COPH researchers investigate HIV/AIDS among indigenous Latin American populations
Researchers at the USF College of Public Health have begun exploratory research examining HIV/AIDS in indigenous populations in Ecuador, Panama and Belize.
Using syndemic theory as their lens, they are investigating factors impacting the spread of HIV/AIDS in each community, according to principle investigator Dr. Dinorah Martinez-Tyson, assistant professor in the Department of Community and Family Health (CFH).
“It’s looking at the interaction or the synergy between multiple factors, such as poverty, food insecurity, drug and alcohol use, all these things, and how they sort of influence each other to possibly create the perfect storm for the spread of HIV,” Martinez-Tyson said.
Dr. Martinez-Tyson (seated at the head of the table) sits with a focus group among a Kichwa community in Ecuador. (Photo courtesy of Dina Martinez-Tyson)
The research, funded by an internal COPH grant, is a multidisciplinary research effort involving faculty from the Departments of CFH and Global Health. Dr. Julie Baldwin, affiliate professor in CFH, served as the original visionary and principle investigator for the project, according to Martinez-Tyson.
Dr. Arlene Calvo, assistant professor in CFH, has been examining the Ngäbe-Buglé in Panama.
She said this population, living in extreme poverty, has seen a dramatic increase in the number of patients going to receive HIV care.
“It has been all over the news here in Panama,” Calvo said. “They have been identifying new cases in the past two years. At the antiretroviral clinic they went from having 30 patients to over 500 patients in less than a year. These are the cases that are identified. We know that there are more cases, we just don’t know how many.”
Members of the Ngäbe-Buglé community advisory committee in Panama with doctoral student and research team member, Dr. Arturo Rebollon (second row) and Dr. Arlene Calvo (third row, far right). (Photo courtesy of Arlene Calvo)
Drs. Miguel Reina and Ricardo Izurieta, from Global Health, and Drs. Dina Martinez Tyson and Dr. Lauri Wright, from Community and Family Health, worked with a Kichwa community in Ecuador.
“The way the communities received us was very positive,” Reina said. “They were very happy to have us there and were very collaborative.”
Through focus groups and key informant interviews with community stakeholders, researchers spoke to both men and women of varying age groups, asking them a variety of questions on topics such as domestic violence, nutrition, and drug and alcohol use.
A poster from a focus group discussion with the Kichwa population in Ecuador. (Photo courtesy of Shirley Bejarano)
“They were so open,” Martinez-Tyson said. “A couple of focus groups were thanking us because they told us no one has ever asked them these questions and that they were able to communicate issues about things they really didn’t think were issues but they realized now that they should do something about.”
Dr. Ismael Hoare, assistant professor in Global Health, and Dr. Martha Coulter, professor in Community and Family Health, focused on multiple indigenous groups in Belize, including the Maya, both Quetchi and Mopan communities, and the Garifuna and Kriol populations.
They concentrated their efforts in Belize on establishing contact with a community that had no prior established relationships.
“We had to do the ground work in organizing and setting up a network of individuals who would inform our research and who would be able to assist us,” Hoare said.
Hoare and Coulter worked together to establish the community advisory board, planning interviews and key informant interviews with stakeholders in the Mayan community. Their next step will be focus groups with the community.
An event on World AIDS Day in Belize with a focus on both AIDS and violence. (Photo courtesy of Martha Coulter)
“They were extremely receptive,” Coulter said. “This is a very small rural southern town in Belize and the concerns of the people there, particularly the political structure there, is that the government in Belize has given more resources to the more populated areas. So, they were very enthusiastic about the possibility of getting more data to support the need for more resources in this more rural population.”
Coulter said having Hoare’s presence made establishing connections smoother, given his prior faculty experience at the University of Belize.
“It’s a really small community, so people need to trust you and make sure they know exactly what you’re doing and why and that there will be outcomes that will be helpful to them,” Coulter said. “We were fortunate in that the mayor and some of the other people in the community really feel like it’s important to get the word to the central government in Belize that they need more resources.”
Izurieta said a unique aspect of this research was its integrative approach.
“There were four key pillars in this multidisciplinary approach,” he said. “The integration of academia with the community, integration between COPH departments, integration between USF and international institutions, and the integration of faculty and students.”
