Seth Kalichman & Lisa Eaton: HIV Prevention & Treatment

Dr. Seth Kalichman is Professor of Social Psychology and Dr. Lisa Eaton is Professor of Human Development and Family Sciences at the University of Connecticut. Seth is also the Editor-in-Chief of the journal AIDS & Behavior and Lisa is an Associate Editor. Seth and Lisa tell the stories of how they became interested in HIV research, share best practices for collecting data at Pride, and think about how to apply lessons learned from HIV research to COVID-19. Seth issues a public apology to Anthony Fauci, and Valerie learns that she’s technically living in the South.

Read more about Seth's work here: https://chip.uconn.edu/person/seth-kalichman-phd/
Read more about Lisa's work here: https://hdfs.uconn.edu/person/lisa-eaton/

Read Lisa and Seth's paper on applying what we know about HIV to COVID here: https://pubmed.ncbi.nlm.nih.gov/32333185/

Transcript

Valerie: 0:08

I'm Valerie Earnshaw.

Carly: 0:09

And I'm Carly Hill.

Valerie: 0:11

And this is Sex, Drugs a nd Science. Today's conversation is with Doctors Seth Kalichman and Lisa Eaton, who are professors at the University of Connecticut. Seth is also the editor of AIDS and Behavior, which is a popular journal for sex and d rug science. And Lisa is an associate editor.

Carly: 0:27

Now guys, this episode is creaky. Seth was sitting in a very creaky chair. So the way to think about it is when Seth got more excited about what he was talking about, he moved or rocked his chair a little bit more. So if you don't hear the creak that's because Seth was not interested in what we are speaking about.

Valerie: 0:42

So we hope that you bear with us on this and just know that the most interesting parts are going to be a little bit creaky today. All right. Seth and Lisa, so happy to connect with you two today.

Carly: 1:10

Yeah. Thank you guys so much.

Valerie: 1:11

Yeah.

Lisa: 1:12

Happy to be here.

Valerie: 1:14

You are this tremendous science team. I feel like this is really like, you know, science squad goals right here. I really admire how you work together and I'm just, I'm excited to be able to, you know, talk to you both today at the same time for this podcast. So thanks so much for making the time.

Seth: 1:34

Well, thank you.

Valerie: 1:36

I thought that maybe we could rewind to the beginning and talk about how we got interested in HIV research. So maybe starting off with Seth, how did you get into the field of HIV research?

Seth: 1:54

Well, that was a long time ago. So I, I actually, as a, as a graduate student, wasn't interested in HIV at all. I was aware of it. This was back in the in the 1980s. And so, as you know, HIV was just coming to be, the national problem, that it is, the global problem that it is. And I was aware of it, but it was really, in my mind and in our national reality, was a gay men's disease. And what I was interested in was two things. I was interested in cancer and the psychological aspects of dealing with cancer and cancer treatment decision making and how you sort of navigate coping with cancer. That was really the direction that I was going in. And I taught as a graduate student, a course in human sexuality at the University of South Carolina to large number of students. So in human sexuality, there was, we did cover AIDS, but it was less than a page in the textbook. And it was a gay men's disease. That really wasn't something that we, we spent very much time on, but I'm a clinical psychologist. And I went on my clinical internship, and by, just by chance, I was assigned to, I didn't request to work with a guy who was doing HIV prevention research, and this was in 1989. And when I met him and saw the work that he was doing, it was obvious to me that, um, he was a real pioneer in that work he was doing was really important. And that, that, uh, the things that I was interested in at that time, actually, I became interested in sexual assault and sexual violence. I thought I might be going in a direction of a forensic psychologist, as much as a health psychologist. So I wasn't really certain where I'd end up. And as soon as I met him and saw the work that he was doing, I just dropped everything else and never looked back. So I started working with Jeff Kelly, who turns out is a pioneer in HIV prevention and HIV prevention research, and just wanted to become him.

Valerie: 4:27

And now here you are! Editor of AIDS and Behavior, well known HIV, social behavioral scientists. So maybe you're not Jeff Kelly, but you are the Seth Kalichman. So well done.

Carly: 4:39

I said,"You're the first person that we've interviewed who has their own Wikipedia page,".

Seth: 4:45

I do.

Carly: 4:46

Yeah.

Lisa: 4:47

Isn't this your like, second podcast?

Seth: 4:49

I, well, I didn't know. I don't, I didn't know that I did though. I think that the AIDS Denial is actually set up, so I don't really know what's on there.

Valerie: 5:01

We're going to get on and update it with everything we learn after this podcast.

Seth: 5:04

I guess I should probably take a look at that.

Valerie: 5:06

Y eah. All r ight. So eventually you land, you know, you move around a little bit, and eventually you land at the fantastic University of Connecticut and you're teaching there. And so, so Lisa, how did you, did you become connected with Seth when you were an undergraduate? Because I know that you w orked together when you were a grad student.

Lisa: 5:29

Yes, I did. I, I, well, I h ad a lot of interests. I had a lot. I think I started as like, an equestrian sciences major...

Valerie: 5:42

That you were a horse science major.

Lisa: 5:45

....criminology maybe, nursing, but there was no, but I had never, I mean, I think the type of work that we all do, you don't get exposure to it's, it's not... I don't think like as a 10 year old, it's an obvious job.

Valerie: 6:02

Right.

Lisa: 6:03

But part of me, and maybe this is just me being like egocentric, but I'm like, who, like,"Who wouldn't be interested in like global health?" I mean, I don't know. It's just, it is fascinating to think about like affecting like health on a population level across the globe. And, you know, it is like what, like uniquely links us is that like, we're all vulnerable to poor health and we all value wellbeing. So, anyway, so yes, I did. I went through a lot of majors, but then when I met Seth, I, you know, I was able to see like in a very practical sense, like how you could do global public health research. And I was just really fascinated by it. And Seth had, I was really interested in the South Africa work, and I was really interested in the country, and I was really interested in the dynamics of the culture. And I think I just, I just loved learning about it. I love learning about it. And so I had started working with, I think, as a junior and, and I had like the most basic of tasks, but I loved it. And, you know, it was like taping receipts and scanning documents, but like, it didn't matter to me. I didn't care. I would have done anything. So, but then, you know, through that work is when I had really become exposed to the realities of the, of the domestic HIV epidemic. And, and it was just extremely eye- opening because that's not part of our, you know, how HIV looks in the US is not part of our national dialogue. It doesn't get the, it doesn't get the attention that it deserves. And, so Seth, you know, fortunately Seth had both a domestic and an international research program. And so as I learned more about what was happening, in particular in the Southeastern US, I thought that actually like, this is a really amazing opportunity. And, and so I took advantage of it as much as I could. And then when I had my first opportunity to lead my own studies, I just couldn't believe what we were seeing in Atlanta. It was really, I mean, I understand that there are quite a few people who had been doing similar work for many years, but this was like... When I started doing work in Atlanta, it was really like, I think, like right before the CDC started releasing a lot of statements on what HIV transmission looks like among race minority and sexual identity minority individuals in the Southeastern US. If I have to say that people didn't know what was happening, but it was like right before the CDC really started putting out a lot of data on annual incidents. And when people really started to take notice. And so when I first started doing work in Atlanta, I really thought there was something wrong with their data collection. Because when we were screening individuals for, at that time, I think it was my masters, it was something like people, it was like 40% of our sample were reporting, living with HIV, and it was shocking. And so, and so anyways, we, you know, that to me, it was like,"Okay, I know what I'm doing. This is what I'm doing," because it was kind of like unbelievable to be like living through that moment where, um, you know, that this is a public health crisis, but... And I use that word with caution because priceless, you know, you can't, you can't sustain crisis. You have to find normality even though normal, normality with a strong sense of urgency to do something. So anyways, it was, um, I just knew that I would be doing that and doing this work for awhile. And I think now it's been... I'm 38. So I don't know. It's probably been almost 15 years now. And I don't think I have lost sight of that at all. I don't think, I mean, I don't, I've, I've done a little bit of pivoting, a little bit of deviating, but I always thought that this is just, just an area of domestic health that is so critical. So...

