David Pantalone's research has been focused on U.S. HIV epidemic since 2000
Nearly 40 years into the HIV epidemic, the Centers for Disease Control finds there are still about 40,000 new infections a year. Three-quarters of new infections are discovered in people of color and two-thirds are in sexual minority (gay and bisexual) men. Professor of Psychology David Pantalone has made it his life’s work to be part of the public health response to the virus. He’s been working to develop interventions to get sexual minority men, especially black and Latino men, tested and treated for HIV.
“The way you think about the different health behaviors—we call it the ‘HIV cascade’—it’s testing, learning about test results, engaging with care if a person is HIV-positive, starting medicine, maintaining themselves on medicine for a long period of time, and then having the virus be suppressed at a level where the person can live a normal life,” Pantalone said.
Much of his recent work has been helping people living with HIV to take their medications and stay engaged with medical care, after beginning his research career focused on HIV prevention. Now, he’s shifting back to HIV prevention, given recent advances in that area. Pantalone is the clinical psychologist on a new 5-year $3.8 million National Institute of Mental Health (NIMH) grant designed to get Latino gay and bisexual men to be tested regularly for HIV and to take pre-exposure prophyaxis (PrEP), a medication treatment that prevents HIV acquisition. UMass Boston’s part of the grant is $228,000.
“The problem is there are lots of people at risk for infection who aren’t tested, and then people who are tested but who aren’t tested regularly enough. Every sexually active person should be tested for HIV and other STIs every six months,” Pantalone said. Most new infections are the result of HIV transmission from people who don’t even know they are infected.
Pantalone, the graduate program director for UMass Boston’s Clinical Psychology PhD Program since 2015, has been researching and creating interventions related to the HIV epidemic in the U.S. since 2000 (he’s been on faculty at UMass Boston since 2012). This grant is one of seven federally funded projects which he is currently helping to lead.
With the new NIMH grant, Pantalone is again working with principal investigator Laura Bogart, a senior behavioral scientist at the RAND Corporation, a private nonprofit based in Santa Monica. Bogart is an expert on community-based participatory research (CBPR), in which you engage closely with community members and use their input to help design the intervention. In this type of intervention development, the project is conducted ‘with’ the community rather than ‘on’ the community.
“My job is to make the intervention work—write a manual, hire and train a staff, and then listen to audio recordings of the sessions and do clinical supervision, to make sure that the therapy that they’re delivering stays within the bounds that we’re hoping for—and the idea there is that our work is replicable, so we can say to an agency that we have evidence that says that this program is helpful—we recommend that you use this for your clients,” Pantalone said.
Before this grant, Bogart, Pantalone, and others were part of a 3-year CBPR project called Still Climbin’ in which they worked to increase engagement with care and medication adherence among Black HIV positive, sexual minority (gay and bisexual) men. As published last year in Cultural Diversity and Ethnic Minority Psychology, the intervention worked, so the researchers partnered with Bienestar, a Latino-serving human services organization in Los Angeles, to see if the intervention might be helpful in another population at high risk for HIV.
“For the Black HIV positive, sexual minority men, … there was a lot of focus on the police, the government, and just in general, because of a legacy of medical mistrust that results from the Tuskegee syphilis experiment and other elements like that where the government did research that harmed people instead of helping them, especially Black Americans in the U.S. South,” Pantalone said. “For the Latino men, some of the issues are similar but the medical mistrust piece seemed less salient for them. [They are more concerned with] immigration and bias from health care providers because of being monolingual Spanish speaking or speaking with an accent, or because of their nationality or visa status.
“Our model is that discrimination experiences happen, and then they are a stressor for folks and then the discrimination experiences and the stress that results from them prevent people from engaging with the health care system, so we’re trying to find ways to reduce these barriers to care.”