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Bringing the social into medical research 

By Karen Herland

Applied Human Sciences professor Gilbert Émond will be lending his expertise and a social framework to a major project funded by the Canadian Institutes of Health Research led by Mark A. Wainberg, of the Lady Davis Institute for Medical Research at the Jewish General Hospital.

Wainberg, a recognized expert in AIDS research, is the principal researcher behind Pro-Active Intervention to Limit HIV Transmission Among MSM (men who have sex with men) Populations. This three-year $750,000 grant is intended to reduce transmission of HIV among men who are unaware that they are infected. The research project builds on work previously published in 2007 by Wainberg and Bluma Brenner, another researcher on the project. They established phenotypes of HIV that demonstrated the relationship between precise strains of the virus; partly by identifying which drugs the virus had been exposed to.

By analyzing patterns in these results, Wainberg and Brenner determined that strains of the virus which suggested long-term exposure to medication generally had limited transmission routes as compared to strains of the virus that had not been treated medically at all. They concluded that people who were aware of their status and getting treatment were less likely to transmit the virus than people who were unaware of their HIV-positive status.

These conclusions led them to add a social component to their research, and that is where Émond’s expertise comes in. Émond will be responsible for recruiting men who may have avoided HIV testing until now. The hypothesis is that those who are reluctant to test and unaware of their status are more likely to be transmitting the virus.

“I have the opportunity to develop an intervention and test it out,” said Émond of his admittedly small piece of a larger medical project.

“Almost everyone knows how to reduce their risk and most take the necessary precautions,” he said. But in terms of numbers, new cases are still highest among gay men. He has identified fear as a key barrier to testing. “A lot of people don’t like the anxiety of not knowing and then having to wait two or three weeks for their test to come back.”

Current tests require that blood samples are sent to a central lab, and positive results are verified by more precise testing, a process that takes several weeks.
Émond will develop a campaign using relatively new rapid testing kits that can provide results in one half-hour with just a drop of blood. “You get counselling and results all at the same time.”

He intends to open up a drop-in space with Séro-Zéro, a local HIV prevention organization that targets gay men. The drop-in will be staffed by a nurse, and will be somewhere close to the gay village. He expects that those intimidated by the waiting period or the clinical atmosphere where most testing occurs will be more likely to access an informal and immediate alternative.

“With the proper discourse and some focus on the importance of knowing [your HIV status], we could bring in a bunch of guys who don’t get tested.”

Although positive results will still need to be verified by other testing, he is hopeful that this approach will remove some of the barriers to testing that may lead men to transmit the virus without knowing they are infected.

Émond is working with the other researchers, including Joanne Otis, of UQÀM, who will research social factors related to participation in the project, to develop a strategy for the three-year project. He hopes to have a recruitment process in place by September.