Survey Research

Originally consulted to Drs. Curran, Thompson, Bill Darrow (at time the first and only behavioral scientist in the Venereal Disease Division of CDC), and Harold Jaffe in mid 1970’s in the process of beginning epidemiological studies of Hepatitis B infection among gay men seen in Chicago and other US cities beginning with the first gay community-based clinic in the US, what is now the Howard Brown Health Center. Teaching the CDC tea, how to take a thorough sexual health history from homosexual men was an unforgettable experience, and one which helped Dr. Curran et al., to quickly respond to the first reported cases of “Opportunistic Infections and Kaposi’s Sarcoma (chronicled in Randy Shilts’ “and the band played on..” Ostrow was then the Chicago Principal Investigator for the HBV epidemiological studies and the double blind trial of the first HBV vaccine (Merck Heptavax) which was made from Hep B antigens associated with the non-infectious outer coat of the virus, purified, made immunogenic, and given in a series of 3 injections over a 3-6 month period. Both studies were completed early, due to the extremely high rates of HBV infection among gay/bisexual men in the 1970s and the >95% efficacy rate for protection of men from HBV infection as compared to men receiving a placebo. The vaccine was approved for use in early 1991, just months before the reports of the first cases of OI-KS among young and previously healthy gay men in the CDC’s MMWR. Made from HepB isolated from the blood of gay men with acute HepB infection, who may have been also carrying whatever was causing this invariably fatal and unexplained new disease syndrome, the vaccine was “dead on arrival” among healthcare workers who were to be vaccinated after occupational exposure to blood from HBV infected patients.

Developed & led the first office for the coordination of policy and information on AIDS, while preventing public panic and isolation of persons with AIDS (PLWAIDs) before knowing its cause and transmission of HIV infection. Chaired monthly meetings of the Chicago AIDS Task Force. Designed, funded, and implemented the first Chicago-wide HIV/AIDS intervention program, CAPEP. The Task Force’s primary function was to ensure that PLWAIDS were treated with dignity & provided competent & compassionate care from the service providers participating in the Task Force aimed at providing up-to-date information to Chicago area citizens about AIDS when the causative agent was unknown, without causing undue anxiety about getting AIDS from casual contact with PLWAIDS or sending their children to a school where a student with AIDS was also attending. Specifically, when Ryan White and his family were forced to move when it became known in the nearby Indiana community that he had AIDS, the Chicago Task Force organized public forums to quell panic among parents of school age children, teachers, emergency responders, police and others who believed they were at risk of getting AIDS through casual or occupational contact. Also, the first MD CDPH Director appointed by Mayor Washington refused to accept an Administrative Deputy Director, resulting in total disconnection of communications between the CDPH and the Mayor’s Office. Negotiating those dangerous political minefields while trying to fight for the rights and health of PWAIDS was a suicide mission, but I think we impacted the spread of HIV in Chicago and the QOL of PWHIVs because of those early efforts.

The “Coping and Change Study,” or C&CS, was the first longitudinal study of the impact, coping and behavioral adaptation to the AIDS epidemic among gay & bisexual men. It was conducted as a parallel study to the Chicago MACS. Started by Professor Jill Joseph and colleagues at the University of Michigan (Ann Arbor) in 1985, Dr. Ostrow moved to Ann Arbor in 1986 as the psychiatric co-Investigator of this study as well as to continue his biological psychiatry research as an Associate Professor of Psychiatry; learn advanced survey research methodologies to track evolution of “sensitive” behaviors such as sexual and drug use as an Investigator at the Institute for Social Research; and collaborate with AIDS epidemiology and prevention researchers as a member of the Epidemiology Department of the School of Public Health. Many important defining discoveries during the first two decades of the AIDS epidemic sprang from this multi-disciplinary collaboration across Schools and Departments at the University of Michigan and the Howard Brown Clinic and Northwestern University of Chicago, including: The importance of self-perceived HIV infection and symptoms in determining mental health and ability to cope with the stresses of the AIDS epidemic when there were no effective treatments to prevent large portions of the gay/bisexual communities being lost to HIV-related illness and death; the importance of psychological counseling at the time of learning one’s HIV test result status in determining negative vs. positive reactions to finding out ones HIV infection status; the coping mechanisms and types of social support that facilitated survival & adaptation to the increasing toll the AIDS epidemic was having on individuals and their communities; & the efficacy of belief & attitudinal changes in reducing HIV risk behaviors and adoption of risk reduction practices to limit spread of infection among gay/bisexual men. He established the Midwest AIDS Biobehavioral Research Center during this period, to foster multi-disciplinary and cross institutional research on the biopsychosocial aspects of AIDS and HIV epidemiology and co-authored the first monograph on the “Psychiatric Aspects of HIV/AIDS” with another pioneer in the biopsychosocial conceptualization of HIV/AIDS, Dr. Stuart Nichols.

