Sex, Drugs & Science

Judy Tan: Art, Aging & HIV

July 07, 2021 Valerie Earnshaw & Carly Hill Season 1 Episode 20
Judy Tan: Art, Aging & HIV
Sex, Drugs & Science
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Sex, Drugs & Science
Judy Tan: Art, Aging & HIV
Jul 07, 2021 Season 1 Episode 20
Valerie Earnshaw & Carly Hill

Dr. Judy Tan is an Assistant Professor of Medicine in the Division of Prevention Science, Center for AIDS Prevention Studies (CAPS), at the University of California San Francisco. She is a behavioral and prevention scientist trained in social and health psychological theory, quantitative research methods, and intervention development. Judy chats with Valerie and Carly about her work with older people living with HIV, researching the role of romantic relationships in health promotion, and developing a choral intervention. 

Read more about Judy’s work here: https://profiles.ucsf.edu/judy.tan
Follow Judy on Twitter: @JudyYTan

Show Notes Transcript

Dr. Judy Tan is an Assistant Professor of Medicine in the Division of Prevention Science, Center for AIDS Prevention Studies (CAPS), at the University of California San Francisco. She is a behavioral and prevention scientist trained in social and health psychological theory, quantitative research methods, and intervention development. Judy chats with Valerie and Carly about her work with older people living with HIV, researching the role of romantic relationships in health promotion, and developing a choral intervention. 

Read more about Judy’s work here: https://profiles.ucsf.edu/judy.tan
Follow Judy on Twitter: @JudyYTan

Valerie Earnshaw:

I'm Valerie Earnshaw.

Carly Hill:

I'm Carly hill.

Valerie Earnshaw:

and this is Sex, Drugs and Science.

Carly Hill:

Today's conversation is with Dr. Judy Tan, who is an assistant professor at the center for AIDS prevention studies at the University of California, San Francisco Judy's research focuses on reducing health disparities among sexual and gender minority people of color.

Valerie Earnshaw:

We had a great time chatting with Judy about her work with older people, living with HIV about researching the role of romantic relationships a nd health promotion, and about developing a c horal intervention, which became particularly challenging when COVID hit. We hope that you enjoy this conversation with Dr. Judy tan. Dr. Judy tan. Welcome to the podcast.

Dr. Judy Tan:

Thanks for having me.

Valerie Earnshaw:

Thanks for joining us. It's always good to see your face. So Dr. Tan, I am very familiar, more familiar than most with your training background, like your scientific training background, but I thought today that we would start with your training in, in art and music, because I'm less familiar than that, but you dropped a bomb the other day when we were chatting t hat y ou're- did you say that you're a classically trained singer? Is that right? no? Where did I get this from?

Dr. Judy Tan:

Did I never go over that in grad school? Like that that's shocking to me.

Valerie Earnshaw:

Okay we'll break it all down because either I have a terrible memory, which is true, or.

Carly Hill:

Either way break it down for me. Cause I am super excited to hear about the intersection of music and science as someone that's quite into music as well.

Dr. Judy Tan:

I mean, yeah, but I mean, going back to like, I mean, I feel like I bared my soul in grad school, to valerie, you know, adn like other folks. Like grad school was just such a long long time that like we cried together, we got safe together. We ate and we drank together. And so like, yeah,...

Carly Hill:

we're going to leave some time in the podcast for you to tell us more about some of those stories Judy,

Valerie Earnshaw:

Judy, I was reflecting as, before you were jumping on. That this is our 15 year anniversary. I don't know if you realize this. I don't know if this is like the year that we got each other diamonds or wood or steel.

Carly Hill:

puppies.

Valerie Earnshaw:

Puppies! This year we'll get eachother puppies.

Dr. Judy Tan:

I'm so down. It's really 15 years? Goodness gracious

Valerie Earnshaw:

I know, right? 15 glorious years who wouldn't want to know Dr. Judy Tan for 15 years.

Carly Hill:

Think of all the glorious science you guys have accomplished in those 15 years.

Dr. Judy Tan:

I don't wanna.

Carly Hill:

So then Judy was Valerie misremembering? Are you not a classically trained singer?

