A new center has been established within Northwestern’s Institute for Public Health and Medicine, aiming to serve as a hub for students, faculty and staff engaged in efforts to improve health equity.
The Center for Health Equity Transformation (CHET), led by Dr. Melissa Simon, the George H. Gardner Professor of Clinical Gynecology, will build research infrastructure, conduct workforce development and support community partners in the effort to advance population health equity.
“There is some amazing health equity work being done across the entire Northwestern Campus, and I hope that this center can serve as a welcoming home and resource to support current work and importantly — to catalyze even more transformational research, education and training that will move the needle in eliminating health disparities and promoting health equity in all sectors,” Dr. Simon said. “This center demonstrates Northwestern’s sincere commitment to not just improve health equity, but to transform health and healthcare delivery to achieve health equity.”
Health touches every aspect of an individual’s life, but a bevy of academic literature has linked an individual’s health status to their education, housing, employment, geographic location and more, Dr. Simon said; that interconnectivity requires a transdisciplinary approach to improving health equity, starting with scientific investigation.
“Ensuring equitable outcomes and the elimination of health disparities is among the most important issues facing our healthcare system today. This new center will serve as a catalyst for population health and community efforts focused on health equity, and I am sure that Melissa will provide dynamic leadership to these critical efforts,” said Dr. Eric G. Neilson, vice president for medical affairs and Lewis Landsberg Dean.
“This will enable a new hub of growth for our many areas of health equity research currently happening across multiple other IPHAM centers,” said Dr. Ronald Ackermann, director of IPHAM and co-director of the Center for Diabetes and Metabolism, senior associate dean for public health and a professor of medicine in the divisions of general internal medicine and geriatrics and endocrinology and of medical social sciences. “This is a visible and meaningful way to demonstrate our longstanding and lasting commitment to health equity.”
The new center will also shape health equity through workforce development, conducting and connecting education and training programs across the entire Northwestern community to integrate health equity education and research opportunities. In particular, encouraging early entry into health equity careers is a priority for the center, according to Dr. Simon.
Northwestern: Reducing HIV Risk in Young Transgender Women
A behavioral intervention program significantly reduced the sexual risk for HIV infection among young transgender women, according to the results of a Northwestern Medicine clinical trial.
The study, published in JAMA Pediatrics, is the first to demonstrate the efficacy of an intervention to reduce sexual risk among young transgender women — a population with extremely high HIV infection rates.
“More than 30 years into this epidemic, it is somewhat appalling that to-date there has not been an intervention that has been shown to be effective with transwomen, a group at very high risk for acquiring HIV, based largely upon sexual behavior. This study changes that,” said first author Dr. Robert Garofalo, chief of adolescent medicine in the department of pediatrics.
Transgender women’s odds of contracting HIV are estimated to be 34 times greater than that of all adults of reproductive age, with research suggesting a particularly high infection rate among younger transgender women.
Still, there has been a lack of evidence-based interventions that focus on reducing sexual risk among this population.
In the current study, investigators evaluated Project LifeSkills, a novel HIV prevention program specifically targeted to young transgender women and led by peers. The group-delivered, empowerment-based curriculum included basic information on HIV but also addressed environmental factors — such as housing, medical care and employment — and promoted behavioral skills, including condom use and communication with sexual partners.
The intervention is grounded in the social realities of the population, Dr. Garofalo explained. “It was never an esoteric research project but was driven and directed by the community. Young transwomen were part of every aspect of the study — from study design, to intervention development, to recruitment and study implementation,” he said.
The randomized clinical trial of the intervention included 190 sexually active transgender women between the ages of 16 and 29 at community-based sites in Chicago and Boston. Project LifeSkills was delivered in six two-hour sessions over the course of three weeks.
At one-year follow-up, the investigators found that the LifeSkills intervention resulted in a nearly 40 percent reduction in condomless sex among participants, compared to those who received standard care.
“We are so proud that it is the first evidence-based intervention for sexual risk reduction and HIV prevention for transwomen,” said Dr. Garofalo, also a professor of pediatrics in the division of adolescent medicine and of preventive medicine. “Our hope is that LifeSkills can now be used by agencies all across the country that serve transwomen, and that it can be used in coordination with other prevention strategies like PrEP as part of more holistic approach to curb the epidemic.”
Dr. Garofalo notes that the project is the result of more than 15 years of work.
“As investigators, you hope that one day your work can be used practically to help the communities you care about,” he said. “For us and for this community this is a landmark moment in that this intervention is practical and one that can now be implemented in places across the U.S. and abroad that are doing HIV prevention work with young transwomen.”
Dr. Garofalo is also a pediatrician at the Ann & Robert H. Lurie Children’s Hospital of Chicago, director of the Gender, Sexuality and HIV Prevention Center and a member of the Stanley Manne Children’s Research Institute.
The study was co-authored by Dr. Lisa Kuhns, research associate professor of pediatrics in the division of adolescent medicine, along with investigators from Harvard University and Brown University.
The research was supported by award R01MH094323 from the National Institute of Mental Health of the National Institutes of Health. The project was also supported in part by the Northwestern University Clinical and Translational Science Institute and grant UL1TR000150 (Clinical and Translational Sciences Award, a registered trademark of the U.S. Department of Health and Human Services) from the National Center for Advancing Translational Sciences.
Northwestern: Sugar Pills Relieve Pain for Chronic Pain Patients
Someday physicians may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology. And the pills will reduce their pain as effectively as any powerful drug on the market, according to new research.
In a study published in Nature Communications, Northwestern Medicine scientists have shown they can reliably predict which chronic pain patients will respond to a sugar placebo pill based on the patients’ brain anatomy and psychological characteristics.
“Their brain is already tuned to respond,” said senior study author Dr. A. Vania Apkarian, professor of physiology. “They have the appropriate psychology and biology that puts them in a cognitive state that as soon as you say, ‘this may make your pain better,’ their pain gets better.”
There’s no need to fool the patient, said Dr. Apkarian, who is also a professor of anesthesiology and of physical medicine and rehabilitation.
“You can tell them, ‘I’m giving you a drug that has no physiological effect but your brain will respond to it,’” he said. “You don’t need to hide it. There is a biology behind the placebo response.”
The findings have three potential benefits: