HIV Center

The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University was established in September, 1987, and is supported by a comprehensive center grant from NIMH and many individual grants, contracts, and inter-institutional collaborations. Now in its third consecutive period of funding, the HIV Center has a commitment to underserved, often neglected, inner-city populations (including the HIV-infected) and to innovative research that emphasizes the social context of vulnerability and risk. From its beginnings, the Center has had particular expertise in sexual behavior and gender issues and has become a site for development of specialized sexual risk behavior assessment batteries and gender-specific interventions; for the exploration of theoretical aspects of human sexuality; and, most recently, for intensive and specialized postdoctoral training in human sexuality research. Over the years, the HIV Center has forged productive community and clinical partnerships, contributing to prevention efforts in the international arena, addressing issues of policy and ethics, and providing a unique multidisciplinary training environment.

Developmental Studies As inner-city youth in the United States became increasingly at risk for HIV infection at earlier ages and families come to feel the severe impact of HIV/AIDS, the HIV Center has made the needs and behaviors of children, adolescents, and families a high priority. The Family Studies Program (Principal Investigator, Claude Ann Mellins, Ph.D.) evaluates and meets the needs of HIV-affected children and their families through a research program at the HIV Center and a dedicated mental health clinic, the Special Needs Clinic at Columbia Presbyterian Medical Center (Clinic Director, Jennifer Havens, M.D.). Both programs provide rich data on these families' stressful experiences and coping resources and on the psychiatric, psychological, and social effects of HIV disease. Dr. Mellins is funded by the W.T. Grant Foundation to examine determinants of sexual and drug-use risk behaviors in early adolescents with HIV-infected mothers; she will be awarded a grant from NIMH to explore risk and resilience among these youth. Her work with families was expanded with a pilot grant from the Columbia-Rockefeller Center for AIDS Research (CR-CFAR) and a supplement from NIMH to explore factors mediating medical adherence among HIV+ children and mothers. Lucia O'Sullivan, Ph.D., supported by a Mentored Research Scientist Award from NIMH, is examining social networks, sociosexual cognitions, and sexual risk behaviors among urban adolescent girls who are at risk for both HIV/STD infection and early pregnancy.

Heterosexual Adults From its early years, the HIV Center has provided a forum for issues of concern to women and has mounted major efforts to identify the barriers and facilitators of safer sex for heterosexually active adults with an emphasis on issues of sexuality and gender. Susan Tross, Ph.D., is leading a study on the Lower East Side to evaluate an innovative prevention program for inner-city women who are sexual partners of injection-drug users that addresses the multiple stressors, poverty, and disenfranchisement these women face to increase HIV-safer sexual behavior.

Supported by an R01 grant from NICHD, Theresa Exner, Ph.D. and her team, including a consortium of family planning clinics serving areas of high HIV/STD prevalence in New York City, are evaluating an intervention to help inner city, heterosexually active women choose and use methods to protect themselves against both HIV/STDs and pregnancy. A pilot grant from the CR-CFAR supports this team to examine the role of health care providers in the acceptability of microbicides and other HIV/STD prevention technologies in this population.

Data from Project FIO The Future Is Ours (Principal Investigator, Anke A. Ehrhardt, Ph.D.), a gender-specific HIV/STD prevention program for non-drug-using heterosexual women of unknown or negative HIV serostatus, is revealing that reduction of unprotected vaginal sex occasions or a continued pattern of safer sex was significantly greater among women in the intervention compared to those in the control condition. The intervention also significantly affected women's skills to apply a variety of strategies in risky situations.

Gay Men Homosexual transmission accounts for over half of AIDS cases in U.S. adult men and over 40% of those cases in New York City. Latino men who have sex with men (LMSM) are at disproportionate risk for HIV infection. High Risk Latino Men: An Empowerment Program to Reduce Unsafe Sex, led by Alex Carballo-Diéguez, Ph.D., is based on his previous research that documented not only cultural diversity among LMSM but also the difficulties they share regarding acculturation and discrimination. Developed and conducted in collaboration with the Hispanic AIDS Forum, this group-based prevention program works aims to help LMSM both to understand the consequences of crucial experiences in their lives and to find alternative, more empowering ways to deal with the everyday demands they face, including safer sex behavior.

HIV-Positive Populations Supported by an R01 grant from NIMH, Robert Remien, Ph.D., in collaboration with Nabila El-Bassel, Ph.D. from the Columbia University School of Social Work, is testing a clinic-based intervention for serodiscordant couples in which the HIV-positive person is having difficulty adhering to therapies. The critical prevention needs of HIV-positive people are also addressed by a large multi-site project supported by an interactive R01 grant from NIMH, Health Related Interventions for Persons Living with HIV, that is testing an intervention to reduce sexual- and injection-practice risk behaviors among 1,200 HIV-infected men and women and to promote other health-related behavior changes. Conducted at four sites, New York (led by Anke A. Ehrhardt, Ph.D. and Robert Remien, Ph.D.), Los Angeles, San Francisco, and Milwaukee, this research focuses on three HIV-positive subgroups: 400 women, 400 men who have sex with men, and 400 injection-drug-using men.

