Engaging Social Networks to Prevent HIV in Latinx Communities
In a shantytown built perilously atop a landfill in Lima, Perú, a young student first confronted the harsh conditions endured by communities experiencing severe health disparities and limited resources to address them.
Mariano Kanamori, PhD was completing his undergraduate internship in the struggling community of Pampas de San Juan when residents began to approach him with concerns about the risk of HIV in their community.
He realized it was critical for every resident to be well-informed about HIV – but how to get the message out there?
That’s when Kanamori came up with a novel way to spread the word – he would use a naturally-occurring resource that already existed within the community: social networks.
Mariano Kanamori, PhD
“I implemented a study to explore how social networks can help disseminate HIV prevention messages in the community,” Kanamori recalled. In the process, he learned about how some social networks can offer significant resources, while other networks have limitations. “The young men and women had very different social networks. The men’s networks were very small and composed mostly of other men, while the women’s networks were quite large and much more diverse.”
It was his first study – and it changed the course of his career trajectory. He wanted to learn how to make social networks stronger, and how to engage these networks to help marginalized communities thrive.
“This experience allowed me to understand the level of poverty and the needs that the residents faced,” he said. “It was a turning point in my life because it showed me that I wanted to dedicate my career to helping underserved communities.”
A passion for social networks
With a newfound passion to understand the potential of social networks to facilitate connection and communication, Kanamori went on to earn his masters’ degree in Communications, Culture and Technology from Georgetown University. After receiving his Ph.D. in Epidemiology in 2013 from the University of Maryland, he applied and gained admission to a National Institute on Minority Health and Health Disparities (NIMHD) P-20 post-doctoral program at Florida International University (FIU) focused on Latino HIV and substance misuse.
While completing his post-doc, Kanamori applied for a prestigious National Institute on Drug Abuse (NIDA) K99/R00 grant and was awarded funding for his novel research applying social network analysis to Latino HIV and substance misuse. This grant funding mechanism helps promising early career scientists receive mentoring and advanced training to develop their research skills.
“The study incorporated socio-centric network-based methods based on groups of interconnected friends,” Kanamori explained. “I looked at how social network configurations and dynamics can place rural Latinx at increased or decreased risk for HIV and substance use disorders.”
Now a tenure-track associate professor of public health sciences at the University of Miami Miller School of Medicine, Kanamori is focusing his research on two populations at high risk for HIV: rural Latinos, and Latino men who have sex with men (MSM).
Preventing HIV among rural Latinas
In 2021, Kanamori was awarded a one-year pilot grant from the NIH-funded Center for Latino Health Research Opportunities (CLaRO), a collaboration between the UM School of Nursing and Health Studies (UM-SONHS) and FIU’s Robert Stempel College of Public Health and Social Work.
Building on his postdoctoral and K99/R00 research, the exploratory study focused on increasing readiness to use Pre-Exposure Prophylaxis (PrEP) – a medication that reduces the risk of getting HIV – among Latina seasonal farmworkers who use alcohol and/or illicit drugs.
“We added a PrEP component to the PROGRESO intervention by developing and pre-testing culturally tailored PrEP materials,” Kanamori said. “And we looked at how Latina friendship networks can be used to disseminate PrEP messages to the network members.”
Kanamori implemented his study during COVID-19, tailoring it to pandemic-imposed challenges by going virtual and by portraying the use of masks and social distancing in the materials.
“We talked about HIV and PrEP within the context of COVID,” he said. “We developed the materials and assessed the acceptability of the messaging and the feasibility of implementing an online social network-based PrEP intervention, all during the pandemic.”
Dr. Kanamori is currently collaborating with UM assistant professor of clinical Laura Beauchamps, M.D. in an implementation science project funded through the Ending the HIV Epidemic (EHE) initiative, which supports research aimed at reducing new HIV infections and HIV health disparities. This work integrates the PrEP component developed in his CLaRO pilot study, PROGRESO’s social network intervention model, gender affirming treatments (GAT), and access to mental health and social services.
“This study is tailored to Black and Latina transgender women,” Kanamori explained. “It is identifying Consolidated Framework for Implementation Science Research (CFIR) factors influencing the feasibility and acceptability of PrEP-GAT, a social network-based multilevel PrEP intervention.”
Becoming an independent researcher
Involvement with CLaRO has led to numerous scientific publications, as well as professional and research opportunities, that have accelerated Kanamori’s journey towards becoming an independent researcher.
