In 2016, Florida was second only to California for the number of new HIV diagnoses, and it consistently ranks among the top three states for its rate of new infections. The Miami metro area in particular has the highest HIV infection rate in the country, and Jacksonville is also counted among the top ten cities in the United States for its HIV infection rate.
Each year, the number of HIV diagnoses increases in Florida, and with Florida cities leading the nation in both new HIV diagnoses and the number of people over 50 living with HIV, public health researchers at the University of Florida and in peer institutions across the state are working together to help combat the trend.
“One of our goals is to spread awareness about HIV prevention treatments among at-risk communities within the state,” said Robert Cook, M.D., M.P.H., a professor in the department of epidemiology at the College of Public Health and Health Professions and the College of Medicine.
Cook organizes research and outreach on HIV prevention and treatment as the director of the Southern HIV and Alcohol Research Consortium Center for Translational HIV Research. The consortium, also known as SHARC, recently moved its base for operations into the Emerging Pathogens Institute. It is guided by an overall mission to improve health outcomes and reduce HIV transmission among the diverse range of populations affected by alcohol and HIV in Florida.
Established in 2012, SHARC is one of the nation’s five Consortia for HIV/AIDS and Alcohol Research Translation. Although the majority of SHARC’s academics and staff members are based at the University of Florida, researchers at Florida International University, the University of Miami, the University of Central Florida and the University of South Florida are also part of the consortium.
SHARC has several ongoing projects ranging from prevention and treatment research to the effect of HIV on the brain. Since being able to survey and engage with at-risk populations is an important aspect of the consortium’s work, one of its projects aims to address HIV-related stigma and improve HIV-care outcomes, with the goal of reducing stigma and its effect on HIV treatment in Florida.
“When public health officials go into a community identified as having a higher risk for contracting HIV than others, it shines a spotlight on that group that a lot of people don’t want,” Cook said. No one wants to be the city or the community associated with HIV or other infectious diseases, he added.
Taking data collected by the Florida Department of Health, Cook and other SHARC researchers are analyzing it and building upon previous HIV stigma research to make recommendations to state legislatures and public health officials about how best to address HIV stigma when making efforts to reduce transmission or improve the health of those already infected with the virus. SHARC receives support from the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse.
For many people, HIV is both an infectious disease and a chronic condition, and much of SHARC’s work focuses on Floridians who have managed the disease for many years. Previous research has shown that HIV can have a negative effect on cognition and brain function, for example, in people who have been treating their HIV infection over a long period of time. Several SHARC projects use neuroimaging (MRI) to study the brains of HIV-positive individuals in order to better understand the effects of alcohol on the brain, cognition, and the efficacy of anti-retroviral medications.
Long-term HIV infection is also associated with brain inflammation. One project, which challenges a group of primarily HIV-positive Floridians not to drink for 30 days, will assess the impact that significant reductions in alcohol consumption have on cognitive performance, brain functions, and other HIV-associated health outcomes.
Given this connection between HIV and alcohol, Rob Leeman, Ph.D., an associate professor in the College of Health and Human Performance’s department of health education and behavior, will lead an effort to encourage reduced alcohol use and HIV preventative measures among men at high risk of contracting the virus.
“Our particular study is for MSM 18 to 30, and specifically men who are born assigned male,” Leeman said. So someone who was assigned male at birth and now identifies as a transwoman can participate in the study.
Young adult MSM – men who have sex with men – constitute a higher proportion of HIV transmission in the United States than any other age demographic. Leeman’s project seeks to enhance both uptake and adherence to Pre-Exposure Prophylaxis, or PrEP, among young MSM who drink alcohol.
The Centers for Disease Control and Prevention recommends those at high risk of contracting HIV consider PrEP. Studies suggest that daily PrEP reduces the risk of HIV transmission through sexual intercourse by over 90 percent. In Florida, most HIV transmission occurs due to sexual intercourse.
Within the young MSM population, however, the rate of HIV transmission varies significantly. Black and Latino men have a higher rate of transmission than white men, and minority transwomen have the highest rate of transmission. Leeman hopes that a substantial number of people of color will participate in the project.
“HIV is still a tremendous public health risk,” he said. About 40 percent of people with HIV in Florida have not achieved viral suppression – meaning they are still capable of passing the disease to others. Furthermore, HIV comorbidities are worse when the virus is more active in the body.
Given the body’s ongoing immune response to the virus, inflammation may become significant not only in the brains of HIV-positive people but also in other parts of the body – especially in those who have been HIV positive for a long time. With this in mind, Cook and his team at SHARC are currently studying the effects of cannabis on HIV-positive Floridians in order to learn whether it has any positive health benefits. Cannabis is thought to have anti-inflammatory properties, yet given the necessity of the inflammatory response in fighting HIV, researchers are unclear about how much cannabis might benefit people with HIV.
There is a chance that cannabis can lower the amount of virus in the body, however.
“Data in monkeys with SIV suggests that giving them marijuana lowers their viremia,” Cook said.
Written by: Evan Barton