Seth Kalichman & Lisa Eaton: HIV Prevention & Treatment

Episode Transcript
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Valerie (00:08):
I'm Valerie Earnshaw.

Carly (00:09):
And I'm Carly Hill.

Valerie (00:11):
And this is Sex, Drugs a nd Science.
Today's conversation is withDoctors Seth Kalichman and Lisa
Eaton, who are professors at theUniversity of Connecticut.
Seth is also the editor of AIDSand Behavior, which is a popular
journal for sex and d rugscience.
And Lisa is an associate editor.

Carly (00:27):
Now guys, this episode is creaky.
Seth was sitting in a verycreaky chair.
So the way to think about it iswhen Seth got more excited about
what he was talking about, hemoved or rocked his chair a
little bit more.
So if you don't hear the creakthat's because Seth was not
interested in what we arespeaking about.

Valerie (00:42):
So we hope that you bear with us on this and just
know that the most interestingparts are going to be a little
bit creaky today.

(01:05):
All right.
Seth and Lisa, so happy toconnect with you two today.

Carly (01:10):
Yeah.
Thank you guys so much.

Valerie (01:11):
Yeah.

Lisa (01:12):
Happy to be here.

Valerie (01:14):
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 worktogether 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 thetime.

Seth (01:34):
Well, thank you.

Valerie (01:36):
I thought that maybe we could rewind to the beginning
and talk about how we gotinterested in HIV research.
So maybe starting off with Seth,how did you get into the field
of HIV research?

Seth (01:54):
Well, that was a long time ago.
So I, I actually, as a, as agraduate student, wasn't
interested in HIV at all.
I was aware of it.
This was back in the in the1980s.
And so, as you know, HIV wasjust coming to be, the national

(02:17):
problem, that it is, the globalproblem that it is.
And I was aware of it, but itwas really, in my mind and in
our national reality, was a gaymen's disease.
And what I was interested in wastwo things.

(02:38):
I was interested in cancer andthe psychological aspects of
dealing with cancer and cancertreatment decision making and
how you sort of navigate copingwith cancer.
That was really the directionthat I was going in.
And I taught as a graduatestudent, a course in human

(03:00):
sexuality at the University ofSouth Carolina to large number
of students.
So in human sexuality, therewas, we did cover AIDS, but it
was less than a page in thetextbook.
And it was a gay men's disease.
That really wasn't somethingthat we, we spent very much time
on, but I'm a clinicalpsychologist.

(03:21):
And I went on my clinicalinternship, and by, just by
chance, I was assigned to, Ididn't request to work with a
guy who was doing HIV preventionresearch, and this was in 1989.
And when I met him and saw thework that he was doing, it was
obvious to me that, um, he was areal pioneer in that work he was

(03:45):
doing was really important.
And that, that, uh, the thingsthat I was interested in at that
time, actually, I becameinterested in sexual assault and
sexual violence.
I thought I might be going in adirection of a forensic
psychologist, as much as ahealth psychologist.
So I wasn't really certain whereI'd end up.

(04:07):
And as soon as I met him and sawthe work that he was doing, I
just dropped everything else andnever looked back.
So I started working with JeffKelly, who turns out is a
pioneer in HIV prevention andHIV prevention research, and
just wanted to become him.

Valerie (04:27):
And now here you are! Editor of AIDS and Behavior,
well known HIV, socialbehavioral scientists.
So maybe you're not Jeff Kelly,but you are the Seth Kalichman.
So well done.

Carly (04:39):
I said,"You're the first person that we've interviewed
who has their own Wikipediapage,".

Seth (04:45):
I do.

Carly (04:46):
Yeah.

Lisa (04:47):
Isn't this your like, second podcast?

Seth (04:49):
I, well, I didn't know.
I don't, I didn't know that Idid though.
I think that the AIDS Denial isactually set up, so I don't
really know what's on there.

Valerie (05:01):
We're going to get on and update it with everything we
learn after this podcast.

Seth (05:04):
I guess I should probably take a look at that.

Valerie (05:06):
Y eah.
All r ight.
So eventually you land, youknow, you move around a little
bit, and eventually you land atthe fantastic University of
Connecticut and you're teachingthere.
And so, so Lisa, how did you,did you become connected with
Seth when you were anundergraduate?

(05:26):
Because I know that you w orkedtogether when you were a grad
student.

Lisa (05:29):
Yes, I did.
I, I, well, I h ad a lot ofinterests.
I had a lot.
I think I started as like, anequestrian sciences major...

Valerie (05:42):
That you were a horse science major.

Lisa (05:45):
....criminology maybe, nursing, but there was no, but I
had never, I mean, I think thetype of work that we all do, you
don't get exposure to it's, it'snot...
I don't think like as a 10 yearold, it's an obvious job.

Valerie (06:02):
Right.

Lisa (06:03):
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 tothink about like affecting like
health on a population levelacross the globe.
And, you know, it is like what,like uniquely links us is that

(06:28):
like, we're all vulnerable topoor 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 ina very practical sense, like how
you could do global publichealth research.
And I was just really fascinatedby it.

(06:51):
And Seth had, I was reallyinterested in the South Africa
work, and I was reallyinterested in the country, and I
was really interested in thedynamics of the culture.
And I think I just, I just lovedlearning about it.

(07:11):
I love learning about it.
And so I had started workingwith, I think, as a junior and,
and I had like the most basic oftasks, but I loved it.
And, you know, it was liketaping receipts and scanning
documents, but like, it didn'tmatter to me.

(07:33):
I didn't care.
I would have done anything.
So, but then, you know, throughthat work is when I had really
become exposed to the realitiesof the, of the domestic HIV
epidemic.
And, and it was just extremelyeye- opening because that's not

(08:01):
part of our, you know, how HIVlooks in the US is not part of
our national dialogue.
It doesn't get the, it doesn'tget the attention that it
deserves.
And, so Seth, you know,fortunately Seth had both a
domestic and an internationalresearch program.
And so as I learned more aboutwhat was happening, in

(08:23):
particular in the SoutheasternUS, I thought that actually
like, this is a really amazingopportunity.
And, and so I took advantage ofit as much as I could.
And then when I had my firstopportunity to lead my own
studies, I just couldn't believewhat we were seeing in Atlanta.

(08:44):
It was really, I mean, Iunderstand that there are quite
a few people who had been doingsimilar work for many years, but
this was like...
When I started doing work inAtlanta, it was really like, I
think, like right before the CDCstarted releasing a lot of
statements on what HIVtransmission looks like among
race minority and sexualidentity minority individuals in

(09:06):
the Southeastern US.
If I have to say that peopledidn't know what was happening,
but it was like right before theCDC really started putting out a
lot of data on annual incidents.
And when people really startedto take notice.
And so when I first starteddoing work in Atlanta, I really
thought there was somethingwrong with their data
collection.

(09:26):
Because when we were screeningindividuals for, at that time, I
think it was my masters, it wassomething like people, it was
like 40% of our sample werereporting, living with HIV, and
it was shocking.
And so, and so anyways, we, youknow, that to me, it was like,

(09:52):
"Okay, I know what I'm doing.
This is what I'm doing," becauseit was kind of like unbelievable
to be like living through thatmoment where, um, you know, that
this is a public health crisis,but...
And I use that word with cautionbecause priceless, you know, you
can't, you can't sustain crisis.
You have to find normality eventhough normal, normality with a

(10:18):
strong sense of urgency to dosomething.
So anyways, it was, um, I justknew 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 15years now.
And I don't think I have lostsight of that at all.

(10:39):
I don't think, I mean, I don't,I've, I've done a little bit of
pivoting, a little bit ofdeviating, but I always thought
that this is just, just an areaof 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 HIVresearch, you have this moment
where you're given anopportunity to dive into a
program of research or, or towork with a mentor in the area.
And then Seth, you go on tocreate this training program,

(11:17):
which I, you know, was a part ofand, um, to, to expose, you
know, social behavioralresearchers, I think it was
originally psychologists, butit's kind of expanded out from
there to HIV research, which Ithink has been super smart.
So it's really neat that you'vegone on then to sort of create

(11:38):
this opportunity for other folkson a much, it feels like a much
larger scale, cause you'veprobably have had, but like 30
people go through that programat...
No more than that.
Cause you have larger cohortsnow.
You've had a lot of people gothrough that T32 program.

