Students and global health experts share their experiences working with communities.

Category: Ian

The End signals the Beginning of Something New

Summer has faded fast. The official end of my practicum with Colectivo Amigos Contra el SIDA (CAS) approaches, sooner than I might like – a gentle reminder that things outside the academia’s confines do not always obey the metronome of a school calendar. I began the summer preoccupied with how I might contribute from afar, in the virtual world, to CAS’s mission, carried out from their clinic in Guatemala City, to provide stigma-free sexual health services to gay and bisexual men. Yet as the summer has worn on, the virtual aspects of my practicum have become less significant. It’s not clear that anything would have been gained, for anyone, by me being present in Guatemala this summer, aside from frequent flier miles. Instead, the great reward – and challenge – became calibrating my expectations of what was feasible in the abbreviated course of this summer.

As I commented in my earlier blog post, CAS maintains a longstanding relationship with Gillings researchers, a collaboration whose current focus is understanding the provision and uptake of HIV pre-exposure prophylaxis (PrEP), a daily medication which is highly effective at preventing the establishment of HIV infection in those exposed to the virus. In Guatemala, CAS is the only provider of PrEP, which it offers free of charge – and remarkably, CAS has greatly expanded its pool of clients using PrEP since the onset of the pandemic. The original design of my practicum focused on developing and implementing data collection instruments, a survey for CAS’s clients and in-depth interviews with providers, that would inform the creation of a mobile app to share health information and coordinate services for CAS’s PrEP program. With delays in the Institutional Review Board (IRB) approval for this phase of the study, my focus shifted to analyzing and preparing to share qualitative and quantitative data from an earlier phase of the research partnership – that is, the dissemination of results.

Before coming back to UNC, I had been exposed to a variety of organizations in the nebulous patchwork that is “international development,” from small NGOs to government agencies. None had the commitment to research that CAS has, to cultivating and producing knowledge to better advance their mission. The accompanying ethical procedures, like IRB approvals, exist for the essential purpose of protecting the human subjects of this research. If anything, given its sometimes-troubled history, stringent ethical standards ought to be at the forefront of global health research and practice. Though I have had to be flexible in my practicum’s immediate aims, my core objective of striving to contribute to CAS’s mission, however modestly, has not wavered. Maybe this reflects my own inexperience in public health research, but I have gained a richer appreciation for the harmony of such community-based, action-oriented research partnerships.

Comparing PrEP users with non-users in the analysis of older study data has revealed differences between each group in the factors influencing PrEP uptake, differing perceptions of the stigma associated with its use, and differing reliance on technology to seek health information. The results of such comparisons will, hopefully, provide insight into how CAS might develop new initiatives to expand the reach of its PrEP program, including via a mobile app. Working through how to best share these results has presented the fresh challenge of how to integrate quantitative and qualitative data sets – and how to do so in such a way that proves most useful to the workings of a fast-paced organization with multiple programmatic objectives. With a keener appreciation for the value of such mixed methods research to public health programs, this is a process I would hope to replicate in future endeavors.

More immediately, I plan to continue as part of the CAS-UNC research collaboration beyond the official end of my practicum. Coming up are results to be shared and interviews to be conducted, both of which hopefully can coexist alongside my coursework commitments. Ten weeks may be a flash in time, but it’s certainly long enough to feel immersed in a project. And this seems only right to me. Exercising humility and creating relationships both call for, among other things, an investment of time. In my own practice, I aspire to be oriented by precisely these values, the foundation of lasting transnational ties that define global health at its best.


A new enterprise

Like so many adaptations made over the past year and a half, the prospect of a remote practicum left me feeling some sense of trepidation. How could I build relationships with work counterparts over Zoom? Would I be able to meaningfully contribute to my practicum organization from an apartment in Chapel Hill? Still, coming to Gillings after several years working in rural Panamá, I was eager to continue honing my global health experience in Latin America – and I’m fortunate to have the opportunity to do so this summer, as I begin supporting a research collaboration with Colectivo Amigos Contra el SIDA (Friends Against AIDS Collective, or CAS), a Guatemala City-based NGO that provides sexual health services for gay and bisexual men, who bear a disproportionately high burden of HIV infection in Guatemala. While the broader global health field, amidst the pandemic, has rightfully reflected on the necessity of boarding airplanes simply to foster productive international partnerships, I am excited to navigate these new challenges during a remote practicum with CAS. After all, every learning experience carries its unknowns and uncertainties.

In Guatemala, a country of nearly 17 million people, CAS is the only entity that provides HIV pre-exposure prophylaxis (PrEP) – and does so free of charge. In my practicum, I join a long-term collaboration between CAS and UNC researchers. Regular PrEP use is highly effective in preventing HIV transmission, but currently formulated as a daily medication, the logistics of taking PrEP can be onerous. This is only exacerbated by the social stigmas attached to PrEP use and sexual orientation. To address some of these concerns, CAS is partnering with UNC researchers to design a mobile app to serve as a kind of “one-stop shop” for PrEP information: anonymous peer-to-peer communication between PrEP users, information provided by medical providers, and clinical appointment reminders. I will be contributing to data collection about the preferences of CAS’s clinical clients and providers for the app.

Here is probably the point at which I should note that this is my first foray into public health research. I have an undergraduate degree in philosophy, but it was only after gaining practical exposure to HIV education, sustainable agriculture, and water and sanitation issues in the course of my time in Panamá that I felt the pull of global health. Yet the research enterprise is new to me, even as research holds immense value for community-based organization like CAS as they evolve to provide new services, like PrEP. Fortunately, I’ll have some latitude, taking part in – and really, learning about as I go – a range of research methods. On the qualitative side, I’ll conduct in-depth interviews with CAS staff about PrEP and their perspectives on using a mobile app. On the quantitative side, I’m helping to create the survey for PrEP users at CAS and analyze earlier survey data. Besides deepening my professional focus in Latin America, I look forward to gaining this broad experience with the full breadth of qualitative and quantitative skills while forming part of a multinational team.

At the moment, we’re waiting on Institutional Review Board (IRB) approvals at UNC and in Guatemala to begin engaging directly with participants. As much as my instinct is to jump in without looking, such approval processes are of course intended to protect people and their health – the ultimate aim of public health. Just as the pandemic has led me to reconsider the value of hopping on an airplane to “do” global health work, I’m coming to value pace and patience in global health research. Even here at a distance, I can still strive to learn something new every day.