year old, cisgender YMSM from across the United States will be recruited for a cross-sectional online survey designed to inform a sexual health education intervention. Ethics questions will be imbedded in the survey to assess: (1) the extent to which questions related to sexual health education and online media meet IRB minimal risk criteria and (2) the degree to which guardian permission is a barrier to YMSM-specific sexual education research. Data will help investigators and IRBs develop methods that promote the sexual health and protect the welfare of YMSM.

H. Jonathon Rendina, M.P.H., Ph.D.

Jonathon Rendina

Assistant Professor
Department of Psychology and Faculty Investigator,
Director of Quantitative Methods at The Center for HIV Educational Studies and Training (CHEST), CUNY
New York, NY

Background
Dr. H. Jonathon Rendina received his MPH in Biostatistics in 2013 from Hunter College, CUNY, and his PhD in Social Psychology in 2014 from The Graduate Center, CUNY. He completed his NIMH-funded NRSA pre-doctoral research training (F31-MH0958622) at Hunter College’s Center for HIV Educational Studies & Training (CHEST;www.chestnyc.org) and currently serves as a Research Scientist at CHEST. Dr. Rendina received a NIDA career development award (K01-DA039030) in 2015 to gain advanced training in neuroscience and behavioral intervention development. He is broadly interested in the role of social stress on health, and is currently pursuing research looking at how HIV-related stigma influences the mental, behavioral, and physical health of HIV-positive gay and bisexual men. Much of his research uses online-based methods, particularly intensive longitudinal designs such as ecological momentary assessment (EMA), and his ultimate goal is to develop and test a stress management/emotion regulation mobile health (i.e., mHealth) intervention. Through his role at CHEST, Dr. Rendina also collaborates on a wide variety of formative and intervention studies on primary and secondary HIV prevention (e.g., pre-exposure prophylaxis, HIV medication adherence) as well as substance use and treatment.

For Dr. Rendina's current research interests, please visit his CUNY faculty page.

Mentored Research Project (MRP) Title
Examining Privacy Concerns and Trust in the Context of Online and Mobile Research with Men who have Sex with Men

Current Project Description
Despite increasing popularity of using online and mobile technologies to conduct research, little research has examined the ethical implications of integrating these technologies into research protocols. This study aims to: (1) test newly developed measures of privacy/confidentiality concerns and trust and to examine the overall patterns in levels of concern and trust; (2) explore sociodemographic and behavioral factors associated with privacy/confidentiality concerns and trust; and (3) test the hypothesis that providing the purpose for data collection/storage, anonymous sharing, and anonymous selling will decrease levels of privacy/confidentiality concerns. I will enroll a large national sample GBMSM across the U.S. through three online and mobile sources and ask them to complete a brief-one time survey on these topics. It is expected that these findings will be used to develop strategies to better guard participant privacy and confidentiality and improve research trust as well as to inform the development of collaborations between HIV researchers and owners of online and mobile technologies. Moreover, by providing participant perspectives on risk, this study is a critical step towards informing ethical decision making about mobile health research in which HIV prevention techniques are becoming more embedded within mobile app environments, blurring the lines between app use and research participation.

Cohort 6 RETI Fellows (2017 - 2019)

Stephanie Cook, Dr.P.H.

Cook

Assistant Professor
New York University

Background
Dr. Stephanie H. Cook is currently an Assistant Professor in the Departments of Biostatistics and Social and Behavioral Health at New York University's College of Global Public Health. She is also a Faculty Affiliate at the Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS).

Dr. Cook aims to understand the pathways and mechanisms linking attachment, minority stress, and health among disadvantaged individuals. In addition, she examines how the inter- and intra- personal features of close relationships influence the health of racial/ethnic and sexual minorities.Through her development of an integrated theory of adult attachment (i.e., the development, or lack, of strong socio-emotional bonds) and minority stress (i.e., social stress experienced by individuals in minority social groups), she seeks to better understand the poor health and HIV prevention needs of disadvantaged youth transitioning into adulthood. She then utilize this theoretical framework of attachment and minority stress to inform effective prevention programs for vulnerable racial/ethnic and sexual minority youth transitioning to adulthood.

