amfAR, The Foundation for AIDS Research

amfAR/Pitt HIV Scholars: An Innovative Solution to a Persistent Problem

Published Tuesday, May 10, 2016

Dr. Antonio Spagnolo knows how isolating it can be living as a gay man in Paraguay. Stigma keeps many gay men, other men who have sex with men, and transgender individuals (collectively, GMT) from seeking public health care services. And while new HIV diagnoses are steadily increasing among Paraguayan men, the government has no policies in place for HIV prevention or care tailored to GMT.

Dr. Spagnolo, who finished medical school last year, is hoping to change that.

“It’s very hard for GMT to access health care because of stigma,” said the 27-year-old. “It leads to major health disparities, including undiagnosed cases of HIV and other sexually transmitted infections (STIs) among MSM and trans women. I want to find a way to help people who have been hit hard by HIV and other STIs.”

Dr. Spagnolo is one of four participants in the 2016 amfAR HIV Scholars program at the University of Pittsburgh’s Center for LGBT Health Research. The program’s mission is to support the creation of public health responses to dramatic HIV health disparities among GMT in low- and middle-income countries. To date the program, which had its inaugural class in 2013, has supported 16 young investigators. Previous scholars have come from a wide range of countries including Pakistan, China, South Africa, Lebanon and Belize, among others.

A special issue of the journal AIDS and Behavior was devoted to the University of Pittsburgh/amfAR HIV Scholars program in the spring.

From left to right: Daniel Dutra de Barros, Dr. Antonio Spagnolo, Kabelo Maleke, Adi Nugroho

Studies show that GMT are disproportionately impacted by HIV in virtually every region of the world. This is compounded by a longstanding and widespread lack of access to appropriate HIV prevention, treatment and care for people in numerous countries, explained Ron Stall, Ph.D., director of the program.

“In turn, this has produced a disproportionate and devastating burden of HIV morbidity and mortality among GMT populations in countless settings,” he said.

During the five-month program, scholars not only improve their research skills but also draft proposals for their own studies investigating culturally appropriate strategies to improve HIV services for GMT individuals in their respective countries. The program includes four small research awards of $25,000 each that support the scholars’ in-country studies.

“This initiative not only advances our understanding of HIV in resource-constrained settings, but it provides the scholars with solid evidence about their local contexts to advocate for increased access to needed HIV services for MSM and transgender women in their communities,” said Michael Cowing, senior advisor for programs at amfAR.

Dr. Spagnolo has proposed analyzing health outcomes in two contrasting clinical scenarios: a GMT-oriented clinic known as SOMOSGAY (We Are Gay) and a government-sponsored one – PRONASIDA (National Program for Control of AIDS/STI). SOMOSGAY provides HIV/STI testing, counseling, treatment and care coordination in a “space designed to combat stigma and discrimination.” It is prohibited from distributing medication but can expedite access to treatment.

“I want to help make health care accessible for LGBT people in Paraguay,” Dr. Spagnolo said. “There is a lot of discrimination against gay men and trans women, especially.  There is no way we can find out how to change this if we don’t do this type of research.”

The other 2016 scholars are Daniel Dutra de Barros of Santa Casa de São Paulo School of Medical Sciences in Brazil; Kabelo Maleke, of Project Boithato at the Anova Health Institute in rural South Africa; and Adi Nugroho, of the GWL-INA Network in Jakarta, Indonesia.

De Barros designed an HIV prevention for GMT individuals based on a program in Pittsburgh called Project Silk, which offers a range of services including HIV and STI testing, mental health care, behavioral interventions, and social services and activities. He proposed a GMT youth specific pilot project that integrates both structural and behavioral interventions to raise rates of HIV testing.

Maleke developed a support group for HIV-positive MSM in Mpumalanga, South Africa, to improve individual knowledge of HIV treatment and adherence to care. It is designed based on data collected during two research studies that found a GMT-specific support group for HIV-positive individuals is needed and desired in that community.

And Nugroho created a tailored smartphone application for HIV-positive gay, MSM and waria (a third gender group in Indonesia) to improve their antiretroviral adherence, health outcomes, and overall quality of life. The Internet may provide an anonymous and safe place for HIV-positive GMT individuals in Indonesia to participate in HIV prevention, care, and treatment, he said.

The scholars returned to their home countries in May but their work is ongoing. They are in the process of completing all of their human subjects ethical reviews, and once done, they will start their projects. When their field research is finished, the program also will help them conduct analyses of their data and write papers for submission to scientific journals.

amfAR is actively collaborating with the University of Pittsburgh to identify alternative sources of funding to help ensure that the program continues when amfAR’s support expires at the end of 2016.