Dr. Martinez-Tyson (second on left), Dr. Miguel Reina (fourth on right) and Dr. Ricardo Izurieta (first on right) also met with key leaders and academic partners in each country as part of the research process. Also in the picture: Vanessa Chee (doctoral student, CFH; first left), Isabel Hernández (Ecuador’s research team; third left), Shirley Bejarano (MPH student, HPM; third right), and Dr. Enrique Terán (Ecuador’s research team; second right). (Photo courtesy of Dinorah Martinez-Tyson).
As an epidemiologist, Izurieta said it put him front and center with new ways of collecting data and brought to his attention the impact the research was having on the community.
“These indigenous communities have been neglected in terms of their access to healthcare services,” he said. “One of the indicators that caught my attention was we observed that there was more cases of AIDS in relation to the cases of HIV reported. For me, as an infectious disease epidemiologist, that was alarming. Indigenous people infected with HIV were arriving at the last stages of the disease and when we tried to see what was going on with these communities, I tried to find information, and we didn’t have any. So, that was our intention, to see what was going on with these populations.”
Shirley Bejarano, a COPH graduate student in the Department of Health Policy and Management who assisted in the research, said one of her top priorities when enrolling in the master’s program was to learn to conduct qualitative research, a skill she honed while assisting with the research in Ecuador.
Researchers traveled through small towns to reach the indigenous communities in more rural areas. This is a photo taken in Ecuador. (Photo courtesy of Shirley Bejarano)
“Every aspect of my involvement with the research captivated me. It was incredible to learn about conducting qualitative research first hand, simultaneously learning and putting it into action,” she said. “Secondly, spending time with individuals from the indigenous community, learning about their culture, and creating rapport with them was a remarkable experience. Third, I had a wonderful time working with the entire Ecuador research team. My research experience in Ecuador was phenomenal, it encompassed everything I wanted to learn and practice.”
Martinez -Tyson said she was thankful to the College for providing this opportunity, as it allowed her to work cross-departmentally on an issue that is experienced worldwide.
“HIV knows no boundaries, it crosses state lines, country lines,” she said. “I would not have had the opportunity to work with colleagues outside of my department if it was not for this grant. From an academic, career development perspective that has been invaluable for me.”
The year-long research is close to wrapping up and researchers aim to start data analysis in the next phase.
Following data analysis, researchers said they hope to move forward with developing interventions.
Agricultural fields in Ecuador. (Photo courtesy of Shirley Bejarano)
“The results we are going to get from this will enable the different countries with developing interventions for HIV prevention, nutrition and intimate partner violence that are respectful to the culture and the society’s we’re working with and that are relevant to them,” Calvo said.
Reina said while it was a challenge to coordinate working in three different locations with three different researchers and IRB approvals, they managed to coordinate and balance it all.
“Overall, it was a very successful and positive experience. We have achieved what we set out to do. I think that’s an important value of this research,” Reina said. “We have communities from these different countries. They are all indigenous; they are similar but are also different. So, it’s going to be interesting to see the results and see how much geographic location will impact the similarities or differences.”
The researchers would also like to extend thanks to the following collaborators who assisted with their research endeavors:
Belize
Community Advisory Group:
Dr. Phillip Morgan, University of Belize
Mr. Roy Polonio, University of Belize
Pastor Lorna Sampson, Community Activist
Mrs. Pulcheria Teul, Women’s Issues Consultant
Mrs. Lorraine Johnson, Women’s Department, Punta Gorda
Mayor Fern Gutierrez, Punta Gorda Town Board
Ms. Christina Coc, Maya Alliance
Mrs. Celia Mahung, TIDE
Mrs. Froyla Tzalam, SATIIM
Ms. Mavis Ogaldez, Community member
Ecuador
Enrique Teran
Isabel Hernandez
Mercedes Flores
Nestor Yamberla
All the community members from Iluman and Cotacachi
Panama
Community Advisory Board:
Vielka Amador
Alejandrina Acosta
Victoriano Amador
Bernardo Pascacio
Valentín Gallardo
Marquelin Gallardo
Mario Caballero
Maribel Caballero
Marino Gallardo
Community Liaison:
Rosmery Pascacio
Research Team:
Dr. Arlene Calvo
Dr. Arturo Rebollón
Natalia Vega
Story by Anna Mayor, USF College of Public Health.