“Being a CLaRO fellow has opened many new directions for my health disparities research,” he said. “I’m grateful to be part of CLaRO because this intense and supervised career development experience has helped me become a better health disparities researcher.”
Kanamori is working with the Florida Department of Health on an intervention that uses molecular and social network data to address HIV outbreaks among injection drug users. He’s also been awarded an impressive three NIH EHE pilot grants: in addition to PrEP-GAT, he has also implemented DiversiPrEP, a client-centered PrEP service model with telehealth for Latinos, and Finishing HIV, a social network-based outreach program that encourages Latinos to use HIV protection, diagnosis and treatment services.
Kanamori recently achieved a major career milestone when he was awarded his first NIH R01 grant from the National Institute of Mental Health (NIMH) – the NIH’s highest-level and most competitive award for individual research projects. PrEParados looks at how friendship, sexual and venue-based social networks promote or suppress encouragement, uptake, and adherence to PrEP.
“This study will determine how social networks impact PrEP uptake and adherence among Latino MSM, based on sexual self-identification,” he said. “I use two social network analytical approaches, Network Meta-Analysis and Spatially-Explicit Analysis, which have been adapted in my lab.”
Early career investigators need caring senior mentors
Kanamori places great value on the caliber of mentoring offered to CLaRO grantees at such a crucial and formative time in their development as researchers.
“When you are early career and just starting at the university, you need support from those who are senior,” he said. “It hasn’t been easy with the pandemic, but my CLaRO mentors have always provided guidance and feedback when I needed it. They enjoy passing on their wisdom and knowledge.”
Kanamori was mentored every step of the way by Victoria Behar-Zusman, Ph.D., professor and associate dean for research at the UM-SONHS and CLaRO principal investigator.
“Dr. Behar-Zusman provided feedback on my grant proposals, and thanks to her support and guidance I was able to get those awards,” he said. “And she was always there to provide emotional support and to help me address obstacles that came up related to implementation of my research.”
He also gained indispensable research skills and career guidance from his pilot study mentor, Adam Carrico, PhD.
“Working with Dr. Carrico has been crucial to the development and success of my grants,” said Kanamori. “He is always available to help me, and has provided guidance that was extremely useful for my career development at the university.”
And Dr. Carrico sees great promise in his mentee’s potential to make a significant contribution to the field.
“It is such a pleasure to see Dr. Kanamori chart a successful course to becoming an independent investigator with NIH R01 funding,” he said. “I am confident that his important work with Latino sexual minority men will have a meaningful impact on the HIV epidemic, particularly in South Florida where we remain a domestic epicenter.”
Kanamori also participated in the CLaRO research training institute, making lasting connections with his fellow mentees.
“The institute expanded my professional network by offering opportunities to connect and collaborate with the other CLaRO grantees,” he said. “We’re a collegial and supportive group. We’ve submitted grant proposals together, we’re co-investigators on grants, we co-mentor students, and we serve together on dissertation and thesis committees. And we help each other overcome the barriers we face as we implement our studies.”
Mentoring the next generation of health disparities scientists
Even as CLaRO continues to support his career progress, Kanamori is already mentoring the next generation of health disparities scientists. In 2020, he was honored to receive the Faculty of the Year Award from the University of Miami Chapter of Delta Omega, the Honorary Society in Public Health.
“As a CLaRO mentee,” he said, “I was grateful for the support I received and I wanted to help the next generation.”
And his mentees are demonstrating impressive achievements.
Edda Rodriguez completed the Florida Department of Health’s Research Excellence Initiative, a program devoted to promoting high quality and innovative research. Rodriguez was recently awarded an NIH diversity supplement – funding to support investigators from groups that are underrepresented in health research – to examine mental health disorders exacerbated by negative social network structures in Latino MSM.
He also mentored Cho Hee Shrader, who is now a Global HIV Implementation Science Fellow at Columbia University. Kanamori sponsored her application for an NIH F31 award – a grant that provides doctoral students with mentored research training. The study, Latinx MSM disparities due to immigration stress and drug use networks, builds on knowledge she developed in his research lab.
Even as he looks toward the next phase of his own career, Kanamori sees his role as a mentor as being integral to his work.
“I’d like to direct a health disparities social network center at UM,” he said, sharing a vision that would take his passion for social networks to the next level.
“And at this center,” he is quick to add, “I’ll be training fellows and students in social network techniques. I believe that mentor-mentee relationships last for a lifetime.”