When UCSF's Center for AIDS Prevention Studies (CAPS) was established in 1986, the landscape of HIV/AIDS prevention work was very different. The first cases had only been identified five years earlier; the number of researchers working on prevention was scant.

Today, CAPS – a program of UCSF's AIDS Research Institute (ARI) – comprises the largest group of HIV prevention researchers in the world. The program's 60 investigators have pioneered studies on the epidemiological and behavioral aspects of HIV/AIDS in at-risk communities in more than 41 countries, representing a majority of the 75 countries in which the ARI as a whole has projects.

CAPS is known throughout the world for the innovative and fruitful collaborations it creates and supports among universities and government, community-based and private agencies.

TAPS Taps Promising Researchers

With the establishment of its Trainees in AIDS Prevention Studies (TAPS) fellowship program in 1988, CAPS also became a global leader in training HIV prevention researchers. Over the last 20 years, TAPS has graduated more than 81 scientists who now work in leadership positions in a wide variety of institutions, including the CDC, international public health organizations, local health departments and universities.

TAPS fellows all focus on AIDS prevention, and their areas of expertise and interest vary greatly. But some of the most innovative work at CAPS and TAPS has focused on men who have sex with men (MSM).

CAPS was founded at the "AIDS epicenter," with its first focus on the group at greatest HIV risk: gay and bisexual men. It was logical to center the early research on MSM domestically, where CAPS continues to conduct a great deal of its work. Dr. Kegeles's HIV prevention program for young gay/bisexual men known as Mpowerment, for instance, has been implemented by at least 125 organizations so far in the U.S., and independent researchers identified it as the most cost-efficient approach to HIV prevention in the U.S.

MSM throughout the world continue to be at very high risk for HIV – a fact that was emphasized at the most recent International AIDS Conference in Mexico last August. Yet, there continues to be little research focused on them. Both CAPS and TAPS meet the challenge to conduct such work, as illustrated by the three individuals profiled here.



Kyung-Hee Choi, PhD, MPH

An early TAPS fellow (she graduated in 1993), Dr. Choi is now a professor with CAPS. Over the last 18 years, she has focused on three areas of research in her work: MSM in China, use of the female condom among ethnically diverse populations in the United States, and Asian and Pacific Islander gay men in the U.S.

As part of that latter work, she developed the only evidence-based HIV prevention intervention yet in existence for U.S. Asian–Pacific Islander gay men.

In 2000, Dr. Choi started her work with MSM in China, where homosexuality is not illegal but is highly stigmatized. "Homosexuality has long been considered a psychiatric disorder," Dr. Choi explains, "and has been a source of great shame among Chinese gay men. These men are expected to marry and have families. And if there's only one son – as can happen with the one-child policy – that expectation is even higher."

Even eight years ago, Dr. Choi says, MSM in China were nervous about her working with the Chinese government. Today, she notes, "the Chinese government is doing a lot of good work on HIV prevention," but there is potential for the rapid expansion of the epidemic among MSM, in part because many MSM engage in high-risk sexual behaviors.

Her most recent research has been on the relationship between homophobia, financial hardship, sexual partner concurrency and unprotected sex among MSM in Shanghai. In 2006-2007, she recruited MSM volunteers to work as peer educators to disseminate HIV prevention information to MSM in that city.

"We followed up three months later and found that the number of MSM engaging in risky sex had dropped, while their knowledge about HIV had increased, and their attitude had improved," she says. "I have benefited from TAPS in a number of ways," she adds, including having the opportunity to get her Master's in Public Health (all TAPS fellows are required to complete an MPH if they don't already have one) and working under mentors who helped her write grants and network with international scholars.



Tim Lane, PhD, MPH

Tim Lane came to TAPS by an unusual route. His doctorate in history had focused on the role of traditional healers in resolving conflict in African villages. But while he was studying and working in South Africa in the 1990s, he was struck by the silence around HIV in many rural communities – as well as the challenges this posed to HIV prevention programs.