Valerie: 10:56

Well, it's interesting because in both of your stories about how you got into HIV research, you have this moment where you're given an opportunity to dive into a program of research or, or to work with a mentor in the area. And then Seth, you go on to create this training program, which I, you know, was a part of and, um, to, to expose, you know, social behavioral researchers, I think it was originally psychologists, but it's kind of expanded out from there to HIV research, which I think has been super smart. So it's really neat that you've gone on then to sort of create this opportunity for other folks on a much, it feels like a much larger scale, cause you've probably have had, but like 30 people go through that program at... No more than that. Cause you have larger cohorts now. You've had a lot of people go through that T32 program.

Seth: 11:55

Yeah. I've, I've..yes we have. So we've had it for like 15 years. Training program needs to be able to research here at the University of Connecticut and it's, it's been somewhat unique because most of these kinds of training programs are focused more on postdoctoral training, and they're housed at medical schools. And our training program has been focused on doctoral students, and it's housed in a traditional academic campus. So it's been, it's, it's been unique that way. And yeah, there, there have been...I'd like to tell you the number, you know, but I, I I'll just make it up. We've had about 25 or 30, that's probably close, you know, 25 or 30 people that have gone through the program. And some of them have been remarkably successful.

Valerie: 12:49

I mean, being part of that program totally transformed my career trajectory. I think I would still be doing like self objectification research and probably doing that pretty poorly. I just wasn't great at it. We talked about that a little bit in an earlier episode, but, um, it, it totally like if you had a moment of working with Jeff Kelly and you were like, I want to do that. I want to go do what he does. I mean, I think that being able to be part of that training program was a moment for me of, I want to do that. I want to, I want to focus in that area. So it's, I mean, you know, it's, it's was a tremendous experience for me to go through it.

Seth: 13:29

Yeah. Well, I'm grateful. I'm grateful for that.

Valerie: 13:36

So let's, let's go back to Southeast, Southeast United States. So you've had a program of research going in, in Georgia and Seth you started, you must have started this research in the nineties, right. Because you were at Georgia state University in the nineties. Is that when you started working there?

Seth: 13:53

Yeah. Well, you know, you, you, you did anyone who would listen to this a favor by skipping that whole part where you said I moved around a bit and ended up at the University of Connecticut because I, I really did move around quite a bit. So, yeah. Cause but I, along that sort of checkerboard moving around, I mean, the summary of that is basically that I kept picking jobs, but always ending up back with Jeff Kelly. So, so I worked with him on internship. I took a job and then I went, I left that job to work with him when at the Medical College ofWisconsin. And then I moved to Georgia State where I was there for two years, and then he recruited me back.... And I, so, so always kinda like back and forth with Jeff Kelly, but there was a two year stint in there where I did, it was in 1996. It was when the Olympics were in Atlanta, that I moved to Georgia State University in Atlanta. And I started a program of research there thinking I was going to be there for a very long time, but he recruited me back to the Medical College of Wisconsin. And when I moved back, I, you know, it was very obvious to me that I should keep that work going. I had just gotten a grant there and it was a project that would have been difficult to do in Milwaukee because it was with people living with HIV. And the population was much larger in Atlanta than in Milwaukee, and people at the Medical College of Wisconsin, were starting to do a lot more work with people living with HIV. And so the population pool was not that large to now bring in another study. So I just said, look, I'll keep this study going remotely with the intention of just finishing that five year study. But that's not what happened. I just continued to do all my work in Atlanta. All of, all of my research has been in, in, in Atlanta and the surrounding area or in South Africa. And so, you know, it's, we've really established the presence there. And then when, when Lisa, you know, started to do her research and she, her interest was there, it was a sort of the obvious place. Her work is distinct from mine. I don't do any of those... Our the populations we work with are actually fairly distinct. Lisa, you've really not done a study that's focused on people living with HIV, right?

Lisa: 16:28

That's true.

Seth: 16:29

I, in Atlanta, I haven't done a study focused on people that are at risk for HIV, not living with HIV. In South Africa, my work has been very much concentrated on at risk populations and doing primary prevention, but not in Atlanta. So, I think that's why Lisa and I have been able to work out of the same place, well together, because our programs of research are actually complimentary t hey're t hey're, t hey're very distinct.

Valerie: 17:00

Yeah. I was thinking about that when I was looking over your, your CVs and your funding. Cause I think what happens to a lot of people is you work together for a long time and then, or you may have trained together or something, and then you just start to look redundant on grants. It's like, why do we need both of you? If you're...have the same expertise they're doing the same thing. So, you know, being thoughtful about how to complement each other with your research studies is a really smart way to do it.

Lisa: 17:31

Yeah. I think it's always worked out.

Seth: 17:33

But it wasn't, it wasn't a plan, right? Lisa, correct me if I'm wrong. It really wasn't a plan. It's just your interests and my work.

Lisa: 17:44

Yeah. I think that, I mean, it is interesting how things out well. But it's not like we ever like sat down and talked about it. It's not like we were ever like, long, long term game plan is X, Y, and Z. I, I was interested. I mean, you know, if you kind of like, think about our research program, I think of it as being like across the continuum of care. And I mean, we, we were doing this before continuum of care really entered the literature too. And so, but I was interested in prevention and I was interested in, in testing uptake and prevention treatment options. I, I even, you know, before prep had been FDA approved, I was, um, you know, kind of like how I feel now about long acting injectables, just kind of like waiting for these things to come out, waiting for PREP to come out, you know, being really interested in understanding how, how things like treatment as prevention, impact prevention for people who are HIV negative, but potentially elevated risk for HIV. Or understanding why, you know, what it would actually take to for the, for the CDC guidelines regarding HIV testing uptake to actually be implemented to actually occur, not just be a guideline on paper, but to actually realize that. So I remember, I, I recall always being interested in that and, and when, when Seth and I first started working together and I, you know, first started having my own research studies, I think it was just, it was just kind of a natural fit. And one thing that I think has worked out really, really well because we, you know. So something I don't have, unlike a lot of researchers who are working out of clinics, um, our Atlanta work is not in a clinic. So, we have had to make considerable investments. And I don't mean, you know, even necessarily from a financial standpoint, I'm talking like a, from a research and being strategic and thoughtful and engaging standpoint regarding recruitment. But one thing that's worked out really well is when we put these recruitment efforts in, we have studies for everybody. I mean, basically everybody, you know, I think for a long time now, we've always run multiple studies simultaneously, but of course you can't, you know, as a rule of thumb, you can't have people enroll in more than one study. So we've always, you know, given like the variety of studies that we've been interested in, we basically always have something for which is really what you need. And that's one, one main, one major piece of having an effective recruitment program.

Valerie: 20:57

Yeah. That's really neat. People see your flyer, they come in and then it's just, you know, where do you fit in this?

Lisa: 21:03

Yeah, yeah, exactly. So, you know, that's been a really effective way for having a presence and a strong base, and just, you know, a strong foothold and being able to do this work. I mean we say Atlanta, but a lot of our participants actually come like from throughout the state of Georgia, but because that's, as things have evolved too, we've done more and more and more work online. So then the limitation becomes well, do we have an agency who we can partner with throughout the state of Georgia? Or, you know, can you go over the state law? I mean, it kind of snowballs from there, but anyways, yeah, we have, we have, I think we've kind of always maintained studies or just about everybody.

Carly: 21:54

So while we're on this subject too, Valerie was telling me about, and I was reading a little bit about, that you guys do some of your study recruitment in Georgia at pride festivals.

Seth: 22:07

Well, well, that's a real, that's a real life thing.

Carly: 22:10

It's just so funny. Cause I, as soon as Valerie said it, I was like,"Well, how come no, you know, how come not everyone's doing that? You know, like...

Seth: 22:19

Yeah, now everyone is doing that. So...But we were doing that before everyone was doing that.

Lisa: 22:28

And we were doing whole studies at pride, not just recruitment. We were...

