Inside Project 18: Laying the Foundation for HIV Prevention

By Arielle Elmaleh-Sachs, Colin Powell leadership fellow HIV testing

I am sitting across from Marvin, and even though we just met fifteen minutes ago, he is sharing with me some of the most intimate aspects of his life—his social support, his sex life, his drug use, his feelings about HIV and his understanding about HIV prevention. We are the same age, and we are having an honest and open conversation about trust in relationships. He grapples with understanding how trust in a relationship can possibly protect him from HIV transmission.

At the end of our conversation, he will be administered an HIV test, and take a computerized self-interview where he will answer 300 questions concerning different aspects of his daily life. Then I will conclude the interview, sending him off with a bag of condoms, community referrals, and of course, his financial incentive.

Increasing HIV incidence At the NYU Steinhardt Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), I have the opportunity to intern with Project 18 (P-18), a three-year longitudinal study investigating young men who have sex with men (YMSM) and their risk factors, behaviors, demographics and mental health outcomes.  Between 2001 and 2006 in New York City, there was a 33 percent increase in HIV incidence in YMSM, according to the New York City Department of Health and Mental Hygiene. Minorities, including Black youth and Hispanic youth, had respectively 126 percent and 81 percent increases in new infections, according to research by NYU professor Perry N. Halkitis. These statistics were similar to those in other cities in the United States.

P-18 looks at the YMSM as part of a syndemic, where these individuals struggle with multiple facets of their identity, including their sexual identity, the transition into adulthood, and their inclusion into their communities.  Further compounding the complexities of this population are the demographics and socio-economic status, which in turn, can contribute to increased risky sexual behavior, drug abuse, and HIV seroconversion.  Acknowledging this, P-18 follows a cohort of 600 YMSM biyearly for three years to try to uncover the behaviors and environmental factors that correlate with and predict HIV transmission. The study findings will allow interventions to be implemented to target vulnerable populations in the most susceptible areas, and especially in HIV prevention.

Appreciating Stigmas and Struggles As part of the research team for P-18, I engage in various tasks to gain a better appreciation of the research process. This includes participant assessments and drug testing, transcriptions of previous interviews, data entry and data cleaning, and literature reviews of HIV-positive populations. Working at CHIBPS has been a valuable experience, where I have had the privilege to strengthen many different skills: computer and database, data analysis, participant/interviewer techniques, approaches to public health investigation and medical knowledge. With a better appreciation of the stigma and struggles within the YMSM and HIV-positive populations, I have learned the necessity to engage with thoughtfulness, sensitivity and understanding. As a future doctor, I believe that the skills that I have acquired in this internship will help me to better understand the importance of psychosocial, environmental and behavioral factors as determinants of health.

Read about Arielle Elmaleh-Sachs and our other contributors here.