Wandering through a graveyard on a genealogical expedition with her father, a young Lisa Eaton noticed tombstone after tombstone of young mothers and their babies from centuries ago.
Her father told her: “We’re just getting out of the dark ages of medicine.”
These early adventures had a lasting impact on Eaton, who has since dedicated her life as a researcher and associate professor of human development and family sciences at UConn to combating the HIV/AIDS epidemic among black gay/bisexual men in the southeastern United States.
“The capacity for a scientist to impact public health was really awe-inspiring,” Eaton says. “I’ve always been captivated by how health care advances could be effected for social good.”
Eaton began her career studying maternal health issues in South Africa, but shifted her focus to the HIV crisis among black gay/bisexual men in the U.S. upon realizing the scope of the epidemic.
In her early work, the HIV epidemic among gay/bisexual black men seemed unbelievable, to the point that Eaton was sure her data were wrong. She found 30 to 40 percent of the black gay/bisexual men in Atlanta reported living with HIV. This is compared to the national average of less than 1% of all adults.
“It was very surprising to me how the HIV epidemic was unfolding in the U.S.,” she says. “Like a lot of people, I didn’t realize the extent of the epidemic we have.”
Around the same time as Eaton’s original study, the Centers for Disease Control released similar findings. The CDC estimates half of all black gay/bisexual men in America will be diagnosed with HIV during their lifetime, if current transmission trends continue.
“We have a public health crisis unfolding before our eyes and what are we doing to address it?” Eaton asks.
The answer to this question can be found, in part, in Eaton’s own work combating the stigma and barriers to receiving health care for HIV.
HIV has long been a highly stigmatized disease; the stigma is more consequential than the disease itself, as it results in a barrier to highly effective treatment. The persistent negative connotations associated with this disease lead many to be reluctant to acknowledge and disclose their diagnosis.
“There’s no way to access health care treatment without disclosing HIV status,” Eaton says. “Whether it’s only to a health care provider or not, you need to have some recognition of having HIV in order to receive treatment.”
The process of treating HIV is a cascade that begins with diagnosis and flows to downstream health care and being prescribed and taking medication until the virus eventually becomes non-transmittable.
“Now, more than ever, we are very highly motivated to get everyone on treatment, not only to help them, but to prevent the spread of the virus,” Eaton says.
Eaton notes that black gay/bisexual men do not engage in risky behaviors (like having condomless sex) more than other communities at elevated risk for HIV infection. In fact, white gay/bisexual men are equally likely to engage in these behaviors and yet their rates of HIV infection are lower.
“We have the epidemic we have in the U.S. today in large part because of racism,” she says. “It’s important to recognize that the history of racism in our country has led us to a place where unequal access to health care and disparity in health care fuel disease in marginalized populations.”
Much of the emphasis in HIV research is on biomedical advancement; Eaton’s work, which is primarily funded by the National Institutes of Health, addresses a critical need in HIV treatment.
“There is this huge gap between biomedical technology available to end the epidemic and our ability to implement it,” she says. “If we’re not able to reach those in greatest need of care we will not affect the epidemic.”
Eaton emphasizes the importance of the health care system meeting the needs of the community it serves. One project she is currently working on brings HIV/STD testing and care right to people’s homes and walks them through the process remotely.
“We’re flipping the system so we can meet as many of the needs of as many people as we can where those individuals are physically located,” she says.
Eaton is also studying the use of a daily pill called PrEP (pre-exposure prophylaxis) that can protect against HIV infection. The pill was approved by the FDA in 2012 and has been shown to be highly effective when taken correctly.
“What’s so remarkable about PrEP is that it is highly effective. It has the potential to really impact the HIV epidemic,” she says. “The big problem isn’t that we don’t have the tools to end the epidemic, it’s that we aren’t able to make the tools accessible to groups at greatest risk for HIV.”
In the population Eaton is working with, lack of access and non-adherence are major concerns. One of her intervention projects from several years ago was adopted by the CDC for implementation in 2015. “Think Twice” addresses common misperceptions about “safe” behaviors that provide a false sense of security for men at elevated risk for HIV/STDs.
Using mini graphic novels, Think Twice helps individuals realize that practices such as only having sex with HIV-negative partners is not a 100% effective prevention method. HIV has a “window period,” in which infection rates are especially high before the virus will have prompted enough of an immune response to be detectable, as HIV screening tests check for antibodies produced to fight the infection, not the virus itself.
Despite the grim statistics and lack of national attention on this issue, Eaton’s work has already helped many members of this population, and its implementation continues to grow.
“When I go to the bigger picture, it can be overwhelming because I can’t take a magic wand and give everyone equal access to health care in this country,” she says. “I do, however, remind myself of the collective efforts of many people who do this work, and the impact that has had on the epidemic. It’s remarkable how far we have come, and – with sustained effort – where we can go.”