HIV Center for Clinical and Behavioral Studies

Anke A. Ehrhardt, Ph.D., Research Chief and Professor
Zena Stein, M.B., B.Ch., Research Scientist and Professor Emerita
Heino Meyer-Bahlburg, Dr. rer. nat., Research Scientist and Professor
Susan Tross, Ph.D., Research Scientist and Assistant Professor
Robert Kertzner, M.D., Research Psychiatrist and Associate Clinical Professor

The HIV Center’s current research portfolio reflects both the unique strengths of its investigators as well as the most pressing needs of the HIV/AIDS epidemic and is concentrated in four areas.

Gender-specific Interventions for Both Uninfected and Infected Women and Their Male Partners
Effective prevention for women must balance both protection against HIV and STDs and the prevention of unwanted pregnancies. A clinical trial funded by NICHD (Theresa Exner, Joanne Mantell, and Zena Stein) tests the efficacy of a clinic-based, provider-delivered intervention to increase adoption and maintenance of dual protection in a cohort of 500 low-income, primarily minority women. This team is also developing a school-based intervention to increase dual protection among rural South African high school students (Exner, Mantell, and Susie Hoffman; NICHD). A related project recently funded by the World AIDS Foundation will train service providers in dual protection counseling in China (Mantell and Stein).

In the “Healthy Living Project” (Anke A. Ehrhardt and Robert H. Remien; NIMH), approximately one-third of the 944 HIV-positive participants being enrolled in this intervention trial to reduce sexual risk behavior are women. The project comprises four linked U10 grants from NIMH that support the development and evaluation of a comprehensive, individually delivered intervention for HIV-positive heterosexual men and women and men who have sex with men (MSM) in four US cities: New York, Los Angeles, San Francisco, and Milwaukee. The HIV Center led the qualitative studies that informed intervention development and focused on the physical, social, and practical contexts that influence risk behavior in HIV-positive people; stages of adapting to knowledge of serostatus; and barriers to safer sex, positive health care behavior, and quality of life.

Women with additional vulnerabilities such as severe mental illness need special attention, and Pamela Collins is funded by NIMH to assess the impact of stigma on sexual risk behavior among women with severe mental illness in order to refine and evaluate an HIV prevention curriculum.

Special risk and added vulnerability is found in the relationship between drug use and sexual risk. Susan Tross directs an HIV Center project testing a peer-activist empowerment intervention among urban women who are partners of injection drug using men. She is also a co-investigator with Edward Nunes on a prevention study with women substance users that is part of a NIDA-funded Drug Abuse Clinical Trial Network. The HIV Center provides expertise to these trials in behavioral science and research assessment, child and adolescent psychiatry, trial design, and HIV risk reduction.

Children and Adolescents
HIV Center researchers include developmental psychologists who are funded to assess sexual risk behavior at different stages of child and adolescent development and to test age- and gender-appropriate interventions. The project, “Social Cognitions and Risk Behavior of Urban Girls” (Lucia O’Sullivan and Heino Meyer-Bahlburg; NIMH), assesses the utility of sociosexual cognitions and social networks in predicting sexual activity among 180 female adolescents and will develop and pilot an HIV intervention involving parental and peer social networks among urban adolescent girls. With funding from NICHD, O’Sullivan is extending this work to young adult women and men in New York and South Africa to develop measures assessing gender scripts that can be used to tailor interventions targeting primary relationships.

“Risk and Resilience in Youths with HIV+ Mothers” (Claude Ann Mellins; NIMH) identifies risk and protective factors related to the onset of sexual and drug use behavior in HIV-negative youths with HIV-positive mothers as they negotiate the critical transition from early to mid-late adolescence. Follow-up data are being collected from 230 youths, ages 14-17 years, who were first interviewed when they were 10-14 years old and will be used to develop and pilot an HIV intervention program for early adolescents with HIV-positive mothers.

Sexual Risk in the Context of Same-Sex Behavior among Both Uninfected and Infected Men
In Project LEO (Latinos Empowering Ourselves; NIMH), Alex Carballo-Diéguez is testing the efficacy of an empowerment program to reduce unsafe sex among high risk Latino men. The intervention is based on extensive qualitative and quantitative studies at the HIV Center that have identified critical issues among minority MSM such as sexual diversity and bisexuality and the meaning of safer sex strategies, gender norms, and gender scripts within different cultural contexts of immigrant men.

