Anya Y. Spector

Male-to-Female Transgender Individuals Building Social Support and Capital From Within a Gender-Focused Network

ABSTRACT The literature on male-to-female transgender myriad problems such individuals face in their day-to-day lives, including high rates of HIV/AIDS, addiction to drugs, violence, and lack of health care. These problems are exacerbated for ethnic and racial minority MTFs. Support available from their social networks can help MTFs alleviate these problems. This article explores how minority MTFs, specifically in an urban environment, develop supportive social networks defined by their gender and sexual identities. Using principles of community-based participatory research (CBPR), 20 African American and Latina MTFs were recruited at a community-based health care clinic. Their ages ranged from 18 to 53. Data were coded and analyzed following standard procedure for content analysis. The qualitative interviews revealed that participants formed their gender and sexual identities over time, developed gender-focused social networks based in the clinic from which they receive services, and engaged in social capital building and political action. Implications for using CBPR in research with MTFs are discussed.

PrEP in substance abuse treatment: a qualitative study of treatment provider perspectives

ObjectivesTo examine substance abuse treatment providers’ views on engaging clients in Pre-exposure Prophylaxis (PrEP) care and research trials.MethodsThirty-six medical and counseling service providers in six New York City outpatient substance abuse treatment programs participated in semi-structured qualitative interviews. Thematic content analysis was conducted by three coders, independently.ResultsProviders’ perspectives toward PrEP were characterized by six salient themes: 1) Limited PrEP awareness. 2) Ambivalence about PrEP; 3) Perception of multiple challenges to delivery; 4) Uncertainty about clients’ ability to be adherent to medication; 5) Concerns about medication safety/side effects; and 6) Perception of multiple barriers to conducting clinical trials.ConclusionsDespite anticipated challenges, providers supported the introduction of PrEP in outpatient substance abuse treatment. Comprehensive training for providers is needed and should include PrEP eligibility criteria, strategies to support adherence and medication monitoring guidelines. Linkages between substance abuse treatment and primary care and/or enhancement of capacity within clinics to offer PrEP may help facilitate PrEP delivery. When conducting research in outpatient clinics, it is particularly important to protect client confidentiality.

Exploring group dynamics for integrating scientific and experiential knowledge in Community Advisory Boards for HIV research.

Abstract To demonstrate how Community Advisory Boards (CABs) can best integrate community perspectives with scientific knowledge and involve community in disseminating HIV knowledge, this paper provides a case study exploring the structure and dynamic process of a “Community Collaborative Board” (CCB). We use the term CCB to emphasize collaboration over advisement. The CCB membership, structure, and dynamics are informed by theory and research. The CCB is affiliated with Columbia University School of Social Work and its original membership included 30 members. CCB was built using six systematized steps meant to engage members in procedural and substantive research roles: (1) engaging membership; (2) developing relationships; (3) exchanging information; (4) negotiation and decision-making; (5) retaining membership; and (6) studying dynamic process. This model requires that all meetings be audio-taped to capture CCB dynamics. Using transcribed meeting data, we have identified group dynamics that help the CCB accomplish its objectives: (1) dialectic process helps exchange of information; (2) mutual support helps members work together despite social and professional differences; and (3) problem solving helps members achieve consensus. These dynamics also help members attain knowledge about HIV treatment and prevention and disseminate HIV-related knowledge. CABs can be purposeful in their use of group dynamics, narrow the knowledge gap between researchers and community partners, prepare members for procedural and substantive research roles, and retain community partners.

Optimizing ART adherence: update for HIV treatment and prevention.

Optimal adherence to antiretroviral therapy (ART) is central to achieving viral suppression and positive health outcomes in HIV-infected individuals. Virally suppressed individuals can also reduce the risk of HIV transmission to uninfected partners. Hence, adherence to ART has become both an HIV treatment and an HIV prevention strategy. However, achieving optimal ART adherence can be challenging, especially over the long term. It is increasingly important for clinicians and researchers to be abreast of the most recent developments in the field as new biomedical approaches to treatment emerge and as guidelines for the use of pre-exposure prophylaxis (PrEP) are disseminated to providers serving HIV affected populations. Several reviews have described numerous ART adherence interventions that have been developed and/or tested with the most recent review including literature up to 2012. To augment the literature, we present a review of ART adherence interventions from 2013 to the present. We included peer-reviewed journals as well as abstracts from two key conferences.