Carly: 22:32

Yes. So tell us a little bit more about that. Yeah.

Seth: 22:36

Lisa's master's thesis was a pride survey.

Lisa: 22:40

I mean, we did, we, we have run the e ntirety of projects...Ron Stall, he, he was the PI of a project that, a five-year study that I was very much involved with, that took place at multiple black gay pride events across the US. So we would do about five or six events a year for about three or four years. And the entirety of those studies were done at pride events. It's a p retty, it's very interesting because it's like, it's just, all your research efforts are just so extremely concentrated into three days. And t here is like a lot of buildup, a lot of b uildup, a lot of strategic maneuvering and events can be very fluid. You have events, canceled events, moved o n three scheduled m eetings, o r, you know, y ou do as much planning and preparing, planning and preparing. T hen you have like three or four days of controlled chaos. But it is amazing i n the sense, you know, in the number of people that you can reach. And as much as like even I know that I, I always k ind o f l ean towards like, let's try and do things remotely. I do things remotely. That's actually been a really nice balance too, because that will frequently remind me of like the importance of being able to have f ace t ime with people. And so that is one thing, you know, as much as I l ike doing studies remotely, I definitely understand the value of having Face time with people. And that's a really nice thing about pride, about pride events is that, you know, that connection and just being able to have like an organic conversation with somebody and like, have it be spontaneous and i t's, it's not controlled through the constraints of technology. So, I mean, t here are advantages and disadvantages to all of it. With the pride event, you can collect a tremendous amount of data in a short amount of time, and you're going to b e able to reach people. You're not going to be able to reach people any other way. There are also a lot challenges. I mean, I d on't k now, I c ould kind of like blabber on forever about it, so...

Valerie: 24:51

Well, I do want to underscore to Carly just how stressful and challenging it, it sounds like it would be to collect data at pride. Given that Carly usually is collecting data at our local methadone clinic. And I just want to say that that's a much better data collection spot to go to, Carly.

Carly: 25:10

If you're asking me if I get a choice between the two....

Valerie: 25:12

Yeah, no, no. We're not asking.

Seth: 25:16

Well, anybody can do a survey at gay pride, but there is a, I really believe that there's a best practices sort of methodology that results in very high quality data from, you know, a very good response rate. Yeah, but they're very, but to pull them off, I mean, anyone could show up at gay pride with a stack of surveys, which are pull off pride survey to get the kind of data that we've got. Our group has been doing. It had, had been doing pride surveys on a fairly regular basis for a long time. To where we were able to really establish at the same place, Atlanta gay pride. So we were able to establish really, you know, time trends, we've published papers, looked at changes in behavior and how that's related to medications coming on scene and people's beliefs about HIV treatment, and how that impacts people's behavior. You know, from like 1997 to 2010 papers like that. So there's a real consistency in our measures in our, our, our procedures that allow for those kinds of, you know, analyses to be robust. And, and I think it has everything to do with, like Lisa was saying...It is a it is a, a concentrated effort to pull to really pull it off with, you know, to walk out after three days with two different studies that each of these studies have, you know, four or 500 participants. But, but it's, it's, it's not, it's, it's not as simple as it sounds.

Valerie: 27:08

What are some of those best practices to, to get it off the ground that would result in better data quality?

Speaker 3: 27:16

Well, I always, what we tried to do was have a presence there, like a community presence to sort of operate like community based organization. So what we would do is we would have, we would rent booths, you know, we would have, just like any other vendor and the vendor area we would rent booths. You know, have a real systematic kind of presence. So I would take down there, you know, a half, a dozen, eight, half a dozen students, and then our full time staff in Atlanta. So we have like 10 or 12 people out there. Everyone wearing t-shirts that we would make for the event that are pride positive, we would have giveaways. So at our booth, you know, people would come and, there was always candy and give away items like pride rings and things that people might want. So that when they leave, having done a survey, someone says,"Where'd you get those pride rings over there?" Those people over there are doing the survey people in cash to do surveys. So trying to show up with like$20,000 in$2 bills and, and pay people. But we would also, knowing that, you know, two or$3, it doesn't necessarily mean a lot to someone who won't necessarily buy you a beer at pride, but, but to make it a charitable event really was an incentive. So we would give, you know, we'd give people what was at least that we give people two, two or$4 for doing the survey, but then we'd match that and give two or four dollars to some designated AIDS charity. So it became a fundraising event. So by doing the survey, we buy you a drink and, and, and we'd also, you know, you'd be donating money to some local HIV organization. So it was that sort of like really orchestrate inherit event, but then comes to the survey. The survey has to be very short. The rule was, it couldn't be more than five pages of questions. And those questions had to be an 18 to 25, so that when you ask someone to do a survey and they look at it, the first thing they do is they feel it. So if it's thick, they're going to walk away. Then they thought through it. And if it looks like a bunch of small type, they're going to walk away. So you have to be very careful about what you ask, because every question comes at a cost. If, for, if you have something you're not going to analyze, then you've, wasted the opportunity to get a question that you would analyze. So the surveys have to be very well, carefully constructed to answer the research questions that you go in to answer for that study, because you don't have a lot of space to be able to do that. It has to be short. People won't stand there for more than you know, five or 10 minutes to do the survey. It has to be completely anonymous and, and people have to know that there can be no sort of like,"Well, you signed this form, but do the survey," it has to be completely anonymous. There, there, like a lot of pieces to that, anything that can sort of attract people. So in Atlanta gay pride, you know, it was always set up really hot. So we would have cold drinks for people, we'd set up fans. We'd have places for people to sit, everybody does their own survey. We never interviewed people. It's always an anonymous survey done completely confidentially on clipboards, you know, so we're kind of a remarkable orchestrated event, but more than anything, it was a lot of fun. So everyone loved it and was having a lot of fun.

Valerie: 30:46

It's very stressful. Carly. It's very stressful.

Seth: 30:51

We were all very tired at the end of the day. That's for sure. Cause this is like a 12 or 14 hour day. But, but when you're out there, I mean, you're having a lot of fun with people that everyone's there to have fun and, and at pride. And so if we're not having fun, then we're, we're out of place. So we were definitely having a good time out there, fooling around with people and having just a good time.

Valerie: 31:17

I'm imagining like a lot of U2 or Bruce Springsteen or something playing from your, like from your tent.

Seth: 31:24

No, that would, that would probably repel people.

Valerie: 31:27

Okay. Your favorite bands repel.

Carly: 31:29

Then they'd be saying boo, instead of Bruce, for sure.

Seth: 31:32

Right? Yeah. No, it was, um, very productive time. We would, we would get several papers out of those surveys. Just pretty remarkable.

Valerie: 31:43

Absolutely.

Carly: 31:44

Yeah. Valerie, I'm, I'm up for the challenge.

Valerie: 31:47

Okay. Noted. Well, prides not on for this year, but we'll, we'll see for now...are you guys still doing these pride surveys or have you taken a pause?

Seth: 31:58

I haven't, you know, we have graduate students that are, but I've actually not been down there when they, so that's more of like, those, I think have been more like a lot, but a lot of other people are doing it, gay pride surveys, um, as opposed to our sort of machine. We haven't done one in a while.

Lisa: 32:22

No, we haven't done one in a while.

Seth: 32:22

Lisa... Lisa has, cause you were part of that Ron Stall study.

Lisa: 32:27

When we did the project...When I did the project with Ron Stall. I mean, we, we kind of our, I mean, I, it was definitely the same sentiment. Like it's, it's much more than the survey, it's about engaging individuals and having fun and understanding that like they're, they're, they're like they're showing up there to have fun. And so like if we're going to make this work, like we better join them, and how they feel and celebrate with them as well. And try to collect a little bit of data along the way. And so, so with that project, we did, we did mostly, we did our data collection electronically. And we also paid, we compensated people higher in that study, because we collected more data. And it actually worked, we were able to do it. The reason why I say it actually worked is because you would assume that if someone's like going through a pride event, that they're like, they're there to like make quick stops and keep going. But, we also did HIV testing as well.

