Fisher was the principle investigator on a recently completed quantitative study that resulted in a paper published in the journal AIDS and Behavior titled “Patient-Provider Communication Barriers and Facilitators to HIV and STI Preventive Services for Adolescent MSM.” In the study, Fisher found that young males who have sex with males were reticent to discuss sex with their doctors. But when doctors initiated the conversation, they were more forthcoming with vital information that could affect their health.

The nationwide study was conducted anonymously via a  questionnaire linked to from a trusted website frequented by gay teens. It surveyed 198 adolescent gay males. Several participants said they completed the survey because they wanted to help their community.

“This is the first study to ask kids about their attitudes on getting sexual health care,” said Fisher, who directs Fordham’s Center for Ethics Education. “Pediatricians and general practitioners are the gateway of youth experiences with health care, but [these patients]only go once a year, so this is an ideal time to ask [about their sexual activity].”

Fisher said there are several studies that have found that most doctors are not trained to ask questions relevant to sexual minorities, and many doctors assume the youth they treat are straight. Furthermore, the language of sexuality has evolved for young people.

“The other issue is that doctors should not use terms like ‘gay,’ or ‘LGBT,’ because for many young people the terminology is in flux,” said Fisher. “Youth no longer identify with these traditional behaviors; the question should be ‘Who are you attracted to sexually?’”

But most importantly, Fisher said, the conversation needs to be initiated by the doctors, even though doctors often have the “misperception that the kid would be uncomfortable.”

“Physicians need to be well versed in safety advice and should be able to communicate to all,” she said. “The kids don’t bring it up because they think the doctor will be prejudiced.”

Another concern among the young men was that the doctors might tell their parents, but Fisher said most states allow doctors to provide information to teens on sexual health, including HIV prevention, without parental consent. Some states, like New York, even allow doctors to prescribe PrEP, the pill that protects against HIV, to minors without getting parents involved.

“The grey area is if the child is having sex with an adult that might be considered sexual abuse and that needs to be reported,” said Fisher.

But such cases only reinforce the need for doctors need to be proactive in their conversations with youth, she said. Even if the relationship is legal and consensual, some youth lack assertiveness skills to demand a condom from an older or aggressive peer partner, she said.

“They need advice specific to males having sex with males,” said Fisher. “Giving gay males advice on sex with females is useless, but when they’re aware of those specifics they’ll be safer and healthier.”

You have been treating HIV and AIDS patients for more than 25 years. What was it like in the early days?
In my second job as a PA, I was working at Beth Israel in the chemical dependency unit. Our role was to detox patients but also address their medical problems. So, early ’80s, what are we seeing? Fevers. We’re asking, why are these lymph nodes enlarged? Why is this person short of breath? Little did we know, this was the only the beginning of the HIV epidemic.

And how has treatment changed?
In the old days, we would say that a CD4 count (T-cell count) below 200 was full-blown AIDS. But that doesn’t really mean anything anymore. With advances in treatment, patients can have the same lifespan as someone who is HIV negative. Now we are more concerned with what diseases they develop as they age, like bone disease, heart disease, liver disease, kidney disease, and cancers. They may happen sooner for people with HIV.

What impediments to treatment do you see for communities of color?
There are layers of challenging obstacles, including poor access to care, misinformation, stigma, and mistrust of the system. For HIV in particular, stigma is big. Also, sometimes people in communities of color don’t feel like they have a doctor, or they wait until they are symptomatic, when it’s often too late.

How do you help your patients advocate for themselves?
As I diagnose and treat them, I also educate them. So they know what medications they’re on. They know their CD4 and their viral load. When they see a specialist, they know how to be very assertive, and if they need to, they can call me. I can’t take anyone dismissing a patient.

You have said your mother inspired you to go into medicine. How?
My mother is my biggest inspiration. She had diabetes and hypertension and was often weak but remained strong and resilient for her children. She was always supporting and encouraging, no matter how badly she felt physically. I witnessed firsthand the impact of health disparities in my community during her illnesses and as I found my passion in medicine, I was by her side. She didn’t always take her medications, because of side effects and because she was busy raising seven children. And she didn’t always keep doctor’s appointments because she didn’t feel great. When she started going more regularly, the damage was done, in terms of her diet. She eventually succumbed to complications of stroke.

So is nutrition part of the community education you provide?
Yes, I’m a member of Harlem Docs, which provides nutrition workshops in conjunction with Harlem’s new Whole Foods. And I do a lot in terms of wellness and overall health, usually around HIV and AIDS. I also founded the Taylor/Moses Institute, a mentoring program for students interested in the health professions.

Tell me about your involvement with MOSAIC, Fordham’s new affinity group.
There used to be a black and Latino alumni association, but it died out. So a group of younger and older alumni got together to establish this new organization embracing the blended mosaic of all cultures and our shared Jesuit values. Right now I’m an unofficial co-chair. We’ve had some networking activities and we’re hoping to have more cultural events open to all alumni. At Homecoming, younger alumni were excited that there was a place they can give back and support Fordham’s mission.