On a trip to South Africa that he took after completing his first year of TAPS in 2003, he became interested in working with one of the most hidden of African populations: men who have sex with men.

"At the time, no one was doing any work with MSM in Africa," Lane says. "In fact, many people thought homosexuality didn't exist in Africa or that it wasn't relevant to a generalized, heterosexual epidemic. But, as it turns out, there are many MSM in South Africa, although stigma against homosexuality requires many of them to keep their identities and behaviors hidden, especially in the townships. It is an epidemiological problem, and it creates a huge challenge to HIV research and prevention efforts."


Fieldworker Christian Letsoalo at a community meeting in Atteridgeville,
South Africa. Photo: Tim Lane

Lane's current research focuses on the HIV prevention needs of lower-income township MSM in Soweto. This is a population that is very vulnerable to HIV, but whose culture and the challenges they face have barely been studied. Specifically, Lane's research has used both ethnography and behavioral surveys to better understand township MSM's beliefs about their sexual identities and behaviors and the role of alcohol and drugs in their communities, as well as their current HIV risk reduction knowledge and practices and their access to health services.

During 2008, he completed the first-ever study to assess HIV prevalence in Soweto's MSM population. Lane notes that as a white American, establishing rapport with this population could be difficult. But his years studying and working in South Africa made it easier for him communicate with township MSM. Being gay himself also helped.

"Just as I have questions about their lives, they have questions about my life as a gay man in the United States," he says. "And I think researchers should share that kind of information. We can't keep people under a microscope."

For Lane, the TAPS experience has been "really quite amazing," because it "brings people from diverse disciplines together to think about HIV," he says. "In my cohort of fellows alone we had an MD, a social psychologist, a clinical psychologist, and me – a historian with training in epidemiology. This provides an incredible opportunity for learning how other people think about HIV and health, as well as insights during the grant and article review process. It's a good intellectual community."



Erin Wilson, DrPH

A second-year fellow currently in TAPS, Dr. Wilson is assessing HIV risk in Nepal among MSM, which includes gay- and non-gay-identified men; and among transgender women.

Her doctoral research focused on HIV risk behavior of male-to-female transgender youth, which resulted in the funding of three intervention projects (two in Los Angeles and one in Chicago).

She'd long known about CAPS, Wilson says, "because it's the preeminent organization for HIV research. And I've always loved the idea of being there. So as soon as I finished my public health doctorate, I applied for TAPS because I wanted training to conduct effective research with marginalized communities."

Now, she notes, she's thriving in the "collaborative environment" of the TAPS/CAPS programs. "As soon as we started our fellowships, my group had other CAPS researchers reaching out to us," she says. "I've never seen anything like that."

The young researcher's interest turned to Nepal because her husband's parents lived and worked there for a number of years. After applying for a small, innovative pilot grant, Dr. Wilson went to Nepal – with her husband and three-month-old baby in tow – to study MSM, one of the groups at risk for HIV in that country.

Only one organization, the Blue Diamond Society, works on HIV issues in Nepal, where homosexual behavior is highly stigmatized and often results in violence against MSM. Despite her commitment to the issue, when Dr. Wilson first met with Blue Diamond staff, "I felt very much like an outsider," she says. "But when I went back with my husband and baby, they warmed up to us. They ended up inviting us to many of their community events. I think bringing a child into the field is very disarming and actually helps establish relationships."


Baby Carter and new friend Jayash. Photo: Justin Meek

While the violence and stigma surrounding homosexuality still exist in Nepal, Dr. Wilson sees hopes for the lesbian, gay, bisexual, transgender and intersex communities in that country. The Nepalese government altered its constitution in December 2007 to include protections for a "third gender," inclusive of all gender and sexual minorities. And the Blue Diamond Society continues to advocate for furthering the rights of the LGBT community.

"They are very brave and very committed to human rights," Dr. Wilson says. "It's very inspiring."

The young researcher aspires to follow Dr. Choi's and Dr. Lane's path and become a faculty member at CAPS, as well as develop an HIV prevention approach for Nepalese MSM.