Valerie: 33:34

Oh, at pride?

Lisa: 33:36

Yeah. So, we, I mean, people, you know, we asked people if they'd be interested in getting an HIV test done, and then if, if they weren't, we asked them if they would be interested in providing a sample for us, just, just, you know, so that we can test to, just for our data, for data collection records, but we ended up doing, it was a little, it was a little different that the, black gay pride events, there are a lot of events that happen outside of like major urban green spaces. So maybe it's, there's like small, there's a lot of smaller events that occur. And a lot of like people waiting to get in to, to, maybe a bar or whatnot, a club. And so we were just, we would be communicating with individuals as they're, you know, basically they have time on their hands. So we were able to do a bit more extensive surveying for that study. But we haven't, we, we haven't done it in... It's been at least a couple of years now. And, I mean, I think a couple things are going on at one of course we have COVID so I think all these events have been canceled. The other thing though, is that, you know, you see, like we've all, I think we've all seen, like there's just so much more online data collection. So like when we were doing, when, at least for my first pride survey, that really wasn't an option, and I'm gonna imagine that for Seth's pride survey, that absolutely wasn't an option. And so, but like, so that has changed. I still though have a strong preference for being able to do surveying in person. And I, I always have concerns about data collection and wondering, you know, data collection that's solely online. I wonder who's actually taking, you know, who's actually taking the survey and like, what is actually being done to verify that these individuals are who they say they are. And I know that there's a lot of best practices around that album. Okay. But that is one thing that I greatly appreciated about doing the pride studies is that you just have more of a handle on like who it is that you, you know, that you're actually interacting with. And at least for me, I've, I, that just instills greater confidence that we're really working with the individuals who we intend to be working with. And so, I don't know, I would, I would like to do them again. I definitely would. It's, I mean, especially with, so one of the things that, like one of the reemerging themes when we did the black gay pride study was that there are just only so many opportunities to interact with, as as many individuals, as we were able to, we were able to survey thousands of individuals. And like, there's just the type of opportunity does not come around very much. And so it was like, why not capitalize on that moment and that space? And, yeah, I would definitely like to do it again. I absolutely would, and I think, you know, as long as there's a need and an epidemic to address and, and, you know, we know that there are some interesting prevention options in the pipeline and, and, you know, my work has basically always been like everything outside of the strict biomedical piece. I'm interested in, I'm interested in how people perceive vaccines and how they perceive prevention and well, what does it actually take to get people to use those items, right? Like in reducing the divide between the advances that we make and biomedicine, and actually people embracing these options. And in terms of HIV prevention, that's like always a moving target. So it might be slow, but it's always a moving target. There's always kind of the next thing on the horizon. And there's a lot of work to be done. Yeah. Yeah, absolutely.

Valerie: 38:05

Okay. So I know that you both have been thinking a lot about what we can take as, you know, social behavioral scientists from HIV and apply it to what's going on with COVID. And you think you've been doing a lot in this space, including, you know, it seems like one of the first things that you did was to coauthor this commentary paper that came out in the Journal of Behavioral Medicine, which was really nice in its approach. So thinking through, you know, at social ecological levels, what are some of the lessons learned? So I was wondering if you could kind of take us through some of the, some of the big pictures that are big picture takeaways, that we should think about applying to COVID from HIV based on how you've been thinking about it so far.

Lisa: 38:56

Well, I think that, one of the, probably the challenge that keeps re-emerging for me is that we know that sustained behavioral change is really challenging. It's not our strong suit. It's not, it's not a universal strength. And so how do you make that? You know, and, and right now, I mean, it, you know, in a lot of ways, it, it does feel like what we've experienced so much in addressing HIV. It's like, well, in the absence of a vaccine, you're really relying on behavioral strategies. Because even the biomedical strategies that we have are reliant on behaviors, and they need to be taken. People need to show up to appointments. I mean, there are a lot of behavioral strategies. There are, there, there are a lot of behaviors you have to engage in in order to get to those places and HIV prevention and treatment that we want to be at. And that's, you know, that's absolutely the case for COVID. I mean, we don't have, I mean, we have supportive care for people who are really sick, but at this point, our greatest strategy is behavior change. And, and I think that, you know, looking at the, I mean, there's just no question, like looking at what we know about HIV prevention, we're best off when we have a multilevel approach to prevention. When we have the policy piece in place, which hasn't been in place, but when we have a policy piece in place, when we can construct structural interventions and when we have some unity among individuals that they need to change their behavior. I think that like, and, and, you know, and I think we've all observed this, like when COVID first hit, I think that, you know, and we know this from like mobile data. I mean, there have been studies that have shown this. And, and I think most of us have probably experienced this personally when COVID first hit that, you know, there was so much uncertainty about what it was going to look like, and a lot of commitment to, to behavioral practices. And then, you know, but then we learn more information and we adapt and we adjust. And I, I refer to it as like trying to figure out how to live with COVID, you know, with the broader context of COVID. And I think it's the, I think Seth and I have actually had many interesting discussions about it because I think we come...I actually think that I think would probably be an agreement on how the HIV behavioral literature is going to be related to the COVID behavioral literature. But I think we both have different stances on like the extent to which prevention measures need to be implemented. Because I'm very much, you know, I've been like, we have to find a balance somewhere. Like, well, we have, like, we have to keep these facilities up and going and, and, you know, Seth will say like, no, like we need to get like prevention under control. It's not under control... and in somewhere. And I think somewhere in the middle is, is the truth is the reality of it. And, but I think we're probably indicative of the broader America in terms of kind of like what, I mean before we started the podcast, we were talking a little bit about what this is going to look like at universities. You know, what I, when I, where I think I was probably at the beginning of this and where I am now, is that we have very strong, varied opinions, and I understand I can understand and appreciate all of that. And so I don't know, I think in the, I think in the approach in the behavioral approaches to HIV, we can, in our reliance on behavior change to prevent HIV is very similar to COVID. It's just like the extent of the problem is on, is on another magnitude. I don't know Seth, what you think? Maybe we can go back and forth on this.

Seth: 43:27

Well, you know, I think it's true. As an emerging infectious disease, the first month of COVID-19 is basically the first decade of HIV wrapped up in a month. Oh, wow. Oh my God. People are getting sick. They're dying. Oh yeah. But it's them. It's not us. What can we do? Oh, we can change these behaviors. Oh, great. For six weeks. It's over.

Valerie: 43:55

We're all good.

Seth: 44:01

So people are still d ying. So, yeah. I m ean, that's, it has been kind of remarkable a t a lot of levels, to live through, t hat w e a re s till l iving t hrough. You know, a lot of things have been very interesting for me to see. Like suddenly everybody goes to Tony Fauci is, that's good. And it's also interesting. It's been interesting to watch him c ause I've watched him my whole career on HIV. And, u m, I guess this is sort of a public apology to Tony Fauci. C ause I've spent the past 30 years saying"Why can't h e pay a little bit of attention to behavior change and stop talking about v accine and therapeutics?"

Valerie: 44:58

Okay.

Seth: 45:00

You know, I've been a great proponent of HIV prevention through behavior change, there are no vaccines. And when I, when I started, there were no therapeutics, but I've come to truly appreciate why he would not believe that people will actually change their behavior in watching the public response to the COVID-19 and, um, uh, how naive I've been to believe that people ever would.

Valerie: 45:34

Wow. That's an interesting takeaway.

Carly: 45:38

I was just going to say, I'm sure that when he listens to this podcast...

