VIDD staff scientist Dr. Michele Andrasik joined the division in July of 2010, but she is no stranger to HIV/AIDS research. Her chosen career path has consistently had a common thread: increasing the availability of HIV/AIDS educational resources to marginalized communities. Since joining VIDD, her research interests have focused on the development of innovative methods for involving communities at the onset of clinical research and the identification of structural interventions that will stimulate dialogue between researchers and community members, specifically focusing on sexual minorities, such as men who have sex with men (MSM) and male-to-female transgender women.
“I see the need for building communities as imperative to HIV prevention,” Andrasik stressed.
Andrasik’s main goal is the identification of specific topic areas and research questions that the HVTN needs to address for successful HIV vaccine clinical trial design. She focuses on community-based participatory research that promotes an open dialogue between researchers and current and potential participants, with the goal of identifying areas where public health availability impacts communities differentially.
Andrasik and her peers are currently compiling data collected from a supplement of the HVTN 505 HIV vaccine trial study. The data consist of 1800 surveys of MSM in six U.S. cities, six MSM focus groups and four male-to-female (MtF) transgender women focus groups in the U.S., looking specifically at their attitudes and beliefs about HIV vaccine research and, more generally, about overall biomedical prevention research. The study identified several barriers for participation of MSM and MtF transgender women in HIV vaccine trials. A major hurdle for the inclusion of MtF transgender women in clinical trials is simply how they are grouped in surveys and questionnaires; they have been previously combined with MSM, a categorization not in line with their behavior or identity.
“They (MtF) had a very poignant point: ‘how are the vaccines going to affect or be affected by my (MtF) hormones?’” Andrasik said. “Findings from previous studies cannot necessarily be applied to those who are transgender.”
A major finding of Andrasik’s research was that there is a general lack of awareness of HIV vaccines. Participants in the 505 study tended to have some knowledge of HIV vaccines, while they commonly filled in the gaps with “half truths” or “false truths.” HVTN researchers found these misconceptions regarding vaccine clinical trials had the largest impact on decisions to participate. Other observed obstacles included: unaware that HIV vaccines exist; perception that vaccination results in adverse effects; and fear of mistreatment or HIV-related stigma. Community involvement at the local level to ensure people are informed is crucial for successful HIV prevention strategies.
“I think the biggest challenge is going to be getting enough information out to communities,” Andrasik said.
The HVTN embraces a unique collaboration between scientists, educators and advocates, a distinctive feature that drew Andrasik to the Hutchinson Center. Andrasik has witnessed the long-standing disconnect between biomedical and social science, an unfortunate rift that frustrates scientists across the board.
“I’ve always believed we have needed more of a connection between social behavioral research and what’s going on in biomedicine,” she said. “I’ve thought that for many years now.”
The HVTN is taking steps to close that gap. Andrasik has often wondered why there has been a lack of communication between these fields; the funding streams are separate despite congruent research, oftentimes working toward the same goal. When the HVTN opened a social scientist position, Andrasik saw the opportunity to participate in this partnership. “I thought, ‘That’s what I do!’” she said.
Andrasik is currently writing manuscripts on the MSM and MtF focus group studies for publication. She is also working on a publication of a landscape analysis of the behavioral risk data collection process at the HVTN and will ultimately use these analyses for improvement of risk assessment and future clinical trial design. She stresses that it is imperative to integrate social and behavioral aspects from the very beginning into design of future trials.