Addressing Housing and Health with Heart: Dedicated investigator works on critical challenges facing vulnerable women
Elise Riley, PhD, MPH by Marc Vincent, MA
(This article reprinted from the Fall 2009-Winter 2010 edition of Positive Spin, official
newsletter of the Positive Health Program).
Passionate about people aptly describes both the approachability and the innate professional drive of Elise Riley, PhD, a UCSF Associate Professor and PHP investigator conducting novel research on powerful socio-economic factors that significantly impact the clinical health of many of the poorest and most marginalized people in our communities. Shuttling between the SFGH campus and her research field site near the often chaotic intersection of 6th and Market Streets in San Francisco, Riley seems indefatigable as she oversees ongoing interviews of people—especially women—living on the margins of urban society due to lack of housing, employment, food and medical care. For years, Riley has been interacting with people, listening, amassing and analyzing data, and publishing work that contributes significantly to enhancing our understanding of structural factors affecting the urban poor, and in particular, women living with or at high risk for contracting HIV.
In this interview, Riley shares a bit about her background, her work and her unwavering commitment to improve the condition of others.
Where did you grow up and attend school? Any special interests or hobbies outside of work? I grew up in a tiny town called Coleville, which is in the Eastern Sierras, went to college at University of California Santa Barbara and later moved to London to see the world. Living and traveling in Europe really opened my eyes to issues of social class and access to health care. These days, I bike, hike and kayak whenever possible. I also paint and sing horribly, but get encouragement from my boyfriend who is entertained by my lack of talent! After college and living abroad, I eventually made my way back to the US for graduate school in public health at Yale and then John’s Hopkins. The first research study I ever designed was on antiretroviral therapy (AZT) among incarcerated women. Conducting the interviews gave me opportunities to hear the stories of how women became infected, what happened to their kids and how they managed to get by day-to-day. To call these women’s stories heartbreaking is an understatement. It was the most humbling experience of my life. I’d drive home everyday, demoralized and wondering how anything I could do would matter. Eventually, I realized there was nothing else I’d rather do.
So how did your career path evolve? Any formidable experiences, projects or people that helped to shape your work? Any significant mentors?
Yes, I had two amazing mentors who I call ‘the two Davids!’ David Vlahov was my doctoral thesis advisor at Johns Hopkins, and David Bangsberg was my postdoctoral advisor here at UCSF. They both have incredible amounts of energy and have offered significant input on my work. What I learned from them is that perseverance is 90% of research. More ideas will be shot down than not, more grant proposals will go unfunded than funded, and sometimes, you’ll just want to give up. They have both been excellent role models for never giving up.
Describe the major project you’re currently working on. Any connection with PHP-specific patient issues or, more broadly, communities living with or at high risk for HIV/AIDS? My main focus is the SHADOW study (Shelter, Health and Drug Outcomes among Women), which follows a cohort of poor urban women living in San Francisco. We wrote the first grant 8 years ago and since then there has been a lot of great input steering our direction forward. Our collaborating investigators have included David Bangsberg, Jackie Tulsky, Tor Neilands, Jim Sorensen, Kelly Knight, Megan Comfort, Adam Carrico and Jennifer Cohen. It’s a privilege to work with such smart, enthusiastic and caring people. The SHADOW team is interested in how structural factors (such as housing instability) and competing risks (such as drug addiction) influence health, use of health services, victimization and risk behavior over time. The literature generally implicates the same risks for HIV that are implicated for inadequate health care (at least among indigent people). Our goal is to better understand the context of risk and poverty so that we can learn how these risks change over time and influence one another. We want to have better answers when providers ask how they can improve health care delivery given all of these competing and unmet needs.
Are there any key findings (or preliminary, observable trends) that might be of particular interest to share? Yes, we’ve found that men and women are homeless in different ways and that the traditional definitions of homelessness (i.e., sleeping on the street or in a homeless shelter) don’t capture the experience of women. This matters because unstable housing carries a lot of health risks that providers can address with their patients (when providers are aware that their patients are unstably housed).
Also, there is a lot of violence among indigent women and it influences most aspects of their lives. The violence becomes normalized for some and eventually they don’t think about it, though it still impacts mental and physical health. If a provider asks an unstably housed woman if she is abused or victimized, she may say no, even if she would say yes to specific questions about being hit or coerced. Again, the traditional terminology doesn’t always get at the most relevant issues, so asking more specific questions is important.
What future work is in the pipeline that you’re especially excited about and what implications might it have for patient care and outcomes? We’ve just started working with community partners at St. Anthony Foundation on an intervention concerning health care and housing access among unstably housed people. It’s been exciting to merge our academic ideas with the “real world” understanding and creativity of our partners and I’m really energized about this!
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