Seth (11:55):
Yeah.
I've, I've..yes we have.
So we've had it for like 15years.
Training program needs to beable to research here at the
University of Connecticut andit's, it's been somewhat unique
because most of these kinds oftraining programs are focused
more on postdoctoral training,and they're housed at medical
schools.

(12:15):
And our training program hasbeen focused on doctoral
students, and it's housed in atraditional academic campus.
So it's been, it's, it's beenunique that way.
And yeah, there, there havebeen...I'd like to tell you the
number, you know, but I, I I'lljust make it up.

(12:36):
We've had about 25 or 30, that'sprobably close, you know, 25 or
30 people that have gone throughthe program.
And some of them have beenremarkably successful.

Valerie (12:49):
I mean, being part of that program totally transformed
my career trajectory.
I think I would still be doinglike self objectification
research and probably doing thatpretty poorly.
I just wasn't great at it.
We talked about that a littlebit in an earlier episode, but,
um, it, it totally like if youhad a moment of working with

(13:09):
Jeff Kelly and you were like, Iwant to do that.
I want to go do what he does.
I mean, I think that being ableto be part of that training
program was a moment for me of,I want to do that.
I want to, I want to focus inthat 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 ofresearch going in, in Georgia
and Seth you started, you musthave started this research in
the nineties, right.
Because you were at Georgiastate University in the
nineties.
Is that when you started workingthere?

Seth (13:53):
Yeah.
Well, you know, you, you, youdid anyone who would listen to
this a favor by skipping thatwhole part where you said I
moved around a bit and ended upat the University of Connecticut
because I, I really did movearound quite a bit.
So, yeah.
Cause but I, along that sort ofcheckerboard moving around, I

(14:16):
mean, the summary of that isbasically that I kept picking
jobs, but always ending up backwith Jeff Kelly.
So, so I worked with him oninternship.
I took a job and then I went, Ileft that job to work with him
when at the Medical CollegeofWisconsin.
And then I moved to GeorgiaState where I was there for two

(14:37):
years, and then he recruited meback....
And I, so, so always kinda likeback and forth with Jeff Kelly,
but there was a two year stintin there where I did, it was in
1996.
It was when the Olympics were inAtlanta, that I moved to Georgia
State University in Atlanta.
And I started a program ofresearch there thinking I was
going to be there for a verylong time, but he recruited me

(14:58):
back to the Medical College ofWisconsin.
And when I moved back, I, youknow, it was very obvious to me
that I should keep that workgoing.
I had just gotten a grant thereand it was a project that would
have been difficult to do inMilwaukee because it was with
people living with HIV.

(15:19):
And the population was muchlarger in Atlanta than in
Milwaukee, and people at theMedical College of Wisconsin,
were starting to do a lot morework with people living with
HIV.
And so the population pool wasnot that large to now bring in
another study.
So I just said, look, I'll keepthis study going remotely with
the intention of just finishingthat five year study.

(15:43):
But that's not what happened.
I just continued to do all mywork in Atlanta.
All of, all of my research hasbeen in, in, in Atlanta and the
surrounding area or in SouthAfrica.
And so, you know, it's, we'vereally established the presence

(16:04):
there.
And then when, when Lisa, youknow, 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 withare actually fairly distinct.
Lisa, you've really not done astudy that's focused on people

(16:26):
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, notliving with HIV.
In South Africa, my work hasbeen very much concentrated on
at risk populations and doingprimary prevention, but not in
Atlanta.
So, I think that's why Lisa andI have been able to work out of

(16:50):
the same place, well together,because our programs of research
are actually complimentary they're t hey're, t hey're very
distinct.

Valerie (17:00):
Yeah.
I was thinking about that when Iwas looking over your, your CVs
and your funding.
Cause I think what happens to alot of people is you work
together for a long time andthen, or you may have trained
together or something, and thenyou just start to look redundant
on grants.
It's like, why do we need bothof you?
If you're...have the sameexpertise they're doing the same
thing.
So, you know, being thoughtfulabout how to complement each

(17:25):
other with your research studiesis 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 mywork.

Lisa (17:44):
Yeah.
I think that, I mean, it isinteresting how things out well.
But it's not like we ever likesat 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 oflike, think about our research

(18:05):
program, I think of it as beinglike across the continuum of
care.
And I mean, we, we were doingthis before continuum of care
really entered the literaturetoo.
And so, but I was interested inprevention and I was interested
in, in testing uptake andprevention treatment options.
I, I even, you know, before prephad been FDA approved, I was,

(18:36):
um, you know, kind of like how Ifeel now about long acting
injectables, just kind of likewaiting for these things to come
out, waiting for PREP to comeout, you know, being really
interested in understanding how,how things like treatment as
prevention, impact preventionfor people who are HIV negative,
but potentially elevated riskfor HIV.
Or understanding why, you know,what it would actually take to

(19:03):
for the, for the CDC guidelinesregarding HIV testing uptake to
actually be implemented toactually occur, not just be a
guideline on paper, but toactually realize that.
So I remember, I, I recallalways being interested in that
and, and when, when Seth and Ifirst started working together

(19:26):
and I, you know, first startedhaving my own research studies,
I think it was just, it was justkind of a natural fit.
And one thing that I think hasworked 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

(19:50):
clinic.
So, we have had to makeconsiderable investments.
And I don't mean, you know, evennecessarily from a financial
standpoint, I'm talking like a,from a research and being
strategic and thoughtful andengaging standpoint regarding

(20:11):
recruitment.
But one thing that's worked outreally well is when we put these
recruitment efforts in, we havestudies for everybody.
I mean, basically everybody, youknow, I think for a long time
now, we've always run multiplestudies simultaneously, but of

(20:34):
course you can't, you know, as arule of thumb, you can't have
people enroll in more than onestudy.
So we've always, you know, givenlike the variety of studies that
we've been interested in, webasically always have something
for which is really what youneed.
And that's one, one main, onemajor piece of having an

(20:55):
effective recruitment program.

Valerie (20:57):
Yeah.
That's really neat.
People see your flyer, they comein 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 areally effective way for having
a presence and a strong base,and just, you know, a strong
foothold and being able to dothis work.
I mean we say Atlanta, but a lotof our participants actually

(21:25):
come like from throughout thestate of Georgia, but because
that's, as things have evolvedtoo, we've done more and more
and more work online.
So then the limitation becomeswell, do we have an agency who
we can partner with throughoutthe state of Georgia?
Or, you know, can you go overthe state law?
I mean, it kind of snowballsfrom there, but anyways, yeah,

(21:47):
we have, we have, I think we'vekind 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 alittle bit about, that you guys
do some of your studyrecruitment 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 saidit, I was like,"Well, how come
no, you know, how come noteveryone's doing that?
You know, like...

Seth (22:19):
Yeah, now everyone is doing that.
So...But we were doing thatbefore 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 moreabout 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 wasthe PI of a project that, a
five-year study that I was verymuch involved with, that took

(23:02):
place at multiple black gaypride events across the US.
So we would do about five or sixevents a year for about three or
four years.
And the entirety of thosestudies were done at pride
events.
It's a p retty, it's veryinteresting because it's like,

(23:26):
it's just, all your researchefforts are just so extremely
concentrated into three days.
And t here is like a lot ofbuildup, a lot of b uildup, a
lot of strategic maneuvering andevents can be very fluid.
You have events, canceledevents, moved o n three
scheduled m eetings, o r, youknow, y ou do as much planning
and preparing, planning andpreparing.
T hen you have like three orfour days of controlled chaos.

(23:49):
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 knowthat I, I always k ind o f l ean
towards like, let's try and dothings remotely.
I do things remotely.
That's actually been a reallynice balance too, because that
will frequently remind me oflike the importance of being
able to have f ace t ime withpeople.

