Sabina Hirshfield, PhD, Visiting Associate Professor
At the intersection of innovation, equity, and impact, STAR’s Dr. Sabina Hirshfield is transforming how we support people living with HIV—one app, one study, one community at a time. From mobile health interventions to groundbreaking research on stimulant use, viral suppression, and aging, her work is helping close critical gaps in care for sexual minority men across the country.
Sexual minority men (SMM)—including gay, bisexual, and other men who have sex with men—make up a small portion of the U.S. population but continue to bear a disproportionate burden of HIV. Despite advances in Treatment as Prevention (TasP) and early antiretroviral therapy (ART), many still face systemic barriers to timely care, adherence, and viral suppression. At the STAR Program and beyond, a new generation of eHealth and mHealth (mobile health) interventions led by Dr. Sabina Hirshfield and her national collaborators are reshaping how we reach and support those most affected.
These NIH R01 studies are currently in the field. For a full list of publications, please visit here.
START: Supporting Treatment Adherence for Resilience and Thriving
Funded by NIDA, the START study is a national, mobile health intervention targeting HIV-positive stimulant-using SMM. Co-led by Drs. Sabina Hirshfield (SUNY Downstate), Adam Carrico (Florida International University), and Keith Horvath (San Diego State University), this randomized controlled trial follows 285 participants over 12 months. The goal: improve ART adherence and achieve viral load (VL) suppression.
Participants randomized to the intervention receive an app with tools for medication adherence, mindfulness, mood tracking, and health education. Those in the control group receive access to a national online resource hub. This approach prioritizes accessibility and scalability, regardless of whether participants are engaged in formal substance use treatment—reaching individuals both inside and outside major urban centers.
The START study has produced three posters by Dr. Hirshfield’s mentees, Michael Daly, rising 3rd year medical student; Paula Pedrani, rising 4th year medical student; and Michael Silver, doctoral student in the School of Public Health, who will present in person at the International Association of Providers of AIDS Care, Continuum Conference, June 10–12, 2025. San Juan, PR. Conference Website
- Daly M, Miller-Perusse M, Rivera Cruz A, Larson M, Ghanooni D, Carrico A, Horvath K, Hirshfield S, Diaz J.
The Association Between Psychological Distress and Emergency Department Visits Among MSM Living with HIV and a Stimulant Use Disorder.
This study found that psychological distress significantly increases the odds of emergency department visits among MSM living with HIV who use stimulants. Childhood sexual assault was also linked to more frequent ED visits, while Black participants had lower odds of ED use—highlighting the need for trauma-informed care to reduce ED burden and improve outcomes.
Citation: IAPAC Continuum Conference, June 10–12, 2025. [Poster]
- Pedrani P, Miller-Perusse M, Larson M, Ghanooni D, Horvath K, Carrico A, Hirshfield S, Diaz J.
Informing Healthcare Approaches for Sexually Minoritized Men with HIV and Methamphetamine Use.
Moderate to severe methamphetamine use among sexual minority men with HIV was strongly associated with suboptimal ART adherence. Adherence disparities were especially pronounced among younger, Latino, and Black participants, underscoring the need for culturally responsive, integrated substance use and HIV care strategies.
Citation: IAPAC Continuum Conference, June 10–12, 2025. [Poster]
- Silver M, Christle Chuku C, Diaz J, Larson M, Ghanooni D, Rivera Cruz A, Miller-Perusse M, Carrico A, Horvath K, Hirshfield S.
Understanding HIV Viral Load Detectability Among Sexual Minority Men with HIV Who Use Stimulants using Andersen’s Behavioral Model.
Using Andersen’s Behavioral Model, the study found that lower education and unstable housing significantly increased the likelihood of detectable viral load. Conversely, recent changes to HIV medication reduced the odds of a detectable VL, highlighting how structural and behavioral factors impact viral suppression among stimulant-using SMM.
Citation: IAPAC Continuum Conference, June 10–12, 2025. [Poster]
UrHeart: Linking Drug Use and Cardiac Health
A sub-study of START, UrHeart tests the feasibility of collecting home urine specimens for drug screening and cardiac health markers. Participants mail urine samples to a forensic lab to test for 50+ substances—including fentanyl analogs—and for troponin, a marker of heart injury. This innovative approach sheds light on the risks of stimulant use and unintentional fentanyl exposure while offering participants feedback and support.
THRIVE 3. This NINR-funded study, Testing the Efficacy of Two Interventions to Improve Health Outcomes and THRIVE 3: Empowering Rural Older Adults with HIV
While much of the HIV epidemic is urban-centered, rural older adults face distinct barriers: isolation, stigma, and limited access to care. Funded by NINR, THRIVE 3 focuses on this underserved group. Using a 2×2 factorial design, researchers evaluate two interventions: supportive-expressive peer groups and strengths-based case management. 352 participants from Southern U.S. states—many in the federal Ending the HIV Epidemic priority zones—are being enrolled. Dr. Hirshfield serves as Co-Investigator, expanding STAR’s reach into national efforts to achieve health equity across geography and age.
UniquelyU: Understanding and Advancing Viral Suppression
In the UniquelyU study, researchers follow 250 newly diagnosed SMM for two years, collecting dried blood spots monthly to track viral load. This NIAID-funded study seeks to identify barriers to achieving and sustaining viral suppression. Co-Investigator Dr. Hirshfield joins a team led by Whitman Walker’s Drs. Ali Talan and Jonathon Rendina to explore factors like stigma, structural challenges, and treatment adherence, all with the goal of strengthening TasP and scaling U=U (Undetectable = Untransmittable) messaging across communities.
At STAR, research is about more than data—it’s about people. Dr. Hirshfield’s work reflects STAR’s commitment to culturally relevant, accessible, and tech-driven approaches to care. These projects are proof that when science meets compassion and innovation, we move closer to ending the HIV epidemic for all—especially those who are too often left behind.
Let’s amplify the message: viral suppression is possible, care should be inclusive, and everyone deserves the chance to thrive.