A medical doctor considers how socioeconomic factors affect our health

Dr. Hussein Safa’s ambitions were shaped by a war. It broke out in 2006 in Lebanon, where he grew up, and he was impressed by the doctors who showed up in his country and risked their lives to provide much-needed medical help.

He later learned the name of their organization: Doctors Without Borders. “When I learned about that, I thought, ‘That’s what I want to do. That’s how I want to give back at some point.’”

Today he’s closing in on that ambition, having just finished medical school at Creighton University and preparing to begin his residency at Montefiore Medical Center in the Bronx.

The idea of giving back was reinforced by his education at Fordham. Grants and scholarships made it possible for him to attend, and the University’s Urban Plunge program fueled his own extraordinary community service efforts, which were recognized by Fordham’s Dorothy Day Center for Service and Justice.

At Creighton, he founded an organization to advocate for the needs of LGBTQ patients and providers. And he sought out his residency program because, in addition to its medical training, it teaches community involvement and advocacy so that doctors can better meet the health care needs of urban, diverse populations.

It was Urban Plunge that opened Safa’s eyes to the particular problems facing some urban residents, like a lack of affordable nutritious food.

“Human health doesn’t happen in a vacuum,” Safa says, expressing a holistic view reinforced at Fordham and at Creighton, both Jesuit universities that nurture the whole person. “The whole person includes their social environment.”

He feels privileged to have the opportunity to be a doctor and wants to use it for others’ benefit. After completing his three-year residency, which will also include an HIV and global health track, Safa plans to join Doctors Without Borders so he can help people in distressed areas, regardless of whether they can pay for health care. He himself didn’t have health insurance until he came to the United States with his parents and settled in Staten Island just before his 17th birthday.

“I know what it’s like to be constantly afraid that you’re going to get sick and you don’t have money for it,” he says. “That’s part of the reason that I want to give back.”

Read more “20 in Their 20s” profiles. 

Here’s one: A researcher, separately interviewing two people who engage in unprotected sex, learns that one is HIV-positive and hasn’t told the other. Should the researcher violate confidentiality by alerting the non-infected partner?

This is just the kind of quandary addressed at a training institute founded four years ago by Celia Fisher, Ph.D., the Marie Ward Doty University Chair and professor of psychology at Fordham. The HIV and Drug Abuse Prevention Research Ethics Training Institute—the only one of its kind—trains scholars to gather data that clarifies ethics questions and shows how they might be resolved.

“What we’re trying to do is to have evidence-based ethical decision-making,” said Fisher, director of the Center for Ethics Education, of which the institute is part. “People have been training in research ethics in general, but nobody has trained people how to do studies to produce evidence on research ethics. We’re the first institute to ever do that.”

It was the dearth of this type of research that led Fisher to found the institute four years ago with a $1.6 million grant from the National Institute on Drug Abuse, part of the National Institutes of Health. Every year, it has admitted six to eight fellows—all of whom have medical or doctoral degrees—and trained them to identify and study ethics questions, produce and publish a research project, and win further grants. They attend a 10-day session the first summer, a five-day session the next, and receive guidance from faculty mentors.

“Our goal is to create a new generation of HIV and drug abuse researchers who are studying ethics, and who are getting grants in ethics, who will be publishing about ethics,” Fisher said.

So far, fellows have published at least 16 articles about how to create scientific knowledge while also respecting the confidentiality of the people involved in studies and treating them humanely and respectfully.

For example, one fellow learned how to address the ethical concerns that arose in her study of HIV prevention practices among female sex workers in the Philippines.

She conducted the study via an advisory board—including health officials, academic experts, former sex workers, and others—that investigated the participants’ privacy worries and provided information on avoiding HIV and improving their circumstances. The women gave in-depth interviews instead of filling out surveys.

It was an effective approach that allowed the women to safeguard their interests and play a more active role in the study rather than feel “researched upon,” said the fellow, Lianne Urada, Ph.D., an assistant professor at the University of California, San Diego, School of Medicine.

Another institute fellow, Brenda Curtis, Ph.D., studied the ways in which researchers protect study subjects’ privacy—and verify that they are who they say they are—when contacting them via social media, which is useful for enlisting members of hard-to-reach populations.

Her research highlighted the various ethical issues involved, as well as the need for researchers to involve their institutional review boards at the outset of their projects so the boards’ concerns can be addressed, said Curtis, a research associate at the University of Pennsylvania’s Perelman School of Medicine.

She and Urada praised the institute for the continuing support it offers; both have won high-level NIH grants for further ethics research.

Other fellows’ studies have upended some of the assumptions underlying ethical dilemmas. One study found that there is, in fact, a way around the stigma that keeps lesbian, gay, bisexual, and transgender (LGBT) teens in Thailand from asking their parents for permission to take part in HIV prevention studies, Fisher said.

