School of Public Health
Using implementation research to describe the benefit of integrated stigma mitigation interventions (ISMI) to potentiate the effectiveness of existing
The proposed study will measure impacts of a scalable package of integrated stigma mitigating interventions (ISMI) for key populations, including men who have sex with men (MSM) and female sex workers (FSW). Employing a non-randomized prospective cohort design in Dakar, Senegal, outcomes will include coverage of HIV and health services and, for participants living with HIV, adherence to antiviral therapy (ART) and viral load (VL) measures. A multifaceted approach will employ behavioral and web-based community interventions in order to support biomedical services deployed in Dakar through the Ministry of Health. The premise relies on the continuum of HIV care for key populations that asserts the most effective process for diagnosis, linkage and retention to care for populations at highest risk of HIV acquisition and transmission is availability of testing services and access to treatment. These services in complex, highly stigmatized setting are often outside the reach of key populations, and this program will measure the effect of ISMI using a prospective cohort design over a two year period. Concurrently, economic evaluation and quality of life assessment will be utilized to assess the cost-effectiveness of the integrated approach to stigma mitigation. There is significant potential for sustainable HIV interventions and stigma reduction for key populations in this context and elsewhere in SSA, and this project was developed in partnership with local investigators and key community stakeholders in Senegal. The research project also builds on the identified priority of the Senegalese National AIDS Committee and Ministry of Health to research best practices to increase coverage of HIV prevention, treatment, and care services among the two highest risk populations for HIV in Senegal, MSM and FSW.
Global Health Mentor/PI: Stefan Baral, MD
It’s strange to reflect on my arrival into Senegal now, two months after returning to the United States, because I’ve grown and learned so much. Although I had lived in Sub-Saharan Africa for three years with the Peace Corps and Population Services International, I felt as though I had completely forgotten how to live in a new environment in which I did not speak the language. During my first week, French-speaking friends had to speak with my cab drivers on the phone to tell them where to take me, and the one-mile radius within my home seemed like a confusing maze. I could not do anything or go anywhere without help. Within a month or two, I was able to joke and bargain in French, and I knew Dakar like the back of my hand.
My time in Senegal shares many similarities with my Peace Corps service. Surprisingly, many cultural nuances in Senegal are similar to what I experienced in Ethiopia, such as the importance of hierarchy, formalities, and greetings. I quickly acclimated to the slower pace of life while simultaneously appreciating the hustle and bustle of living in a developing city. However, the same frustrations I felt in Ethiopia existed in Senegal. I found myself exacerbated and frustrated during moments I couldn’t properly communicate, and it often seemed that nothing “made sense.” It felt that, because of hierarchy and formalities and cultural nuances, it took three times as long to do the simplest task. I also found that my work was very slow starting, and it took longer than I anticipated to become oriented to projects and my team.
That said, this experience strengthened my interest in global health and research. I am proud of all that I accomplished in Senegal because it was so difficult at times. By the end of my time in Dakar, I was able to work and live in French, navigate (albeit not perfectly) through Senegalese society and in the workplace, and feel at home in a foreign environment. I also learned so many important skills through those six months of work, and many of these skills are the reason I had so many job offers when I returned to the States in December.
I would advise a student considering applying for a similar experience to come in with an open mind and try not to be too hard on themselves.