Continuing his work on developing innovative approaches to assess individual and community attitudes, beliefs and potential impacts on sexual and drug use risk behaviors of recent advances in HIV treatment and prevention, Ostrow was one of the first investigators to recognize that the introduction of durable, less toxic and highly active anti-retroviral combination therapies (HAART) first announced in 1996 would not only redefine the natural history of HIV infection but the definitions of safe vs. unsafe sex among MSM. He rapidly organized a research team in Chicago (including David McKirnan, PhD and Peter Vanable, a post-doc working with Professor McKirnan at the time) to develop a short survey instrument to measure attitudes, beliefs and risk behavior/risk reduction strategies that were likely to change in the post-HAART era. Using focus groups, open-ended interviews with community “opinion leaders” and a series of pilot tests undertaken among random samples of men attending summer outdoor events in the Boystown section of Chicago, the team was able to rapidly develop a 21 item survey instrument that accurately measured key determinants of the behavioral impact of new effective ARVs (The Mens’ Attitude Survey”), and then test how changes over time of these attitudinal and belief factors related to changing risk-taking and risk-reduction strategies of men participating in the Multicenter AIDS Cohort Study (MACS). These studies showed that “reduced concern about HIV” and “safer sex burn-out were key determinants of increasing risk-taking. Currently a revised version of the MAS (“the R-MAS”), that includes measures of men’s knowledge of, belief in the efficacy of, and use of ARV-based combination prevention regimens, such as Pre-exposure Prophylaxis, or PrEP, is being used in the MACS and other longitudinal studies to track the potential of these biological prevention regimens to prevent HIV transmission under the appropriate conditions.

More recently Dr. Ostrow has taken his many decades of experience in the development of valid survey measures of “sensitive behaviors” from patients and their caregivers to the development of a North American standardized clinical cannabis research and evaluation database system. With the establishment of State regulated “legal” Medical Cannabis (MC) programs beginning in CA in 1998, we have seen regional and individual practitioner-based efforts to collect longitudinal observational data on the response of specific symptoms, syndromes and illnesses to MC treatment, beginning with the Society of Cannabinoid Clinicians (SCC) based in SF. Through the American Academy of Cannabinoid Medicine (AACM), Dr Ostrow and others saw the opportunity to develop a national network of Cannabinoid Medicine practitioners who, along with patients, caregivers, dispensaries and their many support & advocacy organizations would develop a community-based approach to the scientific study of cannabis treatment to provide data-based therapeutic guidelines.

Two other areas of Cannabinoid scientific investigation in the past 10-15 years have given the North American CBCCERN a level of validity & potential to yield science-based treatment protocols for whole cannabis and complex extracts: the elucidation of the 2 distinct human “endocannabinoid” receptor systems and their properties and distribution; and the development of reliable quantitative analytical techniques to determine the amounts of various cannabinoids in different “strains” of cannabis that can bind preferentially to the two types of endocannabinoid receptors. More recently, expanding MC research has expanded this view to include other subcellular and intersynaptic processes that may modulate both the upstream and downstream effects of specific CB receptor agonist and antagonist binding. While animal and in vitro studies of the pathogenesis of these myriad effects continue to open up new potential sites of action of cannabinoid and terpenoid components of whole cannabis and its extracts, traditional single or even dual active compound comparisons to placebos will be too time consuming and inefficient to target the best complex mixtures of cannabinoid and terpenoid for expensive clinical human trials. The establishment of an NA CBCCERN will provide researchers, patients and caregivers alike and open access database for analysis and modeling of promising complex formulations of cannabis extracts for potential human clinical trials based on both subjective and more objective measures collected through a large number of participants in “closed loop” MC programs.

 

 

 

 

Senior Scientist National Opinion Research Center (NORC)
2007 – 2012 (5 years) Greater Chicago Area

Directed research program within the Stouffer-Ogburn Center for Social Organizational Research that is actively researching and developing peer and structural interventions for the most vulnerable persons at highest risk of HIV/AIDS in Chicago and other metropolitan areas of the US. This work is largely based on assessment methods developed by Dr. Ostrow and colleagues to determine the biopsychosocial drivers of the continuing concentration of newly diagnosed HIV infections in the Chicago among younger Black men who have sex with other men as well as with women.

Chair, Behavioral Working Group Multicenter AIDS Cohort Study (MACS)
1991 – 2011 (20 years)

Coordinated all behavioral and HIV prevention research related to the largest longitudinal study of gay/bisexual men, both with and without HIV infection, based in Chicago, Pittsburgh, Baltimore/DC and LA. Conducted monthly meetings of all members of the BWG and outside investigators interested in working with MACS behavioral data, wrote semi-annual progress reports on all BWG research activities involving MACS subjects or data and prepared Behavioral and HIV Prevention Research sections of MACS funding renewal applications. Major accomplishments included launching first studies of the behavioral, attitudinal and sexual practice implications of the new anti-retroviral treatments beginning in 1996; obtaining funding from NIDA/NIMH for an additional 12 add-on projects to study the role of drugs and mental health in HIV infection and disease progression among men in the MACS; and the demonstration that 2/3rds of all new recent HIV infections in the MACS were associated with the use of stimulants, poppers or erectile dysfunction drugs, either alone or in combination.

