Michele Andrasik, PhD, MS, is a clinical health psychologist and public health researcher dedicated to HIV prevention, vaccine development, and health equity. She serves as Principal Staff Scientist at Fred Hutchinson Cancer Center as well as the Director of Social and Behavioral Sciences and Community Engagement for the Fred Hutchinson-based HIV Vaccine Trials Network (HVTN). Andrasik’s work focuses on understanding and addressing social and structural factors that contribute to health disparities, particularly among underserved communities. Her research explores the intersection of behavioral science, stigma, and medical mistrust in HIV prevention, advocating for inclusive, data-driven interventions to improve health outcomes.
Q: You have an extensive background in behavioral science and public health, particularly in HIV prevention and vaccine research. What inspired you to focus on the intersection of HIV/AIDS and behavioral science, and how has your work evolved over time?
I’ve always been interested in HIV prevention for many reasons – many of them personal. I’ve experienced personal losses and have seen the impact of HIV on my community here in the U.S., and in communities that look like me around the world. HIV is critical to focus on. We need to find an end to HIV, and we can’t do that with just biomedical science. We have all these biomedical interventions, but people have to use them. We have to work to understand why people use some methods, why they won’t, how we can inform adherence to those methods and gather a better understanding of the factors that place people at risk.
Over time, my approach to HIV prevention has evolved. Early in my career, I focused heavily on individual behaviors and risk factors. It has become clear to me that vulnerability isn’t about what a person does or doesn’t do, but rather it really is about their situations, circumstances and the context that they find themselves in. So it’s important to understand those contexts and be able to identify situations that can increase someone’s chances of being exposed to HIV. That’s really the key to reduce vulnerability. My work has evolved from looking at individualistic factors to looking at the larger social and structural factors that place people in a position of vulnerability.
Q: Community engagement is a key aspect of your work. What role does community engagement play in addressing HIV/AIDS disparities or stigma, and how can organizations better connect with at-risk populations?
Community is at the center of everything that we do. You can’t address HIV disparities or stigma if you aren’t clear about how they function in a specific community. The only way that you do that is by engaging with people who are working, living, and navigating those spaces every day.
Any research question that we explore must be rooted in the needs and interests of the communities that we’re working with. What might seem important from a scientific standpoint may have no bearing, little interest or may be unrealistic for the community we are working with, and we wouldn’t know unless we were engaging with individuals existing in those communities. Sometimes, people are only thinking of the scientific data analysis and methods. But just because you create an intervention, it doesn’t necessarily mean that people are going to utilize it. If an intervention is something that people will actually use, we need to understand what people need and the potential barriers to its use. Involving the community from the start not only makes research more meaningful, but more cost-effective and time-efficient. You can’t do good research without the community at the table — their insights fill in the gaps that science alone can’t answer.
Q: Despite women comprising 19% of new HIV diagnoses in the U.S., and Black women representing a disproportionate amount of these new diagnoses, only 8% of PrEP users are female. What barriers do women face in accessing PrEP, and how have advancements in HIV prevention changed the landscape for women and girls?
In the U.S., women have never been the focus when it comes to HIV. From the very beginning of the epidemic, Black women have never been part of the conversation about who should be concerned. As a result, a lot of Black women don’t see themselves as being at risk or vulnerable to HIV. Healthcare providers, who are taking care of our health and wellbeing, aren’t discussing HIV testing or prevention options during routine visits. For many Black women, HIV isn’t a consideration until they receive a positive HIV test, often during pregnancy or after falling seriously ill. Additionally, many of the women that I have met don’t fit the traditional “risk” profile. They may be in a long-term relationship with someone who they thought they were being monogamous with – only to later find out that they are HIV positive.
The lack of visibility for Black women in the HIV narrative fuels stigma, discourages testing, and creates hesitation around using preventative tools such as PrEP. Why would someone take medication if they don’t believe they are at risk? We need to do better at raising awareness about HIV prevalence among Black women, as well as the stigma around HIV. Often, some people don’t want to test because they don’t want to know, honestly. While there are plenty of Black women-led organizations who are doing incredible work around this, the efforts needs to be more widespread and better supported to truly shift the narrative and change the landscape.
Q: As someone deeply involved in behavioral science and public health, how do you see HIV stigma’s role in preventing women and girls from seeking HIV prevention, treatment, testing, and care?
Stigma is so powerful — it creates barriers to addressing HIV and create an “us” vs. “them” narrative. This narrative makes it so easy for women to believe that HIV is only a concern for other demographics or groups.. The reality is that HIV is an infectious disease, it’s a virus, and viruses don’t discriminate. Anyone can come in contact with the virus, test positive, and live with HIV.
Part of the challenge people struggle with is seeing HIV as a chronic disease and talking about it as such. People know how to prevent themselves from getting diabetes and what treatments are available, yet HIV remains taboo. When conversations about HIV do come up, it’s often among those who do HIV work. When it’s brought up outside of this community, people mistakenly believe HIV is no longer a problem simply because they don’t know anyone openly living with HIV. There’s so much stigma around it that people don’t disclose their HIV status. People outside of the HIV research community may know women and girls who are living with HIV, but they’re completely invisible to them in terms of their HIV status because of the stigma. Women living with HIV often have very powerful stories about how they’re treated differently once they disclose their status, especially in romantic relationships. It’s very, very challenging to traverse that when your chronic disease is stigmatized. People aren’t going to say they can’t date you or that they feel uncomfortable around you if you tell them you have diabetes or cardiovascular disease, but the same is not true for HIV. That really is the sad part of it all — we know so much about HIV and yet it is still so stigmatized, which benefits no one.
Stigma also impacts healthcare access. People aren’t going to get tested for HIV out of fear of judgement. Those who test positive may delay or avoid going to get treatment, because often they’re not treated well. During my my graduate research, I interviewed women who never came back for care after diagnosis because of the way they were treated in the medical system by the people who are supposed to be taking care of them. They would rather live knowing that they’re HIV positive and not get care, because they don’t want to be treated that way and suffer that humiliation again.
The same is true for HIV testing sites. While innovations like at-home testing help, access remains limited and many people still fear knowing their status. Addressing HIV stigma is critical, not just to encourage testing and treatment, but to create a more compassionate and supportive environment where women feel safe, seen, and cared for.
Q: National Women & Girls HIV/AIDS Awareness Day (NWGHAAD) is a moment to highlight both challenges and progress in the fight against HIV. What’s one message you have for women and girls on the importance of HIV testing, prevention, treatment, and care?
It is essential for women to take ownership over their health and wellbeing, and that starts with knowing what your health status is. HIV testing should be as routine as getting your blood pressure or weight checked. It should just be normative because of its importance. HIV testing is expecially critical for women who are disproportionately vulnerable: Black women, Latina women, and Indigenous women. Knowing gives you power. When you know your status, you have the ability to take action. HIV is a chronic disease, but in order to tackle it, you have to first know that you have HIV. The sooner you can get on medication, the longer your life will be by navigating the chronic disease that is HIV.