As the Principal Investigator and Director of the Attachment and Health Disparities Research Lab, her team assesses the association of attachment-related functioning on health disparities among racial/ethnic and sexual minority youth. Dr. Cook is first exploring how adult attachment orientation is associated with HIV risk in a community sample of Black gay and bisexual men transitioning into adulthood. Second, she illustrates how transitions in attachment during adolescence are associated with trajectories of depression among a community based cohort sample of African-American youth. Third, she seeks to understand how adult attachment, in the context of minority stress, is associated with biomarkers of physical health.

Mentored Research Project (MRP) Title
Assessing Perceptions of Broad Consent Concerning Biological Specimen Collection in a Cohort of Young Sexual Minority Men

Abstract
With the increase in empirical research utilizing methodologies that collect blood and/or other biological specimens from populations of sexual minority men (SMM), there is a need to understand the influence of broad consent on research participation. In addition, the updated Common Rule regarding broad consent for biomarker data permits the storage and maintenance of identifiable biospecimens for potential secondary research if sources give their broad consent. This also permits secondary research on the conditions that the biospecimens are stored for this purpose under the use of broad consent, and that an IRB’s limited review finds the research to be within the scope of that consent. However, the use of broad consent for secondary research with stored biological data within the context of HIV-related research raises ethical considerations, especially among populations disproportionately impacted by HIV, such as SMM. The proposed cross-sectional study seeks to examine attitudes about the use of broad consent concerning biospecimens for secondary research among a sample of 300 young SMM aged between 23 and 25 years.

Anthony Estreet, Ph.D.

Estreet reti 1

Assistant Professor
Morgan State University

Background
Dr. Anthony Estreet is currently an Assistant Professor in the School of Social Work at Morgan State University. He received his Bachelor of Science Degree from Bowie State University in 2005, his Master of Social Work Degree from Virginia Commonwealth University in 2007, and his Doctor of Philosophy in Social Work from Morgan State University in 2012.

As a clinical social worker, Dr. Estreet works with urban communities through program evaluation, training, and capacity-building at the local and state level.
He is currently a national trainer for the Substance Abuse and Mental Health Services Administration’s (SAMHSA), Addiction Technology Transfer Center (ATTC) region 3 and provides ongoing training around evidence based interventions (motivation interviewing, clinical supervision, and screening, brief intervention, and referral to treatment (SBIRT)), addressing the opioid overdose epidemic, medication assisted treatment, cultural competence, and peer workforce development. Additionally, Dr. Estreet was responsible for development and implementation of the addictions training curriculum within the MSW program which serves to increase the knowledge and skills of emerging social work students. Dr. Estreet is the Co-PI of a HRSA Behavioral Health Workforce Enhancement and Training Grant and an ASCEND research grant that focuses on alcohol use and trauma among black youth.

As a social work researcher, he has primarily focused on applied/prevention research that addresses HIV/AIDS, substance use, and mental health issues among African Americans. He specializes in the design and evaluation of culturally sensitive and community based behavioral health interventions, including those focused on addressing treatment related outcomes. Dr. Estreet’s research focuses on understanding and reducing substance use and related negative consequences (e.g., HIV risk behaviors) among urban African American individuals and communities. His current research project focuses on improving medication adherence and retention among African American HIV positive substance users using a culturally adapted mHealth approach.

Mentored Research Project (MRP) Title
Examining barriers and motivators to research participation among YBMSM HIV positive substance users

Abstract
HIV Seropositive BMSM who use illegal drugs are often recruited to participate in research studies conducted by large urban universities affiliated with medical centers. One body of research suggests that a history of medical discrimination and group stigma combined with research mistrust is a barrier to participation. Nonetheless many agree to participateand questions remain as to what motivates their participation decision. Perceptions of personal and community benefits of research may be one factor influencing agreement to participate. A second factor may be the influence of offering incentives (monetary or other gifts) for research participation or conducting recruitment or implementation at sites where individuals receive HIV medical care. Such influences can be seen as fair compensation for research participation or as a coercive influence that undermines voluntary choice. This project will examine the intersecting influences of research mistrust, perceived participation personal and group benefits, and the fair versus coercive influence of monetary and medical incentives on research participation among young black men who have sex with men.

Rebecca Fielding-Miller, Ph.D.

