This week our featured Fellow is Jennifer Kibicho. Jennifer is Assistant Professor on the faculty of the College of Nursing at UWM, where she teaches and conducts research related to health policy and health economics. She has a diverse research portfolio focus, which includes the economics of prescription drug cost drivers with particular reference to the Medicaid population and the economics of HIV transmission and acquisition risk, in particular how economic vulnerability escalates and intersects with alcohol and substance abuse, gender-based violence and sexual risk behaviors, as it impacts HIV transmission and acquisition. Her other work examines how health-related interventions impact the health care utilization and expenditure patterns, issues of interest to both private and public insurance payers.

Jennifer, thanks for taking a moment to talk with me, and may I say I’m positively delighted we were able to get a Fellow from the College of Nursing this year. As our readers know, I’m a graduate student in English here at UWM, but what they may not know is that before I went back to graduate school I spent almost 20 years working in the medical field in allied health and caregiving roles. I wasn’t a nurse, but I did work for six years as a medical assistant in outpatient clinics, and for those of us who have worked in medicine, a field almost as expansive and complex as academia, it becomes a permanent part of who we are as scholars and teachers. Tell us a bit more about your research, if you would.

Thank you so much for the opportunity to talk with you about my research, Mark. I must say that am very excited and indeed honored to be part of this year’s Global Fellows program. You and I have something in common Mark. Am not a nurse either and yet am faculty at a College of Nursing. I have found that Economics is one of the most diverse fields there is. The reality is that every single person faces the key economic problem—scarce resources whether it’s time or money—and an unlimited and growing list of wants and needs. Therefore, economics has relevance to each person, organization and community. I tell my students that you can combine your passion for, say, sports and economics, and specialize as a sports economist.

I will talk about two types of research am engaged in. The first was a federally-funded National Institutes of Health project that examined the role of pharmacists in promoting adherence to HIV medications within real-world community-based settings. My main findings were that pharmacists who are HIV-certified were more likely to provide what we call adherence-promotion activities. The next step in that line of research is to study whether pharmacists’ involvement in providing adherence promotion does translate to improved adherence to treatment for the HIV population, thus potentially saving health care dollars to both the private and public payer for health care services.

The second research project is on a topic am very passionate about and is the focus on my fellowship program. I come from Kenya, a country on the East Coast of Africa, which has the 4^th highest number of individuals living with HIV worldwide, with an incidence rate above the 1% threshold which makes AIDS an epidemic. Over 30 years of HIV/AIDS research has highlighted the important role that both poverty and wealth play in increasing the vulnerability of individuals in certain regions to HIV transmission and acquisition risk. Well, there is very limited research that examines how economic vulnerability influences certain structural factors, including alcohol and substance misuse, gender-based violence, and sexual risk behaviors, which in-turn increase individuals’ HIV transmission, and acquisition risk for HIV infection. This line of research can inform the design of multi-level combination interventions that address the multiple risks and vulnerabilities that have caused the HIV/AIDS pandemic to persist in Sub-Saharan Africa, 30 years on, while it is virtually controlled in developed countries.

If scholars and curious readers wanted to learn more about the larger topic of health economics, what book or text would you recommend as an introduction?

That is an excellent question, and am sure one that many in the audience would like to have an answer to. Health Economics is a relatively new field that traces its origins to Kenneth Arrow, who received the Nobel Prize in Economics in 1972 for his pioneering contributions to general economic equilibrium theory and welfare theory. Depending on how complex and simplified the information you want, there is a whole range of health economics textbooks out there—for example economics from a nursing perspective—which really speaks to the interest and importance of economics as it applies to the field of health care.

Many people are keenly interested (for scholarly and personal reasons alike) in the cost of healthcare. The discourse of health economics is a key political issue both domestically in the U.S. and globally. It would seem, especially during the debate that our current election has spurred, that this is a conversation that must necessarily include many voices; scholars who speak to economics, cultural values, ethical and spiritual considerations, as well as the practical, entrepreneurial problem-solvers prepared meet intractable challenges like the HIV/AIDS epidemic. Again, since I’ve worked in medicine I know it almost always is, but where do you see your research becoming the most thoroughly interdisciplinary?

You raise many excellent points, Mark. While health care is not center stage in this election cycle as it was in the 2008 election, current headlines including announcements that insurance premiums under the Affordable Care Act are expected to go up by a large percentage is definitely of concern, not just to policy makers but also to the public. As health economists, we care about cost, access, and quality of health care—what is known as the 3-legged stool—and that is how we evaluate the health care economy. We can inform health care reform debate by making predictions about the impact of increased premiums on the cost of care, access to care as well as the quality of care. If we assume that health is a normal good, we anticipate that individuals could respond by dropping insurance, which can impact adversely their access to health care providers, in particular primary preventative care. The downstream impact can be quite substantial, so that the ripple effect is felt by not only patients but also the public payers, etc. Health is a pocketbook issue, and as such economic thinking can help inform that policy making process.

With regard to the HIV/AIDS epidemic which is my field of specialization, economics is both a cause and a consequence of HIV. In other words, there is evidence, though mixed, to suggest that individuals living in poverty are at an elevated risk of acquiring HIV because poverty is associated with certain behaviors such as transaction sex that increases the risk for HIV. Also, there has been other research that suggests that wealth is associated with certain behaviors including sexual networking and multiple sexual partnerships that increase individuals risk of acquiring HIV. Most definitely, HIV and AIDS drives individuals and households to poverty through reduced economic productivity and increased medical costs, in particular in poor countries in Sub-Saharan Africa which do not have a social welfare system like we have in the U.S. Well, it’s complicated I know. Multiple stakeholders are needed at the table to address this and other complex chronic conditions and challenges facing our community.

It’s still very early to make predictions, but can you share with us a preview of what we might hear about during your presentation in April at the conference?

Thank you for asking about the upcoming presentation at the conference next year. Am very excited to be presenting my work based on findings that economic vulnerability, not just a state of being poor or wealth, is a key driver of the HIV acquisition and transmission risk in rural Kenya. I will present my findings on how poverty, economic windfalls and economic opportunistic behaviors impact individuals susceptibility to misuse alcohol, cause poverty and gender-based violence, all of which increases individuals probability of engaging in sexual risk behaviors, and inevitability acquiring HIV.

Thanks for taking the time to talk with us Jennifer; I’m very much looking forward to your presentation. As always, I’d also like to remind our readers keep an eye on Intersections in the near future for more interviews with our Global Studies Fellows, opportunities to see them present at our colloquia, and information about the CIE conference on Diversities, April 20-21^sr.

Thank you Mark. It was my pleasure.