Reducing Black Men’s Drug Use and Co-Occurring, Negative Mental and Physical Health Outcomes: Intersectionality, Social Structural Stressors, and Protective Factors. Popularly known as the Strengths & Stressors Study.
The Strengths & Stressors study is led by Dr. Lisa Bowleg, Professor of Applied Social Psychology and Director of DC CFAR Social and Behavioral Sciences Core at George Washington University, in partnership with Whitman-Walker Institute. The study is funded by the National Institutes of Health through 2023.
Drug use contributes to six of the top ten leading causes of death among Black men ages 18 to 54. Social-structural stressors such as discrimination, based on race or race and sexual identity, and drug use to cope with stress, are well-documented pathways to drug use among Black adults.
This study aims to better understand these dynamics among the Black men’s community in the DMV. The proposed research uses intersectionality, social-structural stress, and resilience frameworks to advance new and important knowledge about the extent to which social-structural stressors and protective factors influence drug use and co-occurring negative health outcomes among Black men at the intersection of sexual identity and SEP, over the years of their life. This intersectional focus represents a paradigmatic shift from conventional single-axis and one-size-fits-all approaches. The significance of the research lies in the expected outcome of the future development of multi-level interventions to reduce drug use and promote mental and physical health among Black men at different intersectional positions of risk.
Potential participants must be Black men between the ages of 21 to 54, living in the DMV for the full three months of the duration of this study. The study consists of two visits in a three-month period, this includes the collection of self-reported social-structural stressors, mental health data, and objective drug use (urine toxicology) and physical health (e.g., blood pressure). During the second visit this will be repeated with a onetime blood sample collection; to assess cardiovascular diseases like cholesterol. Participants will receive up to $150 for their time.
Systemic and Mucosal Immune Dysregulation and HIV Risk in Transgender Women Who Have Sex with Men. Popularly known as the Transwomen HIV study.
The Transwomen HIV study is led by Dr. Mimi Ghosh, Associate Professor of Epidemiology in The Milken Institute School of Public Health at George Washington University, in partnership with Whitman-Walker Institute. The study is funded by the National Institutes of Health through 2023.
Transwomen who have sex with men and cis-men who have sex with men are frequently grouped together in HIV risk assessment studies due to the practice of receptive anal intercourse. However, the odds of HIV infection in this transwomen population are 2.2x greater than cis-men, after controlling for age, condom use, depression, stigma, and violence. The underlying immune-biological mechanisms contributing to this enhanced risk are not known, particularly with regards to use of long-term synthetic estradiol (E2) therapy and interactions with the body’s immune system (the part of the body that fights infection) including the rectal mucosal immune microenvironment and microbiome.
The study aims to close these knowledge gaps and better understand the immune system and its role in HIV infection among people assigned male at birth (AMAB) who have sex with men. The results of the study will help us learn more about the effects of gender affirming hormone therapy (GAHT), specifically E2 usage, on the immune system in the blood and in the rectum and may help us understand how to better prevent HIV infection.
Potential participants must be transgender women, ages 18-45, who are HIV negative, sexually active, and interested or are already on GAHT. The study consists of a single visit, which includes collection of self-reported social-structure stressors and lifestyle behaviors via a survey, three rectal swabs, and a blood sample. Participants will receive $80 for their time.
Genital Health of Trans-males on Testosterone. Popularly known as the Transmen HPV study.
The Transmen HPV study is led by Dr. Mimi Ghosh, Associate Professor of Epidemiology in The Milken Institute School of Public Health at George Washington University, in partnership with Whitman-Walker Institute. The study is funded by the National Institutes of Health through 2023.
The prevalence of Human papillomavirus (HPV) is significantly higher in transgender people relative to cisgender people, including men who have sex with men (MSM). Yet the genital immune microenvironment that may elucidate underlying biological mechanisms of cancer development in this population remains uncharacterized. Scant literature on cancer prevalence and poor understanding of HPV risks have resulted in lack of prevention and vaccination guidance in this high-risk population. Further, although sex hormones have been linked to multiple cancers in cisgender people, the impact of long-term use of gender affirming hormone therapy (GAHT) in transgender people remains unknown.
The study is being conducted to better understand the risk for HPV associated cervical and anal cancers in people assigned female at birth (AFAB) who are now taking the hormone testosterone. This includes a variety of gender identities including but not limited to transmen, transmasculine, and non-binary people. We are comparing non-cisgender persons taking testosterone and cis-females to understand how the immune system (the part of the body that fights infection) interacts with hormones and HPV.
Potential participants must be transgender men who have been on GAHT for at least six months or cis-women, ages 18-45, and sexually active. The study consists of a single visit, which includes collection of self-reported social-structure stressors and lifestyle behaviors via a survey, a set of swabs (three rectal, three vaginal, and one oral), and a blood sample. Participants will receive $100 for their time.
Biopsychosocial Mechanisms Linking Gender Minority Stress and HIV Comorbidities. Popularly known as LITE Plus.