Fielding-Miller

Assistant Adjunct Professor
School of Health Sciences
University of California, San Diego

Background
Dr. Rebecca Fielding-Miller, MSPH is an Assistant Adjunct Professor​​​​​​​ at UC San Diego. Her research agenda addresses structural drivers of HIV and gender-based violence in the US and sub-Saharan Africa, particularly the intersection of race, gender, and economics. She holds a Master’s of Science in Public Health from the Johns Hopkins Bloomberg School of Public Health, and a PhD in Behavioral Sciences and Health Education from Emory University. She served as a Peace Corps Volunteer in South Africa from 2006-2008, and as a Fulbright Scholar in Swaziland in 2013.

Mentored Research Project (MRP) Title
Emotional Distress Among Frontline Research Staff in Low Resource Setting

Abstract
HIV and substance use research frequently deals with sensitive topics. A growing body of evidence suggests that frontline researchers who elicit or process participant’s traumatic experiences are themselves at risk of developing emotional distress or secondary trauma from daily immersion in these data. This both threatens a study’s data quality and calls into question how the harms and benefits of conducting research are distributed across a study team. The MRP is an exploratory, qualitative study with up to 40 frontline research staff in Swaziland (qualitative interviewers, quantitative survey administrators, and transcriptionists). It is intended to provide the empirical evidence needed to ensure local study staff are not in danger of shouldering the majority of the risks of research on sensitive topics while the professional benefits accrue predominantly to study team members based in the global North, and that data quality is not compromised by burnout or turnover.

Elizabeth Pasipanodya, Ph.D.

Elizabeth P.

Postdoctoral Scholar
University of California, San Diego

Background
Dr. Elizabeth Pasipanodya received her Ph.D. in Clinical Psychology from the University of Delaware in 2016 and is currently a postdoctoral scholar in the HIV NeurobehavioralResearch Program (HNRP) at the University of California, San Diego (UCSD). Her research interests lie broadly in the promotion and maintenance of well-being in the midst of chronic illness. Much of her work at the HNRP is oriented towards studying factors related to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP)adherence among individuals at risk for nonadherence, with the goal of designing and implementing interventions to better support adherence. Motivated also by an interest in multilevel modeling and investigating within-person associations, Dr. Pasipanodya attempts to understand the intra-individual and temporal relationships that exist between substance use and ART adherence. She believes that focusing on such within-person processes may have greater clinical implications, as within-person linkages are more amenable to translation to strong clinical interventions.

Consequently, Dr. Pasipanodya is interested in the use of Just-In-Time interventions for medication adherence and relapse prevention. As a step in this direction, she was recently awarded a UCSD Frontiers of Innovation Scholar's Program (FISP) grant to engage in collaborative and interdisciplinary research to assess dynamic individual and contextual risk factors that may predict states of vulnerability during which a person is more likely to use methamphetamine and be ART nonadherent. Dr. Pasipanodya sees such work in identifying dynamic indicators of risk, so as to define windows of opportunity to intervene, as foundational to later work in developing adaptive interventions to support adherence.

Mentored Research Project (MRP) Title
Exploring the Concerns of Ethnic Minority MSM living with HIV on Research Using Mobile Technology to Support Antiretroviral Therapy Adherence and Relapse Prevention in the Context of Methamphetamine Use

Abstract
Methamphetamine (meth) use poses a barrier to antiretroviral therapy (ART) adherence. Although meth use occurs across all socio-demographics, minority people living with HIV (PLHIV) shoulder much of the health burden resulting from meth use. As smartphones are ubiquitous, they are a promising vehicle for intervention delivery. However, the acceptability of applications collecting sensitive information and delivering feedback has not been adequately explored. Consequently, this study aims to examine minority PLHIV’s appraisals of risk/benefit in research using smartphones to support adherence and relapse prevention and explore how such research can promote justice, respect agency, and trust. This mixed-methods study will use brief assessments, focus groups, and individual interviews among 24 African-American and Hispanic PLHIV who use meth regarding smartphones research to promote relapse prevention and ART adherence. As few studies include this population as stakeholders informative study phases, this project promises to further respectful participant engagement among minority PLHIV.

Morgan Philbin, Ph.D.