Building on his work on disclosure of serostatus by HIV-positive persons and supported by an NIMH Mentored Clinical Scientist Development Award, Dr. Robert Klitzman has conducted a study of self-disclosure among HIV-positive health care workers. With support from the Russell Sage Foundation and the Arthur Vining Davis Foundation, he has extended this work to physicians who have a serious disease such as HIV in order to explore these doctors' views of the impact that their own disease has had on the way in which they interact with and treat their patients.

People with Mental Illness An R01 grant from NIMH also supports the project, Sexual Risk Reduction Among Men with Mental Illness (Principal Investigator, Ezra Susser, M.D., Dr.P.H.), to test the efficacy of a sexual risk reduction intervention among at-risk, inner-city men with severe mental illness recruited at four state-operated clinics. Formative work of Drs. Susser and Pamela Collins with homeless mentally ill women has become the basis for an intervention to lower sexual risk behaviors in that population. Dr. Collins is also assessing the impact of the stigma of mental illness on sexual risk behaviors among severely mentally ill women with support from an NIMH Mentored Clinical Scientist Development Award.

International Prevention Research and Capacity Building Third World countries bear an overwhelming burden in the HIV/AIDS epidemic, and, over a decade ago, Center Co-Director Zena Stein, M.B., B.Ch. warned that South Africa was poised to endure an explosive epidemic. Current HIV Center research includes a focus on experiences with medication adherence in Brazil (Robert Remien, Ph.D., and Richard Parker, Ph.D.); development of a program to promote dual protection against HIV/STDs and pregnancy among rural South African youth (Theresa Exner, Ph.D., and Joanne Mantell, Ph.D.); and a program to train mental health providers in South Africa to develop HIV risk-reduction programs (Pamela Collins, M.D., and Ezra Susser, M.D.). Additional initiatives with adolescents in South Africa and family planning clinic clients in China are under development.

Community Partnerships Over the last 14 years, the Community Liaison Program of the HIV Center's Information Exchange Core (Principal Investigator, Robert Remien, Ph.D., and Co-Principal Investigator, Joyce Hunter, D.S.W.) has established the productive working partnerships with communities facing HIV/AIDS that are essential to tackling the epidemic. Center investigators serve on community boards and New York City Department of Health's Prevention Planning Group and have alliances with a variety of local community-based organizations and local government-associated groups including the New York State AIDS Institute. Supported by grants from NIMH and a variety of private foundations, Joyce Hunter, D.S.W., and representatives from six metropolitan area community service organizations developed an intervention (based on the HIV Center video, "Working It Out: Scenes from the Lives of Lesbian, Gay, and Bisexual Youth") that provides lesbian, gay, and bisexual youth with skills to cope with stigma, homophobia, and HIV and has become a resource for agencies serving this vulnerable population throughout the nation.

The STAR (Sexuality Training and Research) Program (Principal Investigator, Lucia O'Sullivan, Ph.D.), supported by a grant from the Ford Foundation, provides community-based organizations with sexuality research training through two sets of training workshops that address research design and implementation, data analysis, and dissemination: one for New York agencies and the other for agencies from around the nation. Educators include HIV Center and NYSPI researchers and experts from the local community. Each participant is linked with an HIV Center mentor who oversees the implementation of the focused sexuality research project at the home agency. The Ford Foundation has funded the HIV Center to conduct a second, enhanced program for new community participants.

Collaborations with Clinical Investigators A series of independently funded studies associated with the HIV Center have arisen at CPMC, including two program project studies funded by NINDS that examine CSF and plasma viral load and cognitive decline in advanced HIV infection (Principal Investigator, Karen Marder, M.D.) and correlates of functional impairment in HIV-associated cognitive motor disorders (Principal Investigator, Steven Albert Ph.D.).

The Columbia-Rockefeller Center for AIDS Research (CR-CFAR) is supported by NIAID, NCI, NIDA, and NIMH. Led by David Ho, M.D. at the Aaron Diamond AIDS Research Center and Jeremy Luban, M.D. at Columbia, CR-CFAR investigators examine HIV replication, transmission, and pathogenesis through studies ranging from atomic resolution of viral protein structure to the psychosocial dynamics of the inner city communities. Anke A. Ehrhardt, Ph.D. is a Co-Director of the CR-CFAR's Clinical Core and Joyce Hunter D.S.W., Director of the HIV Center's Community Liaison Program, insure that an effective bridge exists with affected communities. The HIV Center also provides behavioral expertise and community liaison to the AIDS Clinical Trial Unit in the Department of Medicine, directed by Scott Hammer, M.D., Director of the Division of Infectious Diseases.