The LITE Plus study is led by Dr. Tonia Poteat, Associate Professor of Social Medicine at UNC-Chapel Hill and core faculty in the UNC Center for Health Equity Research, in partnership with Whitman-Walker Institute, The Fenway Institute (MA), and Callen-Lorde (NY). The study is funded by the National Institutes of Health through 2023.
Transgender women bear a disparate burden of HIV and related comorbidities. More than one in five (22%) transwomen are estimated to be living with HIV (TWLHIV), and 80% of TWLHIV are racial and ethnic minorities. It has been proposed that chronic stress from prejudice and stigma drives disparities in mental health and cardiovascular disease among racial and ethnic minorities. Similar data are emerging among transgender people who experience gender minority stress. However, mechanisms linking physiologic chronic stress to mental health and CVD comorbidities have not been examined in the context of HIV nor among transwomen who experience stigma from intersecting identities related to race, gender identity, and HIV status (i.e., intersectional stigma). Protective factors that can impact these mechanisms and mitigate disparities in TWLHIV are understudied. This lack of data leaves clinicians with little evidence for effective ways to assess risk, promote health, and reduce HIV comorbidities among TWLHIV.
The purpose of this research study is to understand how chronic stress affects the physical health of TWLHIV. In addition, the study team would like to learn how gender-affirming hormone therapy affects the health of transgender women. This research has critical implications for all disparities populations living with HIV and will provide novel information that can be used to guide clinical practice and reduce health disparities.
Potential participants must be transgender women, ages 18-45, who are living with HIV and identify as Black/African American or Latina/Hispanic. The study consists of a total of four visits occurring every six months for two years. Study visits will include surveys to collect validated psychosocial measures of stigma, perceived stress, CVD risk behaviors (e.g. smoking), mental health, coping, and social support, as well as a blood draw. Some participants may opt-in to also provide saliva samples for cortisol measurement and may also choose to participate in qualitative interviews. Participants will receive up to $75 per study visit.
Multicenter AIDS Cohort Study (MACS)/Women’s Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS). Popularly known as SHARE (DC/Baltimore).
The SHARE study, as it is known locally, is led by Drs. Joe Margolick and Todd Brown of Johns Hopkins University, along with Dr. Jennafer Kwait of the Whitman-Walker Institute. The study was started in 1983 as part of national research collaborative now known as the MACS/WIHS Combined Cohort Study (MWCCS) which is funded by the National Institutes of Health.
SHARE, and the larger national study, was started to investigate the natural history of HIV among men. Currently, the study has aimed to identify the impact of chronic health conditions affecting people living with HIV, including those related to the heart, lungs, blood, sleep, and mental health, among others. The study has also started conducting surveys looking at psychosocial outcomes, stigma, sexual orientation and gender identity, and health inequities.
Study participants include those living with and not living with HIV, whose ages range from early 30s through early 80s, and most of whom identify as gay or bisexual. Approximately half of the SHARE cohort has participated in the study for the entire time it has been running, and this length of participation is rare in most studies. Additionally, many participants have benefited from the continued lab work and evaluations as part of study and sub-study visits.
As one of the oldest and most impactful studies looking at HIV and other chronic conditions, SHARE and the broader MWCCS have close to 40 years’ worth of data and biospecimens available for analysis. As such, the study has produced more than 3,000 scientific publications and remains a fundamental study in the field of HIV research.
day2day: Testing a Biopsychosocial Model of Minority Stress and Health for HIV-Positive Men. Popularly known as day2day.
The day2day study is led by Dr. Jon Rendina, Senior Director of Research at Whitman-Walker Institute and Associate Research Professor of Epidemiology in The Milken Institute School of Public Health at George Washington University. The study was originally initiated at Hunter College’s PRIDE Health Research Consortium under Dr. Rendina and is now continuing at Whitman-Walker Institute. The study is funded by the National Institutes of Health through 2023.
Gay and bisexual men (GBM) in the U.S. are burdened by a high and disproportionate rate of HIV infection and more than half of all HIV+ individuals are GBM. Chronic experiences of sexual minority stressors have been shown to influence a variety of mental, behavioral, and physical health outcomes for GBM, including general stress and immune outcomes, as well as HIV-specific health outcomes. Moreover, chronic experiences of HIV-related stressors have also been shown to impact mental health and health behaviors for HIV+ GBM, though there is substantially less research on their role in the health of HIV+ GBM.
The goal of the day2day study is to better understand the influence of sexual minority and HIV-related stressors on health outcomes in HIV+ GBM. Specifically, the study aims to learn more about men’s daily experiences, including thoughts, feelings, social interactions, sexual behavior, substance use, medication adherence (use according to your doctor’s directions), and overall health and well-being to develop interventions that are robust and durable.
