In early August SexLab gained a new comrade in the pursuit of sexual health. Longtime behavioral scholar, Dr. Rivet Amico was hired by the department of Health Behavior and Health Education (HBHE) as research faculty and has since joined SexLab’s ranks. As a part of welcoming her to the Lab, I recently had the opportunity to speak with her about her work on strengthening HIV support and prevention services. While explaining her research interests she stressed that utility was essential,
“I would say I have a pretty broad interest base but if you were to think about the commonality between all of them it’s definitely looking at applied strategies to promote health, health behavior and sound decision making around health. And when I say applied it’s that I have a strong interest in working on things that are highly generalizable, highly transportable, things that are able to make an impact on the front line as much as possible.”
Amico attributes a lot of her practice-based research philosophy to her training as a counseling psychologist. At the core of her therapeutic education was learning how to engage and motivate people around change while simultaneously taking into account the environment that shaped them. During her internship and post-doc Amico recognized the importance of understanding each individual’s circumstances,
“Because I worked at a public hospital it really challenged me to think about—and this is totally consistent with counseling psychology as a perspective—how people are influenced by the situations that surround them…You cannot just say this person’s depressed, you really have to look at their entire context that got them to that point and I think that counseling psychology is really strong at that. Therapeutically it’s not as diagnosis oriented, so it fit really well with what ended up being my research interests because it has everything to do with situatedness and contextualizing.”
Once she transitioned out of clinical work and started working for the University of Connecticut Center for Health, Intervention, and Prevention (CHIP), Amico’s focus began to shift towards HIV. Her work centered on supporting people living with HIV in terms of life adjustment, engagement/retention in care, and antiretroviral adherence where her research has become seminal. More recently she has started to direct her attention towards prevention with her work on pre-exposure prophylaxis or PrEP (see video below that Amico and others created about PrEP). Looking ahead, Amico noted that trials establishing the efficacy of PrEP do not provide exploration of how real-world, open-label, real-deal, effective PrEP will be incorporated into sexual health promotion plans. There are too many dramatic differences between participation in a PrEP efficacy study and knowingly opting to use PrEP. In an efficacy study you may be getting an HIV-medication or may be getting a sugar pill, you don’t know which, and even if you are getting the HIV-medication, you don’t know if it actually works to prevent HIV. Contrast that to knowing that you are getting a drug that works when taken to prevent HIV.
“A lot of the work that we’ve done has been necessarily the outcropping of clinical trials. “Please take this” is a very different phenomena than you coming to me and saying, “I’m really interested in pursuing this for HIV prevention””
Demonstration projects on PrEP in the US are ongoing, but in the US, anyone who is at risk for HIV-infection is PrEP “eligible”- you don’t have to be part of a research study to access PrEP. But because it is a prescribed medication, PrEP requires both providers and consumers to navigate new complicated issues surrounding access/coverage and risk assessment that are radically different from how antiretroviral treatment is approached. The means by which this crucial information is disseminated thereby becomes particularly important and in order to help spread the word about preventive measures such as PrEP, Amico also talked about the future potential of social marketing,
“I’d really like to start doing more along the lines of—I don’t know exactly what to call it except for marketing of HIV prevention. I’d like to take a lot of the concepts that are considered cutting edge within commercial marketing and see how they would articulate to sexual health protection and promotion messaging…I think we could learn a lot from a field that’s entirely dedicated towards getting people to rally up and get behind their particular product. Thinking about a product in terms of a health promotion is a new and different way of thinking of things.”
With so much work to be done and possibilities left untapped, Dr. Amico expressed her excitement to become a part of the U-M community,
“I have had a lot of enjoyment actually coming on…there is something really fun and energizing about being able to interact with people who are studying different things and who have different ideas or even just social exchange so it’s been really nice in that sense… I feel that I have had a lot of opportunity to develop different ideas even in the couple of weeks that I’ve been here so I’m really excited about it.”
She is not alone in her excitement. The SexLab and the School of Public Health look forward to working with and learning from Dr. Amico in the years to come—we’ve truly gained an invaluable ally.