Researchers at the University of Kentucky are taking an innovative approach to help a high-risk population by using easily accessible technology: an app on a smartphone.
Carolyn Lauckner, PhD, an assistant professor in behavioral sciences in the College of Medicine, is leading a study to better understand the link between HIV and alcohol use in young adult sexual minority men and transgender (SMMT) individuals aged 18-34, with the goal to reduce HIV risk behaviors.
The CDC reports approximately 1.2 million people in the U.S. have HIV with roughly 13% of them unaware and in need of testing. According to the Kentucky HIV/AIDS Annual Surveillance Report 2020, roughly 11,000 HIV infections were reported in the Commonwealth.
Up to 44% of emerging adult sexual and gender minorities are at especially high risk for alcohol use disorders compared to older adults. Studies have found that alcohol use increases HIV risk behaviors, and HIV disproportionately affects this group.
“We know that drinking is a strong part of college culture, and a lot of people who attend universities engage in very hazardous drinking,” said Lauckner. “So if we can reach some of those individuals locally, plus sexual minority men or trans individuals into their mid-30s who are affiliated with drinking culture, maybe we could help mitigate some of the risks.”
The study will use a three-arm randomized controlled trial to test different approaches to address alcohol use.
Participants will meet with a counselor weekly. They will discuss triggers for drinking, strategies to address those triggers and set goals for reducing drinking. It’s part of Tracking and Reducing Alcohol Consumption (TRAC) intervention messaging that Lauckner developed and has used in other studies.
In combination with that, participants will monitor their alcohol use and sexual behavior daily through an app on their phones. They will take surveys and use Bluetooth breathalyzers twice daily, which send breath alcohol data to researchers.
The customized app also uses geotracking to monitor when participants go to what they’ve deemed risky locations for drinking. While there, the app will deliver intervention messages.
“We’re sort of taking advantage of the fact that, OK, everybody is staring at their phones all day long, so how can we use these phones for a good purpose to promote healthy behaviors,” Lauckner said.
The app also collects real-time data about drinking and other HIV risk behaviors in those environments. If a participant reports drinking, they’ll receive messages to encourage them to avoid other risky behaviors like unprotected sex.
“I have a large practice in sexual and gender minority medicine, and know that there are a lot of disparities in alcohol and substance use in the LGBTQ+ population as a whole,” said Keisa Fallin-Bennett, MD, an associate professor in the Department of Family and Community Medicine. “There are many reasons for increased substance use, but individuals are so much more than a disparity, and I always strive to understand my patients’ goals and struggles, including in relation to alcohol. Societal pressures and religious conventions in this area can weigh especially heavy and it’s no wonder alcohol eases that kind of difficulty of navigating society as a minority person. Especially with today’s political division and loss of in-person social connection.”
Fallin-Bennett also serves as the lead physician of UK’s Transform Health initiative and its LGBTQ+ clinic, which is a partner for this study.
“I think alcohol gets kind of pushed under the rug while we deal with the opioid crisis, which is so much more acutely deadly,” said Fallin-Bennett. “But in terms of being chronically deadly, cigarettes and alcohol affect many more people and for historical reasons have specific cultural relevance in the LGBTQ+ community. By partnering in this study, I really look forward to being able to learn more about this group from their own self-reporting and monitoring in the real world.”
Both Lauckner and Fallin-Bennett also emphasized the importance of listening to the LGBTQ+ population with this study by making sure it’s appropriate and inclusive through upcoming focus groups.
“I believe in this intervention. I’ve tested it in other populations, and I think it can help. If we can potentially make a difference in improving the health of our local LGBTQ+ individuals, then that’s something I’m excited about,” said Lauckner.
The study is still in its planning stages with formative research expected to begin in the fall and participant recruitment in Kentucky to potentially begin in the spring with the help of Transform Health Clinic and UK Family & Community Medicine at Turfland. The study will also recruit participants in Connecticut.
You can find more information about Transform Health Services here.