Dr. Judy Tan:

I am a classically trained singer. Although I would say that almost feels like a past life because of how all consuming unfortunately, this, this line of work is that I don't get to tap into that part of my life, but it's also been really exciting to be able to use a little bit of that right. In the science and the proposing of the science. And you know, even in like bio sketch, which is like, kind of your introduction, like resume, you know, like with, uh, in your grant proposal, I literally had like a one line thing right. In my bio that was like something like, and you know, and the PI, the principal investigator has been trained in classical music, whatever. And like the reviewers were like,"oh my God", that was lucky that they like loved it. Right. So it was like, okay, I can be, you know, like, you know, like in academia I feel like you're not always encouraged to, to be all the intersections of yourself. Right. And so, and I learned very early on, I learned very, you know, very well to do was to compartmentalize and to, you know, to code, switch in different settings and to really, you know, speak the language of the room and, you know, and, you know, code switch. So we moved around a lot cause we just, my parents were poor and we didn't have housing, um, regular housing. So, um, I spent a couple of years in long island, which is part of like New York state, which is weird. Right. Cause it's like, it's like long island and then like, and then like New York city and then like that connects it to the rest of the New York City. Anyway. So the New York school system was like really great. And I go like, go back to like, you know, I'm leaving back to Queens and then I'm like, okay, what do I do now? Right. Like, I, I was in middle school, I just finished eighth grade. So I went to, s o I had to like, u m, usually in j unior high school in the city, what you can do is, and you know, by the time you're eighth grade, you c an a pply to, y ou c an go into high school. So you start your ninth grade in high school, or you could like stay behind at a junior high school and like just, you know, like hang out for another year before going to high school. So I had no choice. I had to like, y ou k now, stay within the junior high school systems. So long story short, I h ad, I must go to a specialized high school because-

Valerie Earnshaw:

"I am Judy tan, and I'm going to a specialized high school!"

Dr. Judy Tan:

I feel Like that was the only way to succeed was to.. yeah like go and like, you know, do something like special, right? Like, like that was, it helped me stand out in college applications.

Valerie Earnshaw:

mhm.

Dr. Judy Tan:

I like Failed to get into like, you know, the top three, like the science and whatever, the science and math, like scientists in Brooklyn Tech and Bronx Science that you had to like test into that was like math and science. And then like, and then like LaGuardia high school of music and art and performing arts, the"Fame" high school, you know, I also was like, why not? You know, I don't even remember how I made the audition. I just like did it. And I'll so little known fact. I also, um, audition for a dance program. This was how good... was not at LaGuardia, but at Bayside high. So, um, this was how good the school system was in New York state compared to New York city was that like, I had all these extracurriculars and I actually like got a good amount of like dance training, well enough that I actually got into a dance program at, you know, at, uh, Bayside high. So that's an aside.

Valerie Earnshaw:

Wow. Well, I'm going to need to see that next time we're at a conference. Not at conference, you know, in the evening,

Dr. Judy Tan:

Yeah

Carly Hill:

Pliés and whatnot.

Dr. Judy Tan:

So I go to the audition, the audition... by the way, I'm like taking the really long story.

Valerie Earnshaw:

Well, that's what we're here for, we're here for the long road.

Dr. Judy Tan:

So I go, and I remember walking into the room, like there were like kids like lined up in the hallway. Right. It's kind of like glee. Right. I've never seen glee by the way. But like, it's kinda like, you know, like a Glee scene.

Carly Hill:

Right. Judy, I also went to an art high school and it's so funny. Cause I was just going to say, it's like Glee like that audition when you, when you go in, like, there's just like piles of kids, like doing different, you know, like some of them are sketching. Some of them are seeing like practicing different show tunes and you're just walking around, like what did I get myself into?

Dr. Judy Tan:

Yeah that's so cool. Which, um, where, where did you go?

Carly Hill:

Cab Callaway school of the arts. So it, same thing though. I don't really know how I got in or, or remember much. I think I just, I actually know that I just winged the whole audition. Yeah. My parents weren't big on back to school night. So they like didn't know about like the roles for the audition, like before I showed up. So I was like, well, I'm just going to like wing it on the drums. And the guy was like, no, you're not. And I was like, oh, okay. All right. It was a totally weird thing, but anyway, sorry. So you go in and they're like, you know, it's like glee in there.

Dr. Judy Tan:

Yeah. And I remember, you know, folks were like really nervous. And then I was like,"wow!" I didn't know, you know, like, it was like, whatever. So I like, like go in and like there would be two teachers sitting behind the desk and then they were like, okay, we'll do this. So we did like rhythm and we did like, they played notes and I like had to like sing it back and like whatever, all these like different things. And then I started to sing, uh, sorry, can I curse? Like friggin Barbra Streisand's like, I don't even know. Like I read her biography when I was like in, I don't anyway, I grew up in New York.

