By: Elizabeth Yuko, Ph.D.

A new video from the University of California Irvine attempts to decrease the stigma attached to HIV through the personal stories of those affected by HIV/AIDS in Peru. Focusing on the only gay men’s health community center in Peru (Epicentro), the video features the work of Dr. Brandon Brown, the director of the Global Health Research Education and Translation (GHREAT) Initiative in the Program in Public Health at UC Irvine and a Fordham University HIV Prevention Research Ethics Training Institute (RETI) fellow.

The video is the final of four visual stories in the GHREAT Initiative outreach program, and attempts to raise awareness of the of the HIV situation in Peru, which Brown hopes will lead to increased knowledge of these issues and support to fight HIV stigma.

The final video focuses on Epicentro, the only gay men’s health center in Lima, Peru, which attempts to slow HIV transmission, promote healthcare, and provide a sense of community for a highly marginalized population.

“Visual communication of our innovative research activities on the human beings afflicted with disease and infirmity in developing countries is crucial to understand our impact on the world,” Brown explained. “Our collection of videos produced by Daniel Anderson show how GHREAT projects are enhancing health and saving lives, one person at a time around the world.”

Brown first became involved with Epicentro after hearing about it from his mentor from the University of California Los Angeles, Dr. Thomas Coates. Coates put Brown in touch with the President of Epicentro, Jerome Galea, with whom Brown worked at UCLA during his Master’s in Public Health (MPH). At that time, Brown noted, Epicentro was a community center with few resources, but that has since changed with the help of a USAID grant that provided funds to train HIV counselors and purchase vital clinic and laboratory equipment. The increase in resources meant that Epicentro now had the infrastructure required to host clinical studies, including those funded by Merck, AMFAR and the National Institutes of Health, among others.

For his RETI Mentored Research Project (MRP), Brown is examining the voluntary study participation in a clinical trial of a Human papillomavirus (HPV) vaccine with Peruvian female sex workers (FSWs). Brown was first introduced to the Peruvian FSW population in 2004 during his MPH with an AIDS travel grant through Coates. At that time, he traveled to Lima, Peru to identify potential locations for HIV interventions, and connected with various universities and non-governmental organizations there.

Once he started his Ph.D. in International Health at Johns Hopkins University, Brown saw conducting his research in Peru as a natural fit. Brown’s Ph.D. dissertation focused on HPV vaccine acceptability among FSWs, and was extended several years following his Ph.D. with additional funding.

“There were obvious issues with FSW participants trusting me (a male) at the beginning of the study for various reasons including historic abuse by health officials, but after two years I became one of the main retention tools of the project: to talk with the gringo and learn about the U.S.,” Brown said. “They called me Mr. Musculo (Mr. Muscle: a version of Mr. Clean in Peru). The MRP is a natural extension of the vaccine study looking at ethical issues from this study, including voluntariness and participant perceptions of participation.”

Given the relative lack of work published on  vaccines and FSWs in South America, coupled with the abundance of sex work, the results from Brown’s MRP will add to the existing knowledge on vaccine trial participation, and he expects that they will be generalizable outside of Peru. In addition, understanding proper recruitment and retention strategies can significantly increase participation of special high-risk populations in clinical research, Brown explained.

“Our high participation and retention figures show that FSWs were willing to participate and complete clinical trials that they deem useful for their health,” Brown said. “Retention trends in our study should be taken into account and applied to future studies that involve Peruvian FSWs, or other high-risk populations. HPV vaccines are not available in most developing countries. If we can capture FSWs at an early stage and target them for HPV vaccination, we may be able to prevention significant HPV related disease in this group, their clients, and their partners.”

Each time Brown goes back to Peru, he brainstorms new project ideas. He believes that there is significant potential for new projects related to sexually transmitted infections (STIs) in Peru, and that, coupled with many knowledgeable scientists on the ground, make it an ideal location for further research. In addition, Brown appreciates the food culture in Peru – particularly the ceviche.

Most of Brown’s research to date has focused on groups at higher risks of STIs, including gay men, transgender women, and FSWs. Most recently, he has branched out to the general population, but globally. In projects with students and colleagues, he is examining issues related to sanitation in Kenya, low-income minority parents in Santa Ana, and refugee populations in Orange County. Brown currently has several grants under review, including ones that include heterosexual couples, and examine the acceptability of a new condom concept with Origami Condoms. He is also expanding his research to include other topics, such as the ethics of incentives, reproductive health in Nigeria, ethics training for students, and zombies. In fact, Brown’s recent article using zombies to raise public health awareness has attracted substantial attention in the media.

Brown is one of seven Fordham University HIV Prevention RETI Fellows from the second cohort, which began the program in 2012. His faculty mentor is Program Director, Dr. Celia B. Fisher, director of the Center for Ethics Education at Fordham University.

Brown believes that the RETI and his MRP have been a great experience: “The mentors and students are wonderful and a great resource as colleagues for the future. This helped build a very important network for me in academia, and has opened up new opportunities in research ethics.”

For more information on the Fordham University HIV Prevention Research Ethics Training Institute, please click here.