Seth: 45:46

Yeah. I know it's been, it is, it is a remarkable time, obviously, I think for everybody living through this, but I, yeah, I do think that, uh, you know, sort of, as Lisa was alluding to, I think that this is true that, in our, in our, in our little world on university campuses, certainly not at a medical school...those of us that do HIV behavior research are in a unique position. Because we're the only ones who have been thinking about an infectious disease, at all. So, outside of medical schools, universities don't have really health like health psychologists and medical anthropologists and medical, sociologists, and nurses, um, people that are trained on academic campuses. No one is thinking about ever infectious diseases, except HIV is something actually working. It's not like you find people on our campus who have been working on influenza or clostridium or TB...you know, infectious diseases, you know, um, was pretty much an area of medicine that was, you know, in the post antibiotic world, infectious diseases were in post antibiotic and, and post you know, polio vaccine world. That was a field that was, it was, it was dying on the vine as much as psychiatry was in the 1970s. And one of the, one of the areas of infectious diseases that remained relevant, although not very relevant, was sexually transmitted infections. And of course, HIV changed all of that. It brought back an entire relevance to that area of medicine, but in behavioral sciences, there's not an infectious disease that has a large number of people working on it other than HIV. And in fact, I'm not sure working on anything other than sexually transmitted infections, TB, things that are related to HIV. So we're like in a unique position. I think we have a unique perspective in our little world, in thinking about a public health response, an individual response, a societal response to this, to this pandemic.

Lisa: 48:17

Well, one in particular too, that it's occurring. So, that we have to think of this context occurring on a college campus. So there are people that do international work and, and can have, um, kind of have long histories of involvement in those areas, but I'd be shocked if people are really thinking of like controlling an infectious disease to the magnitude, we will have to do that on a college campus, which is going to be one of the most challenging places in some ways to do so. And so, yeah, I mean, they're just, there's just simply, you know, many places, many components of it have to be... I mean, probably about every single component of the college environment has to be considered in light of COVID. And that task is taking, is being taken on by individuals who probably haven't had to think that much about infectious disease.

Seth: 49:30

So yeah, college campuses are a total, they're a total COVID-19 disaster zone.

Valerie: 49:34

The Petri dish for COVID.

Seth: 49:37

You know, if you're interested in taking college courses and getting a degree from a reputable university, Cal State is doing that. So it's the social stuff, you know, it's all, it's everything about ecology about going to college is social. And there is remarkable is there's no way that a university can provide that, that fulfilling social experience that college is and mitigate the spread of this infectious disease, highly contagious respiratory disease. So they can, you know, they have to try, they can do the best that they can, the options are don't do anything, which I don't think any university is doing, although it's possible. Or, you know, shut it down, which is what Cal State did. Most places are trying to do something in between. And it's going to be just awful for everybody, you know, because it's not the college experience that students want. And students that can take the year off and can afford to not go and to can afford a gap year. Those, those more privileged students will do that because because of the Fred house is closed, why would I bother, you know, if I can't go to games, you know, why would I bother if, if my classes are gonna have people sitting six feet apart from each other and I have to wear a face mask, what's that going to do to my, you know, to try to pick up chicks in class?

Lisa: 51:23

I mean, I think this is where like Seth and I like go back and forth on things because I like, when I say like, we have to figure out how to live with COVID. I think about things like, so what does that mean for someone who's 20 years old to, you know, kind of like abruptly change their college career plans or say the next year or however long it takes. And I think that there's like this assumption that if students aren't, if students don't come back to campus, then like, oh, they must be home and being safe, but I don't make that assumption. I I'm more along the lines of, like, I actually think that there's a lot of value, value in a different way though. And having someone who is 18, 19, 20, 21, being able, if they so choose, to have some on-campus experiences and that if we can do it in a way with thoughtfulness. And I understand that there's, you know, there's a, there's a leap of faith there. If we can do in a way with thoughtfulness that actually like maybe they are better off on campus, as opposed to, I don't know where, I don't know what, because it's not like there are a lot of jobs out there and I don't necessarily, I, you know, I've advised a lot of students and I think I probably differ from a lot of advisors in that I don't typically advise for a gap year. Because in my personal experience and in my observations, I think a lot of students take time off of education. And then it's really hard to get back into it. Like if you have that educational opportunity, I don't, I am not conceptualizing this as a gap year in the traditional perspective, anyways, because to me a gap year, if you're going to do that, like go big, like go live somewhere else, you know, go learn about another culture for a year, go make that documentary that you always wanted to do. I mean like go, but like, that's not an option right now. You know, you're just not going. I mean, we, we have not lived through travel restrictions like we're living through. I've never seen that in my lifetime. I don't think any of us have seen this in our lifetimes. And so I think that, you can make the argument that with a, that there, that there's potentially better value, better overall gain and being able to provide the most enriching experience that we can provide with limitations. They have students remaining at home. And I know, I mean, we've, we've, we've surveyed students and it's something that, um, I look into on a daily basis. It's not for everybody. It's not. And, you know, and there are plenty of 100% online options and, and that is an option that you should take if that's what you are most comfortable with. But I, I just think it's more complicated than saying that we'll just shut down everything.

Valerie: 54:34

Right.

Lisa: 54:35

I t just, I think there is loss, there is loss there that has to be appreciated, too.

Valerie: 54:43

This is the first time in my career where I'm looking around and I'm like, where are the ethicists? Like, why don't we have ethicists on all of the news channels? Cause it's, it is like, it's a bit of a right and wrong question to some extent. And there, there are people with PhDs in this stuff. And, you know, I think there's a lot of different ways to land on the answer to these questions, but I am, I, you know, I've just been curious about how, how are people thinking about that and how do you even begin to do it? Cause you're right, Lisa. Like a lot of the people who are, who are on these committees, who are making these decisions, I mean, you know, they may not even have, they may not have public health experience that you may not have experience thinking about, you know, behaviors within infectious disease epidemics. And then when you layer into that, just these questions of like, what is right or wrong to do at this time. I think it's challenging. Yeah.

Lisa: 55:42

Yeah. People have very strong opinions on it. And I think that when you, when, you know, in all likelihood, when you're faced with kind of like your first real dose of reality and addressing a public health crisis like this, you're probably g oing t o come from your own personal perspective first.

Valerie: 55:57

Right.

Lisa: 55:58

And it's all very different. I mean, my husband's a respiratory therapist. So the first week this happened, I was like,"Oh my God, like, I, you know, are you going to get terribly sick? Are you going to infect us? Like, should you go to work?" You know, that's a lot of things. And so for me personally, it was kind of like going through like all the phases of grief, really fast. I'm thinking of like, is this worth the paycheck? And we have small children and our, you know, do you have to quarantine? Should, should I move I've I have, should I rent a house? You know, so we're not together. And so I think that for me, I went through all those phases really fast because there was no other option. I kind of got to that, like living with COVID and like learning how to, like, for me personally, mitigate risk, you know, came on like hard and fast and, and listening to other people talk about that. I think, I think others are also going through that as well. And if you're like in a situation where you have a lot of control over your environment, and that feels most comfortable, well, that's like a very comfortable place to be. And like, I think that those were the things that we project. I think people like, like all of us who have a public health background are probably combining that with what we know about the science. I mean, I think I'll share probably really telling that, you know, having, having wanted to hear this nationally, you know, this, this national stance on behavioral responses and waiting for that for 30 years and now seeing like why on a federal level, it's so hard to implement, is, is very eye opening. I mean, it's like any good problem. There's no quick solution. And like, I think it's flexibility and being thoughtful and, but you know, that's not necessarily our strong suit as a nation.

Valerie: 58:05

For sure. Well, speaking of people without a lot of flexibility and thoughtfulness, m aybe, maybe it's too far, but Seth, you have this interest in denialism and, and the anti-vaxxers. And I'm, I'm wondering how you've what you're thinking about in terms of d enialists and y ou've done some talking about the anti-vaxxers within the context of COVID?

