End Transmission: A UChicago Doctor’s Simple, But Monumental Goal
A typical day for Dr. John Schneider is never quiet.
The associate professor in the Department of Medicine & Public Health Sciences and director of the Chicago Center for HIV Elimination (CCHE) might be found working on research projects, spending time in a health clinic that services underinsured populations, or addressing the “the real sexy stuff” like meetings and project oversight. But ultimately his work is geared toward one goal: to stop new transmissions of HIV on the south side of Chicago.
One of the immediate challenges of ending the spread of HIV is how much less deadly the disease is perceived since it was first in the public eye. “In some ways, AIDS was a good thing for HIV prevention,” Schneider says. “If you see your friends die, you’re definitely going to wear a condom.” Now, HIV-AIDS is viewed more as a chronic disease, not the death sentence it once was. “That makes prevention harder, because certainly on the treatment side, there are lots of options.” Condom use has now seen a steady decline. “We need to get back to a place where people are protecting themselves,” Schneider says, not just with condoms, but with the Pre-Exposure Prophylaxis (PrEP), medications that can also prevent the spread of HIV.
Chicago’s HIV epidemic is potent for a big city. “Chicago has a very large population many who live in poverty, with limited government resources and service, and disproportionaterates of violence and incarceration,” Schneider says. In New York and Los Angeles, many people have been priced out of the city proper, hence diffusing the epidemic, but in Chicago, says Schneider, HIV is concentrated in African American communities on the south and west sides.
Over the past five years, according to a 2014 report by the Chicago Department of Public Health, 20-24 year olds were the only group in Chicago continuing to see a rise in new HIV infections. “That’s peak sex time and it’s when people are getting into relationships. Within that group, African Americans are disproportionally affected,” Schneider says. “They’re not doing anything different from their white or Latino counterparts—it’s just that their chances of coming into contact with somebody who is infected is higher and lot of the other groups have had better access to care.”
In order to combat the spread of HIV, Schneider uses social media, a technique he applied when he was conducting research in India. He says that both Chicago and Hyderabad have similarities in terms of their vulnerable communities. “I think my global health work is somewhat unique in that a lot of people work in the States and bring it to the other countries. This was the opposite.”
Schneider’s first approach is to find people who most need preventive services. “We can put an ad on Facebook or hand out fliers, but it’s best when community members recruit themselves. I start with someone who has a lot of condomless sex, and I just ask him to bring in people he knows.” That approach, he says, attracts people most in need of help.
Schneider and his team also identify people in “bridge” positions who can spread valuable information. “Right now we have a PrEP diffusion project where these change agents are getting used to talking about PrEP. There’s very little PrEP-knowledge on the South Side—but it’s getting better.”
Additionally, Schneider partners with other nonprofit organizations that aim to eliminate the spread of HIV, like the Chicago Black Men’s Gay Caucus and the social service agency Chicago House. Schneider also supports his team that organizes the annual Paragon Ball, an event thrown for the South Side’s black gay and transgender community. “We don’t push a lot of HIV prevention; it’s just a time to have fun and let the community know we’re here if they need something.”
When he first arrived at the University of Chicago in 2001, Schneider enrolled in a series of workshops to understand network analysis, because in addition to medicine and public health, his work involves the social drivers of prevention, including understanding why at-risk patients may be reluctant to participate. “To them, HIV is a concern, but it may not be the top five,” he says, adding that they may be thinking, “Why would I spend my limited time trying to work with a complicated medical system and people I may not trust, people who may have exploited my ancestors?”
Schneider sees eliminating the spread of HIV as a cause that should be important to all Chicagoans. “I think morally, it’s the right thing to believe in,” he says. “While we are a segregated city, every new case costs a lot to the city. Prevention creates more opportunities for people to live healthy and productive lives.“
– Claire Zulkey