round up of newly Funded HIv Center Research Studies

From perinatally infected youths moving towards adulthood, to HIV prevention and treatment in South Africa, to the uses of HIV-based home testing, newly funded grants are extending existing lines of investigation while also launching new avenues of inquiry. This article provides brief introductions to four innovative newly funded research studies. Future issues of the HIV Center E-Newsletter will bring you further news and updates.

HIV Prevention among South African MSM

South African men who have sex with men (MSM) are an understudied population in HIV/AIDS epidemiological and social science research. However, evolving evidence indicates that sexual risk behavior among these men is common, and strongly associated with the use of alcohol. Due to the association of HIV/AIDS with poverty, African MSM in townships seem to be at particular risk for HIV infection. Theo Sandfort, Ph.D. has begun a new study to acquire the knowledge needed to be able to create targeted, culturally appropriate, evidence-based interventions addressing HIV risk in this population. The study will employ HIV testing, ethnographic observations, ethnographic mapping, surveys, and in-depth interviewing to identify key behavioral, psychosocial, and network characteristics. The study will focus in particular among African MSM in four townships that are part of the Tshwane Municipality, the greater metropolitan area that includes Pretoria. Building on the ethnographic phase, the team will survey 500 men residing in Tshwane who engage in same-sex sexual practices with men and identify structural and psychosocial correlates, particularly the role of the use of alcohol and other substances in sexual risk behavior. HIV testing of survey participants will allow the identification of risk factors of HIV infection.

Rapid HIV Home Test and Decision-Making Among HIV-Negative Men

More than a quarter of a century into the HIV epidemic, it is evident that many individuals at high risk of contracting HIV cannot or will not use condoms with their partners. Yet, often these individuals would welcome HIV prevention strategies that are not condom based. In response to this issue, Alex Carballo-Dieguez, Ph.D. has launched a new study to examine possible uses and misuses of a rapid HIV home test as a partner-screening device, a study which is particularly timely given that the FDA is considering allowing the over-the counter sale of the OraQuick® In-Home HIV Test. This study, to be conducted with HIV Center co-investigators Ivan Balan, Ph.D., Ana Ventuneac, Ph.D., and Curtis Dolezal, Ph.D., will focus on HIV-uninfected men with knowledge about HIV who choose not to use condoms in circumstances in which there is risk of HIV transmission. This study will provide urgently needed information to harness the harm-reduction potential of this technology and to develop interventions that may be included among an array of non-condom prevention tools.

The Impact of Perinatal HIV on the Transition to Adulthood

Claude Mellins, Ph.D. has been funded to extend her groundbreaking work with perinatally infected youth. Due to advances in antiretroviral therapy, many such children are now for the first time living into late adolescence and beyond. Mellins and her team have previously established that youths who were exposed to HIV before birth, especially those who were born HIV- positive, have a high chance of developing psychiatric disorders. These disorders may place them at future risk for substance abuse, sexually transmitted diseases, pregnancy, and the spread of HIV. In the new study, Mellins and HIV Center colleagues including Mary McKay, Ph.D., Curtis Dolezal, Ph.D., and Katherine Elkington, Ph.D., as well as her biomedical collaborators, Elaine Abrams, M.D., Andrew Wiznia, M.D., and Mahruhk Bamji, M.D. will study the impact of perinatal HIV infection on risk and adaptive behaviors as the same sample of vulnerable youths approach and transition into young adulthood. The study presents a unique opportunity to yield crucial information about ongoing behavioral health outcomes including emotional and behavioral functioning, sexual and drug use behavior, and for infected youths, medication adherence. Important new study variables that are particularly relevant for the transition to young adulthood will also be examined, including functional milestones related to school, vocation, social relationships, pro-social conduct, autonomy, and for the HIV-positive youths, transition to age appropriate medical care. Although perinatal infections have decreased dramatically in the US, they have continued throughout the developing world, where large numbers of such children are poised to enter adolescence and young adulthood over the next several years.

Care and Treatment Uptake among the Newly Diagnosed in South Africa

The greatly expanded availability of antiretroviral medications in the developing world has placed a much greater emphasis on wide- scale HIV testing. However, relatively little attention has been paid to the period immediately after a person receives an HIV-positive diagnosis. Susie Hoffman, Dr.P.H. has launched a new study to fill this gap in knowledge, focusing on facilitators of and impediments to enrolling in HIV primary care and care-seeking more generally among those newly-diagnosed. The four-year study will be conducted in KwaZulu-Natal, South Africa in collaboration with the HIV Prevention Research Unit of the South African Medical Research Council and IBIS Reproductive Health of Cambridge, Massachusetts. The study seeks to determine the most salient influences on enrollment and retention in HIV care that, if addressed, could optimize use of services among newly diagnosed men and women in resource-constrained settings. The study is distinctive in that it will examine multiple levels of influence on enrollment and retention in care. These will include the level of social-structural factors, such as stigma, poverty, and gender inequalities; the level of health systems, including organization, policies, and providers; and the level of the individual, such as mental health and health-related behaviors. In the last year of the study, key stakeholders will meet with the researchers to collaboratively discuss plans for interventions. The HIV Center team also includes co-investigators Theresa Exner, Ph.D., Joanne Mantell, Ph.D., Alan Berkman, M.D., M.P.H., Elizabeth Kelvin, Ph.D., and Cheng-Shiun Leu, Ph.D.