Seth: 58:32

Yeah. So, you know, the, um, my interest in AIDS denialism, for a while and, you know, it's nice to see my old friends are back again. The same, you know, it's the, it's the same bag of nuts and they actually, the, the same players, you know, got, you know, because there's a group of these AIDS denialists who, say that the test for, you know, for HIV are valid. You know, there, there may not even be such a virus, but if there is these tests certainly get, so there's this, all this sort of crazy talk and, uh, by the pseudo scientists. And they're just saying the same thing about COVID-19. And they do intersect, they're not the same people. They do intersect with the anti- vaxxers. The anti-vaxxers are actually quite different, but this is also, a field day for anti-vaccine movement. Because, and, and one of the things that's a little disturbing is there...What anti-vaxxers do and AIDS denialists do is they'll latch on to this one little thing, but, they like cherry pick, you know, they look for this one little thing to say,"See, we're right,". And that's been going on a little bit with, COVID-19 because of the panic and the urgency is we're giving them things to say,"See, we're right. So the rapid development of vaccines and the money that's involved in them and the, and the federal and international agencies and the, and the, and Bill Gates, all of these...all of these, the constellation of the conspiracy that fuels the anti-vaxxers, um, are like, you know, see, see, this is what we're talking about. And, you know, every time that there is a paper retracted, there was a paper retracted yesterday in the New England Journal, you know...

Valerie: 1:00:54

It was a big one. Yeah.

Seth: 1:00:54

It does not help us.

Valerie: 1:00:57

Nope.

Seth: 1:00:57

And so, y ou know, the denialists a re happy to latch o n t o that kind of thing, and s ay,"See the, you know, there's nothing to this all along? And how can you trust any of what they're saying? And i f, if they wouldn't have been called out on that one, it w ould h ave never, they w ould h ave never retracted,". You k now, this is, it's such a, such a magnifying glass that they use to find something to hook onto. And in the, in the, in the, in the flurry, you know, the panic. W e're unfortunately giving them fuel f or their fire. T here w as nothing you c an do about that. I mean, t here's, it's not like I think that science can do anything different, or be any more careful and the urgency is pressing. It's just, I think we have to be more vigilant about trying to combat the, the, the anti-vaxxers and the denialists with science, medical literacy, and, u m, and trying to drown them out with, with facts. T hat's, that's really the, the, u m, the treatment for these problems. But yeah, we're, we're, we're, it's an interesting time in so many ways. And that's another way that it's an interesting time.

Valerie: 1:02:22

Yeah, for sure. Well, I was impressed, or I was surprised maybe initially, when you mentioned that that anti-vaxxers have been out and loud since like February. I mean, that was A before people were like really starting to get afraid of COVID at least in the states and then B there's no vaccine. So just the fact that the you've got these prominent anti-vaxxer folks who are really making a lot of noise well in advance of a vaccine actually existing. You know, like how can they say that the vaccine is dangerous or the vaccines no, good if there is no vaccine yet. I just, I thought that was really interesting and it kind of speaks to just the to me the idea that, like, it's not, it's not about the specific vaccine, or it's not even about like the specific, um, disease that we're talking about, but it's just this, like this overall, you know, a conspiracy theory, that's more of this overall mistrust, or is this overall movement that gets sort of like applied and reapplied, in these different contexts.

Carly: 1:03:29

When I was doing some of the research for a, you know, a COVID conspiracy paper, one of the things that I found really jarring was that these, y ou k now, anti-vaxxers, o r these conspiracy theorists are citing research articles, you know, that are coming out of the NIH to like further prove their own points. And it's like, well, hang on now. One of these things is not like the other, like, how did we, how did you spin that and get that back?

Seth: 1:03:55

Right. Welcome to my world.

Carly: 1:03:55

Right.

Seth: 1:03:55

E xactly. That's exactly what they do. And, it is, it is, it is a, i t i s kind of a remarkable craft. It's, it's, it's exactly what they do. U h, it's, it's more than interesting. So you you've been looking at the a nti-v axxers?

Carly: 1:04:14

So I've been very particularly using my Reddit skills, and scouring all those subreddits. So, yeah, I've, I got really deep into it for a few days there where I was really absorbed in all the conspiracy theories and everything. Yeah.

Seth: 1:04:29

Did you, did you, did you run into Dr. Tenpenny?

Carly: 1:04:35

Uh, I don't know, you know, I have such limited...

Seth: 1:04:39

Yeah. She may not be, she may not have a presence on Reddit, but she has a, a significant presence in Facebook. She's yeah. She's, she's a piece of work.

Carly: 1:04:51

Yeah. I have such a limited you know, space in my memory that I didn't bother committing that one, uh, you know, in there forever, but, uh, I did definitely get pretty, uh, pretty friendly with the whole, like Bill Gates apparently is this really terrible guy, you know? And, uh, 5G boy, howdy. Hope they don't, you know...

Seth: 1:05:13

So Dr. Tenpenny was posting about 5G back in early March.

Valerie: 1:05:20

Oh wow, okay.

Seth: 1:05:20

Yeah. And she's, and she is, it is interesting what you were saying Valerie, cause it is true that they, they are like priming the pump. There is no vaccine when the anti-vaxxers are all up in arms about COVID-19 they're priming the pump. And so they're already laying the groundwork for the we're not don't, don't pick that vaccine. And I, I think that they're, the soil is going to be really rich for them because reasonable people will be concerned about be vaccinated because of all of the, you know, the legitimate discussion around rush through, you know, we're having everyone is saying, Tony is saying, we're having to skip a lot of the early phases and combine phase 1 and phase 2 vaccine development to move this much faster. It takes, you know, 10, 15 years to develop a vaccine. If you get one ever at all. And so two within a year would be unprecedented if they actually are able to develop a vaccine in a year and bring it to market in any near, near that time, it'd be an incredible achievement. And it will be met with a great deal of skepticism. And so the, you know, it's going to be very fertile soil for these otherwise easily ignored people to get traction. Don't be too surprised if they don't end up in, in, in places like CNN talking about, about why we should be concerned about vaccines.

Valerie: 1:07:00

Well, it's really interesting to me because in some of the, you know, literature digging that we've all been doing together, we found that one of the best ways to like deal with conspiracy beliefs, is to warn people about them before they concede and hear about the conspiracy. And these anti-vaxxers seem to be doing that in reverse. So like before, you know, people even start learning about an actual vaccine or yeah. They're getting out ahead of it. So it's like, they're they're ahead of the game. Yeah. They're

Seth: 1:07:36

They are.

Lisa: 1:07:38

Do you think though, that, that, I don't know, I think you were kind of going in this direction, Seth. I think it's a really interesting discussion point that like, like kind of like what's science to do about it. So, I mean, I even sometimes like with COVID sometimes I'll see a headline and I'm like very science. I love science. O kay. Sometimes I'll see a headline on like CNN and it's like, experts say it will be like, b lah, b lah, b lah, according to experts. And I e ven roll my eyes sometimes because I'm like, okay, but like, we do this, we put these things out. And then with COVID, it's just so fluid that like two days later we change it and like, it even irritates me and I am fully on board. I'm very empirical. And so I'm wondering, like, could we really? And I'm sure there are people who do t his, but like the need to really think through how science intersects with the general public is just so urge. We have to stop doing a shitty job.

Seth: 1:08:49

The thing about this that's been most remarkable has been the mathematical modelers.

Lisa: 1:08:56

Ah, it's exhausting.

Seth: 1:08:56

Yeah. No, what they've, they've done a great deal of harm actually, you know, because the public doesn't understand the nuances of assumptions that go into modeling. And no matter how hard people like Tony Fowchee tried to do t o, y ou k now, to reduce those, those anxieties and to sort of explain the caveats, it doesn't matter. It's way too complex. And what I it's become very clear to me that there's a there's there's groups of mathematical modelers t hat are like really like being on TV. And they just c hanged their model today. They're on TV tomorrow. And there was a period of time. T here was like a bout two or three weeks in there where they... The same modelers were talking about the changes in their model every day for like two weeks, you know, like, you know, 20,000 people are g oing t o be dead. No. Now we're saying it's going to be 30. Well, we didn't know that those states a re g oing t o o pen u p. So now we're saying it's going to be 45 and it's like, stop. I mean, it's good to be known and on TV for the quality science you do. It's bad to be k nown a nd o n T V for the rapidly changing, no one can understand, mumbo jumbo that you're saying. I t's, it's a little frightening actually. I t doesn't help us. It doesn't help.