Valerie Earnshaw:

A middle school superfan of Barbara Streisand is auditioning[inaudible].

Dr. Judy Tan:

And like this, this like really big scary teacher, the male teacher was like,"stop, stop right now. Stop it with like the crescendos" or whatever. I don't know what he said, but then he was like, yeah, whatever. And then he like made me sing something else. And I was like, what do I sing? So then I like started singing like star Spangled banner. What else do I sing. So I sang that and then they were, they were obviously pleased because like no one asked me to stop. So, um, so then I like leave and I'm like, I don't know. My mom was like downstairs. My brothers, my twin brothers are like crying in the car. My mom was downstairs, like parked somewhere. And then like, it's like, okay, let's drive home to New York anyway. So it was a crazy experience. I was only there for, you know, you could be there for four years, the full four years, or like three years. I was there for three, from nine to 12. It was a really amazing experience because it was in the city. It was right behind the, uh, Julliard and, you know,

Valerie Earnshaw:

wow.

Dr. Judy Tan:

y eah. Like it was on 6 6th and Broadway, which is one block over from like all the, you know, all the c onstant n ews calls and whatnot in u pper west side. But I remember I needed to wake up in like, like the crack of Dawn to catch the bus, to get into flushing and take the seven train to t ime square, and then t ransferred to the one or the nine back when there was a n ine uptown. The... like one way was like an hour and a half.

Valerie Earnshaw:

Oh, oh. And you're a high school or you're in your ninth and 10th grade. I mean, yeah. That's really young to be, make it a city for art school. Yeah. Okay.

Dr. Judy Tan:

Well, I mean, and to get there by like 8,

Valerie Earnshaw:

oh yeah, y eah, yeah.

Dr. Judy Tan:

And then there were kids like from you know well, but then, well, the special was that, like, it wasn't, it wasn't like your typical high school experience because folks were not, folks, like didn't like hanging out after school. Right. Like we just like, last bell everyone just like dispersed right.

Valerie Earnshaw:

Hour and a half home.

Dr. Judy Tan:

Yeah they're like"Cool. You're like in New York city", I got back on the train and like went home and babysat, but you know, like I had friends who like lugged their cellos from Staten island, you know? And here I was complaining about taking the bus. Right. Like it was so anyway, so I met friends across, like who were instrumental music majors who are art majors who were drama majors. And I think I met a couple of dance majors, but like, they were like all very skinny and very like exclusive, I don't know if they were like different.

Valerie Earnshaw:

Yeah. It is interesting to hear about how this whole like high school clips thing plays out, but in arts, art and music, well, cause yeah, it's like, it's like the same thing, but yeah.

Carly Hill:

But also super different.

Dr. Judy Tan:

And then I continue training in college, um, by taking courses, like voice lessons basically, and then actually audition for after college audition for a musical in this, you know, Val, because by the time the musical was in production, I was already in grad school and yeah, I would like roll in from Boston, like into stats class with like paint my hair still, you know, like I played a 56 year old, um, Cantonese mom. So I had to like dye my hair white or whatever it was. Yeah. It was super fun. Super memorable. But yeah,

Carly Hill:

doing a production and being in grad school was probably like, you probably had 0.0 spare seconds. Like that whole entire period.

Dr. Judy Tan:

Yeah. But at the same time, it is also kind of, one of those are the things I still remember one of our mutual colleagues and friends, Stephanie, I remember her saying Dr.[inaudible] saying that know, those are like the kinds of things that, that he could view actually successful that, you know, because those things are the things that ground you and the things that keep you who you are and who you are is what will carry you through. Right. The science work, you know, the good and the bad. Right.

Valerie Earnshaw:

That's so that's so true. Yeah. And I mean, that is sort of nice to have maybe that grounding, particularly during your first semester of grad school. Cause that's, that is, for me, that was like a wave big wave of imposter syndrome. I think I experienced so much imposter syndrome my first like semester and year that I just got it out of my system for my career. It was just, you know, so to have this other piece of your identity that you can come back to and this thing that you're good at, that feels like a powerful thing. Despite having zero extra minutes in your day and you know, Boston to university of Connecticut, where we were at for graduate school, that's like a two and a half hour commute. That's no joke. Two or maybe two hours to get back and forth.

Dr. Judy Tan:

two hours it was...

Valerie Earnshaw:

Maybe it's maybe it's closer than I remember. Yeah,

Dr. Judy Tan:

definitely not two hours and a half hours, But yeah.

