Treating mind
and body

Jennifer Velloza’s research highlights the vital role of mental-health care in global HIV prevention — work that was supported in part by the UW Magnuson Scholarship.

Jennifer Velloza spent a year crisscrossing the grass-covered plains and sloping hills of rural Swaziland, dividing her time among ten medical clinics in this small southern African country. Here, nearly one in four people have HIV — and that rate is even higher among women.

Thika Partners in Health & Research Development clinic in Thika, Kenya, where Velloza conducted a study on postpartum depression and PrEP use for her dissertation.

Thika Partners in Health & Research Development clinic in Thika, Kenya, where Velloza conducted a study on postpartum depression and PrEP use for her dissertation.

As a study manager for Doctors Without Borders, Velloza saw many pregnant and postpartum women struggle to get the HIV testing and treatment they needed, because they were also suffering from sexual trauma, depression or anxiety.

“Women who are dealing with intimate partner violence may be afraid to come to the clinic or may not have the means or financial independence apart from their significant other,” Velloza says. “HIV and intimate partner violence also often coincide with depression. If you’re depressed, you may lose the ability, foresight and desire to take care of yourself and your health. If you’re afraid of being told you have HIV, you might feel depressed.”

What Velloza saw in Swaziland (recently renamed eSwatini) would follow her to Seattle and inspire her dissertation at the UW School of Public Health: showing how depression and stigma hinder young women from using a highly effective HIV prevention intervention, pre-exposure prophylaxis (PrEP). The drug is highly successful at preventing HIV when taken regularly — but many women don’t follow through on their daily treatment, even if they face a high risk of infection.

“PrEP is a wonderful tool to help stem the HIV epidemic, but it’s also critical that we increase engagement in care by tackling issues around mental health and stigma,” says Velloza, whose research was made possible in part by her Magnuson Scholarship from the University of Washington. “We can’t force anyone to take the PReP pill every day, so we need to support people in integrating HIV prevention into their busy and complicated lives.”

The Magnuson Scholarship

Every year, the Magnuson Scholars Program recognizes one graduate student in each of the six UW health sciences schools (Dentistry, Medicine, Nursing, Pharmacy, Public Health and Social Work) for their academic and research excellence.

Each student receives a $30,000 award for the academic year, funded by a $2 million endowment from the Warren G. Magnuson Institute for Biomedical Research and Health Professions Training.

The late U.S. Senator Warren G. Magnuson, for whom the program is named, was a champion of biomedical research during his long career in Congress, and he was instrumental in creating Medicare, Medicaid and the National Institutes of Health.

A path to public health

Public health professionals like Velloza look beyond individual patients and diagnoses to preventing and treating diseases across entire populations. This high-level approach to addressing the world’s health is what inspired Velloza to switch career tracks from medicine.

Seeing women in Swaziland negotiate the burden of HIV while also struggling with psychosocial issues left Velloza eager to paint a fuller picture of their lives. In choosing a Ph.D. program, Velloza was drawn to the UW’s emphasis on global collaboration and methodology, as well as its long-standing relationships in sub-Saharan Africa, where she wanted to continue working.

For her, there was no better place to investigate the relationship between mental health and HIV prevention than the UW School of Public Health.

In 2018, Velloza was one of six UW health sciences graduate students to receive the Magnuson Scholarship, a prestigious award that recognizes academic performance and research potential.

“I’m a first-generation college student, and I feel so grateful to have been able to receive such generous support from donors,” Velloza says. “My education and where I am now just would not have been possible without that.”

Seeing a fuller picture

Thanks to the scholarship, Velloza could travel more frequently to her clinical project sites in Kenya, Zimbabwe and South Africa, where she collected quantitative and qualitative data on how stigma and depression affect young women’s use of PrEP.

More than 500 participants were enrolled in a study across three urban clinics in Johannesburg, Cape Town and Harare, each of which served different populations, from teenage girls to married women. What the participants had in common was their high risk for HIV — and the stigma they faced in getting tested and taking PrEP.

Since 1993, more than 160 students have received Magnuson scholarships.

“The drugs in the PrEP pill are also part of the medication used to treat HIV, so young women face HIV stigma if they’re seen taking PrEP,” Velloza says of the preventive measure. “PrEP is also a signal that you’re sexually active. In a lot of places, there are conservative gender norms about women’s sexuality and sexual health, which can also lead to stigma around the PrEP pill.”

Velloza took a leading role on the study’s qualitative team, helping design the interview questions that unpacked the effect of stigma, and analyzing and coding the transcripts.

“We learned a lot more about how stigma manifests in the communities, how young women talk about it and how it affects their lives,” Velloza says. “More importantly, the women gave us ideas about how we could try to reduce stigma and address some of these issues.”

For example, they highlighted the importance of TV advertisements and national campaigns to raise public awareness of PrEP. Outreach and support groups offered women the chance to come together and talk about their challenges using PrEP, providing a much-needed sense of community.

A foundation for the future

The Magnuson Scholarship gave Velloza the time she needed to focus on completing her dissertation, publishing her research and applying for grants — laying the groundwork for a career in academia and her goal of integrating mental health with HIV prevention.

The scholarship endowment has grown from $2 million in 1992 to $5.5 million in 2019.

Beyond the generous financial support, the scholarship validated the importance of Velloza’s work toward our understanding of HIV prevention, a point underscored by the family and former staff of the late Senator Magnuson at a lunch with the Magnuson Scholars in March.

“To have a moment to step back and think about larger implications of my work and the impact it could have in the future was quite meaningful to me,” Velloza says.

Velloza’s ultimate aim is a holistic approach to HIV treatment that could help save even more lives — whether in sub-Saharan Africa or here in the United States. As a senior fellow at the UW’s International Clinical Research Center, investigating how counseling and peer support can help women stick with their PrEP regimen, she’s taking a first step toward that goal.