CBPR With Service Providers Arguing a Case for Engaging Practitioners in All Phases of Research

This review synthesizes the literature on CBPR with service providers to identify the benefits to, unique contributions of, and challenges experienced by professional service providers engaged in collaborative research. Service providers benefited by obtaining research-based knowledge to help the communities they serve, gaining research skills, professional relationships, professional development, and new programs. They contributed by informing research aims, designing interventions, conducting recruitment, informing overall study design, and dissemination. Challenges include time, resources, organizational factors, and disconnects between researchers and service providers. Policy and practice implications are explored.

Modeling the Structure of Partnership Between Researchers and Front-Line Service Providers: Strengthening Collaborative Public Health Research

Partnerships between HIV researchers and service providers are essential for reducing the gap between research and practice. Community-Based Participatory Research principles guided this cross-sectional study, combining 40 in-depth interviews with surveys of 141 providers in 24 social service agencies in New York City. We generated the Provider-Researcher Partnership Model to account for provider- and agency-level factors’ influence on intentions to form partnerships with researchers. Providers preferred “balanced partnerships” in which researchers and providers allocated research tasks and procedures to reflect diverse knowledge/skill sets. An organizational culture that values research can help enhance providers’ intentions to partner. Providers’ intentions and priorities found in this study may encourage researchers to engage in and policy makers to fund collaborative research.

Transdisciplinary collaboration and endorsement of pharmacological and psychosocial evidence-based practices by medical and psychosocial substance abuse treatment providers in the United States

Aims: To examine the relative contribution of providers’ professional affiliation (medical vs. non-medical), involvement in research, and training needs for associations with endorsement of the following evidence-based practices (EBPs): (1) pharmacological – buprenorphine treatment and (2) psychosocial – Cognitive Behavioural Therapy (CBT). Methods: Secondary analysis from a 2008 survey of a national sample (n = 571) of substance abuse treatment providers (medical, social workers, psychologists and counsellors) affiliated with the United States National Institute on Drug Abuses National Drug Abuse Treatment Clinical Trials Network. Multivariate linear regression models to analyze cross-sectional survey data. Findings: Results demonstrated that medical providers and providers with previous research involvement more strongly endorsed the effectiveness of buprenorphine over CBT. Compared to medical providers, psychosocial providers more strongly endorsed CBT. There was a positive association between needing training in rapport with patients and endorsement of buprenorphine and a negative association with CBT. There was a positive association between needing training in behavioural management and needs assessment and endorsement of CBT. Conclusions: Results underscore the importance of providers’ involvement in research and the need for training medical and non-medical providers in practice areas that can purposely enhance their use of pharmacological and psychosocial EBPs.

Substance Use, Depression and Sociodemographic Determinants of HIV Sexual Risk Behavior in Outpatient Substance Abuse Treatment Patients.

Objectives:The NIDA Clinical Trials Network trial of rapid HIV testing/counseling in 1281 patients was a unique opportunity to examine relationships among substance use, depressive symptoms, and sex risk behavior. Methods:Past 6-month substance use; substance use severity (Drug Abuse Screening Test – 10); depressive symptoms (Quick Inventory of Depressive Symptomatology); and three types of sex risk behavior (unprotected sex occasions [USOs] with primary partners; USOs with nonprimary partners; and USOs while high/drunk) were assessed. Zero-inflated negative binomial analyses provided: probability and rate of sex risk behavior (in risk behavior subsample). Results:Levels of sexual risk behavior were high, while variable across the three types of sex risk behaviors. Among the patients, 50.4% had engaged in USOs with primary partners, 42% in sex while drunk or high, and 23.8% in USOs with nonprimary partners. Similar factors were significantly associated with all three types of sex risk behaviors. For all types, problem drinking, cocaine use, and substance use severity had an exacerbating effect. Older age was associated with lower risk behavior; other relationship categories (eg, married, separated/divorced, cohabitating) were associated with greater risk behavior than was single status. Depressive symptoms were associated with decreased likelihood of USOs with a primary partner. Conclusions:Sexual risk behavior is common among individuals in outpatient substance abuse treatment. Results highlight problem drinking (eg, up to three-fold) and cocaine (eg, up to twice) in increasing sex risk behavior. They demonstrate the utility of distinguishing between partner types and presence/absence of alcohol/drugs during sex. Findings argue for the need to integrate sex risk reduction into drug treatment.

