CGHSR-Affiliated Faculty Member Receives R01 Award to Study Stigma Faced by HIV-Positive and LGBTQ Patients in Clinical Settings

Kumi Smith, sitting down and third from left, pictured with colleagues involved in her research on stigma faced by people living with HIV and members of the LGBTQ community. 

A Center for Global Health and Social Responsibility-affiliated faculty member is working to ensure all patients, no matter their sexual orientation or health status, receive the same quality of care when they visit the doctor.

Kumi Smith, PhD, says that people living with HIV and members of the LGBTQ community are more likely to experience stigma from healthcare providers, resulting in either unnecessary care or a lack thereof.

Smith, an associate professor in the UMN School of Public Health’s Division of Epidemiology and Community Health, has received an R01 award to study the issue in China, and hopes her research will create better health outcomes for patients around the globe. She engaged in the research after discovering the obstacles HIV patients face in addition to their diagnosis.  

Research Project (R01) awards are funded by the National Institutes of Health and are prestigious grants given to institutions on behalf of researchers. 

“My dissertation project worked with rural farmers in China who had been infected with HIV through unsafe blood donation practices. On top of their health struggles, these farmers also suffered severe social stigma because of their HIV,” said Smith.

“This experience opened my eyes to the importance of tackling stigma as a cornerstone of public health interventions.”

Smith’s research on stigma among those living with HIV and the LGBTQ community started with a Global Health Seed Grant she received in 2019. Through the Seed Grant program, CGHSR provides consultations, project support and advice in addition to funding.

Smith’s initial Seed Grant was the basis for an R34 research grant which allowed her to gather enough preliminary evidence to successfully secure an R01. 

Smith’s R01 research uses a standardized patient model, employing trained actors to visit doctors as if they’re real patients. This allows them to observe doctors’ behaviors in real-life clinic settings. By randomly varying the HIV status and sexual orientation of the standardized patients’ case presentations, the team can see how care quality varies by identity. Participating doctors consent to standardized patient visits beforehand but do not know which patients are actors.

The results of the interactions will inform a training Smith has developed for physicians to give them skills to provide low-stigma, patient-centered care for patients who are LGBTQ or living with HIV.

Stigma can present in different ways. But Smith says her work has shown that some doctors will provide less sexual health counseling for gay patients than straight patients. In other instances, doctors unnecessarily refer patients with HIV to specialty clinics for basic services. 

“We hope our study provides more meaningful insights into how stigma affects marginalized patients while offering a constructive way out of it,” said Smith.

“Although HIV and same-sex behaviors are more widely accepted in China today than 20 years ago, this doesn’t necessarily translate to equitable. Indirect manifestations of stigma may be more subtle, but they are no less harmful to health.”

Smith emphasized the important partnerships that have made the research possible. The work has been in collaboration with the Zhitong LGBT Center and the Guangdong Center for STD Control and Prevention.

She also mentioned the support CGHSR has provided, including help from Senior Research Coordinator Iris Fei, who leads the Center's activities in Asia including research implementation support.

“When beginning our pilot project, we had little on-the-ground support for study coordination. CGHSR blessed us by connecting us with Iris Fei, the Center’s China-based research program coordinator,” said Smith.

“Her ability to work with both US- and China-based researchers helped fill many coordination gaps and helped make our pilot program a success. We are thrilled to have her back on this R01 as a full-fledged member of the team!”

Supporting Smith’s research aligns with CGHSR’s aim to elevate global health researchers.

“In many ways, Kumi’s experience exemplifies what CGHSR hopes it can provide to faculty in growing their global health research portfolio,” said Center for Global Health and Social Responsibility Executive Director Shailey Prasad, MD, MPH.

“Our Center values the opportunity to support strong research focused on pertinent issues in global health.”

Smith’s work demonstrates the effort and dedication needed to build a research question into a prestigious R01 award. This is exactly what CGHSR aims to foster through its new Seed to R01 Accelerator Grant program.

Since its inception, CGHSR has offered project planning, research implementation support, and seed funding to support research development.  

Seed to R01 Accelerator grants build on CGHSR's established success, providing up to $50,000 in funding to advance research projects. Awardees will receive project management support from CGHSR research staff (up to 10% effort each year) and access to support and resources on best practices in global health and managing international collaborations, including budgeting, project timelines, and logistics for travel and sample shipping.

Additionally, awardees can benefit from review and feedback on NIH or equivalent applications from researchers experienced in NIH-sponsored investigations, and will have support connecting with research development programs and training for specialized skill enhancement.

Learn more about CGHSR research opportunities here