In the U.S. and Romania, a Researcher Targets Social Inequities to Combat HIV

Corina Lelutiu-Weinberger, PhD, an associate professor of health sciences research at Columbia Nursing, first became aware of the connections between social inequities and health disparities as a girl in Romania in the 1980s. Her father, a hematologist-oncologist, was on a team that treated one of the country’s first adult HIV/AIDS patients—a gay man who’d contracted the disease while traveling abroad. “My dad was devastated that they couldn’t help him,” she recalls. “He said, ‘This man is dying, and no one wants to touch him.’ The patient was highly stigmatized, not only because of the virus but also because of his sexual orientation.”

That was the first experience to inspire Lelutiu-Weinberger to build a global research career targeting stigma and discrimination mechanisms that lead to health inequities. That focus led to a string of National Institutes of Health (NIH)-funded studies—some in the United States, where she has lived since 1994, and others in Eastern Europe—to improve behavioral, mental, and sexual health for sexual, gender, racial, and ethnic minorities.

One recent award, an R01 grant totaling $3.8 million over five years, supports a study titled “Ending the HIV Epidemic with Equity: An All-Facility Intervention to Reduce Structural Racism and Discrimination and its Impact on Patient and Healthcare Staff Wellbeing.” The project (co-led by Felicia Browne, ScD, of RTI International) will recruit six federally funded Ryan White HIV/AIDS Programs in the Southeastern U.S. to co-develop programs aimed at reducing structural racism and discrimination against patients and health care workers who are Black, Indigenous, or other people of color. Upon successful testing, the template for those programs will be an evidence-based intervention that can be adopted across diverse clinical settings for systematic targeting of structural racism and discrimination and increased health equity.

“The study region is a part of the country where rates of HIV are among the highest, and where instances of racism are frequent,” Lelutiu-Weinberger explains. “We’ll be working with clinic staff to help them understand the intertwined structural factors driving both problems and to take systematic steps to avoid perpetuating them.” After conducting interactive workshops at each clinic, she and her colleagues will lead the staff in creating a manual reflective of the clinics’ commitment to anti-racism that can be implemented and sustained across time.

To gauge the efficacy of the intervention, the research team will conduct six-month trainings at each facility, led by clinic staff trained by the investigative team. “We’ve developed an index that measures how racial dynamics change over time, looking at the experiences of both patients and staff,” says Lelutiu-Weinberger. “We’ll also assess whether patients are healthier at the end of the intervention. Our hypothesis is that if the climate improves, they’ll be more engaged in their own health care due to increased trust in their providers, which could result in reduced HIV viral loads.”

Lelutiu-Weinberger’s other new award, from the NIH’s Fogarty International Center, is funding a study (co-led with John Pachankis, PhD, of Yale University) called “Preparing for Pre-Exposure Prophylaxis

Implementation in Central-Eastern European Countries with Low Access to Biomedical Prevention.” The $982,000 R21/R33 grant is supporting a five-year trial in Romania of a program using in-person and mobile health to empower gay and bisexual men to adopt pre-exposure prophylaxis (PrEP), a regimen that is highly effective in preventing HIV acquisition after exposure but that is not yet officially available in Romania and other neighboring countries.

This effort grew out of earlier studies in which Lelutiu-Weinberger and her team used mobile apps in the U.S. and Romania to promote HIV and substance-use risk reduction for men who have sex with men. For the Romanian PrEP trial, which was launched

Corina Lelutiu-Weinberger, PhD

as a pilot study in 2020, the researchers adapted an app designed and tested in other countries by co-investigator Lisa HightowWeidman, MD, of the University of North Carolina to track patients’ use of PrEP medications and boost their adherence to the regimen. That’s especially important in a country like Romania, where PrEP is available only through quasi-legal sources (i.e., online foreign pharmacies), and where doctors are not yet trained to prescribe it.

Lelutiu-Weinberger and her colleagues persuaded infectious disease clinics in two Romanian cities to collaborate on the PrEP trial with about 140 participants. The researchers are comparing adherence rates among two arms of the study: participants who see a physician at one of the clinics, and participants who follow the same protocol but also receive counseling from psychologists the team has trained in sex-positive messaging and have access to the PrEP adherence support app. “The sex-positive approach is completely novel,” Lelutiu-Weinberger notes. “It’s unheard-of in Romania to embrace sexuality and not think men should be punished for desiring other men.”

If this trial is successful, she adds, “I see us expanding the program to other countries in the region that are in dire need of evidence-based PrEP counseling and adherence protocols, including Bulgaria, Poland, Hungary, and Moldova. We’ll have a model that we can roll across Central and Eastern Europe and, with further adaptation, to other regions of the world in need of critical biomedical HIV prevention.”