The HIV Center Cores enable researchers to stay on the forefront of methodological, design, and analytical advances. The challenges encountered in behavioral HIV research have stimulated a number of innovative approaches that integrate epidemiological and statistical expertise. The weekly consultation meetings of the Statistics, Epidemiology, and Data Management Core (Principal Investigator, Bruce Levin, Ph.D.) have become a focal point of exchange for both established researchers and trainees, and biostatisticians work closely with individual research teams to assure rigor in design and analysis. The Data Management Component, directed by Howard Andrews, Ph.D., coordinates programming and data management for all HIV Center studies.

The Psychosocial/Qualitative Assessment Core (Principal Investigator, Susan Tross, Ph.D.) is a multidisciplinary group of social scientists that serves as a central advisory resource for HIV Center investigators on development of methodologically rigorous, theory-driven, culturally sensitive procedures for qualitative assessment, quantitative assessment, and process evaluation. The Core works through individual and group consultations and through specialized small courses such as that given in fall, 2000, by Gary Dowsett, Ph.D., Deputy Director of the Australian Research Centre in Sex, Health & Society at La Trobe University, who conducted a five-day course at the HIV Center: "Research Design in Qualitative Social Inquiry."

Sensitive population-specific assessment of sexual behavior is crucial for HIV descriptive and prevention research. The HIV Center has exceptional strengths in sexual behavior research in the Psychosexual Core (Principal Investigator, Heino Meyer-Bahlburg, Dr. rer. nat.), which has developed a variety of sexual assessment instruments in English and Spanish for specific populations and manualized training procedures for sexual interviewing. Since 1992, a bimonthly interdisciplinary Work Group on Gender, now hosted at NYSPI by Drs. Meyer-Bahlburg and Ehrhardt, has addressed research, clinical, legal, and ethical topics of relevance to the area of transgender care. Dr. Meyer-Bahlburg is a member of the North-American Task Force for Intersexuality (NATFI), which aims to identify and promote the research necessary for clinical policy formulation and education of both professionals and lay persons. He heads NATFI's Research Protocol Work Group. He also serves on the Scientific Advisory Board of Klinefelter Syndrome & Associates, a large national consumer organization. Dr. Meyer-Bahlburg received an NICHD grant to conduct comprehensive behavioral, hormonal, and molecular genetic assessments of women with congenital adrenal hyperplasia.

In the past year, the HIV Center Cores hosted four two-day seminars to foster cutting edge thinking on theoretical and methodological issues in psychosocial assessment and human sexuality and to bring together researchers, theoreticians, and community workers from around the world. A two-day seminar, "Ethnographic Methods in HIV/AIDS Research," organized by Richard Parker, Ph.D. and Anke A. Ehrhardt, Ph.D. resulted in a special issue of AIDS and Behavior, "Through an Ethnographic Lens: HIV/AIDS Research," to be published in June, 2001. Drs. Parker and Ehrhardt also took the lead in two seminars focusing on human sexuality, "Sexual Scripts: International and Interdisciplinary Perspectives in Sexuality and HIV/AIDS Research" and "Sexual Desire: A Dialogue Between Mind and Body."

In the fall of 2000, Dr. Theo Sandfort, from the University of Utrecht, spent three months at the HIV Center as a visiting professor in the Department of Psychiatry. During his tenure here, he and Dr. Ehrhardt organized the conference, "Sexual Health and Sexual Health Promotion," which was co-sponsored by the HIV Center and the Netherlands Institute of Social Sexological Research.

Since 1987, the Behavioral Sciences Research Training Program in HIV Infection has provided postdoctoral fellowship training for research on behavioral, mental health, and public health issues in HIV infection with support from NIMH. Now under the leadership of Anke A. Ehrhardt, Ph.D., Principal Investigator, and Robert Kertzner, M.D., Training Director, the program focuses on training in human sexuality research as it applies to issues of HIV disease and prevention; within this context, the HIV Center is conducting a new graduate-level course in the Columbia University Mailman School of Public Health, "Critical Topics in Sexuality Across the Life Course." The training program currently has three postdoctoral fellows: Linwood Lewis, Ph.D., Rita Melendez, Ph.D., and David Whittier, Ph.D. This collaboration of the HIV Center with the Department of Psychiatry and the School of Public Health offers intensive research training combined with formal academic training in statistical analysis, epidemiology, human sexuality, and related health care interventions and policy. The HIV Center is also host to two trainees, Miguel Laboy-Muñoz, a minority graduate research assistant, and E.B. Attah, Ph.D., a minority investigator, who are supported by NIH supplements for underrepresented minorities.

In summary, the HIV Center fulfills its mission by conducting innovative studies to reduce HIV transmission in high risk groups, improve the health and well-being of HIV-positive persons, and identify factors that reinforce unprotected sexual behavior. The knowledge gained from this work and the Center's research and policy work groups that focus on gender and human sexuality is shared both with the professional community and with community-based AIDS service agencies. Thus, the HIV Center makes a significant contribution to the worldwide effort to stop HIV and AIDS, while integrating the essential domains of human sexuality and behavior with those of prevention of disease and improvement of quality of life.