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Community-Centered Research Collaboratives

CHRP seeks to center the voices of persons in communities that are highly impacted by HIV in the planning, development, implementation, and dissemination of innovative research to improve HIV-related health outcomes in their local communities.

Community-Centered Research Collaboratives to Address Local HIV-Related Syndemics Across California (2022)

CHRP funded five community-centered collaborative research teams who will work to identify HIV-related syndemic outcomes that are important to that community, jointly create a research agenda to improve those outcomes, implement research projects to serve that agenda, and disseminate research results with and for that community.


 

HOPE: A Status-Neutral Mobile Unit for African Americans Experiencing Homelessness in Alameda County

Co-Principal Investigators: Albert Liu, Natalie Wilson
Academic/Research Partners: San Francisco Department of Public Health, UC San Francisco
Community Partners: AIDS Project of the East Bay, Oakland, Alameda County Public Health Department
Budget: $1,625,761
Start Date: 2/1/2023     End Date: 1/31/2027

African American people experiencing homelessness in Alameda County face many social and economic challenges putting them at risk for HIV, sexually transmitted infections (STI), and Hepatitis C. About 42% of new HIV infections occur in African Americans, and since 2006, the rates of new infections have remained unchanged in Alameda County. The highest rates of STIs are also seen in African Americans, accounting for half to two-thirds of all STIs in Alameda County. Additionally, African Americans accounted for 36% of chronic hepatitis C cases in 2015. Gentrification and a housing crisis have resulted in a 49% increase in people experiencing homelessness in Oakland since 2017. These rates are the highest in the Bay Area. Despite being a quarter of Oakland’s population, African Americans accounted for 70% of people experiencing homelessness in 2019. Along with the COVID-19 pandemic, there are a number of social and societal barriers that have increased racial and health disparities in this population, and effective projects are needed to help this highly impacted community get the healthcare and social support they need. We will develop and test a mobile health clinic model called HOPE (Healthy Outcomes for People Everywhere) to offer services to reduce HIV, STIs, and hepatitis C with prevention and treatment. We will provide clinic services to the homeless community and offer ways to prevent HIV and education for those that test negative, including medications for HIV prevention and clean needles. For those who test positive for HIV and STIs, we will provide on site treatment and referrals for care. For hepatitis C, we will offer referral for treatment or a plan to follow up with the mobile unit. This project will bring together a panel of African American people experiencing homelessness to advise the project and build a coalition of providers committed to providing care to homeless communities to coordinate care and share outcomes. We will use public health data to guide where to focus services provided by HOPE using strategies informed by the community. This project is a collaboration between academic, public health, and community based organizations to provide a synergistic approach to building a sustainable program for African American people experiencing homelessness in Alameda County, one of the most vulnerable populations in California.

 

Sex Work LEARN (Lived Experience Affirming Research Network)

Co-Principal Investigators: Ayako Ochoa, Bamby Salcedo, Sophia Zamudio-Haas
Academic/Research Partners: UC Los Angeles, UC San Francisco, University of Southern California
Community Partners: Los Angeles County Department of Public Health, Sex Worker's Outreach Project Los Angeles, TransLatin@ Coalition, Unique Woman's Coalition
Budget: $1,835,000
Start Date: 2/1/2023     End Date: 1/31/2027

Introduction: Sex workers experience marginalization that contributes to health conditions, including HIV and sexually transmitted infections (STIs). Despite high risk for HIV and STIs, few interventions exist for sex workers. Those that do focus on cisgender women, even though Black and Latinx transgender women are more affected by HIV and STI and evidence suggests higher rates of sex work among this population. Thus, we center the experiences of Black, indigenous people of color (BIPOC) transgender women for our research.

Background: In 2019, we formed a community research group in Los Angeles County (LAC) called Sex Work Lived Experience Affirming Research Network (SW LEARN). This multi-sector group includes people with lived experience, university researchers, LAC Department of Public Health, health care and social services providers, and community advocates.

Community at the Center: We do not think that sex work is the “problem.” Rather, we view sex work as an appropriate solution to a given set of circumstances where opportunity to access traditional jobs may be limited due to discrimination. The group frames research by looking at people’s strengths and ability to persevere.

Partnerships: SW LEARN’s team of scientists has expertise in HIV programs research. We have support from scholars and practitioners of psychology, economics, law, public policy and public health with experience working with diverse sex workers. TransLatin@ Coalition will lead our collaborative, with support from Unique Woman’s Coalition and Sex Workers Outreach Project LA. We aim to include a group of community advisors from the population served. This will be critical to sustain community at the center.

Study Design: We will develop a collective research agenda, and select, and adapt an HIV/STI program for BIPOC trans women sex workers using a systematic approach. We will test the program with 100 volunteers who are from the community and study the process, including what is working and what could be improved, by talking to people and measuring things like attendance and participation. We will also study STI and HIV related health and behavior to see if participants experience improvements from participating in the program. We will share the study results with community audiences and policymakers to better inform programs and policies for sex workers who are BIPOC trans women.

 

Trans(C)ending HIV Syndemics with Black and Latina Transgender Women: A Collaborative Response

Co-Principal Investigator: Laramie Smith, Malek Guerbaoui
Academic/Research Partner: UC San Diego
Community Partner: The San Diego LGBT Community Center
Budget: $1,719,784
Start Date: 2/1/2023     End Date: 1/31/2027

Building on an existing academic-community partnership, this project will form the Trans(C)ending HIV Syndemics Collaborative. Over the next four years, this Collaborative will work to address HIV-related inequities affecting Black and Latina transgender women in San Diego, California who face high rates of social stigma and discrimination.