Valerie Earnshaw:

So just to catch folks up a little bit, you were in Boston after you did undergrad and you did undergrad at Mount Holyoke, you were a psych, psychology major, but you were living in Fenway or sorry.. You were living in Boston because you were working at Fenway Health, which is a place that's known for serving sexual and gender diverse populations providing healthcare. And they also do a lot of HIV related research. So when I was kind of thinking about your trajectory, I was wondering, is this where you became interested in HIV research or did you have that interest earlier on?

Dr. Judy Tan:

So I had zero zero experience, right. And HIV, and I happened to apply for this for a job that was, you know, being a research assistant at Fenway to do this study that was looking at retention and care in folks with HIV who had left the clinic. So I was like calling a bunch of people who had already left clinic. And sometimes, you know, you would get people who were like,"boy, this is a blast from the past." Or like people were like,"let me tell you why I left." Right. Or like you get folks who were like,"oh yeah, well I just moved" you know? So yeah.

Valerie Earnshaw:

So that probably inspires you. I mean, so then you're applying for graduate schools and you apply to come to university of Connecticut and that's where we meet somewhere. You know, they, I guess listeners already know that was 15 years ago. So, so, and that's where, you know, we both, we did a social psych program. You and I did some focus training on HIV with Seth talisman who we've talked to on here. But if we fast forward a little bit, because I've got to like quick, get us past the opportunity for any more like stories from grd school. Uh, you end up having this like really nice merging of your background in art and singing with, uh, your HIV science, because you're currently working on a choral intervention for older adults or sort of older people living with HIV, correct?

Dr. Judy Tan:

Yes. So this was something that, um, actually was really like, it was an amazing thing that I was just, I was in disbelief that, that no one had actually proposed before we actually proposed it. But yes. So how the proposal came together was okay, so here, here, we have this group of people for the first time, since the beginning of the epidemic ever, um, getting older and then experiencing all these new things that like, we had no idea that they would experience because for the first time ever, you know, like since the eighties, since the epidemic, they are living with it and aging with it. So what to do, right. What to do with these, uh, with these folks,

Valerie Earnshaw:

I was reading, it was just to say, I was reading a bit of your, um, your work in this area. And I was really impressed. I mean, it's estimated that by 20, 30, 70% of people living with HIV will be 50 or older, like that's a big chunk of people and some of your work, you've also written about how people living with HIV are like, uh, are at increased risk of like a variety of different chronic illnesses probably due to HIV and the medications that people take for HIV. Right? So anyway, you just really make a good case for why it's important for people to focus on older, you know, older people living with HIV.

Dr. Judy Tan:

So for folks not with, you know, who are HIV negative, you know, the, the syndromes are frailty, the cognitive impairment. If you experience any, they occur later on in life, right? Like six- in your sixties, seventies, eighties, even for folks living with HIV that occurs... those symptoms may occur. And they occur earlier in life as early as in their forties and their fifties. That's why 50 is a benchmark age.

Valerie Earnshaw:

Okay. That makes a lot of sense,

Dr. Judy Tan:

Premature, you know, aging symptoms or syndromes occur earlier for folks with HIV. So I look to the literature and what, you know, what was interesting was, you know, older folks, you know, by the time they're older, they're like, I got my meds down. I know what it's like to live with HIV. You know, I've got this down. Right. So like the social support groups for people with HIV were not appropriate. Like they were like,"this is not really relevant, you know, like for a person newly diagnosed, like this is like where they need to go, but I'm, I'm good. What I would prefer are getting together with folks like myself and talking about how to live my golden years." Right. But also talking about the trauma of and the guilt of having lived while others have died. Right. And I think I looked at the social psych literature and looked at how I came upon this, um, this body of literature that, that really never got kind of intervention-alized, like made into an intervention right. Like it was, it was a, um, a body of literature that really suggested a mechanism of action that, um, to, to confront and to deal with the effects of stigma that building up pride and building identity, social identity, which was our jam. And it was a way of ameliorating, right. Mitigating the effects of stigma on psychosocial health. So that was like,"DUH!" but then I was like, oh, okay. This needed to be said, and like this needs to be applied. And then this needs to be like, looked into, oh, and then that body of literature looked to singing and art and music as a way of building as a way of building pride.

Valerie Earnshaw:

Identity.

Dr. Judy Tan:

Identity right. So I put- Yeah. So they loved it. The reviewers loved it. And it was, yeah, it was funded on the first try at seven percentile.

