“Unprecedented” may be one of the most commonly used words to describe the COVID-19 pandemic. But to Bisola Ojikutu, MD, an infectious disease physician at the Brigham, COVID-19’s repercussions and the racial disparities it has illuminated are tragically well precedented. Ojikutu has dedicated her career to studying and rectifying inequities in health care access experienced by people living with or at risk of HIV. Ojikutu explores structural risk factors and how these may serve as barriers to the uptake of pre-exposure prophylaxis — a daily medication regimen to prevent HIV infection. Using nationally representative data, Ojikutu has probed the Black community’s mistrust of the health care system, examining how issues of homophobia, mass incarceration, immigration status and more play into disparities in risk and access.
“Issues of racial and ethnic disparities in infectious disease risk and access to care are at the forefront of my work,” said Ojikutu. “Since the COVID-19 pandemic emerged, I think everybody is shifting their focus to a certain extent. For me, that means thinking about racial disparities related to COVID-19, understanding what we can learn from the HIV epidemic and determining what actionable steps we can take to address these issues.”
A Lot to Learn
Ojikutu is leading efforts through Harvard’s Center for AIDS Research to engage Black and Latinx communities in COVID-19 vaccine research and working with colleagues at the Brigham to promote equity in clinical trial participation and vaccine access.
“Understanding participation in clinical trials and how to increase diversity is important, and we also need to consider equitable access once a vaccine is available,” said Ojikutu. “People of color are disproportionately impacted by COVID-19, so how do we ensure that these communities have access to not only trials but to an approved vaccine as well?”
Ojikutu plans to study issues of medical mistrust and other structural barriers that may inhibit marginalized populations from COVID-19 vaccine and testing uptake.
“Our goal is to understand and then address issues that lead to disparities in access,” said Ojikutu.
Lessons from HIV
In February of 2019, the federal government announced the launch of “Ending the HIV Epidemic: A Plan for America,” with the goal of ending the HIV epidemic in the U.S. by 2030. Ojikutu has been involved in this effort at the state level, creating connections between policy and academia. Through her research, Ojikutu has been examining perceptions among Black and Latinx individuals regarding their trust in the health care system, access to the health care system, whether they believe themselves to be at risk, and whether messaging around initiatives related to HIV has made them feel excluded.
“There are so many parallels to the COVID-19 pandemic in terms of the work we need to do to understand how to reach vulnerable and marginalized populations,” said Ojikutu.
A Path to the Brigham
Ojikutu has always been interested in HIV because of its impact on vulnerable populations in the U.S. and around the world. After her residency, Ojikutu came to Boston to participate in the Commonwealth Fund Fellowship in Minority Health Policy. Through the fellowship, she studied health policy, public health, and management. She then lived in South Africa for a year, working to support a government-academic partnership that examined strategies to roll out government sponsored HIV treatment. Ojikutu moved back to Boston to finish her infectious disease fellowship, and, after working in non-profit consulting, joined the Brigham.
“I came to the Brigham because I wanted to continue to pursue evidence-based research,” said Ojikutu. “And the Brigham has provided a supportive environment. People are open to acknowledging problems and discussing issues of structural racism and inequity in access to care, and that’s not something that necessarily happens elsewhere.”
A Bellwether Moment
While pursuing timely research, Ojikutu is also thinking about the longer term and how to sustain a focus on the intersection of infectious disease and structural racism.
“My hope is that this is a bellwether moment,” said Ojikutu, “a time when we will take a very intense, intentional look at what’s happening and redouble our efforts, utilizing the experiences that we’ve had and learning from the the past and other infections like HIV. My hope is that we will channel those lessons on disparities towards doing something different to address the COVID-19 pandemic.”