Grantee- Coping and Change Study; Mens Attitude Survey Projects NIMH 1985 – September 2001 (16 years)Chicago and the four field sites of the Multi center AIDS Cohort Study

The Coping and Change Study was the first longitudinal study of the impact, coping and behavioral adaptation to the AIDS epidemic among gay & bisexual men. It was conducted as a parallel study to the Chicago MACS. Started by Professor Jill Joseph and colleagues at the University of Michigan (Ann Arbor) in 1985, Dr. Ostrow moved to Ann Arbor in 1986 as the psychiatric co-Investigator of this study as well as to continue his biological psychiatry research as an Associate Professor of Psychiatry; learn advanced survey research methodologies to track evolution of “sensitive” behaviors such as sexual and drug use as an Investigator at the Institute for Social Research; and collaborate with AIDS epidemiology and prevention researchers as a member of the Epidemiology Department of the School of Public Health. Many important defining discoveries during the first two decades of the AIDS epidemic sprang from this multi-disciplinary collaboration across Schools and Departments at the University of Michigan and the Howard Brown Clinic and Northwestern University of Chicago, including: The importance of self-perceived HIV infection and symptoms in determining mental health and ability to cope with the stresses of the AIDS epidemic when there were no effective treatments to prevent large portions of the gay/bisexual communities being lost to HIV-related illness and death; the importance of psychological counseling at the time of learning one’s HIV test result status in determining negative vs. positive reactions to finding out ones HIV infection status; the coping mechanisms and types of social support that facilitated survival & adaptation to the increasing toll the AIDS epidemic was having on individuals and their communities; & the efficacy of belief & attitudinal changes in reducing HIV risk behaviors and adoption of risk reduction practices to limit spread of infection among gay/bisexual men. He established the Midwest AIDS Biobehavoral Research Center during this period.

Originally consulted to Drs. Curran, Thompson, Bill Darrow (at time the first and only behavioral scientist in the Venereal Disease Division of CDC), Thompson, and Jaffe in mid 70’s in the process of beginning epidemiological studies of Hepatitis B infection among gay men seen in Chicago and other US cities with concentrated numbers of gay/bisexual men being seen at Public Health Clinics and the first gay community-based clinic in the US, what is now the Howard Brown Health Center. Teaching them how to take a thorough sexual health history from homosexual men was an experience I will never forget and one which helped Dr. Curran et al. to quickly respond to the first reported cases of “Opportunistic Infections and Kaposi’s Sarcoma (chronicled in the “and the band played on..” Was then Principal Investigator for the Chicago components of the HBV epidemiological studies and the double blind trial of the first HB vaccine (Merck Heptavax) which was made from Hep B antigens associated with the non-infectious outer coat of the virus, purified, made immunogenic, and given in a series of 3 injections over a 3-6 month period. Both studies were completed early, due to the extremely high rates of HBV infection among gay/bisexual men in the 1970’s (which obviously also included infection with the virus that causes AIDS, HIV, that wouldn’t be discovered until ten years later) and the >95% efficacy rate for protection of men from HBV infection as compared to men receiving a placebo. The vaccine was approved for use in early 1991, just months before the reports of the first cases of OI-KS among young and previously healthy gay men in the CDC’s MMWR. Made from HepB isolated from the blood of gay men with acute infection, who may have been also carrying whatever was causing this invariably fatal and unexplained new disease syndrome, the vaccine was “dead on arrival” among healthcare workers who were to be vaccinated after occupational exposure to blood from HBV infected patients.

Founding PI and Chair, Behavioral Working Group Multi center AIDS Cohort Study (MACS) 1991 – 2011 (20 years)

Coordinated all behavioral and HIV prevention research related to the largest longitudinal study of gay/bisexual men, both with and without HIV infection, based in Chicago, Pittsburgh, Baltimore/DC and LA. Conducted monthly meetings of all members of the BWG and outside investigators interested in working with MACS behavioral data, wrote semi-annual progress reports on all BWG research activities involving MACS subjects or data and prepared Behavioral and HIV Prevention Research sections of MACS funding renewal applications. Major accomplishments included launching first studies of the behavioral, attitudinal and sexual practice implications of the new anti-retroviral treatments beginning in 1996; obtaining funding from NIDA/NIMH for an additional 12 add-on projects to study the role of drugs and mental health in HIV infection and disease progression among men in the MACS; and the recent demonstration that 2/3rds of all new recent HIV infections in the MACS were associated with the use of stimulants, poppers or erectile dysfunction drugs, either alone or in combination.

Senior Scientist National Opinion Research Center (NORC) 2007 – 2012 (5 years)

Directed research program within the Stouffer-Ogburn Center for Social Organizational Research that is actively researching and developing peer and structural interventions for the most vulnerable persons at highest risk of HIV/AIDS in Chicago and other metropolitan areas of the US. This work is largely based on assessment methods developed by Dr. Ostrow and colleagues to determine the biopsychosocial drivers of the continuing concentration of newly diagnosed HIV infections in the Chicago among younger Black men who have sex with other men as well as with women.