Julie Levison ’98 Uses Video to Encourage HIV Care Adherence Among Latino Immigrants
Julie Levison ’98, a physician-researcher at Massachusetts General Hospital, assistant professor at Harvard Medical School, and infectious disease physician at MGH Chelsea HealthCare Center, has spent her career working to narrow the gap between the scientific potential of medicine and the reality experienced by her patients, many of whom are Latinos or Latino immigrants. She developed and runs a National Institutes of Health-funded research program in the Division of General Internal Medicine at MGH devoted to addressing disparities in HIV care.
“HIV can effectively be managed with a single antiretroviral pill, and 70 percent of HIV patients in the U.S. have viral suppression in the blood, which is the goal. Yet Latinos—like other racial and ethnic minorities—are disproportionately affected by the disease, and HIV remains a major cause of morbidity in the Latino community,” said Levison.
In 2012, Levison, a Philadelphia native who majored in history and also completed pre-med classes at Wellesley, began looking for an effective way to achieve consistent attendance in HIV primary care among Latino immigrants and the larger Latino community. She said she used the liberal arts approach to problem solving she had learned in college.
“I started with a question: Why are only 30 to 40 percent of Latinos infected with HIV achieving the goal of virologic suppression? That led to a series of questions about the social, behavioral, and cultural aspects of HIV care at the level of the patient as well as the community,” said Levison.
Barriers to care include a lack of insurance, uncertainty about finances, not understanding English, and the fact that more pressing needs, such as securing shelter and food, can come before seeking medical care. Another hurdle is the stigma and shame that come with an HIV-positive diagnosis. “Many patients in the Latino community are afraid to keep doctor’s appointments for fear that their HIV status will become public,” said Levison.
Levison, her team, and their community advisory board considered how to address those challenges. At first, they wondered if a photo-heavy magazine with a compelling story line and very little text might be a good way to convey the importance of regular HIV primary care, but research with focus groups and one-on-one interviews with patients revealed that many people would not want to carry around a magazine about HIV. However, the researchers noted that the people they surveyed carry cell phones, and also that they love the format of telenovelas—Spanish-language soap operas.
That feedback inspired Levison, who is bilingual in Spanish and English, and her research team to write a storyline for a video. Then they worked with a production company to develop a screenplay and create Tiempos De Cambio (Times of Change), a telenovela about the challenges faced by a Latino family in Boston that is dealing with HIV and how the disease affects their lives.
The video is now being used with patients in several clinics across Greater Boston as part of one-on-one interventions between a community health worker and a patient who has lapsed on HIV care. Early feedback from patients has been overwhelmingly positive, said Levison, because the drama makes them feel less isolated and does not require literacy.
Levison’s team will assess the effectiveness of the interventions by monitoring how regularly patients attend their appointments over time and by the levels of HIV in their blood. If the approach is successful, it could benefit both individuals and the community.
“Those who have an unsuppressed viral load in the blood risk accelerated inflammation that can lead to cancer and cardiovascular disease as well as a compromised immune system. Detectable virus in an individual also places the community at risk for ongoing spread of HIV,” Levison said. “If we can get everyone with HIV diagnosed, linked to an HIV provider, and on treatment, and assure adherence, we can effectively eradicate the disease.”
That possibility excites Levison, who said that as a researcher, she is always looking for ways to end the HIV epidemic and to ensure that all patients can reap the benefits of science. “Treatment can help someone achieve an exceptional quality of life, and live as long as people without HIV,” she said.
Levison hadn’t expected her career to involve screenwriting, but she didn’t hesitate to tackle the project in part because of advice she received from her mentor at Wellesley, Marjorie Agosin, professor of Spanish, who is the author of young adult novels, memoirs, and several collections of poems.
“Marjorie always told me that if I wanted to be a good doctor, I needed to be a good poet and understand the soul,” said Levison. “That advice has helped me find ways to connect with patients, help them move themselves toward their goals, and support them to become active participants in managing their health.”
Other Wellesley professors helped Levison understand that the treatment of disease is affected not just by biological factors but by social, cultural, political, and economic forces as well. That perspective shaped her senior thesis, on social responses to leprosy and syphilis, and her work at Oxford University as a Rhodes Scholar, where she continued to study social responses to infectious disease. When she returned to the States, she attended Harvard Medical School and School of Public Health, then completed an internal medicine/primary care residency at Brigham and Women’s Hospital and subspecialty training in infectious diseases at MGH and Brigham and Women’s Hospital.
While the telenovela focuses on HIV, Levison thinks similar videos could be used to address a variety of illnesses and problems. “There will always be diseases we can’t anticipate, yet the more informed and activated people are toward managing their health, the better,” she said. “When individuals feel that their lives matter, that their place in the community matters, we as a society have set up a platform for a healthier future.”