Even as a young child growing up in Ghana, Nana Ama Aya Bullock understood the terror associated with an HIV/AIDS diagnosis.
The first AIDS case in the west African nation was reported in 1986. In the years that followed, cases would increase by as much as 600 percent annually, according to the U.S. National Institutes of Health. By 2000, about 350,000 Ghanaian adults and children were infected with HIV, which is the virus that causes AIDS.
“It was just a lot of stigma, it was a lot of fear, it was a lot of a lack of knowledge... It was just like a death sentence,” says Bullock, who lost an aunt to AIDS.
Those childhood memories inspired her to pursue a career in public health. Now her efforts have landed the University of Louisville doctoral student a prestigious Fulbright U.S. Student Program Fellowship this year. Even as HIV/AIDS cases dwindle worldwide, Bullock says the virus remains a problem in Ghana.
“Literature suggests that women are affected the most when it comes to HIV,” she says. “In Ghana women are twice as likely to contract HIV or are living with HIV.”
Bullock says most transmission comes through heterosexual sex, so her Fulbright research will focus on understanding the personal, social, and cultural factors that influence high-risk behaviors among the men who ultimately pass HIV on to their female partners.
“Being able to understanding these things will be very effective in programming and policy in getting the word across when it comes to HIV or just any other health issue that we need men to be on board,” she says.
The Long Road to a Fellowship Award
Bullock came to America when she was a teenager. After attending a Catholic high school in Chicago, she got a bachelor’s degree in health education at Southern Illinois University and a master’s in public health at Michigan State University before moving to Louisville to pursue her doctorate.
“U of L actually found me,” says Bullock. “They wanted to get to know me and what I wanted to do... And they were giving me funding, and that was really nice.”
In the health promotion and behavioral sciences program at U of L’s School of Public Health and Information Sciences, Bullock met Associate Professor Muriel Harris, who is director of the PhD program. The two women found they had a unique connection: Harris had travelled to Ghana a few years ago on her own Fulbright fellowship.
“So it was a real joy when Nana came and said she was interested in applying for the Fulbright Fellowship,” says Harris, “That’s always been my goal, is to have students be exposed to all these opportunities... and just get a world view that is so different.”
Bullock started the application process in June 2019. She had to find a sponsor, get letters of recommendation, compile her transcripts, and complete a personal statement and statement of purpose for her research. After multiple reviews by Fulbright officers and officials in Ghana, she got word this summer that she had been selected for Fulbright-Fogarty Public Health Fellowship. That’s administered through the Fogarty International Center of the U.S. National Institutes of Health. Harris says Bullock is the first public health student at U of L to receive a Fulbright.
But how do you do research abroad during a global pandemic?
“With COVID right now everything is in limbo,” says Bullock. “We’re doing what we’re supposed to do [for] our pre-departure stuff but we’re not sure when we’re going to leave yet.”
Understanding Systemic Issues that Impact Public Health
Exploring the role of men, especially men of color, who are often reluctant to visit doctors, is a key part of addressing racial disparities in public health, says Harris.
“We really do need to understand different perspectives and the root causes of our disparities,” the professor says. “One of the things we don’t understand quite oftentimes is how people want to be treated and how people want care, and that’s something we need to get at.”
Harris contends that blame for poor health outcomes usually falls on the patient. While personal choices and habits are key to a healthy lifestyle, Harris says we can’t overlook the systemic issues that contribute to health problems among certain groups of people. She says people of color can feel excluded from health care if they aren’t comfortable talking with providers who don’t look like them or share the same cultural background. Accessibility to care is also an issue if services aren’t available nearby or if there is limited time or transportation to travel to providers.
“Once we begin to understand the disparities at that level, what’s happening institutionally and what’s happening systemically in order to exclude people from health care and access to health care, then I think we begin to address the issue of disparities,” says Harris.
Race-based systemic challenges aren’t limited to health care. Harris says they are also present in education, where children as young as elementary school may get a message that they can’t or shouldn’t attend college. So it should be no surprise, she says, when there are so few students of color in degree programs like medicine that would benefit from greater diversity. Harris says that’s left U of L and other universities to play catch-up in helping those students overcome the barriers they face.
“We’ve made a concerted effort to recognize that not all students start at the same place and we have to be willing to go that extra mile in order to make sure that they can be successful,” says the professor. “Every student has a place, every student has an opportunity to learn, and we have a responsibility to make sure that happens.”