The current HIV service landscape in San Diego was largely developed without considering the unique challenges and strengths of Black and Latina transgender women. As a result, these services are less equipped to address experiences related to sex work, violence, and substance use that are a direct result of high rates of social stigma and discrimination and simultaneously interact to increase Black and Latina transgender women’s vulnerability to poorer HIV-related health outcomes. Locally, Black and Latina transgender women are overrepresented in new HIV diagnoses, have less access to medications that can prevent HIV, and have lower engagement in HIV care over time resulting in poorer personal health and increased risk of transmission to sexual and injection partners. Improving sustained engagement in HIV testing and HIV viral load monitoring is an important step to reducing HIV inequities in this community.

To address this gap, the Trans(C)ending Collaborative will convene twelve representatives, six from Black and Latinx Trans-led Advocacy groups, and six providers and frontline staff from the local HIV service landscape. In partnership with our implementing organization, the San Diego LGBT Community Center and our evaluation organization, UC San Diego, the Collaborative will work together to inform how we can make existing evidence based interventions we already have support better HIV outcomes by purposefully addressing the unique needs of Black and Latina transgender women in San Diego. Because this work will only be as effective as the Black and Latina transgender community members who know about it, we will prioritize disseminating the Collaborative’s vision, planning process, progress, and results to the transgender community and local stakeholders throughout the 4-years process.

 

Transgender Health/Housing/HIV Equity Project (T.H3.E. Project): Ending the Transgender HIV Epidemic

Principal Investigator: Lois Takahashi, Jury Candelario
Academic/Research Partner: University of Southern California
Community Partners: Asian Pacific AIDS Intervention Team, Los Angeles County Department of Public Health, Orange County Health Care Agency, TransLatin@ Coalition
Budget: $1,654,401
Start Date: 2/1/2023     End Date: 1/31/2027

The Transgender Health/Housing/HIV Equity Project (T.H3.E. Project) is a partnership of researchers, public health departments, and community activists working together to reduce HIV infections for Southern California's transgender community. The partnership will use research, programs, and consultation with community members to collect and analyze data that studies how stable housing, mental health services, and intensive case management together help end the HIV microepidemic for transgender women.

Transgender women in California are an important population for HIV research. California has the largest estimated number of people who are transgender in the nation. The number of transgender women who have been infected by HIV has increased since 2018 and, when they are diagnosed with HIV, these women are usually at later stages of the disease than other groups. There are many reasons for this pattern. Though transgender women are similar to other groups in many ways, they are also different because of the challenges they face with staying housed. HIV can be managed with the proper medication, but for transgender women, the virus is not controlled as well over longer periods of time compared to other groups. Many transgender women are unhoused or homeless, and research has shown that people who are homeless have worse HIV disease. T.H3.E. Project focuses on Los Angeles and Orange counties, a region that is well known for its high rents and lack of affordable housing.

T.H3.E. Project will study a program that has several parts, including bridge housing (housing for 6-12 months), mental health counseling, and a case manager to help to manage life's challenges. T.H3.E. Project will study the idea that transgender women in this program will be able to prevent HIV infection and manage HIV better than in other types of programs that do not have housing as part of the program. T.H3.E. Project will also collect data on the partnership and how it is working so that other partnerships can build on what the project team learns. By studying the partnership and the program, T.H3.E. Project aims to show organizations in other regions of California how to create similar partnerships.

T.H3.E. Project will also create a plan for sharing the results of the project with community members, elected officials, and researchers in California, the US, and the world.

 

Unidos en Salud: Multi-Disease HIV Testing Hubs for Latinx Immigrant Communities in San Francisco

Co-Principal Investigator: Carina Marquez, Aleks Zavaleta
Academic/Research Partner: UC San Francisco
Community Partner: Mission Language Vocational School
Budget: $1,742,750
Start Date: 2/1/2023     End Date: 1/31/2027

Unidos en Salud (UES) is a multi-sector collaboration founded in April 2020 to address health disparities in the Latinx community. Our collaboration brings together the expertise of community (San Francisco Latino Task Force— a coalition of over 30 Latinx-focused CBOs), Infectious Diseases researchers and clinicians (UCSF), local health care service delivery businesses, and the San Francisco Department of Public Health. While our initial collaboration formed to address COVID-19 in the Latinx community, over the past year, we have expanded our efforts to address HIV, which disproportionately impacts the Latinx community. Year after year the largest proportion of new HIV diagnoses in San Francisco are among Latinx people. We have tools to stop these epidemics, but we are not reaching all members of the Latinx community—especially undocumented immigrants.

Our piloted low-barrier multi-disease testing model takes a community health approach, integrating testing for HIV and related syndemics and linkage to a broad array of services (e.g., financial, housing, mental health resources). Our model is well-suited for addressing conditions that share common social underpinnings and cause an increased public health burden on a community (i.e., a syndemic) and the components of the model can be tailored to meet the priorities of the targeted community. Our preliminary data show that our model is acceptable and feasible in the Latinx community and evidence-based, but further work is needed to tailor the model to reach Latinx immigrant communities at high risk for HIV. We build on the community’s trust in the Latino Task Force and the collaboration mitigates many access, stigma, and trust-related barriers to HIV testing that Latinx immigrants face.

The overall objective of our well-established collaboration is to expand the reach of our multi-disease testing model to immigrant and marginalized Latinx communities in San Francisco. In Aim 1, we will refine our research agenda and tailor our model to improve our reach to Latinx immigrant communities. In Aim 2, we will implement and evaluate the model. In Aim 3, we will augment the reach of our model with social network informed outreach and home-based HIV testing. Data from this community collaborative will help close the implementation gaps needed to end the HIV epidemic, especially for Latinx immigrant communities.