HIV practitioners in Madrid and New York improving inclusion of underrepresented populations in research

Practitioners have frequent contact with populations underrepresented in scientific research--ethnic/racial groups, sexual minorities and others at risk for poor health and whose low participation in research does not reflect their representation in the general population. Practitioners aspire to partner with researchers to conduct research that benefits underrepresented groups. However, practitioners are often overlooked as a work force that can help erase inclusion disparities. We recruited (n = 282) practitioners (e.g. physicians, social workers, health educators) to examine associations between their attitudes toward research purposes, risks, benefits and confidentiality and their involvement in recruitment, interviewing and intervention facilitation. Participants worked in community-based agencies in Madrid and New York City (NYC), two large and densely populated cities. We used cross-sectional data and two-sample tests to compare attitudes toward research and practitioner involvement in recruiting, interviewing and facilitating interventions. We fit logistic regression models to assess associations between practitioner attitudes toward ethical practices and recruitment, interviewing and facilitating interventions. The likelihood of recruiting, interviewing and facilitating was more pronounced among practitioners agreeing more strongly with ethical research practices. Though Madrid practitioners reported stronger agreement with ethical research practices, NYC practitioners were more involved in recruiting, interviewing and facilitating interventions. Practitioners can be trained to improve attitudes toward ethical practices and increase inclusion of underrepresented populations in research. Funders and researchers are encouraged to offer opportunities for practitioner involvement by supporting research infrastructure development in local agencies. Practices that promise to facilitate inclusion herein may be used in other countries.

Book and Media Review: Community-Based Participatory Research for Health: From Process to Outcomes Minkler, M., & Wallerstein, N. (Eds.). (2008). Community-Based Participatory Research for Health: From Process to Outcomes (2nd ed.). San Francisco: Jossey-Bass. 508 pages. ISBN: 978-0-4702-6043-2

Community-based participatory research (CBPR) is an orientation or approach to research that favors equitable relationships between researchers and community members through collaboration in all phases of the research process. Guided by Critical Theory, CBPR is particularly concerned with changing the power dynamics related to race, class, and gender to reduce health disparities. This second edition of Community-Based Participatory Research for Health: From Process to Outcomes (published in 2008) has effectively built on and strengthened the earlier 2003 edition. Minkler and Wallerstein, two of the most prolific scholars of CBPR, provide rich and detailed examples of CBPR methodologies in health research that promote sustainable outcomes while maintaining a rigorous stance on the research design’s internal and external validity. New appendices and added features include known funders of CBPR projects, summaries of trainings (e.g., “Undoing Racism” to help researchers engage communities), methods for evaluation of CBPR projects (e.g., reliability-tested guidelines for asses sment of research), and recommendations for faculty members wishing to make a case for CBPR during tenure review. The book is divided into six parts with chapters written by the editors and many established experts in CBPR, including scholars, practitioners, researchers, and community partners. The diversity of voices represented in this book models the merits of collaboration. Minkler and Wallerstein’s comprehensive and thorough scholastic work is a must-have addition to one’s academic library. The relevance of this book extends beyond public health research to a number of related research fields, including sociology, psychology, social work, medicine, and education. In part 1, titled “Introduction to Community-Based Parti cipatory Research,” Minkler and Wallerstein outline the organization of the book and the conceptual framework and principles underlying the CBPR approach. The chapters provide the guiding principles and the scholarly relevance of CBPR as tools to address health disparities and contextualize the theoretical, historical, and practical applicability of CBPR to the practice of collaboratively developing knowledge. A cadre of CBPR experts critically examines the nine core principles of CBPR, immersing the reader in the language, philosophy, and defining values that distinguish CBPR from traditional research paradigms. The new chapter 4 in this edition introduces several case examples of partnerships that successfully conducted planning for randomized controlled trials, challenging the notion that community collaboration cannot be scientifically rigorous. A community-based effort to improve access to mental health services in underserved communities of color in Los Angeles, Witness for Wellness, increased local relevance because it chose a Community-Based Participatory Research for Health: From Process to Outcomes