When interviewed, parents—who didn’t know whether their children were LGBT—said they would be willing to let their children’s schools approve their participation instead, as long as the children’s privacy was protected. (See Inside Fordham V. 37, No. 2 for more on Fisher’s new funding on ways to question LGBT teens about HIV.)

Some of Fisher’s research also showed that drug users who were paid to participate in a study used the money to buy clothes and food—not more drugs. “That kind of research has changed how people look at whether or not it’s fair to pay drug users” to take part in studies, she said.

And as for those study participants who hadn’t told their partners that they’re HIV-positive, Fisher said, some of her research indicates that they recognize their moral obligation to do so, and would be receptive to the researcher at least warning the other partner to take precautions.

The researcher can also try to convince the HIV-positive partner to have a talk with the other partner, another option for maintaining the confidentiality essential to winning study participants’ trust.

“It’s what I have called the scientist-citizen dilemma,” Fisher said. “As the scientists, we’re obligated to maintain confidentiality; as a citizen and human being, we are obligated to help those who we know are in danger.”

Why, she wondered, couldn’t clients of Catholic Charities of the Archdiocese of New York also benefit from brightly colored artwork in its facilities?

So in 2013, Bruce, the agency’s director of volunteer services, began soliciting artists’ designs for therapeutic art that could hang in its various facilities.

Artists Olivia Servais and Mackensie Leigh answered the call, and on July 17, members of Fordham’s Office of Development and University Relations (DAUR) paid a visit to Catholic Charities’ offices to help replicate their work. After tracing the outlines of the art on to square wood-and-cloth canvases, DAUR members used watercolors and sharpies to fill in the blues, reds, yellows, and greens of the collages.

Bruce said the canvases will be hung in facilities that are home to Beacon of Hope, an assisted living facility for 400 adults with severe mental illnesses; Catholic Guardian Services, which provides foster care services; and Incarnation Children’s Center, a nursing facility that provides specialized care for children and adolescents living with HIV/AIDS.

Beacon of Hope, she said, was the first to receive art, and the response was so positive that organizers at other programs began asking for pieces as well. In addition to the assembled canvases, Bruce has arranged for traditional outdoor murals to be painted on-site at the Incarnation Children’s Center.

“It’s an easy, fun way for groups to get together and contribute to the program,” she said.

For more information on how to volunteer, visithttp://www.catholiccharitiesny.org/get-involved/volunteer/.

—Patrick Verel

“Taking one’s medications is one of the most important behaviors patients can engage in,” said Monica Rivera Mindt, Ph.D., assistant professor of psychology who will serve as principal investigator on the grant project. “But researchers have been looking at the problem of adherence without a focus on sociocultural factors among Hispanic HIV-positive patients. The ultimate goal of this study is to eventually develop culturally tailored interventions to improve health among this group [of Hispanics]. Right now, something as simple as how to read a pill bottle may be serving as a barrier.”

The federal funding is part of the National Institutes of Health’s Mentored Patient-Oriented Research Career Development Award program and is the first of its kind awarded to Fordham University. Often referred to as K23 grants, the funding is designed to support the career development of investigators who focus on patient-oriented research.

The study will involve 100 HIV-positive Hispanic patients and 50 HIV-positive non-Hispanic white adults. Participants will be given pill bottles with a Medication Event Monitoring System embedded inside the cap of each bottle that will keep track of when and how often participants open and close their medicines, Rivera Mindt said. Patients will also be screened for health knowledge and other areas. The study’s design will allow the investigators to compare adherence to the drug regimens between the two groups and to measure health and neuropsychological outcomes of patients.

Nancy Busch, Ph.D., dean of the Fordham Graduate School of Arts and Sciences and associate vice president for academic affairs, said the project represents a major opportunity for Fordham to engage in research.

“This award demonstrates that Fordham has achieved a new level of research sophistication,” Busch said. “[Rivera Mindt] worked . . . with several faculty members in the Department of Psychology to develop this proposal and to tailor it to the expectations we have for the involvement of students in research.”

Rivera Mindt said that Hispanics, particularly those of Puerto Rican and Dominican ancestry in New York, have been among the hardest hit by HIV/AIDS. Most of the research involving Hispanics and HIV/AIDS, however, has focused on people of Mexican descent, she said.

“Culturally, it is not clear that you can generalize findings from one Hispanic subculture to another,” she said. “This study will shine a light on groups who have been disproportionately affected by the HIV/AIDS epidemic.”

Co-investigators on the study are Susan Morgello, M.D., professor of pathology and neuroscience at Mt. Sinai Department School of Medicine; Julia Arnsten, M.D, chief of the Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center; and Anna Abraido-Lanza, Ph.D., associate professor of sociomedical sciences at Columbia University’s Mailman School of Public Health.  Fordham College at Rose Hill doctoral students Alyssa Arentoft and Kaiori Kubo Germano and Erica D’Aquila, a junior at Fordham College at Lincoln Center, will serve as research assistants.