WORLD AIDS DAY 2012: Time to Listen to Service Providers, the Unsung Heroes in the Fight Against AIDS

By Rogério Meireles Pinto

The World Health Organization has declared that between 2011 and 2015, World AIDS Days will have the theme of "Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS related deaths."

Service providers—professionals and paraprofessionals, social workers, physicians, health educators and others—can help get us there, especially if empowered by community based participatory research (CBPR). CBPR calls for the involvement of service providers in academic research that focuses on the development of social and public health interventions. Thus, CBPR can help close the gap between academic knowledge/methods and on-the-ground knowledge.

At the start of the epidemic, people with HIV/AIDS depended on interventions provided by health care service agencies. Service providers launched awareness campaigns and abstinence programs; they devised behavioral interventions and lobbied for biomedical advances. But to what extent have they been involved in the HIV research itself? In fact, members of the provider community who participate in HIV/AIDS research are far more likely to put research findings into practice—but such provider-research partnerships remain few.

The idea of provider involvement in research is supported by the diffusion of innovations theory—the process by which innovation spreads through a social system. Working with researchers, service agencies are able to integrate intellectual, financial, and technological resources in innovative ways. According to this model, providers not only benefit from but are a source of innovation, helping to generate new knowledge through iterative processes.

My research shows that CBPR can jump start this integration of resources by involving HIV/AIDS service providers in research trials—a finding that applies internationally. Whether they are part of a domestic or international research trial, researchers are advised to:

• use a dialectic process to exchange information with their provider partners; and
• encourage mutual support in working with providers and achieving consensus, regardless of social, professional or cultural differences.

To date, HIV/AIDS service providers have been involved in myriad research tasks and procedures. For example, data from 141 New York City providers in 24 settings showed that at least half of these providers had recruited and/or interviewed research participants, collected data, or facilitated interventions. Forty to fifty percent had helped develop aims, surveys, and data collection procedures. Almost ninety percent agreed with this statement: “I would like to contribute to my community by partnering with researchers.”

Similar data from health care providers in Spain and Brazil showed that 71 percent and 94 percent, respectively, would like to contribute to their communities by partnering with researchers.

Perhaps most important of all, providers involved in research develop positive attitudes toward evidence-based practice (EBP) and engage in it more readily than peers who lack research experience. Using a sample (n = 571) of U.S. substance abuse treatment providers affiliated with the Clinical Trials Network—including medical staff, social workers, psychologists and counselors—and a multiple linear regression model, we found that providers involved in research were more willing to use research findings in daily practice, and that providers with favorable attitudes toward EBP were also more willing to use such findings.

Currently, a research-to-practice gap exists of 15-20 years, and many clients/patients may be receiving substandard and outdated services. By contributing to research through CBPR, providers can improve the research itself and their own knowledge bases. This will help close this research-to-practice gap.

Creating opportunities for providers to engage in scientific research will help them help us “get to zero.”

Rogério Meireles Pinto is an associate professor of social work at the Columbia University School of Social Work. He has published widely on the topic of provider involvement in HIV research and was recently awarded a major grant from the National Institute of Mental Health (NIMH) to conduct the first-ever longitudinal study involving training and follow-up of HIV prevention counselors, program managers, educators, and coordinators in New York City.

Related links:

• What Does "Getting to Zero" Mean for Women and Girls? by Nabila El-Bassel
• Talk by Judith Auerbach on World AIDS Day [livestream video]

Img: AIDS ribbon photo courtesy of Lammy831 on Flickr.