(24:10):
And so that is one thing, youknow, as much as I l ike doing
studies remotely, I definitelyunderstand the value of having
Face time with people.
And that's a really nice thingabout pride, about pride events
is that, you know, thatconnection and just being able
to have like an organicconversation with somebody and
like, have it be spontaneous andi t's, it's not controlled

(24:32):
through the constraints oftechnology.
So, I mean, t here areadvantages and disadvantages to
all of it.
With the pride event, you cancollect 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 toreach people any other way.
There are also a lot challenges.
I mean, I d on't k now, I c ouldkind 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, itsounds like it would be to
collect data at pride.
Given that Carly usually iscollecting data at our local
methadone clinic.
And I just want to say thatthat'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 thatthere's a best practices sort of
methodology that results in veryhigh quality data from, you
know, a very good response rate.

(25:39):
Yeah, but they're very, but topull them off, I mean, anyone
could show up at gay pride witha stack of surveys, which are
pull off pride survey to get thekind of data that we've got.
Our group has been doing.
It had, had been doing pridesurveys on a fairly regular
basis for a long time.
To where we were able to reallyestablish at the same place,

(26:01):
Atlanta gay pride.
So we were able to establishreally, you know, time trends,
we've published papers, lookedat changes in behavior and how
that's related to medicationscoming on scene and people's
beliefs about HIV treatment, andhow that impacts people's
behavior.
You know, from like 1997 to 2010papers like that.

(26:24):
So there's a real consistency inour measures in our, our, our
procedures that allow for thosekinds of, you know, analyses to
be robust.
And, and I think it haseverything to do with, like Lisa
was saying...It is a it is a, aconcentrated effort to pull to

(26:47):
really pull it off with, youknow, to walk out after three
days with two different studiesthat each of these studies have,
you know, four or 500participants.
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 inbetter data quality?

Speaker 3 (27:16):
Well, I always, what we tried to do was have a
presence there, like a communitypresence to sort of operate like
community based organization.
So what we would do is we wouldhave, we would rent booths, you
know, we would have, just likeany other vendor and the vendor
area we would rent booths.
You know, have a real systematickind of presence.

(27:41):
So I would take down there, youknow, a half, a dozen, eight,
half a dozen students, and thenour full time staff in Atlanta.
So we have like 10 or 12 peopleout there.
Everyone wearing t-shirts thatwe would make for the event that
are pride positive, we wouldhave giveaways.
So at our booth, you know,people would come and, there was

(28:02):
always candy and give away itemslike pride rings and things that
people might want.
So that when they leave, havingdone a survey, someone says,
"Where'd you get those priderings over there?" Those people
over there are doing the surveypeople in cash to do surveys.
So trying to show up with like$20,000 in$2 bills and, and pay

(28:24):
people.
But we would also, knowing that,you know, two or$3, it doesn't
necessarily mean a lot tosomeone 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'dgive people what was at least

(28:46):
that we give people two, two or$4 for doing the survey, but
then we'd match that and givetwo or four dollars to some
designated AIDS charity.
So it became a fundraisingevent.
So by doing the survey, we buyyou a drink and, and, and we'd
also, you know, you'd bedonating money to some local HIV

(29:06):
organization.
So it was that sort of likereally orchestrate inherit
event, but then comes to thesurvey.
The survey has to be very short.
The rule was, it couldn't bemore than five pages of
questions.
And those questions had to be an18 to 25, so that when you ask
someone to do a survey and theylook at it, the first thing they
do is they feel it.
So if it's thick, they're goingto walk away.

(29:28):
Then they thought through it.
And if it looks like a bunch ofsmall type, they're going to
walk away.
So you have to be very carefulabout what you ask, because
every question comes at a cost.
If, for, if you have somethingyou're not going to analyze,
then you've, wasted theopportunity to get a question
that you would analyze.
So the surveys have to be verywell, carefully constructed to

(29:49):
answer the research questionsthat you go in to answer for
that study, because you don'thave a lot of space to be able
to do that.
It has to be short.
People won't stand there formore than you know, five or 10
minutes to do the survey.
It has to be completelyanonymous and, and people have
to know that there can be nosort of like,"Well, you signed

(30:11):
this form, but do the survey,"it has to be completely
anonymous.
There, there, like a lot ofpieces to that, anything that
can sort of attract people.
So in Atlanta gay pride, youknow, it was always set up
really hot.
So we would have cold drinks forpeople, we'd set up fans.
We'd have places for people tosit, everybody does their own
survey.
We never interviewed people.

(30:31):
It's always an anonymous surveydone completely confidentially
on clipboards, you know, sowe're kind of a remarkable
orchestrated event, but morethan anything, it was a lot of
fun.
So everyone loved it and washaving 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 14hour day.
But, but when you're out there,I mean, you're having a lot of
fun with people that everyone'sthere 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 agood time out there, fooling

(31:14):
around with people and havingjust 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 productivetime.
We would, we would get severalpapers out of those surveys.
Just pretty remarkable.

Valerie (31:43):
Absolutely.

Carly (31:44):
Yeah.
Valerie, I'm, I'm up for thechallenge.

Valerie (31:47):
Okay.
Noted.
Well, prides not on for thisyear, but we'll, we'll see for
now...are you guys still doingthese 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 downthere when they, so that's more
of like, those, I think havebeen 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 ofthat 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, Imean, I, it was definitely the
same sentiment.
Like it's, it's much more thanthe survey, it's about engaging
individuals and having fun andunderstanding that like they're,
they're, they're like they'reshowing up there to have fun.

(32:49):
And so like if we're going tomake this work, like we better
join them, and how they feel andcelebrate with them as well.
And try to collect a little bitof data along the way.
And so, so with that project, wedid, we did mostly, we did our
data collection electronically.

(33:09):
And we also paid, we compensatedpeople higher in that study,
because we collected more data.
And it actually worked, we wereable to do it.
The reason why I say it actuallyworked is because you would
assume that if someone's likegoing through a pride event,
that they're like, they're thereto like make quick stops and
keep going.

(33:30):
But, we also did HIV testing aswell.

Valerie (33:34):
Oh, at pride?

Lisa (33:36):
Yeah.
So, we, I mean, people, youknow, we asked people if they'd
be interested in getting an HIVtest done, and then if, if they
weren't, we asked them if theywould be interested in providing
a sample for us, just, just, youknow, so that we can test to,
just for our data, for datacollection records, but we ended

(33:59):
up doing, it was a little, itwas a little different that the,
black gay pride events, thereare a lot of events that happen
outside of like major urbangreen spaces.
So maybe it's, there's likesmall, there's a lot of smaller
events that occur.
And a lot of like people waitingto get in to, to, maybe a bar or

(34:25):
whatnot, a club.
And so we were just, we would becommunicating with individuals
as they're, you know, basicallythey have time on their hands.
So we were able to do a bit moreextensive surveying for that
study.
But we haven't, we, we haven'tdone it in...
It's been at least a couple ofyears now.

(34:45):
And, I mean, I think a couplethings are going on at one of
course we have COVID so I thinkall 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

(35:07):
pride survey, that really wasn'tan option, and I'm gonna imagine
that for Seth's pride survey,that absolutely wasn't an
option.
And so, but like, so that haschanged.
I still though have a strongpreference for being able to do
surveying in person.
And I, I always have concernsabout data collection and

(35:29):
wondering, you know, datacollection that's solely online.
I wonder who's actually taking,you know, who's actually taking
the survey and like, what isactually being done to verify
that these individuals are whothey say they are.
And I know that there's a lot ofbest practices around that album
.
Okay.
But that is one thing that Igreatly appreciated about doing

(35:50):
the pride studies is that youjust have more of a handle on
like who it is that you, youknow, that you're actually
interacting with.
And at least for me, I've, I,that just instills greater
confidence that we're reallyworking with the individuals who
we intend to be working with.
And so, I don't know, I would, Iwould like to do them again.

