ABCT 57th Annual Convention Banner Cultivating Joy with CBT Seattle 2023

Presidential Address

Saturday, November 22 | 6:15 PM–7:30 PM

Defending Behavioral Science While Embracing Diversity in a Politicized Time: Examples from HIV and Behavioral Health

Steven A. Safren, Ph.D., ABPP, Professor of Psychology, and Cooper Fellow University of Miami (UM), Director Center for HIV and Research on Mental Health

Participants earn 1 continuing education credit

Categories: Health Psychology/Behavioral Medicine — Adult, LGBQT+, Treatment — CBT

Keywords: HIV/AIDS, LGBTQ+, Public Health

All levels of familiarity with the material.

Dr. Steven Safren is a Professor and Cooper Fellow at the University of Miami (UM) where he is the Director of the UM Center for HIV and Research in Mental Health. His research is on health behavior change and behavioral health, with a particular emphasis on mental health and substance use components of HIV prevention and treatment domestically and internationally. He joined the Department of Psychology at the University of Miami in 2015 after 18 years working in the Harvard Medical School system at Massachusetts General Hospital where he was a Professor and Director of the Behavioral Medicine Service and led behavioral science studies at Fenway Health. He has been PI or protocol chair of 20 federally funded studies (via NIMH, NIDA, and NIAID), and, in addition to studies where I am PI, he has regularly served as co-PI, co-investigator, or mentor on studies related to HIV prevention and treatment. Finally, he developed and tested one of the only evidenced-based psychosocial treatments for ADHD in adults and extended that to adolescents.

We are at a unique inflection point in the United States, with core values at the foundation of ABCT’s mission under increasing attack. Two specific foundational core values central to ABCT’s mission are “science” and “diversity”. These two core values also have been key guiding principles during my Presidential term, and of the conference theme which has the focus on promoting rigorous science and inclusive affirming therapies. These values are also foundational and critical to domestic and global public health more generally, and the attack on science and on diversity seriously thwarts any progress towards health equity; with the worst consequences being to the most vulnerable populations.

One area particularly affected by changes in national funding practices and new regulations is HIV prevention and treatment. In the U.S., HIV differentially affects sexual, gender, ethnic, and racial minority populations. Globally, HIV differentially affects marginalized populations. This talk will draw on over two decades of global and domestic work in HIV prevention and treatment, to illustrate just how vital behavioral research is to improving public health and to reducing human suffering. It will begin with an overview of recent changes to funding and the resulting ramifications to public health. Starting with the example of work to optimize adherence to life-saving antiretroviral medications for people living with HIV, through trials and studies focused on behavioral health and health behavior change, including examples where behavioral science has driven meaningful outcomes especially for marginalized and diverse populations. Through these examples from my work and that of others, this talk will also explore how science can and must remain rigorous while still affirming identity and lived experience, the importance of community engagement and equity in ultimately developing and implementing evidence based mental health treatments, and why continued investment in mental health, behavioral science, and diversity continues to be critical.

Outline:

  1. Discuss recent initiatives that place behavioral science and diversity in a negative lens and resulting in oppressive public health consequences.
  2. Review selected studies that highlight the role of behavioral science in protecting health in the context of HIV,
  3. Highlight specific CBT trials that emphasize both diversity (inclusive of sexual and gender minority level diversity) and rigorous science; including studies designed to address behavioral health as a means to increase benefit from health behavior change interventions.
  4. Discuss the need for using and protecting objective science in the context of advocacy efforts and policy.

At the end of this session, the learner will be able to:

  1. Articulate the importance of science and diversity through specific example CBT oriented studies related to HIV prevention and care.
  2. Describe, in the context of HIV prevention and care, the rationale and science behind improving behavioral health as a means to increase the potential benefit from interventions to address health behavior change
  3. Explain the need for evidence-based treatments for sexual and gender minority individuals, and the outcomes of selected existing trials.

Long-term Goals:

  • Be able to articulate the importance of behavioral science in public health in general and HIV in particular.
  • Be able to understand that to change health behavior in people living with a behavioral health problem, one needs to address both the behavioral health problem as well as intervene on the health behavior.

Recommended Readings:

Mayer, K. H. (2025). The lavender purge. Journal of the International AIDS Society, 28, e260509. https://doi.org/10.1002/jia2.26509

Safren, S. A., O’Cleirigh, C., Andersen, L. S., Magidson, J. F., Lee, J. S., Bainter, S. A., Musinguzi, N., Simoni, J., Kagee, A., & Joska, J. A. (2021). Treating depression and improving adherence in HIV care with task-shifted cognitive-behavioral therapy in Khayelitsha, South Africa: A randomized controlled trial. Journal of the International AIDS Society, 24, e25823. https://doi.org/10.1002/jia2.25823

Pachankis, J. E., Harkness, A., Maciejewski, K. R., Behari, K., Clark, K. A., McConocha, E., Winston, R., Adeyinka, O., Reynolds, J., Bränström, R., Esserman, D. A., Hatzenbuehler, M. L., & Safren, S. A. (2021). LGBQ-affirmative cognitive-behavioral therapy for young gay and bisexual men’s mental and sexual health: A three-arm randomized controlled trial. Journal of Consulting and Clinical Psychology, 90(6), 459–477. https://doi.org/10.1037/ccp0000724

Safren, S. A., Thomas, B., Biello, K. B., Mayer, K. H., Rawat, S., Dange, A., Bedoya, C. A., Menon, S., Anand, V., Balu, V., & O’Cleirigh, C. (2021). Strengthening resilience to reduce HIV risk in Indian MSM: A multicity, randomized, clinical efficacy trial. The Lancet Global Health, 9(4), e446–e455. https://doi.org/10.1016/S2214-109X(20)30547-7

Safren, S. A., Bedoya, C. A., O’Cleirigh, C., Biello, K. B., Pinkston, M. M., Stein, M. D., Traeger, L., Kojic, E., Robbins, G. K., Lerner, J. A., Herman, D. S., Mimiaga, M. J., & Mayer, K. H. (2016). Treating depression and adherence (CBT-AD) in patients with HIV in care: A three-arm randomized controlled trial. The Lancet HIV, 3(11), 529–538. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5321546/