There’s a shift happening in HIV prevention and care, and UMKC public health researcher Joseph Lightner, Ph.D., is gathering the data to back up that shift. According to Lightner, an assistant professor in the UMKC School of Nursing and Health Studies, HIV is no longer a disease of behavior, but a disease of poverty. The current medications used to treat the disease are so effective that a person with HIV who is following the regimen can live their life with a nearly undetectable amount of HIV in the blood.

According to the National Institute of Allergy and Infectious Diseases, there is an overwhelming body of clinical evidence firmly establishing that when HIV is undetectable it becomes untransmittable, a concept the scientific community has dubbed U=U. Thus, encouraging and maintaining treatment for HIV is a powerful weapon in fighting the disease.

Researchers like Lightner are looking at interventions, beyond antiretroviral therapy, that help individuals with HIV successfully achieve an undetectable viral load, the amount of HIV in the blood. One such initiative Lighter studied is KC Life 360, a program through the Kansas City Public Health Department that provides housing and employment support to low-income, uninsured and under-insured persons living with HIV in racial and ethnic minority communities.

According to Lightner, it’s a critical group in HIV prevention, since most new HIV cases are occurring in these marginalized individuals. That knowledge has led the HIV care community to adopt a housing-first model nationally because data shows that homelessness and housing instability are major threats to HIV management.

“When someone is living on the street, they're not going to take their meds. It's not feasible for an unhoused person to carry around a three-month supply of their HIV meds,” Lightner said. “If we get these individuals housed and they have a safe place to take and store their medications, downstream that translates into treatment as prevention and reduces later infections.”

In conjunction with the Kansas City Health Department, Lightner examined the outcomes of the intervention to improve housing and employment for the individuals in KC Life 360. His research found that the individuals within the study were 25 times more likely to be housed and twice as likely to have improved their employment status. Most importantly, the data showed that the viral suppression improved among those within the study.

“What I want people to see from this research is that to solve the HIV epidemic, it's going to take multi-level interventions that focus on the whole person," Lightner said. "These are people who want to be members of society just like anybody else."

Although Lightner’s primary research focus within public health is physical activity, he continues to come back to HIV research. His team also has studied how HIV stigma affects individuals professionally and socially, as well as how best to provide treatment to those living with HIV. He said that the good thing about public health is that it’s broad, and the research methods translate from one field to another.

For Lightner, there’s also a deeply personal connection to HIV research.

“As a gay kid growing up in the 1980s, my family always told me that AIDS is a death sentence if you are gay. Couple that with having an uncle die of HIV/AIDS complications in the 1990s, the disease has been a part of my life since childhood,” Lightner said. “I think many gay men have similar experiences. By doing this research, I hope we can destigmatize the disease and make the world a better place for our friends and family.”