Potential participants must be HIV+ gay and bisexual cis-gendered men who reside in the Washington, D.C. metropolitan area. The study consists of five in-office visits approximately 90 days apart, which will include blood draws, urine sample, and two rectal swabs, as well as saliva collection, a series of neurocognitive tasks, and an interview with the Research Specialist that looks at the past 30 days of an individual’s life. Participants will receive up to $347 for full participation in the study over 12 months.
Understanding Viral Suppression for Newly Diagnosed HIV+ Men to Inform Implantation of TasP and U=U. Popularly known as UniquelyU.
The UniquelyU study is led by Dr. Jon Rendina, Senior Director of Research at Whitman-Walker Institute and Associate Research Professor of Epidemiology in The Milken Institute School of Public Health at George Washington University. The study was originally initiated at Hunter College’s PRIDE Health Research Consortium under Dr. Rendina and is now continuing at Whitman-Walker Institute. The study is funded by the National Institutes of Health through 2023.
Sexual minority men are the most impacted by the HIV epidemic in the U.S–therefore, linking this group to care is an imperative step in reducing the impacts of long-term health outcomes and reducing rates of HIV transmission. Several clinical trials have shown that with HIV medications or antiretroviral therapy and other forms of care, people living with HIV who have suppressed viral load have shown no linked transmission to their partners. This finding highlights the importance of treatment as prevention – meaning that consistent use of HIV medication is one of the most highly effective means of preventing HIV transmission. This is otherwise termed as U=U, or Undetectable = Untransmittable, a movement that stresses that being undetectable, or having suppressed viral loads, not only reduces the risk of infection to sexual partners, but it is prevented entirely.
The purpose of the UniquelyU study is to learn about experiences and behaviors related to mental health, physical health, and medical care experiences that influence the U=U movement along the HIV continuum of care. The findings from this research will be critically important as some hesitation to promote U=U still exists in HIV providers and the general population, despite wide scientific consensus of the adequacy of treatment as prevention.
Potential participants must be gay, bisexual, or queer men, with a recent positive HIV diagnosis, living in the United States. For two years, participants will be asked to answer online surveys, provide regular dried blood spot (DBS) samples, as well as details about their medical care. There is also the option to complete a once-yearly self-swabs for sexually transmitted infections (STIs) and digestive health/inflammation. UniquelyU is an entirely remote study, meaning that participants are not required to come into a research site to complete study tasks. Participants will be compensated up to $1,285 for full participation over 2 years.
Multilevel strategies to understand and modify the role of structural and environmental context on HIV inequities for sexual and gender minorities of color. Popularly known as UPLIFT.
The UPLIFT study is led by Drs. Tamara Taggart, Assistant Professor in the Department of Prevention & Community Health, and Jon Rendina, Senior Director of Research at Whitman-Walker Institute and Associate Research Professor of Epidemiology, at The Milken Institute School of Public Health of George Washington University. The study is funded by the National Institutes of Health through 2026.
Rates of HIV infection continue to rise among racial minority men; however, intersectionality paints a more vivid picture for the severity of risk that presents itself to communities who find themselves at the junction of multiple minority identities. There is an urgent need to reduce rates of infection specifically among Black, Latinx and Multiracial sexual and gender minorities who have sex with men (BLM SGMSM). Research suggests that individual risk behaviors alone are not enough to account for inequities despite significant advances in HIV prevention and treatment; there is a need for research to move beyond this to examine socio-structural factors that maintain inequitable risk environments. Systemic oppression of LGBTQ+ communities are rooted within laws, policies and practices and structural racism is one such way in which vulnerability to HIV infection is exacerbated and access to health-promotive resources are limited.
The UPLIFT study aims to home in on state and local socio-structural factors that directly and indirectly influence HIV inequities for marginalized communities and identify community driven intervention and policy strategies in support of the US Ending the HIV Epidemic (EHE) initiative. This study will use a longitudinal epidemiologic cohort study to test a socio-structural model of HIV inequities for BLM SGMSM, which has strong potential to move the field beyond individually-focused models of risk and identify new opportunities for structural and community-level intervention. Moreover, the research will be strengthened with the addition of the community leaders with a strong voice recognized by the community to maximize the value this research will have on community outcomes and research literature.
Potential participants must be at least 16 years of age, HIV negative, and identify as BLM SGMSM. In addition, as UPLIFT is an entirely remote study, participants must have a mailing address within the 50 states, D.C., or Puerto Rico where packages can be received as well as smart phone. The study will consist of annual home-based HIV test and brief, online daily surveys for 6 weeks over the course of 3 years. Participants will be compensated up to $291 for full participation over 3 years.
INCLUDE is a study being conducted by researchers at Whitman-Walker Institute, in collaboration with the Cancer Support Community (CSC), to test a new multi-cancer early detection product called Galleri®.
Galleri® is a simple blood test that detects and measures potentially cancerous cells circulating within the bloodstream. With this new technology, Galleri® provides a new solution for detecting many common cancers that do not have a targeted screening available.
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