Philbin

Assistant Professor
Columbia University

Background
Dr. Morgan Philbin is a social and behavioral scientist whose work explores how social-structural factors impact health outcomes for vulnerable populations. She received her Masters of Health Sciences in International Health: Social and Behavioral Interventions (2007) and PhD in Health, Behavioral and Society (2013) from the Johns Hopkins Bloomberg School of Public Health. Dr. Philbin completed her postdoctoral fellow in the Division of Gender, Sexuality and Health (HIV Center for Clinical and Behavioral Studies) at Columbia University. She is currently an Assistant Professor in the Department of Sociomedical Sciences at the Columbia University Mailman School of Public Health. Her primary project is a NIDA-funded K01 that explores how state-level policies impact sexual health and substance use risk for sexual minority youth, and the factors that influence of the uptake of these policies; she is also leading an HIV Center funded pilot study that explores how state-level immigration policies influence health outcomes for Latinos. Dr. Philbin is currently a Co-Investigator on an NICHD-funded project through the Adolescent Trials Network that examines how HIV-infected youth transition to adult care; her previous work has explored factors that influence linkage to care and engagement in care for newly diagnosed HIV-positive adolescents.

Mentored Research Project (MRP) Title
Attitudes of young Black men who have sex with men (YBMSM) toward recruitment for HIV prevention studies

Abstract
Young Black men who have sex with men (YBMSM), have disproportionately high HIV rates and are frequently constrained by structural factors that also exacerbate HIV acquisition such as low graduation rates, limited employment options, lack of healthcare, and structural stigma due to their race and sexuality. YBMSM are differentially recruited by HIV prevention research at the individual-, dyadic-, and community-levels. Although YBMSM must be included in such research, little work as explored how being labeled as ‘at risk’ might exacerbate the stigma and ‘double marginalization’ YBMSM already face due to their sexual and racial minority status. We propose to conduct in-depth qualitative interviews with 35-40 YBMSM, ages 18-29, in New York City, to explore theimpacts of research recruitment into HIV prevention studies on YBMSM’s relationships with family, friends and community members.

John Sauceda, Ph.D.

John S.

Assistant Professor
University of California, San Francisco

Background
Dr. John Sauceda received his MA in Clinical Psychology and PhD in Health Psychology from the University of Texas at El Paso (2013). After completing his doctoral training on the U.S.-Mexico Border, he completed both a postdoctoral fellowship (2016) at the Center for AIDS Prevention Studies (CAPS) and a MSc program in Global Health Sciences (2014) at the University of California, San Francisco (UCSF). He is currently an Assistant Professor at CAPS in the Department of Medicine at UCSF. Dr. Sauceda’s research is aimed at reducing health disparities and improving the mental health of Latino/a communities impacted by HIV. He has been supported by a NIMH predoctoral diversity supplement (R34MH084674-S1) and a T32 training grant (5-T32MH1910527). He has received a NIMHD LRP Award, a UCSF CFAR Pilot Grant, and a NIMH supplement for investigators developing independent research careers (3R01MH102198-03S2). He has also worked on a HRSA-funded multi-site initiative to develop and evaluate culturally-specific service delivery models focused on improving health outcomes among Latinos/as living with HIV.

Dr. Sauceda is currently conducting two qualitative studies to test the concept and dimensions of engagement in HIV care among Spanish and English-speaking Latinos in San Francisco, as well as the role that internalized study has on engagement in HIV care. He is also conducting a secondary retrospective analysis to model the trajectories of HIV treatment outcomes as a function of depression and substance use in a national cohort of Latinos in HIV care settings. His research aims to identify how culture and language affect one's ability to be fully engaged in HIV care and utilize mental health care; which can ultimately inform the development of adaptive treatment strategies to treat mental health problems and promote sustained engagement in HIV care.

Mentored Research Project (MRP) Title
Appraisal of risks and benefits in HIV cure studies and the role of altruism

Abstract
Participation in HIV cure studies carries a set of wide-ranging risks and negligible (if any) direct medical benefits. The imbalanced risks/benefits ratio requires investigation into how individuals understand risks and benefit information, and why they (who are otherwise healthy and virally suppressed) consent to participate in HIV cure studies. We will apply the Fuzzy Trace Theory (FTT), a medical decision-making model, to alter how the risks and benefits of an HIV cure study are framed. The aims are to test whether a willingness to participate in a hypothetical HIV cure study is influenced by the framing of the risks and benefits (using the FTT), and whether altruism moderates the effect of framing. We hypothesized that framing of the risks and benefits and reliance on altruism can implicitly influence the decision/willingness to participate. We hope to provide empirically-derived recommendations for framing the risks and benefits for participation in HIV cure research.