Valerie Earnshaw:

Gosh, that's nuts.

Carly Hill:

What does that intervention look like? Like tell me, like, I want the nitty gritty of like, how did you carry that out? Like, what was that? As someone that does like the data collection for the lab primarily. Like, I would just try to think about how I'd even do that. And what does that look like?

Dr. Judy Tan:

Yeah. It's happening now? The current, yeah. It's a, it's a grant that's currently happening. And so a lot has been stalled when we got funded because of the pandemic. And, um, the proposed intervention was a once a week rehearsal for an hour or so. Um, we've proposed to adapt an intervention that actually showed efficacy. And in the general population of older adults. We proposed to adapt that for folks with HIV or 50 and older to kind of test that hypothesis. Right. And then it's a once a week, you know, uh, intervention that, um, was an hour-ish long. And then there was a, like a, maybe 10 or 20 minute break in between that was like for socializing. So, you know, so the, the idea was that, you know, you get folks into a regular routine, you get them to meet new people, to gain skills and learn new material, you know, and to, you know, and, and then during rehearsal, you're actually, you know, engaging different cognitive functions. You're, you're clapping you're on your feet, you're breathing. So those are some physical aspects. And then there are also social aspects, right. So then the pandemic hit and there were like, uh,

Valerie Earnshaw:

yeah,

Dr. Judy Tan:

so then we're like crap. And then whole bunch of crap went down and with the project officer and whatever, and fast forward to now, we are transitioning to a virtual platform, which obviously is wrought with lots of issues. The most obvious thing that, you know, can you really be social? If the primary outcomes are loneliness and social isolation, can you really actually address those- move the needle on those outcomes? You know, virtually, you know, on a virtual interaction basis. Right. I highly, you know, like I'm like, well, but also an interesting scientific, empirical question, right? Which is why like I hate the word, social distancing. Cause I'm like, I'm not socially distancing. Like I'm physically distant. I'm socially connected. Right. So like, to me, it's an empirical question. I don't have a whole kind of whole, like, I don't want to put all my eggs in that basket, but I do think that you can't, we can, we can be socially connected. It's, it's arduous, it's a tenuous interaction, but I think it could be done. It's the best that we can do.

Valerie Earnshaw:

I think it's smart to take the approach of, you know, like, like it's an empirical question as to what's going to happen now that we've been dealt this deck of cards and let's see what happens to our study under these circumstances. But if we take a step back just to the idea of a choral intervention to kind of combat social isolation, I, I am not a singer. I do not sing with other people. If I can help it,

Carly Hill:

but she's going to debut her first song right now on this podcast.

Valerie Earnshaw:

I'm really not. And Judy is she, it is no joke. I mean, she's a wonderful singer. We did go to karaoke nights and she would always bring down the house. It was amazing. But one of the things that I think about when I think about this intervention is, you know, not only this like piece of building a different identity and the social support that you're going to get, but just what it almost physically feels like to combine a noise that you're making. So in this case, your voice, or I've had this experience playing the clarinet when I was like in high school in band, like what it actually feels like to combine your sound with other people's sound and to like, what happens when that lines up, when you fall into tune with each other. And then also when you create, like, when you actually create music, you know, and I just think that coming together with other people and in this case with other people who different from you in some ways, but similar to you in like their experience of living with HIV and creating this like beautiful thing together, whether it's, you know, in this case it's music, but you could extend this out to other forms, art. I just, I think that there is something like really unique and special about that, that like, I wouldn't expect to see in like the boxes in lines figures, like there's like a little bit of like magic dust spread on top of it. That's hard to put my finger on like, exactly, exactly what it is. Does that make sense or ring true?

Dr. Judy Tan:

It makes sense. And you really hit i t on the nail and you've articulated kind of the magic of it. Right? Like i t's, it's o ne o f t hose things that like, m ake some people like give some people heebie-jeebies right. Like, like you d on't as a scientist you don't want to be like, u h, it's like magic, right. So much. Right. That we don't know. And like, we're trying to wrangle the world into like these like weary, you know flat pieces of understanding, but we understand so little, you know, a nd, and I've spoken with some neural- neuro people, neuroscientists. They're like, yeah. You know, like this, this part lights up a nd that part lights up. And I'm like, yeahhh.

