Co-Creating Research with Latino Sexual Minority Men to Promote HIV Health Equity
As far back as she can remember, Audrey Harkness, PhD has been driven by curiosity and a thirst for knowledge. Even as a child, she relished the freedom to learn about anything and everything that called to her.
Today, Harkness is a psychologist and research assistant professor at the University of Miami (UM) Miller School of Medicine, and as of June 1, 2022, joins the School of Nursing and Health Studies (UM-SONHS) as a tenure-earning assistant professor, where her inquisitive nature will continue to find an outlet in scientific research and innovation.
Audrey Harkness, PhD
“I always loved learning and enjoyed school from a young age – that’s where it all started,” said Harkness. “I just kept following that natural curiosity – it always guided me, and it led me to where I am now.”
Harkness arrived at UM as a postdoc under the mentorship of professor Steven Safren, Ph.D. She worked to promote mental health and sexual health among young sexual minority men who were participating in the ESTEEM (Effective Skills to Empower Effective Men) clinical trial.
She wore many hats, including coordinator, therapist and clinical supervisor – and she quickly learned to blend a strong clinical sensibility with scientific rigor to help address challenges the study team encountered.
“We were reaching out to Latino gay and bisexual men in Miami, a group very much impacted by HIV disparities,” she said. “But there were obstacles to recruitment – the message on our flyers wasn’t resonating, and they were reluctant to acknowledge depression, anxiety and sexual behaviors. We had to adapt our messaging, making it less explicitly LGBTQ-focused and less about mental health, so it would feel safe to participate, particularly for those who might feel stigmatized.”
Participants were encouraged to consider using Pre-Exposure Prophylaxis (PrEP) – a medication that reduces the chances of getting HIV – but Harkness found it difficult to obtain services for them.
“They were facing unique obstacles to accessing and navigating services,” she recalled. “Some had unpredictable work hours, or they lived with their parents and weren’t out to them, so they didn’t want to bring PrEP into their homes. There were also a lot of challenges navigating the services available in Miami. There was a lot of complexity and stigma.”
Soon, curiosity about what was driving these challenges led Harkness to an idea for her own pilot study.
CLaRO offers a new research opportunity
At a meeting for HIV researchers, Harkness met Victoria Behar-Zusman, Ph.D., professor and associate dean for research at the UM-SONHS, who serves as principal investigator for the NIH-funded Center for Latino Health Research Opportunities (CLaRO).
“Dr. Behar-Zusman encouraged me to apply to CLaRO’s pilot study program,” she recalled. “I didn’t have complete confidence to develop a study like this. But Dr. Safren and his Ph.D. student, Brooke Rogers, helped me shape the study proposal.”
Harkness became one of the first investigators to be awarded a CLaRO pilot grant. Her study focused on Latino sexual minority men (LSMM) – gay, bisexual and other men who have sex with men (MSM) – and on the barriers and facilitators that impact their access to and engagement with HIV prevention, including PrEP and HIV testing, and behavioral health services.
She called the study DÍMELO (“Tell me about it”) – Determining Influences on MSM Engagement among Latinos. One of the research associates helping out with the project, Rosana Smith-Alvarez, came up with the name during a long brainstorming session.
“We chose the name DÍMELO because based on participant feedback, we wanted a name that was fun and culturally relevant, and didn’t risk eliciting stigma related to mental health, sexual health, and being LGBTQ,” Harkness said.
CLaRO funded a longitudinal component of the study – a survey that followed the participants for eight months – while UM’s Center for AIDS Research (CFAR) funded the qualitative work leading up to the survey and baseline assessment of the survey.
“I wanted to study what I was seeing clinically, but in a more systematic way,” said Harkness. “To conduct interviews and a rigorous qualitative analysis, then take what we learned, develop a set of measures, and evaluate at multiple time points. The longitudinal survey allowed us to look at patterns over time.”
Pilot study findings highlighted the need to address misconceptions about HIV prevention and mental health issues that are rooted in stigma. They also found that peers and providers strongly influenced whether participants learned about and engaged with services.
“If they knew someone on PrEP or who was receiving mental health services, they were more likely to seek those services,” said Harkness. “Some providers discouraged participants from using PrEP, telling them ‘it isn’t for you, it’s for high risk people.’ This highlights the need for provider training.”
With longitudinal analyses underway, Harkness convened a Community Advisory Board (CAB) composed of Latino gay and bisexual men to ensure her work is always informed by the community.
“They identified variables they think are important for PrEP engagement over time, as well as other outcomes” she said. “We’re using their input to create our longitudinal model, and we’ll invite them to help us interpret what we find.”