Cohort 7 RETI Fellows (2018 - 2020)

Courtney Peasant Bonner, Ph.D.

Bonner RETI ethics

Research Clinical Psychologist
RTI International

Background
Dr. Courtney Peasant Bonner is a Research Clinical Psychologist at RTI International where she works in the Substance Use, Gender, and Applied Research (SUGAR) Program to adapt and evaluate women-focused HIV prevention interventions. Dr. Bonner has worked with young people living with and affected by HIV for 10 years. During her graduate training, she worked in the Departments of Psychology and Infectious Diseases at St. Jude Children's Research Hospital and advocated to improve mental health services for those living with HIV in Memphis, TN. Dr. Bonner’s research explores the impact of gender-based violence, substance use, and mental health on HIV risk to reduce health disparities among vulnerable women. Currently, Dr. Bonner is examining the feasibility of integrating mental health, HIV prevention, and substance use services for young women in Cape Town, South Africa. Her mentored research project (MRP) will examine the motivations for research participation, benefits, risks, thoughts about parental consent, and understanding of research among young women, 16 -19 years old, who have dropped out of school and are using substances in Cape Town.

Dr. Bonner earned her Ph.D. in Clinical Psychology at The University of Memphis and completed her postdoctoral fellowship in HIV Prevention at the Center for Interdisciplinary Research on AIDS at Yale University. She has been supported by the Southern Regional Education Board Fellowship and a T-32 training grant (T-32 MH020031-16A1). She is currently supported by a NIDA-funded diversity supplement (R01DA041227-03S1). Dr. Bonner currently serves on the Governing Board of the Society for the Analysis of African American Public Health Issues and as the HIV/AIDS Topic Chair for the Society for Behavioral Medicine.

Title of Mentored Research Project (MRP)
Expanding HIV Testing and Prevention to Reach Vulnerable Young Women

Abstract
This study seeks to explore the motivations and actual experiences of risks and benefits among young women who participated in a brief behavioral HIV prevention trial. This study will involve conducting 4 post-trial focus group discussions with 32 former participants of the HIV prevention trial. The aims of this study are as follows: Aim 1. To assess the risk and benefits experienced by South African young women who have completed a behavioral HIV prevention and substance use intervention study as it relates to the following phases of the research study: (1) community recruitment, (2) in loco parentis consent and their assent; (3) completion of a computer-based questionnaire assessing sensitive topics, and (4) participating in the group intervention sessions which discuss sensitive topics, Aim 2. To understand young women’s motivations to participate in a brief HIV and substance use intervention study with attention to the influence of linkages to healthcare services and monetary compensation in the decision to participate, Aim 3: To obtain young women’s recommendations for improving future research procedures to address to their unique needs and concerns related to HIV prevention research; and Aim 4: To compare the responses and recommendations of Black African and Coloured young women. Results from these group discussions will aid in the development of refined and improved research methods for future HIV prevention studies with young women in South Africa.

Virginia Fonner, M.P.H., Ph.D.

Fonner RETI ethics

Assistant Professor
Medical University of South Carolina 

Background
Dr. Ginny Fonner is an Assistant Professor within the Division of Global and Community Health in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina (MUSC). She earned her Master’s in Public Health (2010) and Ph.D. in the Social and Behavioral Interventions Program (2015) from the Johns Hopkins Bloomberg School of Public Health. Dr. Fonner began her career in global health as a U.S. Peace Corps Volunteer in Zambia where she served as an HIV/AIDS Community Mobilizer in a rural area for two years. Her work largely focuses on HIV prevention in low- and middle-income countries, specifically in sub-Saharan Africa. Her research interests include developing community- and family-based interventions for HIV prevention, understanding social and behavioral aspects of biomedical interventions, and investigating gendered aspects of HIV prevention and health-related partner communication. Dr. Fonner is the Principal Investigator on a Fogarty-sponsored R21 assessing the potential for a family-based intervention for people living with HIV and a non-communicable disease (diabetes and/or hypertension) in Dar es Salaam, Tanzania. She is also a Co-Investigator on several R01s involving couples-based HIV self-testing, pre-exposure prophylaxis (PrEP), integration of HIV and NCD care, and systematic reviews and meta-analyses related to HIV prevention.