Valerie Earnshaw:

but what about the feeling when I'm into someone else? Yeah. Or like, what is that culmination of? Right. It's a combination of things, right? Like it's a, it's almost meditative. And I think a lot of it is meditative, especially, you know, for folks who have been through trauma, not just, you know, the trauma of living through HIV, but a lot of folks who are disproportionately affected by HIV tend to come from disadvantaged backgrounds. Right. Like marginalized communities and black and brown folks. Right. And so, you know, and, and, and through this project, I encountered a lot from the community where there's a lot of they're teaching me and I'm like, I'm like,"okay, teach me. But like, oh God, this is so difficult." Like, you know, people are like,"I want gospel music. I want church music. The church rejected me, but I also belong to a church. I want to, you know, like I also want that I want to sing in, I want to perform it." And then there are also obviously tensions from, from white folks who were like,"I don't identify with gospel music. I don't want anything to do with church". Right. And then there also black folks are like,"I don't want to do anything with church. I left church for very specific reason". So spiritual singing and the spiritual aspects of singing. I think it's like, no one knows, no one has any idea. Right. Like, you know what, you know, gospel music, like being in a, you know, it's almost trance-like. And then there's also like the history right, of spirituals and in gospel music and that connection that you have with, folks that look like you. Right. Like, that's so powerful. So it's like, so like layered, I have no freaking clue. We're like,"okay, we'll just measure like personal control and centralize[inaudible]"

Carly Hill:

l ike o nly make t hem sing like row, row, row, your boat or something, and we'll figure it out.

Valerie Earnshaw:

It's so cool. It's really amazing, Judy. I mean, hopefully your plan is to see what happens on zoom with[inaudible]. But there, it seems like there's a lot here to be dug into for future, for future projects funded or unfunded, or, you know, look forward to seeing where it goes.

Dr. Judy Tan:

Yeah and older folks are just hilarious. Like, they're just amazing. They're like,"I'm not stressed out about nothing" or like, they're just colorful. It's just, they're great. They're amazing people. Yeah.

Carly Hill:

Right. Yeah. It'll be interesting to see how that population adapts to like singing over zoom. That was like one of the first things that I was thinking about is like, what if someone has like a glitch and then they're a beat off, and that throws everybody off. Like what all these different things that we like these different, um, I guess like barriers to completing it, but, you know, you wouldn't have had to otherwise consider so good for you for rolling with the punches there.

Dr. Judy Tan:

Well, I mean, it's all the community and like the community, these churches and these groups have already figured out, pre-screened ways of doing it, like before we even... like, they've done like literally they YouTube it, and then like, you'll see these like virtual concerts, like from churches and community groups. And it's like, they figured out how to do it.

Carly Hill:

I know I'm so amazed when that all comes together like that. That's so neat.

Valerie Earnshaw:

All right. Well, I want to transition us over to thinking about your work with couples, because I think this is a really, like, it's another really innovative and different part of what you're doing. So most HIV research is done focused on individual people like, and including our interventions, it focuses on individuals, but much of your work dating back since grad school focuses on couples or dyads. So dyads are two people. So could you talk a little bit about why it's important to focus on couples or, or, you know, two people at a time? Why do you think that's been overlooked, you know, overall in HIV research? I mean, I know that people are doing it, but in comparison to all of the work that we have that focuses on individuals, there's a lot less, you know, that focuses on people and couples, or two people at a time.

Dr. Judy Tan:

Yeah thanks. So, um, like there are so many times I can't tell you how often I will think and like chastise myself for not paying attention or enough attention in like, you know, and like Dave Kenny's class when he's talking or like, you know, like the APIM and, you know, all like all these other, like the social relation model, like i t just like my, I would just like, be like, okay, okay. Okay.

Valerie Earnshaw:

I think most grad students are in a little, in, over their head in their stats class with a pretty big deal, quantitative person leading the class. So, you know, we'll, we'll let you off the hook.

Dr. Judy Tan:

Yeah. Yeah. I'm trying to think. I mean, I wasn't really super big into dyadic research actually in grad school until I think until like, I mean, pretty much my post-docs well, for some reason I thought it was a little earlier, but, okay. So it was in your post-doc. I think,

Valerie Earnshaw:

I'm getting everything wrong today, by the way,

Carly Hill:

15 years huh?

Valerie Earnshaw:

Classically trained! you started doing dyad research in high school!

