Pilot Award

Publications:

• PubMed# 19359579

Publications:

• PubMed# 18796674
• PubMed# 19186350
• PubMed# 18688706
• PubMed# 19455012
• PubMed# 19477406

There is wide agreement that street children carry a greater risk of HIV/AIDS infection than their peers, yet this sub-epidemic has been largely ignored by the HIV research community, in part due to their marginalized status. Our ability to design interventions that will improve the health of street children is compromised by the absence of answers to fundamental questions, including: What are their rates of HIV and STIs? What are the modifiable social and contextual factors that increase their risk for infection? Given their marginalized status, how can they best be reached and recruited?

The dual pandemics of tuberculosis (TB) and human immunodeficiency virus (HIV) have coincided in sub-Saharan Africa. Kenya is a clear example of this situation with high regional HIV prevalence (as high as 17.4%) and highly endemic TB with an annual case rate of 329 per 100,000 people. Children have not been immune from the rise of these pandemics. In Kenya an estimated 200,000 children are HIV-infected and between 10-20% may be co-infected with TB. Children with HIV have 20 times the risk of TB and co-infected children face 3-6 fold increased mortality.

Family planning is an effective way of decreasing vertical transmission of HIV and maternal and neonatal morbidity and mortality associated with untreated HIV and pregnancy. Clinicians and researchers world-wide are recognizing the importance of integrating family planning and HIV care for these reasons. However, there are many recognized obstacles to integrating these two types of care and funding streams remain separate.

Almost half of the human genome is composed of transposable retroelements. These include human endogenous retroviruses (HERV), which are thought to be remnants or fossils of ancient viral infections. Previously, we have identified HERV-specific CD8+ T cell responses in HIV-1 infected adults. For some HIV-1-positive individuals, the strength of their responses against HERV was associated with lower HIV-1 viral loads, suggesting that these responses contribute to immune containment of HIV. However, nothing is known about HERV-specific CD4+ T cell responses.

In recent years the risk of mother-to-child transmission of HIV in developed countries has declined to less than 1%. This success is due to the implementation of a package of interventions including universal HIV screening in pregnancy, provision of highly active antiretroviral therapy (HAART) to HIV-infected pregnant women, antiretroviral (ARV) prophylaxis for the infant during the first 6 weeks of life and avoidance of breastfeeding. In resource-limited countries however, vertical transmission rates can be as high as 35-40% in untreated breastfeeding populations.

Research on the role of migration in the spread of HIV/AIDS has almost exclusively focused on male labor migration patterns, finding migration to be a risk factor for men and their non-migrant partners, yet neglecting to measure the HIV risks of migration for women. Moreover, the very manner in which migration is conventionally studied is shaped by the paradigm of male labor migration, and thus fails to capture the complexity of women's mobility in sub-Saharan Africa today.