Title of Mentored Research Project (MRP)
Couples' perspectives on research participation involving dyadic-based HIV prevention and care in Tanzania

Abstract
The study is a small qualitative sub-study to understand more about couples’ decision-making to participate or not participate in dyadic-based research involving access to PrEP and ART. The proposed qualitative sub-study will enhance the study aims by investigating how couples are making decisions about their health, including their decision to participate as research subjects and their uptake of interventions services, including ART and PrEP.

Randolph Hubach, M.P.H., Ph.D.

Hubach RETI ethics

Director, Sexual Health Research Lab
Assistant Professor

Oklahoma State University

Background
Dr. Randy Hubach is the Director of the Sexual Health Research Lab at Oklahoma State University (OSU) and Assistant Professor of Rural Health at Oklahoma State University—Center for Health Sciences. He holds a Ph.D. in Health Behavior from Indiana University’s School of Public Health and MPH from California State University, Fullerton. Early in his career, Dr. Hubach’s research and practice experiences included serving as PI on a federally funded community-based sexual health intervention project, developing managed care programs for local public health and mental health jurisdictions, and serving in leadership positions in multiple community health coalitions and planning processes. As a behavioral scientist and public health researcher, he has gained a practical understanding of the challenges associated with the delivery of public health programs that are scientifically sound and responsive to the needs of diverse communities.

Dr. Hubach’s research interests include using community engaged principles to address sexuality-related health disparities, sexual behavior, LGBT population health, and HIV/AIDS within urban and rural communities. Although there is an increased utilization of electronic (online and mobile) resources to conduct behavioral research, there is a dearth of evidence evaluating the ethical implication of integrating such technology into behavioral risk studies of rural men who have sex with men (MSM). In an effort to maximize the HIV care continuum within rural areas, Dr. Hubach seeks to enhance behavioral research to account for ethical considerations. This includes identifying ethical concerns of rural MSM related to the participation in electronic daily diary studies which include event-level monitoring of sexual partner-seeking, sexual event, and substance use behaviors.

Title of Mentored Research Project (MRP)
Assessing the ethical concerns for participation in ecologic momentary assessment (EMA) studies in a sample of rural men who have sex with men (MSM)

Abstract
In an effort to enhance research efforts with sexual and gender minorities within rural areas, a qualitative study of Oklahoma rural MSM will be conducted to detail barriers to and preferences for participating in research studies which utilize electronic devices for the collection, storage, and maintenance of data. Forty rural MSM (18-40 years of age), residing within designated rural zip codes in Oklahoma, will be recruited through purposive sampling techniques and invited to complete an in-depth one-on-one interview. The short-term goal of this project is to identify research barriers and preferences of rural MSM and associated proximal and distal factors in an effort to inform culturally and contextually relevant research protocols. This contribution will be significant because it is expected to have broad translational importance in the collection of data to inform the prevention and maintenance of HIV in rural areas.

Stacy Ryan, Ph.D.

Ryan RETI ethics

Assistant Professor of Psychology
Baylor University

Background
Dr. Stacy Ryan received her Ph.D. in Clinical Psychology from Emory University and completed a NIDA T32 research fellowship at the University of Arkansas for Medical Sciences’ Center for Addiction Research. She is currently an Assistant Professor in the Department of Psychology and Neuroscience at Baylor University. As a licensed clinical psychologist, she provides supervision and training to clinical doctoral students completing practicum placements at a local juvenile detention center. Her research focuses on the development of adolescent substance use and substance use treatment outcome. She is currently principal site investigator of a randomized clinical trial (R01 MD011322) examining whether caregivers receiving contingency management for attendance and participation in juvenile drug court and adolescent drug treatment show greater attendance and participation in juvenile drug court and drug treatment relative to caregivers not receiving contingency management. Additionally, this trial seeks to examine whether youth whose caregivers receive contingency management have greater reductions in drug use and criminal re-offending. In addition to this line of research, Dr. Ryan received a Career Development Award (KL2 TR001118) in 2016, which initiated a program of research to develop mobile technologies designed to deliver after-care support to teens and their parents following substance use treatment. The aim of these technologies is to mitigate adolescent relapse.