Valerie: 1:10:15

It's hard. Even as a stigma researcher, you know, folks in the media have been asking me, like, what does stigma look like in COVID? And it's just it's and this was earl-. This might've been two months ago. And it's like, well, I can tell you based on, you know, what people are reporting in the media and things, but we didn't even though, and I can make some pretty good educated guesses, based on what we know about infectious disease, stigma overall, about what it's, what it's looking like, what it's gonna look like. And of course there was the whole racism, dynamic in the US that was pretty, you know, reported. But, but even that, which is, you know, it's hard to get that totally wrong. I felt sort of uncomfortable cause I was like, we don't, you know, hold on, we don't have the data yet. Like we don't have the, but that people really want to know, like tell me what it looks like now. And it's like, I don't know how I would have gotten, how I would've gotten all that data yet. Like, can I, so it's an, it's an interesting. moment of like people really wanting information and you know, trying to catch up with that.

Lisa: 1:11:24

I mean, I think like, even for me, I, when Donald Trump won the election, I was like, that's a, I'm never looking at another p oll again ever, ever. I d on't k now l ike what y ou a ll are doing, but y'all failed. You failed, you failed. O kay. All your polls, you failed and that's not good. It's not good when like it's lost on me. And, because this is w hat, this is what I've committed my life. I mean, I'm not a modeler and you know, a nd the times I've done modeling, I, I mean, I know l ike we've talked about this i n the past a nd w hen you put the assumptions i n i t's, a bit like reading tea leaves. And might be right, m ight not be right, but you like understand that and you like a re you're processing all this information in the context of what you've put into the model. But, that type, that process just does not bode well for a two minute sound b it or, you know, a four minute to read article. Like those worlds just don't come together well. So I d on't k now.

Valerie: 1:12:38

All right, well...

Seth: 1:12:39

But I should, I should say though, that just to be, to be fair, I brought up the modelers and I mentioned retractions and I mentioned the rush. Um, and I would, but, uh, but I, but I also feel that in that I have to say the vast majority of the science reporting that I've seen has been good and, and balanced. And I think that, you know, I know, I know some of these people, I don't know a lot of these people, but I know some of these people, um, you know, from my life in HIV, who I know some of these people who are on TV and in the media around COVID-19. And I think for the most part, they're actually doing a really good job, but the issue in why we're talking about this, I think is because it just takes like one retracted paper. It just takes saying one thing in a, you know, in a non so certain ambiguous way. And it gives, it can undermine public trust, but also it gives the people who are out to undermine public trust, the opportunity. And so, but for the most part, I think people are trying to be responsible, you know, they're, it's been interesting to see how people that have worked in HIV that are broader in public health. They're not like me, I'm really one trick pony. But there are a lot of people in public in HIV who have a broader public health portfolio. And I, and I'm really proud of him actually to see some of these and see some of the colleagues really focusing on this problem, and trying to communicate responsibly. So that's been in some ways inspiring and, and certainly, a source of pride for me. But then there are these other things that it's just like a disaster.

Carly: 1:14:47

Well, I like, I'm going to steal your line Seth about priming the pump, but it, you know, it doesn't take much to prime the pump at all, right? Like it's not one, like you're saying, it's, it's that one redacted article, it's the one. And they hang on to them and they circulate the articles really get...

Seth: 1:15:03

Yeah. If our president ever like, you know, comes out of the bunker and will actually leave the White House because he's afraid of, you know, 21 year olds with signs. If he ever we ever hear from him again, you can, if you ever hear from him again on COVID-19, which we might not actually. I can guarantee you that if he ever talks about Chloroquine and Hydroxychloroquine again, he'll say,"Well, we know that that study was retracted, that it was garbage, that it was..."

Carly: 1:15:35

Oh, you're exactly right. Yeah.

Seth: 1:15:36

Because he is a part of that mindset. He, he is as much an anti-science denialist as we're ever we're going to find. Right. And so he won't let that go by.

Carly: 1:15:50

Nope.

Seth: 1:15:51

He'd be happy to trash the entire scientific enterprise in the New England Journal of Medicine over this one thing.

Valerie: 1:15:59

Yeah. And you've done some really interesting, you know, thinking Seth. I know we've got to wrap it up, but you've done some really interesting thinking about... Carly and I had both read your paper, looking at what Pence, Putin, Libecki, and their HIV related crimes against humanity. And we will, we'll go ahead and recommend all readers, all readers, all listeners to read it. And then just to think, as we were that you could just do Pence, Putin, Lubecki, Trump, and their crimes against HIV and their HIV, and COVID related crimes against humanity right now. Cause I felt like you could just like update that paper, you know, and rerelease it to be, you know, relevant right now.

Seth: 1:16:41

Yeah, no, it's absolutely, it's absolutely true that those guys have never been held accountable. And President Trump isn't being held accountable either for, you know, for the, the number of, of senseless and needless deaths that occurred because of the way he handled this pandemic in this country in the first month, we've lost six weeks because of him.

Valerie: 1:17:09

Well, as a social behavioral science scientist, I'm really, you know, I'm grateful for the all hands on deck approach to this. I'm grateful that you guys are all hands on deck. I feel like to try to understand this and, you know, to both of you for creating spaces, both at AIDS and Behavior for people to share their insights on, COVID quickly through the, you know, the rapid papers that you've been publishing. And then also, you know, the Facebook community, which has really, I think, you know, really taken off for HIV researchers to connect. I think it's a real testament to, you know, your leadership in the field to be able to get both of those up and going. That, you know, and then just more personally, you know, I wouldn't be doing sex and drugs science if it weren't for Seth's mentorship. And I certainly wouldn't be having as much fun with it as I have been lately. If it weren't for...

Seth: 1:18:07

Very good. I was going to let this go by, but it's good that you, that you, you use the word science in this context and that you use the word research in the other context. Cause I noticed this, if you would pick out the word research and if you would think of the word science, what you have just said over the past hour and a half, is that you owe it to me for exposing you to HIV and getting you into sex and drugs.

Carly: 1:18:36

That's going to be the tagline, just right there. I can feel it already. That's the tagline for this episode. Like thanks to Seth Kalichman for getting Valerie Earnshaw into sex and drugs.

Seth: 1:18:45

And exposing her to HIV.

Valerie: 1:18:48

And Lisa to keep the party going.

Seth: 1:18:51

You really have to make sure that you say that it's HIV research and sex and drug science. So thank you for that.

Valerie: 1:18:58

Yes. And thank you for your time. All right. So just as a reminder, we're trying something new on the podcast here and the undergrads who helped produce the show have listened to it. And they pointed us in the direction of a few things that we may want to clarify for folks who are not, you know, just us or listening in. So that first thing was that they pointed out was that Lisa and Seth are doing research in the south. And you know, they're up in Connecticut. We talked about this a little bit on the show, but they really want to a little bit more detail as to why they're doing research in the south and what the HIV epidemic looks like down there. So I thought that I would share some sort of like basic epi data or epidemiological data on the HIV epidemic in the US. I pulled an HIV surveillance report for 2018. And so in 2018 there were 36,400 new HIV cases, and the HIV incidence... So this number of new cases, was 19,200 in the south, which is 53% of all US new infections.

Carly: 1:20:24

Which is wild.

Valerie: 1:20:26

It is wild. So I wanted to also read which states count as the south. Cause I think you're going to be surprised. So Alabama, Arkansas, Delaware...I didn't know that Delaware counted as the south. Did you know that?

Carly: 1:20:40

Yeah, I did. Unfortunately. Yes I did. Yeah. Was that the mind blowing fact?

Valerie: 1:20:46

That is the mind blowing...I did not know that we count as the south. I grew up in Pennsylvania, and I always thought of myself as just like, Mid-Atlantic like not a thing? Really actually that just like something that...

Carly: 1:20:57

Only to everyone above Delaware, honestly. S o D elaware's really interesting though. C ause it gets to pick and choose how it identifies in the continental US. So in some statistics, w e'll be northerners and t hen s ome statistics. Yeah.