Harkness has published several articles detailing her initial findings. And the data set lives on, generating additional research opportunities for Harkness and her mentees.
“It’s a remarkable resource for me as a mentor,” she said. “My mentees use this data to conduct secondary analyses, ask their own questions and build their own careers. A number of papers have come out of this work.”
CLaRO meets COVID
Harkness had just begun collecting her longitudinal data when COVID arrived in Miami.
In one of Behar-Zusman’s monthly group mentorship meetings, the CLaRO pilot grantees decided to move ahead with their projects, but to capture what was going on. Harkness, alongside Behar-Zusman and Safren, did this with the DÍMELO study by developing the “Pandemic Stress Index,” a measure that was made widely available in numerous languages and was also used with all their DÍMELO study participants.
Meanwhile, the CLaRO cohort worked on a paper exploring the impact of COVID on Latino health research, which was published in the Annals of Behavioral Medicine.
“It was the first paper published by our CLaRO grantee cohort,” she said. “Dr. Behar-Zusman encourages us to think about things we didn’t know could become a paper. She shows us how to turn challenges like COVID into opportunities to contribute, and guides us toward what is a good next step.”
Especially during COVID, Harkness found refuge in her fellow CLaRO grantees.
“We collaborate and support each other,” she said. “In our group mentoring meetings we discuss our projects and next steps. That informal peer support is so helpful.”
Harkness also found new learning opportunities through CLaRO’s research training institute.
“The institute gives us a dedicated week just for thinking and learning about new things,” she said. “It provided a space to connect with my CLaRO cohort. And it’s where I learned about implementation science, so it was quite impactful.”
Inspired by what she learned in the training institute, Harkness is developing expertise to make her mark as an investigator in the emerging field of implementation science.
“It’s changed the way I think and shifted my approach. In my pilot I focused on consumers mostly, but it I were to do it again I’d engage the implementers to a greater extent.”
Moving toward research independence
Harkness is pursuing two lines of research that build on her pilot study.
“I’m extending my DÍMELO research to continue exploring barriers and facilitators to LSMM access to HIV prevention and behavioral health services,” she said. “And I’m looking at how implementation science can help impact programs and policies to achieve HIV health equity in LSMM and other communities.”
Her work is currently supported by an NIH K23 award – a grant that supports the development of clinical investigators who are committed to patient-oriented research – as well as by an administrative supplement to her K23 award. Harkness also receives funding from UM’s NIH-funded Center for HIV and Research in Mental Health (CHARM), through an administrative supplement to a National Institute of Mental Health grant that channels funds from “Ending the HIV Epidemic” – an initiative aimed at reducing new HIV infections and HIV health disparities.
She’s also participating in “Planning for Success” – a year-long grant writing program, sponsored by Emory University’s CFAR, that prepares early career investigators to submit their first NIH R-level grant proposals.
“It’s a structured training program, so it’s keeping me on track,” she said. “I’m working on an R01 to implement ‘DÍMELO 2.0.’”
According to Safren, who mentored her postdoc as well as her CLaRO pilot study, Harkness is well on her way to achieving her career goals.
“It has been such a pleasure to be Dr. Harkness’ mentor on this award,” he said. “The award was so instrumental in not only gathering important and impactful data on HIV prevention and behavioral health in Latino men who have sex with men, but also in laying the groundwork for Dr. Harkness to really transition to being the outstanding emerging independent investigator that she is.”
And Harkness has only praise for her longtime mentor.
“Dr. Safren is an amazing mentor,” she said. “I developed more advanced quantitative research skills and learned to work in an NIH-funded environment. He’s invested so much in me over the past five years, helping me move towards that next phase of research independence.”
Co-creating with the community
With her lifelong, trademark curiosity urging her on, Harkness has come a long way from the young postdoc who was still developing confidence in her research skills.
In June 2022, she begins a new position as a tenure-track assistant professor at the UM-SONHS. And with funding from three prestigious centers – CLaRO, CFAR and CHARM – and new co-investigator roles on other implementation science and HIV projects, she increasingly turns to the local community to identify needs her research might help to address.
Recently, when Harkness asked the men in her CAB about what research they thought her lab should focus on next, they talked about how dating can be a challenge to navigate. She asked if it would be helpful to develop a dating skills program specifically for Latino gay and bisexual men.
Harkness lights up when talking about how she’s partnering with the CAB members to address this unique community need.
“I love doing community-engaged work,” she said. “In my ideal world, I wouldn’t come up with my own research projects. People in the community would know me, would say ‘we need this, could you help us make it happen?’ And I would say ‘yes, let’s work on it!”