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5 Questions for Kim Blankenship

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Kim Blankenship

AU Sociology Professor and Chair Kim Blankenship is part of a national consortium of scientists focused on reducing rates of HIV infection and AIDS, particularly in areas where the numbers are still alarmingly high. She recently received $490,000 as part of a five-year grant from the National Institutes of Health to support HIV research and prevention. 

Blankenship is the director of the Social and Behavioral Sciences Core of the District of Columbia Center for AIDS Research (DC CFAR). Its mission is to provide scientific leadership in HIV/AIDS research, and to work with the DC government and community to make sure the research translates into better prevention and care in DC and beyond. 

Blankenship also directs AU’s Center on Health, Risk, and Society, an interdisciplinary group of scholars conducting research that applies social science perspectives to the analysis of health. 

We asked Kim about her work, and the impact she hopes it will have.

What is the HIV infection rate in DC, and why is it so high? 

The HIV rate in DC is about 2.5 percent across the population as a whole. This is very high—the World Health Organization defines a severe epidemic as 1 percent of the population living with HIV—but the DC rate is down from 3 percent of the population in 2009, so that is some good news. The number of newly diagnosed infections has also declined. There were 680 new infections in 2012 (most recent complete data). Most striking about the epidemic in DC and across the US is that it disproportionately affects blacks, who make up 77 percent of new infections in DC. Black men who have sex with men (MSM) and black MSM who inject drugs (IDU) make up one fourth of all new HIV cases, the largest share, and black heterosexual women make up another 18 percent, the second largest. Contrast that white MSM and MSM/IDU, who comprise 10 percent of new infections. White women make up only 0.6 percent of new cases in DC. 

Newly diagnosed cases are also geographically concentrated in certain wards in DC. There are many reasons for the high rates in DC, but in general, they do not result from lack of knowledge about HIV-related risk factors. What interests me most is how social processes of community disruption and social structures of race, gender, and class inequality produce vulnerability to HIV. I’m especially interested in the disruptions created by mass incarceration and the re-entry cycle, and the policies and systems of class, race, and gender inequality that create them. Gentrification is also a major disruptive process.

Are the known prevention measures working or not, and what could the city and community be doing to improve the situation? 

Yes, known prevention approaches are working. This partly explains the decline in HIV rates over the last five years or so here. DC is doing a good job offering many different opportunities for people to get tested, and if they do get tested, DC does a better job of linking people to care than a lot of other places. 

But there is a lot more to be done. For example, there are still people who don’t get tested, and we need to understand the reasons for this. I think the reasons are more complicated than simply that there aren’t enough testing sites. Even when people are tested and linked to care after a diagnosis, they don’t necessarily remain in care. And many of the same things that put people at risk in the first place—homelessness, joblessness, disruption of stable relationships, violence and trauma, incarceration—also help explain why they don’t get or stay in care.

How do you think the DC CFAR collaboration can help prevent future infections and treat those who are infected now? 

One of the great strengths of the DC CFAR is that it represents a highly committed, multidisciplinary group of researchers. Through our collaborations we can challenge the epidemic from many different directions. We have people doing research to try to find a cure, people doing research to identify new models for linking people to and keeping them in care, and people doing research to understand how social processes, structures, and behaviors create vulnerability, and more. I think it will take all of this to ensure not just that the overall rates go down, but that the disparities are eliminated as well. 

What are the most recent national trends in HIV transmission, and the newest means of countering them? 

New infections in the US have been holding pretty steady over recent years, but, so have the disparities. In DC, new infections have declined, but the disparities have not. I think this is something that we cannot forget when considering trends. As for new approaches, people have probably heard about a lot of biomedical approaches to prevention—antiretroviral therapy (ART) for those who are infected, which reduces viral load and makes it much harder to transmit HIV to others; pre-exposure prophylaxis (PrEP), which can be taken by people who don’t have but are at high risk of getting HIV, and which can keep the virus from getting established if they are exposed; and post- exposure prophylaxis that can be taken soon after a high risk event to prevent acquisition of HIV. 

As a social scientist, I understand the value of these biomedical approaches, but think that they will only be of limited impact until we really understand the factors in people’s lives and social contexts. For example, PrEP is only effective if taken consistently. These new approaches are not really all that different from condoms in this regard. Condoms work extremely well at preventing transmission/ acquisition of HIV in the laboratory, but consistent condom use in people’s lives is incredibly difficult to maintain.

What do you, personally, hope to see come out of the DC CFAR collaboration? 

An end to AIDS! And a knowledge base that can be used to address a wide range of other diseases and health issues that already exist or that may emerge.