Valerie: 1:21:13

Yeah. Well I should've known that I wasn't gonna blow a native Delawarean's mind with, you know, how Delaware is categorized...Pennsylvania.

Carly: 1:21:23

Yeah. Yes, exactly. Yeah.

Valerie: 1:21:26

All right. Well then there's like a bunch of other states, there's a lot of states in the south.

Carly: 1:21:30

A nd t hen it's all the regulars.

Valerie: 1:21:32

Delaware down. And then all the way out to Texas.

Carly: 1:21:36

Oh wow.

Valerie: 1:21:37

Yeah. Texas is included. So, all right. And then you hit the west essentially. Okay. And then, you know, continue with our numbers. There were 19,200 in the south, but then there were 7,500 in the West 5,000 in the Northeast and 4,700 in the Midwest. So that's just, it's a lot of cases for one, you know, one section of the country.

Carly: 1:22:00

Yeah, for sure.

Valerie: 1:22:02

All right. Then if we break this down by race and ethnicity, which I wanted to do because, you know, in part, I guess because Lisa and Seth focus a lot of their research, not all of it, but a lot of it on Black men who have sex with men specifically. So we had 15,300 of those new cases were among Black and African Americans. So this is 42% of all new HIV infections across the US were among Black and African Americans in 2018, which is quite concerning because they're only 13% of the population.

Carly: 1:22:36

Right.

Valerie: 1:22:37

And then we see more disparities if we look at Latinx folks. So 10,300 of those new infections were among Latinx folks. And they're only, um, that, so that's 28% of new infections and they're only 18% of the population. And then 9,000 were among whites. So that's 24% of the HIV infections, but white people are 77% of the US population. So it just really goes to show that this is just, it's not equally distributed...

Carly: 1:23:07

No, super disproportionate, yeah.

Valerie: 1:23:09

Yeah. Both by race and ethnicity, and by location. So a few years ago, I think that the New York Times actually ran an article really highlighting that this epidemic is, is an epidemic of disparities in the US both in terms of location, race, ethnicity. And then if we layer in LGBT health disparities, 66% of the infections in 2018 were among folks who were having were among men who have sex with men, essentially. So gay men or bisexual men.

Carly: 1:23:44

Right.

Valerie: 1:23:45

Yeah.

Carly: 1:23:46

Wow.

Valerie: 1:23:46

We need to do better.

Carly: 1:23:47

Right? Yeah. Well, definitely super grateful that Seth and Lisa are continuing to do this work. Cause, you know, I think that a lot of people, you know, when you hear about, you know, the AIDS crisis, like you think back to like, you know, gay white men in the eighties and that's about it, you know? And so it's like this really highlights the fact that now this work is still super important and it still needs to be done to address these like wild disparities that we have here.

Valerie: 1:24:12

Yeah. I think that's a really great point that the face has really changed over the years. And unfortunately it's not changing a whole lot, so we need to do better here for sure. So.

Carly: 1:24:23

Exactly.

Valerie: 1:24:25

All right. So the second thing that they raised was what's a 332, which is actually a T 32. So a T 32 is something we talked about in the episode and it's a training program. So it's sponsored by the National Institutes of Health and essentially, the idea of the training program that Seth is the lead of, which is called the Social Processes of AIDS Training Program, is to take people who are from other fields who are, who are doing their doctoral dissertations and they're studying in other fields. So for me, it was, you know, studying psychology and then to get them to apply what they're learning to the HIV epidemic. And the idea is really, if we could get more people from more diverse backgrounds trying to solve, you know, issues that are unfolding in the HIV epidemic that we could make sort of like faster, better progress towards solutions. So maybe we could actually like, you know, change those disparities or get...

Carly: 1:25:26

Right.

Valerie: 1:25:27

Yeah. So what's, I think really fun here is that Seth has been running this program for 15 years. And Lisa was in the first year of the program and she actually now co-leads it. And I was in the second year of the program. So I think, you know, it's been a, it's been a great program and I'm, like I said on the podcast, I mean, I just, would've gone in a totally different direction. Who knows what I would have been doing.

Carly: 1:25:52

Right. So the moral of the story here is that the T 32 is cranking out some really bad ass researchers that are doing some really solid, awesome, especially in the field of HIV.

Valerie: 1:26:05

Yeah. Me aside, they're all doing really well.

Carly: 1:26:09

That's not true. That's not true.

Valerie: 1:26:11

All right. And then the last thing that they wanted some clarity around was what's up with this for retracted paper on COVID. So what is the, what does it mean for a paper to be retracted? Where was it retracted from, and what, what did those papers originally report? So there have actually now been two papers that were retracted. They were retracted from two of our big deal medical journals. So from the Lancet and the New England Journal of Medicine, and they were both, focused on COVID. So the Lancet journal looked at, chloroquine and hydrochloroquine, and it concluded that these medications might be dangerous to patients. And then the second article in New England Journal of Medicine found that some blood pressure drugs might protect against COVID-19. So both of these have been retracted, which essentially means that they were published and to be published, a paper has to pass peer review. So it's sent out to other scientists, they read it and they, they kind of like give it a thumbs up or thumbs down. So it had been reviewed by other, by other scientists. And it might've been like two or three other people. They gave it a thumbs up. They said it looks good. Then it was published. And then I think what happened was people started looking at the paper in closer detail. They started looking at the data and there were a lot of like flags on the play. Essentially. They, you know, people reading the articles thought that there, there were some inconsistencies I think, was the language that had been used. And interestingly, both studies were led by the same professor. They relied on the same database that people, and like, people hadn't really heard of this database before. So, with some further investigation, it was concluded that there were problems in the database. And so both papers were pulled back, so they were retracted. And so the journal basically essentially says like, you know, we're not, we're not as clear on whether these are good results. So I think that this is really tough because on one hand, you know, everyone's calling for like fast science to addressCOVID. Like, we're really reliant on figuring out like, just how long can COVID last on surfaces or can I go running behind like someone who might be coughing? Or we so much science is needed for vaccines. So we're really trying to like put the gas on science, but then at the same time, science is just really slow. Like everything from running our studies to really verifying that the results are true, is a slow process. Like typically for if I am asked to review peer review journal article, I'll get like at least a month to do that. And now reviewers are being asked to review things in like a week or less to try to keep up with the demand for for just more information about it.

Carly: 1:29:10

Right. And you know, the, the back to, you know, the point that Seth was trying to make is that, you know, I think that the, the bigger problem here that we'll see in the future, like the ripple effect is that, you know, all the nonbelievers or the, you know, conspiracy theorists are going to use this and jump on it for any, you know, solid, good science that does come out about COVID, especially related to a vaccine. You know, this is going to be all the ammo that they think they need. And likely, probably is all the ammo that they need to get more people to believe them when they say, you know, like, yeah, but look, they put out this science and we learned that that's not true. So, you know, who's to say, this is going to be the same and it's going to be this, you know, the naysayers are going to have some ground to walk on. So it'll be interesting to see how this sort of unfolds in the future as more science kind of comes out.

Valerie: 1:29:58

Yeah. We're all really concerned actually about conspiracy theorists over in our lab right now. So..

Carly: 1:30:06

Yep. Y eah. For sure. We'll probably have an episode coming at ya quickly about that too.

Valerie: 1:30:13

I mean, hopefully we all, you know, in this moment of time that we can all take some time to reflect too as scientists about, you know, how, how we do things and how we can do things better. I think that this is really a call to action for sort of some self-examination for kind of, fo r s cience, a s t h e l arger picture. So.

Carly: 1:30:36

Absolutely.

Valerie: 1:30:38

Yeah. A huge thanks to the Stigma and Health Inequities Lab at the University of Delaware for their h elp w ith this episode, especially Alyssa Leung and Natalie Brousseau. This episode was researched by Saray Lopez and Kristina Holsapple, and it was also edited by Kristina Holsapple.

Carly: 1:30:58

And as always, thank you to City Girl for the music for the podcast.

Valerie: 1:31:01

And thanks to you for listening.