Title of Mentored Research Project (MRP)
Justice-Involved Youth and Caregiver Concerns about Consenting to Substance Use Treatment Research

Abstract
The goal of this project is to examine the reactions of justice-involved youth and their guardians to key information included in consent forms currently used to enroll families in drug treatment research. Adolescents who are required to attend drug treatment (n=15) and guardians of these youth or others mandated to drug treatment(n=15) will participate in this study(N=30). Youth and their legal guardian will separately complete questionnaires about their attitudes toward the justice system, their attitudes toward mental health treatment, and their general attitudes toward researchers. Participants will also complete an in-depth interview about treatment design and processes for disclosure of information currently included in consent forms from ongoing substance use treatment research. Interview questions will assess attitudes toward perceived risk and benefits, privacy and confidentiality, guardian permission and independent youth assent, voluntariness to participate, and coercion and undue pressure. Participants will also provide information about willingness to participate in substance use treatment research within the context of their justice involvement and to provide truthful responses on questionnaires that measure drug use and related problematic behaviors when protocols include any disclosure of information to probation. This MRP will provide empirical data to guide the development of consent forms for substance use treatment research with justice-involved youth and establishing relationships with juvenile probation departments for recruitment.

Argentina E. Servin, M.P.H., M.D.

Servin RETI ethics

Assistant Professor
University of California, San Diego

Background
Dr. Argentina Servin is an Assistant Professor in the School of Medicine at the University of California, San Diego. Dr. Servin is a bilingual and bicultural clinician-researcher with training in preventive medicine, infectious disease and clinical epidemiology. She received a Medical Degree and Master’s in Public Health from Universidad Xochicalco in Mexico. She also received Postgraduate Training in HIV and Gender-Based Violence (GBV) at the London School of Hygiene and Tropical Medicine.

Her research has focused on understanding and improving gender-based aspects of the health of women and girls, particularly regarding the implications of violence and coercion for heterosexual HIV/STI infection, including the development and testing of behavioral interventions in both domestic and international settings to address these issues. With diverse funding including from National Institute of Drug Abuse, the World Bank, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Center for AIDS Research, and The Health Initiative of the Americas, Dr. Servin has lead multiple studies on sexual and reproductive health of medically underserved women, sexual violence, substance abuse, human trafficking, and HIV across Latin America, the U.S. – Mexico Border Region and Southeast Asia.

Dr. Servin is also a volunteer physician at UCSD’s Health Frontiers in Tijuana (HFiT) Student-run Free Clinic located in the Mexico-U.S. border region. As a volunteer physician, she provides quality health care access to vulnerable underserved populations in the border region, such as migrants, deportees, homeless individuals, female sex workers (FSWs), people living with HIV/AIDS and people who inject drugs (PWIDs). Additionally, because HFiT is an elective clinical training course Dr. Servin participates leading clinical sessions and is shadowed by pre-med and medical students from UCSD’s School of Medicine and Universidad Automa de Baja California in Mexico.

Title of Mentored Research Project (MRP)
Ethical Considerations for HIV and GBV Research: Adolescent Perspectives on Research Participation in Mexico

Abstract
Various ethical challenges arise in conducting research with female adolescents focused on the intersection of HIV/STIs and gender-based violence (GBV), especially in low-and-middle-income countries (LMIC). While female adolescents have distinctive needs that merit special consideration as research subjects, their emotional and physical development may also place them at increased risk of research harms. Utilizing qualitative methods, the proposed study seeks to identify unrecognized or unacknowledged factors that have not been adequately considered and addressed in past research. Adolescent perspectives are needed to inform ethical research and effective health policies and interventions focused on reducing risk for HIV/STIs and GBV.

 

Cohort 8 RETI Fellows (2019 - 2021)

Sameena Azhar, M.S.W., Ph.D.

Assistant Professor

Sameena Azhar


Fordham University

Background
Sameena Azhar has more than 15 years of clinical and research experience in the fields of mental health, substance abuse and HIV care. For her dissertation research, Sameena conducted a mixed methods study of people living with HIV in Hyderabad, India. Over the course of three years of fieldwork, she examined the intersections between HIV stigma, gender and depression among cisgender women and hijra/third gender people with HIV. Her research has been funded through the Council on Social Work Education's Minority Fellowship Program, the University of Chicago's Center for the Study of Gender and Sexuality, the Foreign Language and Area Studies Fellowship (FLAS) in Urdu through the U.S. Department of Education, Ford Foundation, and the Fordham-NYU Collaboration Grant. Sameena is beginning an exploratory research project on cisgender female sex workers and injection drug users in Sikkim in northeastern India. She is also currently working on a social media analysis of tweets under the #ThisIs2016 hashtag, which has archived more than 5,000 tweets of experiences of microaggression and prejudice against Asian Americans. Sameena also plays jazz piano and grows orchids.

