Pilot Award

Chlamydia pneumoniae and Chlamydia trachomatis are obligate intracellular bacterial pathogens that are important causes of human infections for which no vaccine exists. C. pneumoniae is responsible for ~10% of respiratory tract infections. C. trachomatis serovars D-K are the leading cause of bacterial sexually transmitted infections and preventable infertility in the US. Serovars A-C are associated with trachoma, the leading cause of non-congenital blindness in developing nations.

HIV continues to impose a heavy burden on pediatric care services in sub-Saharan Africa, where 90% of the estimated 630,000 HIV-infected children receiving antiretroviral therapy (ART) live. The availability of ART has resulted in increasing numbers of HIV-infected infants surviving to older childhood, and respiratory conditions are the leading cause of death in this group. Recently, a novel form of chronic lung disease (CLD) has been described that may affect up to one-third of children aged 10 years and older in HIV care in Southern Africa.

Though combined antiretroviral therapy (ART) has reduced both morbidity and mortality due to HIV, ART does not lead to eradication or restore normal health to HIV-infected individuals. Given the staggering health and financial costs of HIV, it seems imperative to explore new therapies that can possibly lead to viral eradication. Obstacles to eradication include latent infection in resting memory CD4+ T cells and the presence of other cell types or organs that serve as sanctuary sites for virus.

The majority of the global HIV epidemic is occurring in sub-Saharan Africa, where the main route of transmission is heterosexual intercourse. An understanding of factors impacting transmission risk is necessary for effective prevention strategies, especially in countries such as Kenya, where the majority of infected individuals are in relationships with HIV-negative partners. One of the factors thought to be associated with sexual transmission is the presence and quantity of HIV-1 in the genital tract.

Preliminary data from pregnant women in rural Kenya indicate that fear of violence from a male partner is an important reason why some women refuse HIV testing, and that pregnant women who test HIV-positive or refuse testing may be more likely to be victims of violence. In response to these findings, we aim to develop an intervention on gender-based violence (GBV) for health workers who provide HIV-related services to pregnant women in this setting.

Numerous gender-transformative HIV/AIDS prevention interventions are carried out in developing country contexts with heterosexually-active women, but very little gender transformative HIV work is carried out with heterosexually-active men. This study qualitatively examines the impact of an HIV/AIDS and anti-violence program known as the One Man Can Initiative (implemented by Sonke Gender Justice, Cape Town, South Africa). Men will be recruited from Cape Town and Johannesburg, South Africa (N=120).

Publications:

• PubMed# 18945778
• PubMed# 19381272
• PubMed# 18362693
• PubMed# 19390417
• PubMed# 19265479
• PubMed# 19109229

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.