July 15, 2019
John Schneider MD, MPH, Professor of Medicine and Epidemiology at the University of Chicago, directs the University’s Chicago Center for HIV Elimination (CCHE). CCHE’s goal is to eliminate new HIV transmission events in Chicago and develop generalizable approaches to HIV elimination. The Center's faculty, staff, and partners accomplish this by using network science to target and integrate prevention, along with creating structural and community-specific interventions.
Schneider’s recent research, which is co-sponsored by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), focuses on the impact social determinants of health has on HIV prevention and diagnosis. A number of programs have been developed to address social determinants, including racism, and other HIV-related issues in the Chicago area and beyond. UChicago was recently awareded a five-year, $17 million grant from the National Institute on Drug Abuse, which Schneider will lead alongside alongside Harold Pollack, PhD, Helen Ross Professor in the School of Social Service Administration.
Q. What roles do race and racism play in HIV transmission?
A. There’s been an HIV epidemic in Black people since the very beginning. However, so much of the scientific and media coverage focused on White gay people. That is what dominated our narrative early on, and there hasn’t been as much attention paid to Black gay, bisexual, same-gender loving, and transgender communities until recently. As a result, limited research dollars have been spent investigating and addressing the impact HIV has on these stigmatized yet resilient Black communities. These men and women are often invisible because of the intersection of race/sexual identity, and they often experience denial and stigma within their communities and outside. Many have also not had access to adequate educational and prevention resources because of systemic discrimination. Unfortunately, the end result is an HIV epidemic in Black communities that will need more than just research and service provision. To get to HIV elimination and zero transmission, we will need research that leads to advocacy to dismantle system-level structures that fuel the epidemic, as well as building on community strengths. It is at a point where it will take a lot more service provision and research to turn it around.
Q. How is your research and the work of the Chicago Center for HIV Elimination making an impact in this area?
A. We’re being more inclusive in our research and are making sure that the research process, results, and outcomes include and can be used by Black people. All of our work is based around programmatic implementation, creating various programs and identifying ways in which they can be made better for highly vulnerable people. In Chicago, we’re really focused on optimizing the intervention portion of programs and adapting them to the South Side community. We actually have all the tools we need to eliminate HIV, but the key is making sure we’re distributing them effectively and equitably.
Q. What are examples of some successful projects?
A. We’ve tested a study called PrEP Chicago, an intervention program to help prevent HIV. PrEP is a medication that if taken once daily as directed is 100% effective. The issue is that Black people were either not included in the research that examined PrEP efficacy or did not find the original studies applicable. Our most recent randomized controlled trial involved training people in their communities to motivate people in their networks to tell others about PrEP. We found that people who started in the intervention portion of the study first were more likely to have their friends, lovers, and other Black men initiate PrEP.
An earlier research study, Project nGage, is a support intervention program focused on improving and maintaining care among HIV-positive Black gay, bisexual, and same-gender loving men. In this project, participants brought in someone who the client trusts with personal information and we trained these “support confidants” on how to best support the participant in their care through encouragement, assistance with reminders around medical appointments, and medication taking. Participants in the intervention arm were more likely to continue with their care programs. This program was effective, and now the CDC has designated Project nGage as an evidence-based intervention. People can get materials online to help implement the program.
Q. Do any of your current programs have broader reach beyond the Chicago area?
A. We developed the forecasting models for the State of Illinois that informed the Getting to Zero Illinois initiative, which aims to end the state-wide HIV epidemic by the year 2030. Our work involved informing policymakers of the levels of program scale-up that would need to be implemented across the state if getting to zero is going to become reality. We’re working with the governor’s office, the mayor’s office, and we’ll be rolling this out beginning next year for a 10-year intervention period. It will be tough going and we need to ensure that getting to zero is a goal for all populations, and that we design the programs in an equitable and just way so that everyone benefits, especially Black, Brown, and low-income people.
Q. You're helping to lead UChicago's $17 million grant to tackle opioid addiction in criminal justice settings. What will this research project entail?
A. The project has several components. We will have three projects that work on models to predict when and where an opioid overdose might occur, what opioid treatment interventions are most effective (and cost-effective), and what specific network factors create the social environment for an individual to start using opioids or relapse. The center will also support ten research hubs across the country, each having six to ten sites where interventions are occurring. Support includes providing added value to their intervention projects through advanced analytics and modeling, as well as creation of a data commons where all data can be stored, processed, and harmonized.