(36:15):
I definitely would.
It's, I mean, especially with,so one of the things that, like
one of the reemerging themeswhen we did the black gay pride
study was that there are justonly so many opportunities to
interact with, as as manyindividuals, as we were able to,

(36:40):
we were able to survey thousandsof individuals.
And like, there's just the typeof opportunity does not come
around very much.
And so it was like, why notcapitalize on that moment and
that space?
And, yeah, I would definitelylike to do it again.
I absolutely would, and I think,you know, as long as there's a

(37:03):
need and an epidemic to addressand, and, you know, we know that
there are some interestingprevention options in the
pipeline and, and, you know, mywork has basically always been
like everything outside of thestrict biomedical piece.
I'm interested in, I'minterested in how people
perceive vaccines and how theyperceive prevention and well,

(37:27):
what does it actually take toget people to use those items,
right?
Like in reducing the dividebetween the advances that we
make and biomedicine, andactually people embracing these
options.
And in terms of HIV prevention,that's like always a moving
target.

(37:48):
So it might be slow, but it'salways a moving target.
There's always kind of the nextthing on the horizon.
And there's a lot of work to bedone.
Yeah.
Yeah, absolutely.

Valerie (38:05):
Okay.
So I know that you both havebeen thinking a lot about what
we can take as, you know, socialbehavioral scientists from HIV
and apply it to what's going onwith COVID.
And you think you've been doinga lot in this space, including,
you know, it seems like one ofthe first things that you did
was to coauthor this commentarypaper that came out in the

(38:28):
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 lessonslearned?
So I was wondering if you couldkind of take us through some of
the, some of the big picturesthat are big picture takeaways,
that we should think aboutapplying to COVID from HIV based

(38:52):
on how you've been thinkingabout it so far.

Lisa (38:56):
Well, I think that, one of the, probably the challenge that
keeps re-emerging for me is thatwe know that sustained
behavioral change is reallychallenging.

(39:16):
It's not our strong suit.
It's not, it's not a universalstrength.
And so how do you make that?
You know, and, and right now, Imean, it, you know, in a lot of
ways, it, it does feel like whatwe've experienced so much in
addressing HIV.

(39:38):
It's like, well, in the absenceof a vaccine, you're really
relying on behavioralstrategies.
Because even the biomedicalstrategies that we have are
reliant on behaviors, and theyneed to be taken.
People need to show up toappointments.
I mean, there are a lot ofbehavioral strategies.
There are, there, there are alot of behaviors you have to

(39:59):
engage in in order to get tothose places and HIV prevention
and treatment that we want to beat.
And that's, you know, that'sabsolutely the case for COVID.
I mean, we don't have, I mean,we have supportive care for
people who are really sick, butat this point, our greatest

(40:19):
strategy is behavior change.
And, and I think that, you know,looking at the, I mean, there's
just no question, like lookingat what we know about HIV
prevention, we're best off whenwe have a multilevel approach to
prevention.
When we have the policy piece inplace, which hasn't been in

(40:42):
place, but when we have a policypiece in place, when we can
construct structuralinterventions and when we have
some unity among individualsthat they need to change their
behavior.
I think that like, and, and, youknow, and I think we've all
observed this, like when COVIDfirst hit, I think that, you
know, and we know this from likemobile data.

(41:03):
I mean, there have been studiesthat have shown this.
And, and I think most of us haveprobably experienced this
personally when COVID first hitthat, you know, there was so
much uncertainty about what itwas going to look like, and a
lot of commitment to, tobehavioral practices.
And then, you know, but then welearn more information and we
adapt and we adjust.

(41:25):
And I, I refer to it as liketrying to figure out how to live
with COVID, you know, with thebroader context of COVID.
And I think it's the, I thinkSeth and I have actually had
many interesting discussionsabout it because I think we
come...I actually think that Ithink would probably be an

(41:45):
agreement on how the HIVbehavioral literature is going
to be related to the COVIDbehavioral literature.
But I think we both havedifferent stances on like the
extent to which preventionmeasures need to be implemented.
Because I'm very much, you know,I've been like, we have to find
a balance somewhere.

(42:06):
Like, well, we have, like, wehave to keep these facilities up
and going and, and, you know,Seth will say like, no, like we
need to get like preventionunder control.
It's not under control...
and in somewhere.
And I think somewhere in themiddle is, is the truth is the
reality of it.
And, but I think we're probablyindicative of the broader

(42:28):
America in terms of kind of likewhat, I mean before we started
the podcast, we were talking alittle bit about what this is
going to look like atuniversities.
You know, what I, when I, whereI think I was probably at the
beginning of this and where I amnow, is that we have very
strong, varied opinions, and Iunderstand I can understand and

(42:52):
appreciate all of that.
And so I don't know, I think inthe, I think in the approach in
the behavioral approaches toHIV, we can, in our reliance on
behavior change to prevent HIVis very similar to COVID.
It's just like the extent of theproblem is on, is on another

(43:15):
magnitude.
I don't know Seth, what youthink?
Maybe we can go back and forthon this.

Seth (43:27):
Well, you know, I think it's true.
As an emerging infectiousdisease, the first month of
COVID-19 is basically the firstdecade 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?

(43:47):
Oh, we can change thesebehaviors.
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 beenkind of remarkable a t a lot of
levels, to live through, t hat we a re s till l iving t hrough.
You know, a lot of things havebeen very interesting for me to

(44:23):
see.
Like suddenly everybody goes toTony Fauci is, that's good.
And it's also interesting.
It's been interesting to watchhim c ause I've watched him my
whole career on HIV.
And, u m, I guess this is sortof a public apology to Tony

(44:45):
Fauci.
C ause I've spent the past 30years saying"Why can't h e pay a
little bit of attention tobehavior change and stop talking
about v accine andtherapeutics?"

Valerie (44:58):
Okay.

Seth (45:00):
You know, I've been a great proponent of HIV
prevention through behaviorchange, there are no vaccines.
And when I, when I started,there were no therapeutics, but
I've come to truly appreciatewhy he would not believe that
people will actually changetheir behavior in watching the

(45:23):
public response to the COVID-19and, um, uh, how naive I've been
to believe that people everwould.

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 aremarkable time, obviously, I
think for everybody livingthrough this, but I, yeah, I do
think that, uh, you know, sortof, as Lisa was alluding to, I
think that this is true that, inour, in our, in our little world
on university campuses,certainly not at a medical

(46:08):
school...those of us that do HIVbehavior research are in a
unique position.
Because we're the only ones whohave been thinking about an
infectious disease, at all.
So, outside of medical schools,universities don't have really
health like health psychologistsand medical anthropologists and

(46:31):
medical, sociologists, andnurses, um, people that are
trained on academic campuses.
No one is thinking about everinfectious diseases, except HIV
is something actually working.
It's not like you find people onour campus who have been working

(46:51):
on influenza or clostridium orTB...you know, infectious
diseases, you know, um, waspretty much an area of medicine
that was, you know, in the postantibiotic world, infectious
diseases were in post antibioticand, and post you know, polio

(47:15):
vaccine world.
That was a field that was, itwas, it was dying on the vine as
much as psychiatry was in the1970s.
And one of the, one of the areasof infectious diseases that
remained relevant, although notvery relevant, was sexually
transmitted infections.

(47:36):
And of course, HIV changed allof that.
It brought back an entirerelevance to that area of
medicine, but in behavioralsciences, there's not an
infectious disease that has alarge number of people working
on it other than HIV.
And in fact, I'm not sureworking on anything other than
sexually transmitted infections,TB, things that are related to

(47:57):
HIV.
So we're like in a uniqueposition.
I think we have a uniqueperspective in our little world,
in thinking about a publichealth response, an individual
response, a societal response tothis, to this pandemic.

Lisa (48:17):
Well, one in particular too, that it's occurring.
So, that we have to think ofthis context occurring on a
college campus.
So there are people that dointernational work and, and can
have, um, kind of have longhistories of involvement in
those areas, but I'd be shockedif people are really thinking of

(48:43):
like controlling an infectiousdisease to the magnitude, we
will have to do that on acollege campus, which is going
to be one of the mostchallenging places in some ways
to do so.
And so, yeah, I mean, they'rejust, there's just simply, you

(49:09):
know, many places, manycomponents of it have to be...
I mean, probably about everysingle component of the college
environment has to be consideredin light of COVID.
And that task is taking, isbeing taken on by individuals
who probably haven't had tothink 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 degreefrom a reputable university, Cal
State is doing that.
So it's the social stuff, youknow, it's all, it's everything
about ecology about going tocollege is social.
And there is remarkable isthere's no way that a university

(50:04):
can provide that, thatfulfilling social experience
that college is and mitigate thespread of this infectious
disease, highly contagiousrespiratory disease.
So they can, you know, they haveto try, they can do the best
that they can, the options aredon't do anything, which I don't

(50:28):
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 dosomething in between.
And it's going to be just awfulfor everybody, you know, because
it's not the college experiencethat students want.

