Univ. helps fight AIDS

As the city with the second-highest number of AIDS cases in the state, New Haven looks to a variety of resources, including Yale professors, to help address the problem.

It is not uncommon for Yale faculty to be mindful of the potential real-world consequences of their research, particularly when the subject is AIDS, a global epidemic that hits particularly close to home in New Haven. Professors undertaking AIDS research must consult with community groups before beginning their projects, and in turn, many of these groups look to faculty to provide them with theories that can be tested in New Haven. But professors said it is often Yale students with a rigorous academic background and an interest in public service who end up bridging the gap between the University and its city.

Trace Kershaw, a professor at Yale’s School of Public Health, recently received a $2.5 million five-year grant from the National Institute of Mental Health for a study titled “HIV/STI Risk Among Young Expectant Fathers: Relationship Attachment & Transition.” While most AIDS-related research to date has focused primarily on transmission among three groups — young pregnant females, homosexual males, and intravenous drug users — Kershaw said his work, which is focused on young expectant fathers, will fill a gap in the current body of AIDS research.

Kershaw said his study will follow young couples expecting a child from the beginning of the pregnancy to one year after the birth of the child and will focus particularly on changes in the relationship and each partner’s sexual behavior.

“The idea following this research would be to include males in more prevention programs,” Kershaw said. “This could be done through couple-based initiatives or a more focused, integrative approach to preventing risky behavior in men.”

According to the Connecticut Department of Public Health, the Elm City currently ranks just behind Hartford as the Connecticut city with the most cases of AIDS. Hartford registers 1,480 individuals living with the virus, while New Haven reports 1,150 and Bridgeport reports 786. 51.3 percent of New Haven’s reported AIDS cases occur in the African American community, compared to 42 percent of Bridgeport’s cases and 35 percent of Hartford’s cases. Of new cases of HIV in New Haven in 2005, 55 percent were contracted from contaminated needles related to intravenous drug use. Heterosexual transmission caused 17.9 percent of reported cases, and male homosexual transmission accounted for 15 percent of new HIV cases in New Haven last year.

Leeway Inc. is one New Haven community organization that has provided skilled nursing care in a facility solely dedicated to those living with HIV and AIDS for the past decade. Executive Director Martha Dale EPH ’80 said Leeway strives to provide a complete network of services to keep patients connected with social structures while also caring for them and their condition.

“Only 77 new cases were reported in New Haven during 2005, but that’s still 77 cases too many for a completely preventable disease,” Dale said. “Leeway’s efforts are aimed at reaching out and engaging people so that they access this care as early in their illness as possible. We teach people how we can provide care and treatment for this complex chronic disease and get them back to their normal lives as much as possible.”

Leeway was founded by the late public health advocate Catherine Kennedy, who sought to address the lack of adequate coverage for poor AIDS patients living in New Haven.

Ellen Anderson EPH ’76, former chairman of the board for Leeway, said Kennedy saw that without a support network, AIDS patients discharged from the hospital would routinely return to their old lifestyles back on the streets.

“It was like a revolving door,” Anderson said. “They would be discharged and end up going right back to the hospital, because they lack a social support network and are incredibly vulnerable.”

While these programs seem to be fairly independent of Yale’s academic world, both Dale and Anderson said Leeway’s efforts are intimately related to the public health school and have the potential to provide valuable assistance to Kershaw and other faculty members in their studies.

“We have worked closely with the School of Public Health in the past, and we continue to do so,” Dale said. “We are a critical resource for academic research of this kind.”

Prior to applying for research grants, professors in the department of epidemiology and public health are required to consult with a community group engaged by the Center for Interdisciplinary Research on AIDS. This group evaluated Kershaw’s grant proposal to ensure that it included community participation and was in line with community needs, and will provide more feedback to him now that his grant has been approved, he said.

Anderson, who also serves as director of special studies at the School of Public Health, said the school has endeavored to involve community groups in plans for research and interventions as often as possible.

“The possible benefits that accrue to the community don’t always happen the way you would hope, but we always try to keep [community advocacy groups] as an important voice,” she said.

Kershaw said he thinks this form of collaboration is helpful in keeping researchers mindful of the city’s needs.

“It’s an effective research model,” Kershaw said. “By providing community feedback to faculty, you get to produce research that will be of real benefit to the city.”

But other Yale faculty members said they think more could be done to improve upon the already strong links between researchers and community AIDS organizations. Professor Kaveh Khoshnood EPH ’95 said collaboration between faculty and community leaders has been inconstant over the years, with more intense periods of collaboration occurring between the late 1980s and the mid-1990s.

“There is absolutely room to do more to bridge the traditional gap between research and policy, I won’t deny that,” Khoshnood said. “With AIDS particularly we’ve been mindful and tried to do a better job of bridging that gap, but we could definitely do more.”

Khoshnood got his start in public health as a volunteer for AIDS Project New Haven, another local advocacy organization, and said it had a tremendous influence on his public health career. He continues to serve as a mentor for other individuals interested in AIDS advocacy, particularly the students involved in Yale AIDS Watch.

Khoshnood said he was responsible mainly for facilitating and channeling the “incredible energy” that students in AIDS Watch brought to local advocacy efforts.

“I was simply overwhelmed by their enthusiasm,” he said. “It’s easy for people to feel that we’ve taken care of AIDS locally and can now move on to other things, but that’s just not true.”

Evan Orenstein ’08, co-coordinator of Yale AIDS Watch, said that while there is not an official connection between the student group and the public health researchers, students frequently reach out to faculty members like Khoshnood for advice on starting community projects, publishing educational materials and bringing speakers to campus.

“I’d say the big thing the faculty has done for us has been inspirational work,” Orenstein said. “Kaveh [Khoshnood] got his start in advocacy, and he got me and a number of other AIDS Watch members really excited about this kind of work.”

Disseminating information on HIV test facilities, improving condom access, and helping with needle-exchange programs rank among AIDS Watch’s top projects in the New Haven community. New Haven was among the first American cities to institute a needle-exchange program, which it started in the mid-1990s as a means of safely providing clean needles to drug users in a non-threatening manner.

Orenstein said the political debate surrounding needle-exchange programs has not deterred faculty, students and community groups from continuing to implement them in New Haven.

“It’s controversial because people say it’s condoning drug use, yet the evidence indicates that as a program it is very effective,” Orenstein said.

But this kind of pragmatic approach to AIDS prevention in New Haven is just why community and academic leaders alike value student involvement so highly, Anderson said.

“The students bring a perspective that the faculty sometimes does not have,” she said. “They bring us back to reality in certain respects when the faculty gets too theoretical, and they make sure that the research going on is being applied to as many community issues as possible. For them, it’s why they got into this in the beginning.”

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