Carballo-Diéguez is also part of a multi-site national team funded by the CDC to establish a cohort of Latino MSM for the purpose of HIV surveillance, counseling, and testing. This four-year project, “Brothers y Hermanos,” will involve a qualitative phase examining contextual and structural issues and a survey-based quantitative phase including HIV testing to generate prevalence and incidence data.

Sexual risk within the context of same-sex behavior is also part of “The Healthy Living Project,” the multi-site intervention trial with HIV-infected populations discussed above (Ehrhardt and Remien), and the New York site enrollment of MSM reflects a particularly high number of African-American/Black and Latino men.

Coping with the Consequences of HIV Infection
Mental illness and mental health are intricately interwoven with sexual risk for uninfected populations and for persons already living with HIV. “Sexual Risk Reduction Among Men with Mental Illness” (Ezra Susser; NIMH) tests the efficacy of a sexual risk reduction intervention among 200 at-risk, inner-city men with severe mental illness recruited at four state-run clinics. Milton Wainberg and Remien will extend this work to Brazil with a grant from NIMH. In collaboration with Brazilian researchers, mental health care providers, and a community service agency, they will adapt and test an intervention to be delivered by providers to reduce risk behavior among patients with serious mental illness.

HIV Center research also focuses on behavioral and clinical strategies to increase medical adherence. In the “SMART Couples Study” (NIMH), Remien and his colleagues are testing a clinic-based intervention for serodiscordant couples in which the HIV-positive person has difficulty adhering to medical therapies. Remien and Richard Parker have extended this work on couples coping with disease and medication to Brazil with supplemental funding from the OAR. Mellins and her team have pursued issues of medical adherence for women and, with pilot funding from the Columbia-Rockefeller Center for AIDS Research (CR-CFAR), for children. Remien and Ezer Kang are currently funded through another CR-CFAR pilot grant to expand this work to Asian-American and Pacific Islanders.

Robert Klitzman has addressed disclosure of serostatus and stigma towards HIV-positive persons, particularly HIV-positive health care providers. He has extended this work to physicians who have a serious illness such as HIV, exploring the impact of their health on communication with and clinical care of their patients. This work has led to a newly funded study on privacy and disclosure of genetic diseases (Klitzman; NHGRI).

The biomedical and clinical research initiatives affiliated with the HIV Center are exemplified by a productive collaboration funded through the Columbia-Rockefeller Center for AIDS Research (CR-CFAR). Ehrhardt is a Co-Director of the CFAR’s Clinical Core (with Scott Hammer and Martin Markowitz). HIV Center behavioral and social scientists (e.g., Mellins, Joyce Hunter, Remien, and Carballo-Diéguez) collaborate with clinical and basic science researchers in community outreach and recruitment, pilot studies, and clinical trials. Carballo-Diéguez is collaborating with Wafaa El-Sadr, on microbicide research within the HIV Prevention Trials Network. Karen Marder, Steven Albert, Judith Rabkin, and Wilfred Van Gorp are studying the neurological and psychiatric sequelae of HIV disease and clinical treatment strategies.

Training Activities
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 Ehrhardt and Robert Kertzner, the program focuses on training in human sexuality research as it applies to issues of HIV disease and prevention. The training program has developed an innovative Master’s degree track, directed by Melissa Begg in the Department of Biostatistics at the Columbia School of Public Health, that provides training for HIV Center fellows in Biostatistics and course work relevant to human sexuality research. 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 five postdoctoral fellows: Eric Cerwonka, Brian Dodge, Shari Dworkin, Linwood Lewis, and Rita Melendez.

International Prevention Research and Capacity Building
The HIV Center’s international agenda particularly focuses on South Africa, Namibia, and Brazil, countries in which we have established research and community partnerships and a funded record of research initiatives, some of which were noted above. At the same time, we are expanding to other regions, such as Nigeria, China, India, and Mexico, with feasibility, pilot, and training programs. In 2001, Parker and Ehrhardt brought researchers from around the United States and abroad together with funders of international research to spend two days addressing international and cross-cultural issues critical to effective HIV/AIDS and sexuality research.

In summary, the HIV Center conducts 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. In sharing the knowledge gained from this work both with the professional community and with community-based AIDS service agencies around the world, the HIV Center makes a significant contribution to the global effort to stop HIV and AIDS by integrating the essential domains of human sexuality and behavior with those of prevention of disease and improvement of quality of life.