(50:48):
And students that can take theyear off and can afford to not
go and to can afford a gap year.
Those, those more privilegedstudents will do that because
because of the Fred house isclosed, why would I bother, you
know, if I can't go to games,you know, why would I bother if,

(51:10):
if my classes are gonna havepeople sitting six feet apart
from each other and I have towear a face mask, what's that
going to do to my, you know, totry 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 becauseI like, when I say like, we have
to figure out how to live withCOVID.
I think about things like, sowhat does that mean for someone
who's 20 years old to, you know,kind of like abruptly change
their college career plans orsay the next year or however

(51:46):
long it takes.
And I think that there's likethis assumption that if students
aren't, if students don't comeback to campus, then like, oh,
they must be home and beingsafe, 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 ina different way though.

(52:08):
And having someone who is 18,19, 20, 21, being able, if they
so choose, to have someon-campus experiences and that
if we can do it in a way withthoughtfulness.
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 withthoughtfulness that actually

(52:29):
like maybe they are better offon campus, as opposed to, I
don't know where, I don't knowwhat, because it's not like
there are a lot of jobs outthere and I don't necessarily, I
, you know, I've advised a lotof students and I think I
probably differ from a lot ofadvisors in that I don't
typically advise for a gap year.

(52:49):
Because in my personalexperience and in my
observations, I think a lot ofstudents take time off of
education.
And then it's really hard to getback into it.
Like if you have thateducational opportunity, I
don't, I am not conceptualizingthis as a gap year in the
traditional perspective,anyways, because to me a gap
year, if you're going to dothat, like go big, like go live

(53:13):
somewhere else, you know, golearn about another culture for
a year, go make that documentarythat you always wanted to do.
I mean like go, but like, that'snot an option right now.
You know, you're just not going.
I mean, we, we have not livedthrough travel restrictions like
we're living through.
I've never seen that in mylifetime.
I don't think any of us haveseen this in our lifetimes.

(53:33):
And so I think that, you canmake the argument that with a,
that there, that there'spotentially better value, better
overall gain and being able toprovide the most enriching

(53:58):
experience that we can providewith limitations.
They have students remaining athome.
And I know, I mean, we've,we've, we've surveyed students
and it's something that, um, Ilook into on a daily basis.
It's not for everybody.
It's not.
And, you know, and there areplenty of 100% online options

(54:21):
and, and that is an option thatyou should take if that's what
you are most comfortable with.
But I, I just think it's morecomplicated 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 arethe ethicists?
Like, why don't we haveethicists on all of the news
channels?
Cause it's, it is like, it's abit of a right and wrong
question to some extent.
And there, there are people withPhDs in this stuff.
And, you know, I think there's alot of different ways to land on

(55:05):
the answer to these questions,but I am, I, you know, I've just
been curious about how, how arepeople thinking about that and
how do you even begin to do it?
Cause you're right, Lisa.
Like a lot of the people whoare, who are on these
committees, who are making thesedecisions, I mean, you know,
they may not even have, they maynot have public health

(55:27):
experience that you may not haveexperience thinking about, you
know, behaviors withininfectious disease epidemics.
And then when you layer intothat, just these questions of
like, what is right or wrong todo at this time.
I think it's challenging.
Yeah.

Lisa (55:42):
Yeah.
People have very strong opinionson it.
And I think that when you, when,you know, in all likelihood,
when you're faced with kind oflike your first real dose of
reality and addressing a publichealth crisis like this, you're
probably g oing t o come fromyour own personal perspective
first.

Valerie (55:57):
Right.

Lisa (55:58):
And it's all very different.
I mean, my husband's arespiratory therapist.
So the first week this happened,I was like,"Oh my God, like, I,
you know, are you going to getterribly 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 waskind of like going through like
all the phases of grief, reallyfast.

(56:20):
I'm thinking of like, is thisworth the paycheck?
And we have small children andour, you know, do you have to
quarantine?
Should, should I move I've Ihave, should I rent a house?
You know, so we're not together.
And so I think that for me, Iwent through all those phases

(56:42):
really fast because there was noother option.
I kind of got to that, likeliving with COVID and like
learning how to, like, for mepersonally, mitigate risk, you
know, came on like hard and fastand, and listening to other
people talk about that.
I think, I think others are alsogoing through that as well.

(57:04):
And if you're like in asituation where you have a lot
of control over yourenvironment, and that feels most
comfortable, well, that's like avery comfortable place to be.
And like, I think that thosewere the things that we project.
I think people like, like all ofus who have a public health
background are probablycombining that with what we know
about the science.
I mean, I think I'll shareprobably really telling that,

(57:27):
you know, having, having wantedto hear this nationally, you
know, this, this national stanceon behavioral responses and
waiting for that for 30 yearsand now seeing like why on a
federal level, it's so hard toimplement, is, is very eye
opening.

(57:47):
I mean, it's like any goodproblem.
There's no quick solution.
And like, I think it'sflexibility and being thoughtful
and, but you know, that's notnecessarily our strong suit as a
nation.

Valerie (58:05):
For sure.
Well, speaking of people withouta lot of flexibility and
thoughtfulness, m aybe, maybeit's too far, but Seth, you have
this interest in denialism and,and the anti-vaxxers.
And I'm, I'm wondering howyou've what you're thinking
about in terms of d enialistsand y ou've done some talking

(58:27):
about the anti-vaxxers withinthe context of COVID?

Seth (58:32):
Yeah.
So, you know, the, um, myinterest in AIDS denialism, for
a while and, you know, it's niceto see my old friends are back
again.
The same, you know, it's the,it's the same bag of nuts and

(58:57):
they actually, the, the sameplayers, you know, got, you
know, because there's a group ofthese AIDS denialists who, say
that the test for, you know, forHIV are valid.
You know, there, there may noteven be such a virus, but if
there is these tests certainlyget, so there's this, all this

(59:19):
sort of crazy talk and, uh, bythe pseudo scientists.
And they're just saying the samething about COVID-19.
And they do intersect, they'renot the same people.
They do intersect with the anti-vaxxers.
The anti-vaxxers are actuallyquite different, but this is
also, a field day foranti-vaccine movement.
Because, and, and one of thethings that's a little

(59:43):
disturbing is there...Whatanti-vaxxers do and AIDS
denialists do is they'll latchon to this one little thing, but
, they like cherry pick, youknow, they look for this one
little thing to say,"See, we'reright,".
And that's been going on alittle bit with, COVID-19

(01:00:04):
because of the panic and theurgency is we're giving them
things to say,"See, we're right.
So the rapid development ofvaccines and the money that's
involved in them and the, andthe federal and international

(01:00:25):
agencies and the, and the, andBill Gates, all of these...all
of these, the constellation ofthe conspiracy that fuels the
anti-vaxxers, um, are like, youknow, see, see, this is what
we're talking about.
And, you know, every time thatthere is a paper retracted,

(01:00:49):
there was a paper retractedyesterday in the New England
Journal, you know...

Valerie (01:00:54):
It was a big one.
Yeah.

Seth (01:00:54):
It does not help us.

Valerie (01:00:57):
Nope.

Seth (01:00:57):
And so, y ou know, the denialists a re happy to latch o
n t o that kind of thing, and say,"See the, you know, there's
nothing to this all along?
And how can you trust any ofwhat they're saying?
And i f, if they wouldn't havebeen called out on that one, it
w ould h ave never, they w ouldh ave never retracted,".
You k now, this is, it's such a,such a magnifying glass that

(01:01:23):
they use to find something tohook onto.
And in the, in the, in the, inthe flurry, you know, the panic.
W e're unfortunately giving themfuel f or their fire.
T here w as nothing you c an doabout that.
I mean, t here's, it's not likeI think that science can do
anything different, or be anymore careful and the urgency is

(01:01:47):
pressing.
It's just, I think we have to bemore vigilant about trying to
combat the, the, theanti-vaxxers and the denialists
with science, medical literacy,and, u m, and trying to drown
them out with, with facts.

