Integration of Social and Behavioral Science with Medical Models of Research

1. Integration of Social and Behavioral Science with Medical Models of Research Gail E. Henderson, PhD University of North Carolina-Chapel Hill Yingying Huang, PhD Suiming Pan, MA Peoples University-Beijing Xiangsheng Chen, MD National Center for STD Control-Nanjing “Partnership for Social Science Research on HIV/AIDS in China” (1R24 HD056670)

2. Interdisciplinary/Transdisciplinary Research Collaboration: Definition 1) Research by teams or individuals that • Draws upon theoretical and methodological aspects of two or more different disciplines • Integrates/synthesizes information, data, techniques, tools, perspectives, concepts, and/or theories… • To address a defined problem area whose solutions are beyond the scope of a single discipline or area of research practice (National Science Foundation website; Nash, 2008).

3. Interdisciplinary/Transdisciplinary Research Collaboration: Definition 2) Collaboration between diverse stakeholders, including those who will be affected by the research, to define the objectives and strategies so that the products will be appropriate, feasible, and acceptable. This engagement with communities beyond the academy improves the transformative nature of research and translation into policy and practice (Horowitz et al., 2009; Martinez et al., 2011; Minkeler et al., 2008; Wallerstein & Duran, 2006; 2010)

4. R24 Research and Training Grant • and Liuzhou City • Guangxi Province • Demonstration • Research Site • Public Health and • Clinical Medicine • University of North Carolina, Chapel Hill • Sociology, Health Behavior, Epidemiology, Medicine • Peoples University of China, Beijing • Sociology, Gender and Sexuality Studies • National Center for STD Prevention & Control, Nanjing • Public Health and Clinical Medicine

5. R24 Collaborating Sites T Beijing Nanjing Liuzhou, Guangxi

6. The China R24 Proposal • Goal: To create an environment where Chinese social scientists implement high quality research that will contribute to evidence-based strategies for the prevention of sexual transmission of HIV and STD. NOTE: is this interdisciplinary/transdisciplinary? • Method: Institute a developmental award mechanism to create multidisciplinary teams to conduct pilot research studies related to sexuality and sexual transmission of HIV, and enable partners to apply new research skills and address structural determinants of HIV behavior and risk NOTE: multidisciplinary teams  transformative?

7. The Research Team At work

8. Using Research to Train and Build Teams • Developmental pilot awards required joint proposals from social scientists and public health researchers; plus Liuzhou CDC staff involved in each proposal • 5-day grant writing workshop • Work with a UNC mentor until protocol completed and approved by Peoples University ethics committee • Workshops addressed the needs of the pilot studies • Qualitative data collection • Measuring stigma • Qualitative analysis • Writing for publication • Trainers always included senior investigators from U.S. and China, and from social science and public health

9. Grant Writing Workshop

10. Using Research to Train and Build Teams (2) • Cross-training for Chinese graduate students from Peoples (social science) and Nanjing STD Center (public health), through creating platforms for them to interact, learn from each other, and develop joint projects • Dissemination of the model and our study results • May 2008 inaugural conference, brought national leaders in social science & HIV research to launch Liuzhou site • June 2010 conference for provincial and local CDC staff to present study results in Liuzhou • May 2010 & 2012, presentations on R24 studies at National STD conferences • Articles (planned for) AIDS & Behavior Supplement

11. Public Health and Sociology Graduate Students Collaborating

12. Pilot study example #1: Male migrants and risk • Background: National 2000 sexual behavior survey found STD risk higher for wealthy, traveling businessmen. Epidemiological and behavioral research show “internal migrants” at higher risk for HIV/STD • Pilot Project: “Networking Activities and Perceptions of HIV Risk Among Male Migrant Market Vendors in China” –Wang Wenqing, PhD, Sociologist • Aim: To design effective interventions, we need deeper understanding of the contexts in which sexual risk behaviors take place and the meanings attached to these behaviors within specific physical and social environments. Methods: Mapped markets, interviewed shop & stall vendors, found striking differences in risk and the business practices that are implicated. • Social scientist took the lead

13. Pilot study #2: Living with HIV/AIDS • Background: Liuzhou’s HIV prevalence highest in Guangxi province. HIV-related stigma fuels the epidemic and undermines effectiveness of AIDS control efforts. • Pilot Project: “Coping Strategies for HIV-Related Stigma in Liuzhou” – Zhang Yingxia, MD, local CDC • Aim: To explore the feelings, experiences, coping strategies, and recommendations for reducing HIV stigma. Methods: Interviewed 47 PLWHA. Qualitative analysis revealed 4 distinct coping strategies. • Project led by local CDC physician. This represented her first qualitative research experience, and “listening” to patients for a different purpose. But the training courses were challenging, exemplifying barriers faced by public health practitioners in interdisciplinary research.

14. Training Courses

15. Pilot study example #3: IDU FSW • Background: IDUFSW are a bridge population from IDU to FSW clients. Studies have neglected factors such as social support, violence, perceived stigma, service utilization & condom availability. • Pilot Project: “Socio-environmental factors and condom use among female injection drug users who are sex workers in China,” – Gu Jing, PhD, Epidemiologist and Yu Cheng, Medical Anthropologist • Aim: To investigate associations between socio-environmental factors and consistent condom use for IDUFSW. Methods: Survey, using questions developed from formative interviews, found violence & other environmental factors related to condom use Public health, anthro, & local CDC collaboration

16. Potential Barriers to Collaboration • Across disciplines • Intervention-focused: Medicine/public health • Theoretical & descriptive: Social science • Across levels of interactions • International  National • National = 1 Academic & 1 Public Health • National  Local Liuzhou field site, CDC • Within academic & public health systems • Target different training for different level investigators • Splitting funding across units • Logistics of travel

17. Lessons Learned INTEGRATION ACROSS DISCIPLINES Most important aspect was demonstration pilot project mechanism, where teams had to work out the details of the collaboration, on the ground, and in specific projects. 3 pilot case examples demonstrate that it doesn’t always work out the same way Next generation of young investigators who want to work on public health problem area should be exposed to the contributions of social science. Team members can rely upon and appreciate the expertise of the other sides.

18. Lessons Learned INTEGRATION WITH LOCAL SITE Senior public health leaders are needed for initiating integration with local public health collaborators. Liuzhou CDC had NEVER considered social science, had no capacity in social science. R24 introduced idea of new perspectives, through conferences and trainings, about including social science in public health. Hired a sociologist, built a center in the CDC. Value added with projects taking place in same site. All developmental awards had Liuzhou CDC staff involved in implementing. Dr. Zhang Yingxia took the lead on one.

19. Implications for the Future The past: Social science work on HIV/AIDS for the past decade produced findings, but in isolation, with no translation. Public health practitioners never paid attention to social science literature (and vice versa). The present: After implementing our “training through research” model, we recognize the need to harmonize various modes of engagement of the disciplines. The future: We plan to develop 1) a minimum training package for public health people who will never become social scientists but can gain appreciation for social science, and 2) a workshop on how to translate formative results from our pilot studies to evidence-based interventions