Professor of Sociomedical Sciences, Mailman School of Public Health
Professor of Social Work, School of Social Work w Center for the Psychosocial Study of Health and Illness Director
Director, Center for the Psychosocial Study of Health and Illness
Past Research: Professor Siegel, whose early work examined risk behavior in men who have sex with men (MSM), was among the first social scientists funded by NIH to conduct HIV-related research. Fifteen years ago—long before the advent of anti-retroviral therapy (ART)—Siegel began to focus on how people live with HIV as a ‘chronic disease.’ Siegel has focused on identifying the major illness-related adaptive tasks that HIV disease poses for infected individuals and the coping strategies they enact in an effort to master these tasks. With support from NIMH, NIA, NICHD and NIDA, Siegel has explored these issues with HIV-infected MSM, HIV-infected adults 50 years of age or older, HIV-infected women, HIV/HCV co-infected injection drug users (IDU), and behaviorally-infected adolescents. Findings from these studies have appeared in journals such as the American Journal of Public Health, Journal of Health and Social Behavior, AIDS and Behavior, the Journal of Behavioral Medicine, AIDS Prevention, and Archives of Sexual Behavior. Siegel’s research has deepened understanding of how HIV-positive individuals manage uncertainty, stigma, and disclosure, how they deal with negative emotions, and how the mastery of these challenges may be complicated or impeded by co-morbidity, a history of substance use, developmental limitations, or inadequate social support. Using matched samples of women living with HIV infection in the pre-ART era and the ART era, Siegel and her colleagues have demonstrated that women’s psychosocial adjustment to the disease has not significantly improved in the ART era, despite the transformation of HIV from an acute fatal disease to a chronic illness; even in the ART era, disclosure remains stressful as women continue to feel stigmatized and devalued by the disease. These findings suggest the importance of critically examining assumptions often made regarding how the advent of ART has greatly alleviated the level of distress associated with HIV diseases and with sharing one’s seropositive status with others.
Present Research: Currently, Siegel and her team are completing the analysis of data from a study of HIV/HCV co-infected IDU and preparing manuscripts for publication, as well as beginning a new program of research in which they will examine populations at risk for heterosexual transmission. This past March, she and her team began work on a NIMH-funded study of men who have sex with both men and women (MSMW), which will investigate the sexual behavior of non-gay identified MSMW who are sexually active with both men and women and conceal their same-sex behavior from their female partners. This study will examine whether these men are putting themselves at risk of acquiring infection through unsafe sex with their male partners (MSM, a high-risk population) and transmitting it to their heterosexual female partners through unsafe sex with them, and it will explore their motives for concealing their same-sex behavior from their female partners. Findings from a pilot study conducted with this population, under review at the Archives of Sexual Behavior, reveal a high incidence of unsafe sex with either male or female partners—or both—and the need for HIV-prevention interventions with this population. Work on this recently-funded study, which will include 200 MSMW, is the first known study to look at the specific subgroup of MSMW. There is great concern in the public health community that these men may be a “bridge population” spreading infection between their male and female partners. Thus, it will be important to try to understand under what conditions this may occur.
Future Research: In addition to carrying out her recently-funded study of MSMW, Siegel has plans to study the female partners of men in this population, examining their appraisal of the risk associated with having unprotected sex with a bisexual man and the strategies/heuristics they use to evaluate whether a potential partner might be sexually active with men as well, despite his self-presentation as a heterosexual male. She also recently submitted a grant application in response to RFA-HD-07-020 to examine desire for pregnancy, contraceptive behavior, as well as HIV- and conception-risk behavior among 100 serodiscordant heterosexual couples, exploring how these couples balance the risks of HIV transmission and the desire to conceive. This study (if funded) together with the recently-begun study on MSMW, will be part of her new program of research on heterosexual transmission risk behavior.
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