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Guam Trip Studies HIV/AIDS Impact

By: Jordan Pye
Posted: April 5, 2010

Since the first journey to Guam in 2008, Dr. Todd Sabato, Assistant Professor in the Department of Health Sciences, has offered students a unique three-week glimpse into the dynamic world of HIV/AIDS, from an unparalleled Micronesian perspective.

This May, he will lead 12 students on a third trip to Guam, to examine the impact that HIV and AIDS have had upon Asian and Pacific Island communities. Specializing in HIV/AIDS prevention, this is Dr. Sabato’s second study abroad program – he had previously been an assistant to an HIV-related program in Trinidad and Tobago. 

“In 2006, while attending the United States Conference on AIDS, I randomly came across a contact who was an employee of the U.S. Office of Minority Health, who has done a great deal of work at the international level and throughout parts of the Pacific,” he said. “It sparked my interest in considering the possibility of extending what I do to another level, and actively engaging students in that process as well.”

Sabato explained that, statistically, African Americans suffer the greatest burden of HIV infection, yet that over the last six years, Asian and Pacific Islander Americans are the only population showing a statistically significant increase in AIDS prevalence rates.  These numbers are startlingly high among API females. Such rates make Guam an ideal environment for programming and education, allowing students to examine how an environmental domain impacts affects the trend, on an island that covers approximately 220 square miles.

“Why Guam? Not only because it provides an opportunity for students to examine cultural, historic, economic, social, and political contributors to HIV, but it also allows those students who have never traveled internationally to dip their feet into the aspect of studying abroad,” Sabato said. He explained that, because Guam is a U.S. territory, with the same currency and predominant language, students spend less time assimilating, and can thus focus on the program’s content.

The program exists through Dr. Sabato’s working relationship with the Guam HIV/AIDS Network (GUAHAN) Project, the island’s only AIDS Service Organization.  Sabato explained that the collaboration’s purpose is to “ultimately provide the greatest amount of good to the greatest amount of people - not only to students, but also to instructors, the inhabitants of the island, and the Guam community as a whole.  It’s not necessarily an issue of JMU providing specific resources,” he added. “It’s a symbiotic relationship that we have with the island community.  The program includes students in an effort to collectively meet personal and community-based desires, and deliver health- and life-impacting outcomes.”

GUAHAN Project’s Executive Director, Alexis Silverio, said the organization exists to save lives through HIV/AIDS education, prevention, and care services, and acts as an advocate for people living with HIV or AIDS on Guam. He said the collaboration with JMU’s student learning experience boosts the program’s activity.

“The JMU students deepen and enrich the scope of GUAHAN Project's community work by making tangible contributions in bridging HIV education and awareness services to under-served and under-represented at-risk communities for HIV infection on Guam,” Silverio said. “The students also bring with them ideas and concepts that strengthen the organization's role in the community, such as activism and addressing shame and stigma issues around AIDS.”    

Prior to their departure in May, students study the impact of the island’s economy and politics on HIV/AIDS prevalence.  Students also meet with Congresswoman Madeleine Bordallo, Guam’s elected delegate to the U.S. House of Representatives, to address the growing impact of tourism, as well as a looming military buildup, on island health.  While on the island, Sabato’s students also meet with members of the local government, including Joanne Camacho, Guam’s First Lady.

“The fact of the matter is that, as an island community, Guam has been greatly overlooked with regard to health resource allocation and funding,” Sabato said, “Sadly, marginalized communities become further marginalized, so that those who have none then have even less. That’s where a great portion of our program focuses – whether it’s children and youth, single mothers, aging populations – all of those from the standpoint of HIV/AIDS among API populations are at risk when marginalized.”

Silverio added that he would like to see Guam’s local leaders acknowledge the program’s interaction with JMU, to apply those successes elsewhere.  He explained that, despite the region’s cultural diversity, there are still few opportunities to exchange learning experiences and understand the AIDS epidemic.
 
“It is also critical to note that Guam is undergoing immense social and political changes that can serve as a study of the adverse impact of the global economy and balances of power,” Silverio said. “Through their studies on Guam, JMU's student groups can take their observations and experiences and become social justice advocates for the Pacific region.”       

