Casey Adrian stands in front of the Polyform outside Martha Van Rensselaer Hall. (Photo credit: Juan Vazquez-Leddon)
Casey Adrian has been researching HIV for a long time. As a student at Binghamton University, Adrian studied the history of Gay Men’s Health Crisis, the world’s first HIV service organization. His upcoming research work will continue to revolve around HIV, but now with eyes toward the future – specifically the lack of HIV prevention efforts for a vulnerable group, youth in foster care.
“There’s always been this historic health inequity around HIV, including health inequities with kids in the foster care system,” said Adrian, who is the research aide and community outreach coordinator for the Program for Research on Youth Development and Engagement (PRYDE) in the Bronfenbrenner Center for Translational Research (BCTR). “There is a huge disproportionality of HIV risk among kids in foster care.”
In an editorial published in the American Journal of Public Health, Adrian says a key method to help reduce the disproportionality is to make pre-exposure prophylaxis (PrEP) easier for foster youth to access. When taken as directed, PrEP can reduce the risk of contracting HIV through sex by 99%. But there are many roadblocks that youth face, especially youth in foster care, in trying to acquire PrEP.
“Minor consent laws vary state by state, which is a huge problem,” said Adrian. “A teenager must navigate all of these medical and legal landscapes to understand: How can I do this? Can I go to my doctor and ask for it? How do I get to the doctor? Are they going to send an EOB (Explanation of Benefits) home to my parents? Do I know what an EOB is? How am I going to pay for it? There are just so many considerations, and so many of those fall around minor consent.”
The National HIV/AIDS Strategy for the United States aims to reduce the number of new HIV infections in the U.S. by 75% in 2025 and 90% by 2030. Adrian states that tearing down the roadblocks adolescents face in accessing PrEP, especially youth in foster care, can help achieve this goal.
“If we’re going to accomplish that goal, it’s important to look at this one subset of the population that represents a group that’s already marginalized.”
Adrian will start this research with Stacey Shipe, an assistant professor in Binghamton’s Department of Social Work who advised him when he was getting his master’s degree there. Shipe studies systemic disparities in the child welfare system. Working together on this research was a natural match.
They recently received approval to analyze data from youth in foster care and general adolescent health data. Adrian then hopes to take use data as a basis for conversations with foster youth around their knowledge of PrEP, but that can be challenging. He’s hoping to partner with fellow BCTR programs that do work involving adolescent sexual health and foster youth for guidance.
“We have a body of work written about them, but until you really have these conversations with them, you don’t really fully understand the scope of their experience,” said Adrian.
The difficulty of research with foster youth and HIV prevention could partially stem from objectionable media coverage of youth in foster care who participated in clinical trials of an experimental HIV treatment in the 1990s.
“They were getting all of the things that anyone in a clinical trial would get, so it was protected,” said Adrian. “There were clinicians looking after them, and they were receiving supervised access to potentially life-saving experimental drugs. But there was a lot of fear-mongering.”
However, erasing many of the fears foster youth may have around trying to access PrEP is the ultimate goal for Adrian.
“Young people want sexual and reproductive health care,” said Adrian. “We just really need to understand their emotions and motivations and support them as they navigate complicated legal landscapes to access this care. Then we can translate this into policy and practice to better serve these kids.”