(01:02:07):
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'san interesting time.

Valerie (01:02:22):
Yeah, for sure.
Well, I was impressed, or I wassurprised maybe initially, when
you mentioned that thatanti-vaxxers have been out and
loud since like February.
I mean, that was A before peoplewere like really starting to get
afraid of COVID at least in thestates and then B there's no

(01:02:42):
vaccine.
So just the fact that the you'vegot these prominent anti-vaxxer
folks who are really making alot of noise well in advance of
a vaccine actually existing.
You know, like how can they saythat the vaccine is dangerous or
the vaccines no, good if thereis no vaccine yet.
I just, I thought that wasreally interesting and it kind

(01:03:03):
of speaks to just the to me theidea 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'retalking about, but it's just
this, like this overall, youknow, a conspiracy theory,
that's more of this overallmistrust, or is this overall
movement that gets sort of likeapplied and reapplied, in these

(01:03:25):
different contexts.

Carly (01:03:29):
When I was doing some of the research for a, you know, a
COVID conspiracy paper, one ofthe things that I found really
jarring was that these, y ou know, anti-vaxxers, o r these
conspiracy theorists are citingresearch articles, you know,
that are coming out of the NIHto like further prove their own
points.
And it's like, well, hang onnow.
One of these things is not likethe other, like, how did we, how

(01:03:51):
did you spin that and get thatback?

Seth (01:03:55):
Right.
Welcome to my world.

Carly (01:03:55):
Right.

Seth (01:03:55):
E xactly.
That's exactly what they do.
And, it is, it is, it is a, i ti s kind of a remarkable craft.
It's, it's, it's exactly whatthey do.
U h, it's, it's more thaninteresting.
So you you've been looking atthe a nti-v axxers?

Carly (01:04:14):
So I've been very particularly using my Reddit
skills, and scouring all thosesubreddits.
So, yeah, I've, I got reallydeep into it for a few days
there where I was reallyabsorbed in all the conspiracy
theories and everything.
Yeah.

Seth (01:04:29):
Did you, did you, did you run into Dr.
Tenpenny?

Carly (01:04:35):
Uh, I don't know, you know, I have such limited...

Seth (01:04:39):
Yeah.
She may not be, she may not havea presence on Reddit, but she
has a, a significant presence inFacebook.
She's yeah.
She's, she's a piece of work.

Carly (01:04:51):
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 Gatesapparently is this really
terrible guy, you know?
And, uh, 5G boy, howdy.
Hope they don't, you know...

Seth (01:05:13):
So Dr.
Tenpenny was posting about 5Gback in early March.

Valerie (01:05:20):
Oh wow, okay.

Seth (01:05:20):
Yeah.
And she's, and she is, it isinteresting what you were saying
Valerie, cause it is true thatthey, they are like priming the
pump.
There is no vaccine when theanti-vaxxers are all up in arms
about COVID-19 they're primingthe pump.
And so they're already layingthe groundwork for the we're not

(01:05:41):
don't, don't pick that vaccine.
And I, I think that they're, thesoil is going to be really rich
for them because reasonablepeople will be concerned about
be vaccinated because of all ofthe, you know, the legitimate
discussion around rush through,you know, we're having everyone
is saying, Tony is saying, we'rehaving to skip a lot of the

(01:06:07):
early phases and combine phase 1and phase 2 vaccine development
to move this much faster.
It takes, you know, 10, 15 yearsto develop a vaccine.
If you get one ever at all.
And so two within a year wouldbe unprecedented if they
actually are able to develop avaccine in a year and bring it

(01:06:28):
to market in any near, near thattime, it'd be an incredible
achievement.
And it will be met with a greatdeal of skepticism.
And so the, you know, it's goingto be very fertile soil for
these otherwise easily ignoredpeople to get traction.

(01:06:50):
Don't be too surprised if theydon't end up in, in, in places
like CNN talking about, aboutwhy we should be concerned about
vaccines.

Valerie (01:07:00):
Well, it's really interesting to me because in
some of the, you know,literature digging that we've
all been doing together, wefound that one of the best ways
to like deal with conspiracybeliefs, is to warn people about
them before they concede andhear about the conspiracy.
And these anti-vaxxers seem tobe doing that in reverse.

(01:07:23):
So like before, you know, peopleeven start learning about an
actual vaccine or yeah.
They're getting out ahead of it.
So it's like, they're they'reahead of the game.
Yeah.
They're

Seth (01:07:36):
They are.

Lisa (01:07:38):
Do you think though, that, that, I don't know, I think you
were kind of going in thisdirection, Seth.
I think it's a reallyinteresting discussion point
that like, like kind of likewhat's science to do about it.
So, I mean, I even sometimeslike with COVID sometimes I'll

(01:07:58):
see a headline and I'm like veryscience.
I love science.
O kay.
Sometimes I'll see a headline onlike CNN and it's like, experts
say it will be like, b lah, blah, b lah, according to
experts.
And I e ven roll my eyessometimes because I'm like,
okay, but like, we do this, weput these things out.

(01:08:19):
And then with COVID, it's justso fluid that like two days
later we change it and like, iteven 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 peoplewho do t his, but like the need
to really think through howscience intersects with the

(01:08:42):
general public is just so urge.
We have to stop doing a shittyjob.

Seth (01:08:49):
The thing about this that's been most remarkable has
been the mathematical modelers.

Lisa (01:08:56):
Ah, it's exhausting.

Seth (01:08:56):
Yeah.
No, what they've, they've done agreat deal of harm actually, you
know, because the public doesn'tunderstand the nuances of
assumptions that go intomodeling.
And no matter how hard peoplelike 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'tmatter.

(01:09:16):
It's way too complex.
And what I it's become veryclear to me that there's a
there's there's groups ofmathematical modelers t hat are
like really like being on TV.
And they just c hanged theirmodel today.
They're on TV tomorrow.
And there was a period of time.
T here was like a bout two orthree weeks in there where
they...
The same modelers were talkingabout the changes in their model

(01:09:38):
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 tobe 30.
Well, we didn't know that thosestates a re g oing t o o pen u
p.
So now we're saying it's goingto be 45 and it's like, stop.
I mean, it's good to be knownand on TV for the quality
science you do.

(01:09:59):
It's bad to be k nown a nd o n TV for the rapidly changing, no
one can understand, mumbo jumbothat you're saying.
I t's, it's a little frighteningactually.
I t doesn't help us.
It doesn't help.

Valerie (01:10:15):
It's hard.
Even as a stigma researcher, youknow, folks in the media have
been asking me, like, what doesstigma look like in COVID?
And it's just it's and this wasearl-.
This might've been two monthsago.
And it's like, well, I can tellyou based on, you know, what
people are reporting in themedia and things, but we didn't
even though, and I can make somepretty good educated guesses,

(01:10:36):
based on what we know aboutinfectious disease, stigma
overall, about what it's, whatit's looking like, what it's
gonna look like.
And of course there was thewhole 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.

(01:10:57):
I felt sort of uncomfortablecause I was like, we don't, you
know, hold on, we don't have thedata yet.
Like we don't have the, but thatpeople really want to know, like
tell me what it looks like now.
And it's like, I don't know howI would have gotten, how I
would've gotten all that datayet.
Like, can I, so it's an, it's aninteresting.
moment of like people reallywanting information and you

(01:11:19):
know, trying to catch up withthat.

Lisa (01:11:24):
I mean, I think like, even for me, I, when Donald Trump won
the election, I was like, that'sa, I'm never looking at another
p oll again ever, ever.
I d on't k now l ike what y ou all are doing, but y'all failed.
You failed, you failed.
O kay.
All your polls, you failed andthat's not good.

(01:11:47):
It's not good when like it'slost on me.
And, because this is w hat, thisis what I've committed my life.
I mean, I'm not a modeler andyou know, a nd the times I've
done modeling, I, I mean, I knowl ike we've talked about this i
n the past a nd w hen you putthe assumptions i n i t's, a bit
like reading tea leaves.

