Fordham RETI fellow examines gender-based violence, HIV, and the intersection of these two health threats

As a teenager growing up in Massachusetts, Elizabeth Reed became very familiar with scenarios of dating and sexual violence against women and girls, as well as the damaging impact of these forms of gender-based violence. She soon recognized that it was not just occurring in the town where she grew up, but that various forms of sexual exploitation, violence, and harassment of girls and young women occur in high proportions across the U.S. and abroad. This exposure initiated her interest in the prevention of partner, dating, and sexual violence against women and girls in the U.S. and across the globe.

In college in Pennsylvania, she worked as a group counselor for teens at a local rape crisis center, and as a sexual and dating violence educator in local high schools.

“Through this work, the intersection between violence and risk for HIV/STI became very apparent to me,” Reed said. “Namely, girls often described scenarios in which abusive partners limited their control over decisions in sexual relationships, and in particular, restricting girls’ decisions to use contraception and condoms. This increased girls’ risk for STIs including HIV.”

Reed also recognized the role of substance use as a major consequence of violence and heightening women and girls’ risk for STI/HIV, and later became involved as a volunteer and advocate at a needle exchange program in New York City. At the needle exchange program, she worked with a multidisciplinary team of counselors, outreach workers, physicians, and researchers.

“This experience, for the first time, exposed me to the role of public health research in advocating for policy and programmatic change,” Reed explained. “Altogether, these early experiences led to my interest in HIV prevention research. Now, twenty years later working as a social epidemiologist, these experiences have set the foundation for my research and programmatic work on the topic areas of gender, violence, drug use, and HIV.”

Reed’s first HIV research project was an evaluation of a group-based HIV prevention program for women at high risk for HIV in Boston, Massachusetts.

“The intervention was highly efficacious; however, this experience left me wondering how public health interventions could have a broader reach,” she noted.

Later, in 2009 as a postdoctoral fellow, Reed was hired to evaluate a structural-level community mobilization intervention to prevent HIV among female sex workers in Andhra Pradesh, India (Avahan: The India AIDS Initiative; Project Parivartan; PI: Blankenship, Kim).

“It was a fitting experience for me to evaluate a structural-level intervention that aimed to reach and provide benefits for the larger community,” she explained. “Drawing from my own experiences growing up in Massachusetts, I was very interested in programs that addressed exposures within social and environmental contexts. In my hometown, I saw how social norms supportive of male dominance over females contributed to dating and sexual violence. Subsequently, I recognized the need for programs and research to look beyond characteristics of individuals to identify and address the broader social and environmental determinants of such violence. Thus, I have focused my research and programmatic work on the social, economic, and environmental determinants of gender-based violence, HIV, and the intersection of these two health threats.”

Reed worked in Andhra Pradesh, India for about two years on the project and was very interested in what women’s perceptions were regarding their research participation. At that time, there had been a number of research projects focused on HIV prevention with women working as sex workers in this region. She was curious to understand women’s motivations for participating, their experiences as participants, and whether they perceived such research as benefitting their community in the long-term.

Reed was given the opportunity to conduct a research project on that topic when she was selected as a Fordham University HIV and Drug Abuse Prevention Research Ethics Training Institute (RETI) fellow in 2011. Reed’s RETI mentored research project examines the perceptions of HIV prevention research among women working as sex workers in Andhra Pradesh, India. Her mentor for the project was Dr. Kaveh Khoshnood of Yale University.

Her work specific to this population has largely focused on social and economic challenges among women working in sex work and how these increase vulnerability to HIV and violence. Many interventions have sought to address social barriers (e.g. violence, safety issues on the job, interactions with police), such as via community mobilization interventions.

“My work has shown a need to also address the economic challenges that create urgency in women’s work, thereby decreasing condom negotiating power with clients, increasing reports of unprotected sex trades for more money, and increasing women’s exposure to violence,” Reed said.

For her next project, Reed – now an Assistant Professor in the Division of Global Public Heath at the University of California San Diego – and her team are initiating the implementation and evaluation of a microfinance and gender equity intervention among women working as sex workers in Tijuana, Mexico. This project aims to address both social and economic challenges that increase vulnerability to HIV among women working as sex workers. Development and implementation of the program will initiate during the fall of 2014 (1K01MH099969-01A1; ESTIMA: Economic and Social Empowerment To Increase Upwards Mobility among Women; PI: Reed, Elizabeth;).

“Many women working in sex work in Tijuana have told us that they are interested in starting their own business. ESTIMA aims to provide loans and training to start a business, alongside support on social challenges in women’s lives (e.g. housing stability, gender-based violence, women’s roles as caretaker for family and/or children),” Reed explained.

Reed has identified many similarities in her research populations across the two sites in Mexico and India. Additionally, she has used the findings from this work in India to inform research protocols for the work in Mexico. Reed and her team also plan to evaluate women’s experiences as research participants within the new research projects taking place in Tijuana.

As a result of her training and research as an RETI fellow, Reed has incorporated participant feedback in all of her studies in order to refine research and ethics protocols with the goal of maximizing community benefits and minimizing community burden.

“Overall, the research that I conducted as an RETI fellow broadened my knowledge on research ethics issues and increased my awareness regarding the need to think beyond standard ethics protocols when designing research projects with vulnerable and/or stigmatized populations,” Reed said.

For more information on Dr. Reed’s work, please visit the websites of her projects on perceptions of female sex workers in India, and economic debt, drug use, and HIV risk among sex workers in Tijuana, Mexico.

Written By Fordham University Center for Ethics Education

Fordham RETI fellow examines gender-based violence, HIV, and the intersection of these two health threats was originally published @ Ethics and Society and has been syndicated with permission.