research at pitt
Featured Faculty Researchers
Thomas E. Guadamuz, PhD, MHS, and Chongyi Wei, DrPH
Chongyi Wei, DrPH, was directing a focus group when he heard something that shocked and upset him. As a part of a pilot intervention project to increase HIV testing among men who have sex with men (MSM) in Nanjing, China, he had recruited several men for a focus group about HIV testing and the stigma of being HIV positive. He had asked what the men would do if they found out a friend was HIV positive. To Wei’s profound dismay, one man answered that he would cut off contact with that friend, and the rest of the focus group agreed. Yet, when Wei asked how the men would react if they discovered they were HIV positive, they said they’d hope for community support and no discrimination. As a researcher, Wei couldn’t say anything in that moment. Personally, his response was anything but neutral.
“Their response was upsetting,” says Wei, assistant professor of behavioral and community health sciences in the Graduate School of Public Health (GSPH). “But, the stigma of being HIV positive in China is a huge social and cultural issue that’s going to take a long time to get rid of. The whole behavioral intervention business is pretty incremental, but even a small change can make a big difference.”
Part of Wei’s effort at “small changes” is developing a social marketing campaign to encourage frequent HIV testing, which is supported by a Pathways to Independence Award (K99/R00) from the National Institute of Mental Health. According to Wei, only 20-30 percent of MSM in China got tested in the past year, which means many others don’t know their status and could be spreading the disease without knowing it. MSM in China have become a significantly high-risk group for HIV infection.
So, why aren’t people getting tested and using that knowledge to protect themselves and others?
Wei’s research and focus groups reveal that the stigma of being gay or HIV positive is a huge deterrent for MSM in China. Men spoke to Wei about the discrimination faced by people who are HIV positive, the fear of being HIV positive, and that those factors keep men from getting tested.
“Also, there isn’t much promotion or education for HIV that resonates with Chinese MSM in a social context,” Wei says.
Wei is currently mapping out a social marketing tool that will, he hopes, reach past the stigma and encourage MSM to get tested. Because of the anonymity of the Internet, he wants to make it an online tool that could reach anyone, anywhere.
Wei’s colleague, Thomas E. Guadamuz, PhD, assistant professor of behavioral and community health science at GSPH, is another researcher using technology as a tool in HIV infection intervention in Asia. Guadamuz is a K01 grantee, but his work with mobile technology interventions among young people in Thailand is supported by a Center for AIDS Research (commonly known as CFAR) grant from the University of Pittsburgh. Using netbooks loaded with software he helped design, Guadamuz went into schools and community settings to ask young people questions about things such as social and sexual behaviors, cyber bullying, and violence. The software uses cartoons and interactive animations to engage them, and their answers are sent immediately and anonymously to a large database, so he reassures them that even he won’t see their answers. Guadamuz then uses the responses to acquire baseline information and is now trying to incorporate technology into his HIV intervention strategies.
“My next step is using mobile technology to design online games, or maybe a smartphone app, and use a social media platform for HIV intervention in Thailand,” he says. “Young people are online a lot, and I’m working on ways to reduce their behavior risks—using condoms, having fewer sexual partners, and getting HIV tested.”
Like Wei, Guadamuz’s passion for his work stems partly from witnessing the social stigma of HIV. During his Fulbright scholarship, he lived in and worked as an ethnographer in a Buddhist temple in Thailand that served as an AIDS hospice. At the time, there were no antiretroviral drugs in the country, so people were dying quickly from the disease. He remembers people who were sick being dropped off in front of the hospice and the cars peeling away without a word from their drivers. People would die often and so quickly that caskets lay at the foot of their beds. The stigma surrounding the disease was so great that farmers living near the hospice had trouble selling their fruits and vegetables at the local market because they were viewed as unsafe.
“Seeing people die made HIV very vivid and real for me,” says Guadamuz. “I started thinking about human rights, dying with dignity, religion, and all of this came together and solidified my commitment to public health.”
The stigma of HIV also confounds Wei’s and Guadamuz’s research processes. Both had difficulty with recruitment; Wei had trouble getting volunteers for his focus groups because of the inherent lack of anonymity, and both found that very few men would self-identify as gay, bisexual (hence the term “MSM,” which describes a behavior rather than a sexual orientation or gender identity), or as being HIV positive. When the two were recruited to analyze the results of the Asian Internet Men Sex Survey, an online questionnaire sponsored by Fridae.com and partially funded by the Hong Kong Department of Health, they were amazed at the wealth of data from more than 13,000 respondents (the survey was offered in 10 different Asian languages). They analyzed answers from MSM all over Asia about their HIV testing history, knowledge and attitudes towards HIV, drug and alcohol use, and travel history, and are continuing to use the results to inform their research and to make presentations for organizations like the United Nations and the World Health Organization that, in turn, help create public policy.
HIV infection is increasing rapidly across Asia, and researchers have to be able to reach MSM to understand behaviors and create interventions best suited for them.
“That’s why we’re going online,” says Guadamuz. “I think the Internet is the next frontier for recruitment.