Profile: Sandra Wilson, Ph.D.

A major research focus of the Department of Health Services Research is the prevention of HIV and other sexually transmitted diseases (STDs). The goal of this research is to develop better tools for assessing and reducing behavioral risk and for evaluating HIV-prevention programs, according to Sandra Wilson, Ph.D., chair of the department.

"We started our HIV-prevention studies in 1990, in direct response to scientific findings that HIV and AIDS epidemics were out of control and moving out of populations they were known to affect," Dr. Wilson said.

"It is estimated that $10 billion is being spent each year in the United States on major STDs other than AIDS," she added. "Their preventable complications include cancers, infertility, ectopic pregnancy, spontaneous abortions, stillbirth, low birth weight and pelvic inflammatory disease.

"HIV and AIDS add another $7 billion to this annual cost."

The Practicing Safer Sex Today (Psst!) study focuses on women and HIV. "Each year the proportion of women with HIV increases steadily including monogamous women who do not inject drugs," Dr. Wilson, principal investigator of the study, said. She said women are more likely to become infected with HIV or an STD if they have multiple sex partners or a partner who does not consistently use condoms.

"But women also may be at risk and deny that risk because its acknowledgment would result in a confrontation with facets of their lives that are painful (such as a partner's sexual activity with others) or threatening (such as loss of the partner, or fear of physical or emotional abuse).

"Women need education and potentially other forms of assistance in order to protect themselves against both STDs and HIV. The Psst! educational program was developed with this in mind."

Psst! integrates individual and small-group education strategies proven effective in other HIV-prevention programs and endorsed by the United States Centers for Disease Control and Prevention into a program directed at women who have recently been diagnosed with an STD, Dr. Wilson said. A National Institute of Child Health and Human Development grant is supporting the development and evaluation of the program. PAMF investigators are working in collaboration with the Kaiser Foundation Research Institute, and with Kaiser Permanente Departments of Obstetrics and Gynecology and Health Education in Santa Clara, Milpitas, Richmond and Oakland, Calif.

To test the efficacy of this approach, the research team is recruiting women willing to be randomly assigned to receive either the Psst! program or written information and safer sex materials. Psst! and control participants are being followed over an 18-month period to learn whether they differ in their rates of safer sexual practices, new STDs and health care utilization for conditions that result from STDs.

A second study, "Evaluating an HIV Prevention Program for IDU Women," received funding this year through the University of California's Universitywide AIDS Research Program. Principal Investigator Nancy Brown, Ph.D., and her collaborators are evaluating a small group program for women at the highest risk for contracting HIV injection drug users (IDUs) or the sexual and/or needle-sharing partners of IDUs. This program is being carried out by community AIDS prevention agencies funded by the State Office of AIDS High Risk Initiative.

According to Dr. Brown, "In the United States from July 1998 to July 1999, women accounted for 23% of reported adult cases of AIDS. Among these women, 80% were African American or Latino. As of June 1999, intravenous drug injection was the exposure category for 42% of the cumulative cases of women with AIDS."

Beginning in April 2000, the participating community agencies began to offer a series of four workshops, in conjunction with STD and HIV testing. They hope to teach women how to recognize their HIV risk, access available services, and then initiate and sustain drug-related and sexual practices that prevent HIV.

To evaluate the impact of the workshops on participants, Dr. Brown plans to recruit 250 women who will complete a baseline interview and be followed over a year's time to monitor intravenous drug use and the adoption of behavior that reduces the harm from intravenous drug use. Whether or not the program is showing signs of success will be judged by whether there are changes in key outcome variables, including needle exchange, condom use, reduction in the number of sexual partners, and participation in STD/HIV testing.

The evaluation also will document the experience of providing the intervention through a collaboration involving multiple community-based organizations.

A grant from the National Institute of Child Health and Human Development continues the department's ongoing investigation of HIV-risk behavior among California Latinos and Latinas through a door-to-door survey of 573 Latino couples that include a man, 18 to 40 years of age, who is predicted to be at somewhat elevated risk of sexual infection with HIV. "We are exploring the influences of personal, psychological and social-context characteristics of the partners, their relationship to each other, and their sexual behavior as a couple on the female partner's risk of HIV infection," Dr. Wilson said.

"The study addresses a population showing evidence of increasing rates of heterosexual HIV infection of women and will provide a stronger basis for planning risk-reduction interventions with Latinas."

"HIV risk can be controlled by behavior changes," Dr. Brown added. "Therefore, it is very important to understand the factors that have led to more or less risky behavior."

In addition to making a unique contribution to understanding HIV risk in the context of a couple's relationship, Dr. Wilson and her colleagues have developed a means by which HIV researchers can produce individualized estimates of a person's risk of HIV infection based upon his or her behavior.

"Combining multiple behaviors to produce individualized HIV-infection-risk estimates facilitates several research activities: analysis of sources of infection risk, evaluation of risk-reduction interventions, power analysis for planning trials of HIV-prevention programs, cross-population risk comparison, and analysis of transmission processes," Dr. Wilson said.


Back to top