Working Title of Mentored Research Project (MRP)
Ethical Issues Surrounding Safety, Violence and Homicide of Third Gender People in HIV and Drug Abuse Research 
 

Derek Dangerfield, Ph.D.

Derek Dangerfield

Assistant Professor
Johns Hopkins School of Nursing

Background
Derek Dangerfield’s research targets ways to reduce HIV/STIs and promote sexual health for sexual minority men (SMM).  Dr. Dangerfield received his undergraduate degree in Sociology at Georgetown University and his PhD in Preventive Medicine at the University of Southern California in Los Angeles. His research has been supported by the U.S. Department of State, the National Science Foundation, and the Johns Hopkins Center for AIDS Research. Currently, Dr. Dangerfield is leading two qualitative studies in Baltimore City and Los Angeles exploring opioid use patterns and HIV treatment adherence strategies among Black SMM. 

Working Title of Mentored Research Project (MRP)
Exploring the preferences for community and research engagement among drug-using BMSM in Baltimore City

Étienne Meunier, Ph.D.

Étienne Meunier

Associate Research Scientist
Columbia Mailman School of Public Health

Background
Étienne Meunier, PhD, is a sociologist studying the sexual cultures and health of LGBT populations. He has published research using ethnographic, qualitative, and quantitative methods to understand the structural, contextual, and cultural influences on sexual behavior. Dr. Meunier’s research of group sexual behavior has described how public health policies in New York City have led to a proliferation of clandestine sex-on-premise venues that present both opportunities and challenges for sexual-health promotion. He also has conducted harm-reduction training with male sex workers in NYC, and is currently coordinating an NIH-funded study exploring the risk-taking behaviors of men who find transactional sex partners online. Dr. Meunier contributed work on HIV-related, NIH-funded studies with diverse populations including HIV-affected heterosexual couples, HIV-positive crack-cocaine users, non- disclosing bisexual men, and heterosexual men and women who find sex partners online. Dr. Meunier’s research has been published in English and French in journals such as The Journal of Sex ResearchArchives of Sexual Behavior, and Sexually Transmitted Infections. His research on group sex has been funded by the Fonds de recherche du Québec – Société & Culture and the Desjardins Foundation in Québec. Dr. Meunier earned his PhD in Sociology with a certificate in Women’s and Gender studies in 2016 from Rutgers University. He joined the Department of Sociomedical Sciences at Columbia University’s Mailman School of Public Health in 2015, where he currently holds a faculty position as Associate Research Scientist.

Working Title of Mentored Research Project (MRP)
Ethical Concerns Regarding Research and Interventions at Collective Sex Environments: Perspectives from Gay Sex-Club Organizers and Attendees 
 

Roman Shrestha, M.P.H., Ph.D.

Roman Shrestha

Postdoctoral Research Associate
Yale School of Medicine

Background
Dr. Shrestha is a postdoctoral associate at the Yale School of Medicine’s AIDS program. His background is in Public Health (Ph.D. from University of Connecticut, 2017) and completed a year of postdoctoral training at the University of Connecticut. His research has largely centered on enhancing the design, delivery, and placement of interventions that integrates evidence- based behavioral approach, biomedical components, and innovative use of mHealth strategies, aimed at improving health outcomes and the quality of life of underserved populations. Specifically, he is interested in syndemics of health issues that have profound implications for access to and utilization of healthcare services and overall HIV prevention efforts in a range of settings, including community and healthcare, addiction treatment, and criminal justice settings, both domestically and internationally. His current work focuses on reducing the HIV epidemic that disproportionately affects socioeconomically disadvantaged (i.e., drug users) and sexual minority group (i.e., men who have sex with men or ‘MSM’) using mHealth technologies as an innovative platform to scale-up prevention efforts.

Working Title of Mentored Research Project (MRP)
Exploring Ethical Concerns Related to Participation in mHealth Research in Men Who Have Sex with Men in Malaysia