(01:12:07):
And might be right, m ight notbe right, but you like
understand that and you like are you're processing all this
information in the context ofwhat you've put into the model.
But, that type, that processjust does not bode well for a
two minute sound b it or, youknow, a four minute to read
article.

(01:12:28):
Like those worlds just don'tcome together well.
So I d on't k now.

Valerie (01:12:38):
All right, well...

Seth (01:12:39):
But I should, I should say though, that just to be, to be
fair, I brought up the modelersand 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 ofthe science reporting that I've

(01:13:02):
seen has been good and, andbalanced.
And I think that, you know, Iknow, I know some of these
people, I don't know a lot ofthese people, but I know some of
these people, um, you know, frommy life in HIV, who I know some
of these people who are on TVand in the media around
COVID-19.

(01:13:24):
And I think for the most part,they're actually doing a really
good job, but the issue in whywe're talking about this, I
think is because it just takeslike one retracted paper.
It just takes saying one thingin a, you know, in a non so
certain ambiguous way.
And it gives, it can underminepublic trust, but also it gives

(01:13:48):
the people who are out toundermine public trust, the
opportunity.
And so, but for the most part, Ithink people are trying to be
responsible, you know, they're,it's been interesting to see how
people that have worked in HIVthat are broader in public
health.
They're not like me, I'm reallyone trick pony.

(01:14:11):
But there are a lot of people inpublic in HIV who have a broader
public health portfolio.
And I, and I'm really proud ofhim actually to see some of
these and see some of thecolleagues really focusing on
this problem, and trying tocommunicate responsibly.

(01:14:34):
So that's been in some waysinspiring and, and certainly, a
source of pride for me.
But then there are these otherthings that it's just like a
disaster.

Carly (01:14:47):
Well, I like, I'm going to steal your line Seth about
priming the pump, but it, youknow, it doesn't take much to
prime the pump at all, right?
Like it's not one, like you'resaying, it's, it's that one
redacted article, it's the one.
And they hang on to them andthey circulate the articles
really get...

Seth (01:15:03):
Yeah.
If our president ever like, youknow, comes out of the bunker
and will actually leave theWhite House because he's afraid
of, you know, 21 year olds withsigns.
If he ever we ever hear from himagain, you can, if you ever hear
from him again on COVID-19,which we might not actually.
I can guarantee you that if heever talks about Chloroquine and

(01:15:27):
Hydroxychloroquine again, he'llsay,"Well, we know that that
study was retracted, that it wasgarbage, that it was..."

Carly (01:15:35):
Oh, you're exactly right.
Yeah.

Seth (01:15:36):
Because he is a part of that mindset.
He, he is as much ananti-science denialist as we're
ever we're going to find.
Right.
And so he won't let that go by.

Carly (01:15:50):
Nope.

Seth (01:15:51):
He'd be happy to trash the entire scientific enterprise in
the New England Journal ofMedicine over this one thing.

Valerie (01:15:59):
Yeah.
And you've done some reallyinteresting, 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 yourpaper, looking at what Pence,
Putin, Libecki, and their HIVrelated crimes against humanity.
And we will, we'll go ahead andrecommend all readers, all
readers, all listeners to readit.
And then just to think, as wewere that you could just do

(01:16:23):
Pence, Putin, Lubecki, Trump,and their crimes against HIV and
their HIV, and COVID relatedcrimes against humanity right
now.
Cause I felt like you could justlike update that paper, you
know, and rerelease it to be,you know, relevant right now.

Seth (01:16:41):
Yeah, no, it's absolutely, it's absolutely true that those
guys have never been heldaccountable.
And President Trump isn't beingheld accountable either for, you
know, for the, the number of, ofsenseless and needless deaths
that occurred because of the wayhe handled this pandemic in this

(01:17:03):
country in the first month,we've lost six weeks because of
him.

Valerie (01:17:09):
Well, as a social behavioral science scientist,
I'm really, you know, I'mgrateful for the all hands on
deck approach to this.
I'm grateful that you guys areall hands on deck.
I feel like to try to understandthis and, you know, to both of
you for creating spaces, both atAIDS and Behavior for people to

(01:17:29):
share their insights on, COVIDquickly through the, you know,
the rapid papers that you'vebeen publishing.
And then also, you know, theFacebook community, which has
really, I think, you know,really taken off for HIV
researchers to connect.
I think it's a real testamentto, you know, your leadership in
the field to be able to get bothof those up and going.

(01:17:53):
That, you know, and then justmore personally, you know, I
wouldn't be doing sex and drugsscience if it weren't for Seth's
mentorship.
And I certainly wouldn't behaving as much fun with it as I
have been lately.
If it weren't for...

Seth (01:18:07):
Very good.
I was going to let this go by,but it's good that you, that you
, you use the word science inthis context and that you use
the word research in the othercontext.
Cause I noticed this, if youwould pick out the word research
and if you would think of theword science, what you have just
said over the past hour and ahalf, is that you owe it to me

(01:18:29):
for exposing you to HIV andgetting you into sex and drugs.

Carly (01:18:36):
That's going to be the tagline, just right there.
I can feel it already.
That's the tagline for thisepisode.
Like thanks to Seth Kalichmanfor getting Valerie Earnshaw
into sex and drugs.

Seth (01:18:45):
And exposing her to HIV.

Valerie (01:18:48):
And Lisa to keep the party going.

Seth (01:18:51):
You really have to make sure that you say that it's HIV
research and sex and drugscience.
So thank you for that.

Valerie (01:18:58):
Yes.
And thank you for your time.
All right.
So just as a reminder, we'retrying something new on the

(01:19:21):
podcast here and the undergradswho helped produce the show have
listened to it.
And they pointed us in thedirection of a few things that
we may want to clarify for folkswho are not, you know, just us
or listening in.
So that first thing was thatthey pointed out was that Lisa
and Seth are doing research inthe south.

(01:19:42):
And you know, they're up inConnecticut.
We talked about this a littlebit on the show, but they really
want to a little bit more detailas to why they're doing research
in the south and what the HIVepidemic looks like down there.
So I thought that I would sharesome sort of like basic epi data
or epidemiological data on theHIV epidemic in the US.

(01:20:03):
I pulled an HIV surveillancereport for 2018.
And so in 2018 there were 36,400new HIV cases, and the HIV
incidence...
So this number of new cases, was19,200 in the south, which is
53% of all US new infections.

Carly (01:20:24):
Which is wild.

Valerie (01:20:26):
It is wild.
So I wanted to also read whichstates count as the south.
Cause I think you're going to besurprised.
So Alabama, Arkansas,Delaware...I didn't know that
Delaware counted as the south.
Did you know that?

Carly (01:20:40):
Yeah, I did.
Unfortunately.
Yes I did.
Yeah.
Was that the mind blowing fact?

Valerie (01:20:46):
That is the mind blowing...I did not know that we
count as the south.
I grew up in Pennsylvania, and Ialways thought of myself as just
like, Mid-Atlantic like not athing?
Really actually that just likesomething that...

Carly (01:20:57):
Only to everyone above Delaware, honestly.
S o D elaware's reallyinteresting though.
C ause it gets to pick andchoose how it identifies in the
continental US.
So in some statistics, w e'll benortherners and t hen s ome
statistics.
Yeah.

Valerie (01:21:13):
Yeah.
Well I should've known that Iwasn't gonna blow a native
Delawarean's mind with, you know, how Delaware is
categorized...Pennsylvania.

Carly (01:21:23):
Yeah.
Yes, exactly.
Yeah.

Valerie (01:21:26):
All right.
Well then there's like a bunchof other states, there's a lot
of states in the south.

Carly (01:21:30):
A nd t hen it's all the regulars.

Valerie (01:21:32):
Delaware down.
And then all the way out toTexas.

Carly (01:21:36):
Oh wow.

Valerie (01:21:37):
Yeah.
Texas is included.
So, all right.
And then you hit the westessentially.
Okay.
And then, you know, continuewith our numbers.
There were 19,200 in the south,but then there were 7,500 in the
West 5,000 in the Northeast and4,700 in the Midwest.
So that's just, it's a lot ofcases for one, you know, one

(01:21:59):
section of the country.

