CAIR: Science and Service in the Fight Against AIDS

Because individual behavior plays such a large role in the spread of HIV, interventions that help prevent people from contracting the infection are often delivered through community-based agencies. The Medical College of Wisconsin Center for AIDS Intervention Research (CAIR) closes the gap between science and direct service by working with those agencies to bring scientific advances and successful interventions to the street level.

“We try to find the most effective ways to prevent risky behavior through interventions that change that behavior,” said Karen M. Opgenorth, MS, CAIR Director of Administration. “We work with populations who are at most risk, directly and indirectly through a number of community agencies. We’ve partnered with Meta House, the AIDS Resource Center, homeless shelters and many others.”

CAIR describes AIDS as “the most serious infectious disease epidemic of modern times,” certainly no overstatement – nearly one million Americans live with HIV, and estimates range as high as 45 million worldwide. More than 40,000 persons become infected with HIV in the US each year.

Opgenorth noted that the US populations now at most risk for HIV infection are younger than ever before, and more disadvantaged. The homeless, those with alcohol and other drug addictions, mental illness sufferers, low-income persons with limited access to quality health care, and other at risk groups are served by community agencies like those mentioned above.

Providing these people with workable ways to prevent HIV infection is a big part of CAIR’s mission, but by no means all of it. CAIR has 11 Medical College of Wisconsin faculty investigators working on HIV behavioral research, other affiliated faculty and a staff of about 50 research, professional and support people.

Multiple Disciplines Tackle Complexities of HIV/AIDS
With primary funding from the National Institute of Mental Health, CAIR applies a multidisciplinary approach to a wide range of endeavors, including:

• Evaluation of HIV prevention interventions for women, adolescents, young gay men, persons with severe mental illness, injection drug users, and others
• Helping people benefit from new treatments through health promotion and finding ways to simplify regimens and make them easier to adhere to
• Conducting HIV mental health research to evaluate interventions to enhance coping among those living with HIV, identify the mental health needs of older persons with HIV, and address the HIV-related mental health needs of underserved populations including those living in small communities and rural areas
• Training a new generation of AIDS scientists through a post-doctoral research fellowship program at CAIR, an international AIDS research training program in Russia (which is experiencing the early stages of what is likely to be a major AIDS crisis), and other international activities
• Evaluating the cost-effectiveness of HIV prevention policy and interventions, working from the established fact that it costs far less to prevent HIV than to treat AIDS
• Providing HIV prevention training, videos and other materials to service providers in the community and working toward better technology transfer between researchers and service providers

The ultimate goal of CAIR’s work is to get the results of research and experience into the hands of those who need it the most. “Service providers working with CAIR learn how they can take a scientifically proven intervention and use it within specific communities that they serve,” Opgenorth said.

One example of a CAIR-researched method that is useful in HIV prevention is utilizing “popular opinion leaders,” – peers within a target population – who are trained to send a message to their social group that incorporates specific practices and real-world discussions of safe behavior. “Our research shows that popular opinion leaders are among our most effective communicators,” said Opgenorth, “and we’re able to help agencies educate their communities by using this technique.

“We’ve also just developed a research core looking at qualitative or ethnographic data, using observations about how different cultures function, so we can use that information to tailor our interventions to be very specific and sensitive to unique cultures.”

Tailored Solutions at the Local Level
Lance S. Weinhardt, PhD, Assistant Professor in the Medical College Department of Psychiatry and Behavioral Medicine, is one of the CAIR researchers with hands-on experience in working with local direct-service agencies. “We participate in Centers for Disease Control (CDC) and National Institutes of Health (NIH) projects to help communicate effective interventions,” said Dr. Weinhardt.

“Our CAIR director, Jeffrey Kelly, PhD, has been an innovator in developing new interventions – both the CDC and the NIH have used programs he’s developed and produced polished training materials, modifying them from the “science side” of things to make them more applicable to the “outreach side,” said Dr. Weinhardt. “We produce professional manuals, videos and materials that organizations can use for training their own staff.”

“There are also two Internet-based projects that we’re involved in that are designed to take the information we’ve gathered through scientific studies and help international and domestic community-based organizations. These organizations can then decide if the intervention program will work for them, talk with our staff about how to adapt it for their own context, and actually put it into practice.”

Out of cyberspace and closer to home, Dr. Weinhardt has worked with Meta House, a highly respected local substance abuse treatment agency, in one of his local projects funded by the National Institute on Alcohol Abuse and Alcoholism. “Meta House recognized that they could be doing more for their clientele – women who have substance use problems, have children, and have limited resources. The staff thought that their clients could use more information about HIV and AIDS, and we worked with them very closely to develop an HIV prevention intervention and evaluate it through our research.

“We talked to Meta House clients and staff what information the clients are most interested in, what their reactions to different types of information have been in the past, what would and wouldn’t work for them. We wanted to know what gets their attention – what makes things stand out to them, given the sometimes-chaotic context of their lives?

“Changing AIDS-related behavior is complex,” said Dr. Weinhardt. “It’s much more complex than stopping smoking or changing diet or other kinds of health risk behaviors, because it involves another person and a lot of contextual factors.

We have to communicate clearly, for example, that people need to reduce their number of unprotected sexual encounters because someone might be HIV-positive. How we get that message across, and how we get people to react to it, is different in different situations, but the basics are very similar across all groups.”

Dan Ullrich
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.