Dr. Judy Tan:

I think what got me interested was in thinking about actually power basis theory. So power basis theory was this theory about power, uh, that I co-developed with my graduate advisor, uh, Dr. Felicia Prado. And it was, uh, it was formative for me because I think a lot about that theory when I think that people, and I think that like social psychology. So, um, and then also I'm also, you know, I, I've also been like hugely passionate, I guess, about how social inequality impacts health. Right. And so I look at communities of color, I look at communities at the intersections of, you know, gender, race, sexual orientation, you know, like all these different, um, demographics, right? Like, and so I started to look into African-Americans, um, and specifically black gay men, and then folks were not really, you know, it's just people weren't really doing dyadic research with black gay men. You know, there's like in the literature, we talk a lot about whether two partners, you know, when they're in a relationship together, one is positive. One is negative, both are negative, and you know, how do you get them to stay negative? How do you get the negative partner in, you know, in a relationship where there's also a positive partner, how you get the positive partner, you know, or the negative partners to stay negative. Right? Like there's a lot of that. Right. But, um, a lot of the focus, a lot of my research actually focuses on sort of concordant positive couples where both partners are, are positive and then how they manage their care, what are their points of like engagement, you know, um, where they helped support each other and where they kind of like, you know,"leave me alone"

Valerie Earnshaw:

I really liked, in one of your papers, how you, you talked about relationships can be a support, or it can be a source of either support or challenge in chronic disease management. I really thought that was super well-stated kind of considering like a relationship can be a good thing for you in your, you know, seeking medical care, taking your medications or, or it could be something that gets in your way. And I thought that that was a nice framing. And the other thing that I really liked, um, in one of your papers is you characterized involvement of partners in each other's HIV care along these two sort of axes. So it was"how involved are they?" and"how reciprocal is the care?" And I loved it because then you get these four boxes. And so you talked about, there's like a mutual box for both. Partners are very actively involved in each other's care. You got to got a peripheral box, or both partners were like peripherally or involved on an as needed basis. And you have an asymmetric box or one partner describes being more involved in care than the other partner does. And then you have an independent box where both people are just like, kind of un-involved and they're both doing their own thing. And my favorite, you had these four boxes. And my favorite was the asymmetric box, because you had these lovely quotes from this couple where the one was like the one couple, the one member was basically saying like,"yeah, I schedule his appointments and I make sure he takes his meds and I do all the cooking". And then you talk to the other partner. And the other partner was like,"yes, he does all of the cooking. And I think you asked like, well, would you ever want to? And he was, and he's like, well, yeah, maybe, but it's great that he does it". It was just, it was like a really nice, nice and intuitive way of like categorizing what those different, um, combinations can look like for people, you know, in this type of relationship.

Dr. Judy Tan:

You know, I tend to credit our training, um, our training program. I think a lot of the theoretical training that we got, you know, or, I, and I somehow knew that that asymmetric would be like your favorite. And I was like, asymmetric.

Valerie Earnshaw:

Yes. Everyone's like, come on mutualist sort of boring, and dependent is... asymmetric there's like something there.

Dr. Judy Tan:

No, I mean, I, my big thing about couples research is yeah, exactly that. It's that like, when we think... in the literature, it's like, it's a very white people focused perspective on the relationship, the relationship, you know, either you... there's intimacy, trust there's commitment. There's like, there's all this like fluffy stuff. That's like very Western relationship types. That's not, that's not at all my parents' relationship. That's not at all, a lot of different people's relationships. Right. A lot of times you're in a relationship to survive. You're in a relationship because this partner brings something that you don't have. Literally. Right. That you need in order to live. Right. And so what about those relationships? Like what about those relationships? How do people leverage their relationship and their relationship partner to meet their needs? Right. So, so that's what, like, that's what, like, I'm really intrigued more interested in, rather than the fluffy stuff. I'm more interested in leveraging and the survival and the resiliency, right? Like, to me, that's resilience. Like if you just stay together with a partner, you can't stand, but that partner helps you survive and you help each other survive, but you can't[inaudible] like that is some like weird, but like, you know what I mean? Like,

Carly Hill:

Your totally right. It is good because a lot of people would just call it quits. It's like the Western white person way of thinking about it. Right. Like you just go, you just get a divorce. Why wouldn't they just call it quits?

Dr. Judy Tan:

And then my parents would be like, that's not even relevant. Like, that's, that's not something that we do.