Carly (01:22:00):
Yeah, for sure.

Valerie (01:22:02):
All right.
Then if we break this down byrace and ethnicity, which I
wanted to do because, you know,in part, I guess because Lisa
and Seth focus a lot of theirresearch, not all of it, but a
lot of it on Black men who havesex with men specifically.
So we had 15,300 of those newcases were among Black and

(01:22:22):
African Americans.
So this is 42% of all new HIVinfections across the US were
among Black and AfricanAmericans in 2018, which is
quite concerning because they'reonly 13% of the population.

Carly (01:22:36):
Right.

Valerie (01:22:37):
And then we see more disparities if we look at Latinx
folks.
So 10,300 of those newinfections were among Latinx
folks.
And they're only, um, that, sothat's 28% of new infections and
they're only 18% of thepopulation.
And then 9,000 were amongwhites.
So that's 24% of the HIVinfections, but white people are

(01:23:01):
77% of the US population.
So it just really goes to showthat this is just, it's not
equally distributed...

Carly (01:23:07):
No, super disproportionate, yeah.

Valerie (01:23:09):
Yeah.
Both by race and ethnicity, andby location.
So a few years ago, I think thatthe New York Times actually ran
an article really highlightingthat this epidemic is, is an
epidemic of disparities in theUS both in terms of location,
race, ethnicity.
And then if we layer in LGBThealth disparities, 66% of the

(01:23:35):
infections in 2018 were amongfolks who were having were among
men who have sex with men,essentially.
So gay men or bisexual men.

Carly (01:23:44):
Right.

Valerie (01:23:45):
Yeah.

Carly (01:23:46):
Wow.

Valerie (01:23:46):
We need to do better.

Carly (01:23:47):
Right?
Yeah.
Well, definitely super gratefulthat Seth and Lisa are
continuing to do this work.
Cause, you know, I think that alot of people, you know, when
you hear about, you know, theAIDS crisis, like you think back
to like, you know, gay white menin the eighties and that's about
it, you know?
And so it's like this reallyhighlights the fact that now
this work is still superimportant and it still needs to

(01:24:08):
be done to address these likewild disparities that we have
here.

Valerie (01:24:12):
Yeah.
I think that's a really greatpoint that the face has really
changed over the years.
And unfortunately it's notchanging a whole lot, so we need
to do better here for sure.
So.

Carly (01:24:23):
Exactly.

Valerie (01:24:25):
All right.
So the second thing that theyraised was what's a 332, which
is actually a T 32.
So a T 32 is something we talkedabout in the episode and it's a
training program.
So it's sponsored by theNational Institutes of Health
and essentially, the idea of thetraining program that Seth is

(01:24:46):
the lead of, which is called theSocial Processes of AIDS
Training Program, is to takepeople who are from other fields
who are, who are doing theirdoctoral dissertations and
they're studying in otherfields.
So for me, it was, you know,studying psychology and then to
get them to apply what they'relearning to the HIV epidemic.
And the idea is really, if wecould get more people from more

(01:25:11):
diverse backgrounds trying tosolve, you know, issues that are
unfolding in the HIV epidemicthat we could make sort of like
faster, better progress towardssolutions.
So maybe we could actually like,you know, change those
disparities or get...

Carly (01:25:26):
Right.

Valerie (01:25:27):
Yeah.
So what's, I think really funhere is that Seth has been
running this program for 15years.
And Lisa was in the first yearof the program and she actually
now co-leads it.
And I was in the second year ofthe program.
So I think, you know, it's beena, it's been a great program and
I'm, like I said on the podcast,I mean, I just, would've gone in

(01:25:47):
a totally different direction.
Who knows what I would have beendoing.

Carly (01:25:52):
Right.
So the moral of the story hereis that the T 32 is cranking out
some really bad ass researchersthat are doing some really
solid, awesome, especially inthe field of HIV.

Valerie (01:26:05):
Yeah.
Me aside, they're all doingreally well.

Carly (01:26:09):
That's not true.
That's not true.

Valerie (01:26:11):
All right.
And then the last thing thatthey wanted some clarity around
was what's up with this forretracted paper on COVID.
So what is the, what does itmean for a paper to be
retracted?
Where was it retracted from, andwhat, what did those papers
originally report?
So there have actually now beentwo papers that were retracted.

(01:26:32):
They were retracted from two ofour big deal medical journals.
So from the Lancet and the NewEngland Journal of Medicine, and
they were both, focused onCOVID.
So the Lancet journal looked at,chloroquine and
hydrochloroquine, and itconcluded that these medications
might be dangerous to patients.

(01:26:52):
And then the second article inNew England Journal of Medicine
found that some blood pressuredrugs might protect against
COVID-19.
So both of these have beenretracted, which essentially
means that they were publishedand to be published, a paper has
to pass peer review.
So it's sent out to otherscientists, they read it and
they, they kind of like give ita thumbs up or thumbs down.

(01:27:14):
So it had been reviewed byother, by other scientists.
And it might've been like two orthree other people.
They gave it a thumbs up.
They said it looks good.
Then it was published.
And then I think what happenedwas people started looking at
the paper in closer detail.
They started looking at the dataand there were a lot of like
flags on the play.
Essentially.

(01:27:35):
They, you know, people readingthe articles thought that there,
there were some inconsistenciesI think, was the language that
had been used.
And interestingly, both studieswere led by the same professor.
They relied on the same databasethat people, and like, people
hadn't really heard of thisdatabase before.
So, with some furtherinvestigation, it was concluded

(01:27:57):
that there were problems in thedatabase.
And so both papers were pulledback, so they were retracted.
And so the journal basicallyessentially says like, you know,
we're not, we're not as clear onwhether these are good results.
So I think that this is reallytough because on one hand, you
know, everyone's calling forlike fast science to

(01:28:18):
addressCOVID.
Like, we're really reliant onfiguring out like, just how long
can COVID last on surfaces orcan I go running behind like
someone who might be coughing?
Or we so much science is neededfor vaccines.
So we're really trying to likeput the gas on science, but then
at the same time, science isjust really slow.

(01:28:41):
Like everything from running ourstudies to really verifying that
the results are true, is a slowprocess.
Like typically for if I am askedto review peer review journal
article, I'll get like at leasta month to do that.
And now reviewers are beingasked to review things in like a

(01:29:03):
week or less to try to keep upwith the demand for for just
more information about it.

Carly (01:29:10):
Right.
And you know, the, the back to,you know, the point that Seth
was trying to make is that, youknow, I think that the, the
bigger problem here that we'llsee in the future, like the
ripple effect is that, you know,all the nonbelievers or the, you
know, conspiracy theorists aregoing to use this and jump on it
for any, you know, solid, goodscience that does come out about
COVID, especially related to avaccine.

(01:29:32):
You know, this is going to beall the ammo that they think
they need.
And likely, probably is all theammo that they need to get more
people to believe them when theysay, you know, like, yeah, but
look, they put out this scienceand we learned that that's not
true.
So, you know, who's to say, thisis going to be the same and it's
going to be this, you know, thenaysayers are going to have some
ground to walk on.
So it'll be interesting to seehow this sort of unfolds in the

(01:29:56):
future as more science kind ofcomes out.

Valerie (01:29:58):
Yeah.
We're all really concernedactually about conspiracy
theorists over in our lab rightnow.
So..

Carly (01:30:06):
Yep.
Y eah.
For sure.
We'll probably have an episodecoming at ya quickly about that
too.

Valerie (01:30:13):
I mean, hopefully we all, you know, in this moment of
time that we can all take sometime 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 acall to action for sort of some
self-examination for kind of, for s cience, a s t h e l arger

(01:30:35):
picture.
So.

Carly (01:30:36):
Absolutely.

Valerie (01:30:38):
Yeah.
A huge thanks to the Stigma andHealth Inequities Lab at the
University of Delaware for theirh elp w ith this episode,
especially Alyssa Leung andNatalie Brousseau.
This episode was researched bySaray Lopez and Kristina
Holsapple, and it was alsoedited by Kristina Holsapple.

Carly (01:30:58):
And as always, thank you to City Girl for the music for
the podcast.

Valerie (01:31:01):
And thanks to you for listening.

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