The trip allows students to experience the role of an epidemiologist, or a health care or social service provider.

“We spend a great deal of our time in the field - asking questions, shadowing specialists in public health and social services, working with our experts on the ground that work in AIDS care prevention, treatment, testing and counseling,” Sabato said. “So we can then begin to see, what does it take for us to really capture and conquer this beast, which is the rising tide of HIV and AIDS among Asian and Pacific Islander populations?”

Dr. Sabato believes students gain the most from the trip’s experiential learning opportunities. Like other study abroad programs, the trip allows students to transition from reading about theoretical components in a classroom, to understanding them by engaging in those actual scenarios in the “real world.” Concepts such as privacy, confidentiality and communication become applicable when students must address how to deliver an HIV-positive test result to an individual whose family is unaware they’ve been engaging in risk-related behaviors.

“The experience provides an opportunity for students to note that what we oftentimes read about in books, while valuable, doesn’t always ring itself out in pure truth when we start to examine what happens in the field, in nature, in reality,” Sabato said.

Students often ask Sabato whether they will have contact with HIV-positive individuals while on the trip.

“I tell them immediately that the answer is yes - every single day on our trip we will interact with at least one HIV-positive person,” Sabato said. “What I always add as a caveat is that students may not know that a person is HIV positive, or that a person has been clinically diagnosed with AIDS.”  Because Guam is a U.S. territory, and is thus under the auspices of federal policy, HIPPA laws and regulations still apply.  Such an answer also points out that one cannot consider HIV or AIDS as a mere physical manifestation, and that a positive test can’t be distinguished by casual observation.    

Having gown up in Honolulu, Hawaii, JMU alumnae Lillian Duckworth was already familiar with HIV/AIDS in the Pacific.  She traveled with Dr. Sabato in 2008, to return to the region and reacquaint herself with its healthcare concerns. Her experience not only furthered her studies in public health education, but also allowed her to give back.

“The people of Guam are a very loving people and I most enjoyed connecting with the Chuukese people of Guam, through outreach,” Duckworth said, adding that she still continues this work. “As part of my commitment to public health education and to bring more awareness to HIV/AIDS in my community, I volunteer as [a] Certified HIV Testing Counselor at a local testing site in Jacksonville, Florida. I plan on returning to the Pacific to work in public health education and HIV/AIDS awareness.”

Biology major Cody Childress, as well as Health Sciences pre-medicine major Megan Lukschander, both juniors, will participate in this May’s program.  Both were intrigued by the opportunity to take part in a study abroad with global implications. Childress is excited to help people alongside GUAHAN Project.

“I'm ready to roll up my sleeves and get to work making a change in the world. I'm also looking forward to studying on Guam,” Childress said. “I think Guam is one of those places that Americans here on the mainland don't really think about, but it has such a diverse population and is influenced by so many different cultures. It really is a gem in the middle of the Pacific.”

Lukschander hopes the trip will contribute to her expertise in public health.

“I am most looking forward to exposing myself to uncomfortable but enlightening situations that will make an impression on me that I can bring back to the mainland,” Lukshander said, adding that she plans to educate others about Guam’s issues with HIV/AIDS. “This is not a problem to only be fought on Guam, this is an issue to bring up to Congress and the American people.”

As the program expands, this year’s students plans to appear in television and radio interviews on Guam, in an effort to utilize the mass media to spread awareness of HIV/AIDS prevention and testing.  In addition to increasing their focus on both young and aging populations, students will also address issues related to the military, a growing topic of concern as Guam is about to see an unprecedented military buildup of 35,000-50,000 members of the United States Air Force and Navy.

“We are able, simply based upon what’s happening on the island, to focus on some of the new and immediate areas of concern.  We will have thousands of new military personnel - what’s it going to do to a fragile and outdated economic and social infrastructure?” Sabato questioned. “We are adapting to the changes as the changes are given to us. And that provides the success for any program.”

To learn more about the HIV/AIDS in a Diverse World program, and see photos from past trips, visit the program’s website at http://guamabroad.cisat.jmu.edu/index.html.