Valerie Earnshaw:

And it calls into question, like, what is the goal of a relationship for different types of people. And I mean, that was really powerful for me to hear you say that. Yeah. A lot of the, all of the, you know, research on relationships is through this lens of like white middle class people, college students who- and yeah. That's just so not reflective of most people's relationship. That's just, that's a really powerful observation, especially then when you layer in, who are the folks who are living with HIV. And then if you add in like the age layer with all of that trauma, that especially, you know, some of your qualitative research highlights in this like beautiful and heartbreaking way of just like what it must be like to live through your twenties and thirties and lose all of your friends. And now you're in your fifties and sixties, and maybe you're in this partnership. And what does that partnership mean to you? And how do you yeah. To think about that as like, how do you leverage that for, for lots of different needs, maybe happiness, maybe survival, maybe, you know, whatever it is. That's really interesting Judy, to like to think about all of those pieces coming together.

Dr. Judy Tan:

Relationships are not always, you know, happy, but sometimes they're a means to an end for a lot ofpeople, and then there are like some of the strongest relationships I've ever seen in, in some of the participants. I mean, it's just the amount of things that they're willing to share. I mean, it's such a privilege and I'm like, oh my God, like, I hope I do this justice. You know, like, it's just, you know, it's like amazing. It's amazing that people give and they give based on just a bit of interaction that they have with you. Right. It's so much faith that they have in you in that short interaction that you have in the interview room. Yeah. And just strong, strong people, just really resilient, strong people.

Valerie Earnshaw:

I feel the same way about, you know, our participants. We were joking about this, uh, yesterday with Carly about, you know, people coming in and her being like"come to the back room and share with me all of your secrets"

Carly Hill:

because I got a Wawa gift card for you to come back and tell me everything, like.

Valerie Earnshaw:

all your secrets,

Carly Hill:

all the secrets you have.

Valerie Earnshaw:

In your whole entire life. Like, let's go get it.

Carly Hill:

You feel pretty low. Tell me everything you got about that.

Valerie Earnshaw:

Well, Judy, I was also wondering, as I was thinking about, you know, in grad school, we all got familiar with the saying of research is me-search. So you are in a relationship you're married to the wonderful Mike. Is there any bleed over from being a relationships researcher into how you think about your own,

Carly Hill:

Do you just come home after like interviewing those powerful couples. And you're just like,"Mike, we have nothing on them". Like we're never going to be, what does that look like?

Valerie Earnshaw:

Does mike get tired of being put into a quadrant. I mean like,"no we're being too independent or asymmetrical. We need to move into mutual support"

Dr. Judy Tan:

Guess which one is my favorite because I know a lot, like I'm super sensitive to those dynamics, right? Like, yeah. And I think we all are as, as a function of our training. I don't know what it is about that frickin program that like, we're all just like super... yeah power dynamics. So Mike, Mike learns a lot. Um, and I, I do too. I try. Um, so I think, I think so far it's working,

Valerie Earnshaw:

you're still married so A+ All right, Judy. Well, um, I so have enjoyed these 15 years of, of sciencing along together. Um, I really, I really love how you are coming around to bringing these different pieces of yourself back into your work. I mean, these, these two examples of, of, you know, the choral intervention and then noticing like a mismatch in the literature between, you know, your experiences, what you observed with your parents and like the reality of what you know, of what participants are experiencing versus the literature. It's like, that's a really wonderful way to bring yourself and your perspectives to the research. And so it's so lovely to talk to you to hear more about it. Thank you so much for sharing your time with us. And I can't wait to see how these two lines of research and others continue to, you know, progress over the next 15 years.

Carly Hill:

I'm sad that we didn't get to, uh, get to any of the Val grad student stories. Um, but maybe I'll, I'll try to pitch that in for maybe the intro or the outro for this episode and work it in somehow.

Valerie Earnshaw:

next year,

Carly Hill:

that's true. Yes.

Dr. Judy Tan:

I want to come back and talk about this, but I have such love and respect and heart for one Valerie Earnshaw. I think that I think the world of Valerie and I'm thrilled to be, you know, um, I'm so I'm so honored and glad that you both are doing this and I'm thrilled that this is something that you're doing. This is something that is so true. Um, you're giving voice, you know, to a lot of things that you don't typically talk about. Right. And yeah, it's wonderful. It's just a really creative and fun endeavor that is so important. So thank you both.

Carly Hill:

Well thank you, Judy. It wouldn't be possible without guests like you.

Valerie Earnshaw:

Yeah. Thank you. Thanks to the stigma and health inequities lab at the university of Delaware for their help in the podcast, including Sarah Lopez, Molly Marine, James Wallace, and Ashley Roberts,

Carly Hill:

Thanks to city girl for the music. As always be sure to check us out on Instagram at@sexdrugsscience, and stay up to date on new episodes by clicking subscribe.

Valerie Earnshaw:

Thanks to all of you for listening[inaudible]