Pilot Award

Poverty and gender inequality are two core structural factors that shape women's vulnerability to HIV/AIDS. Recent research demonstrates that access to and control over assets such as property can empower women, provide them with a secure means of livelihood, prevent food insecurity, and improve household bargaining power, all of which mitigate the negative effects of HIV/AIDS. However, little work has intervened at the intersection of property rights and HIV/AIDS prevention.

Publications:

• PubMed# 18949024
• PubMed# 19189205
• PubMed# 18703133
• PubMed# 18376407
• PubMed# 19500013
• PubMed# 18809675

Publications:

• PubMed# 18645515
• PubMed# 18945778
• PubMed# 18362693
• PubMed# 19381272
• PubMed# 18376407
• PubMed# 19123869

The science of implementation begins with the ability to measure important occurrences in routine, day-to-day clinical care. Although the provision of care and treatment for HIV-infected patients in Africa over the last five years has scaled up rapidly, loss to follow-up (i.e., unknown outcomes) commonly exceeds 40% at 1 year. By precluding knowledge of key events, such as mortality and retention in care, losses systematically impair our ability to measure occurrences in clinical care for the conduct implementation science.

Publications:

• PubMed# 18953617
• PubMed# 19175285
• PubMed# 19223785
• PubMed# 19283464

Chronic immune activation is a significant determinant of HIV-mediated CD4+ T cell loss and disease progression. Despite effective viral suppression, chronic inflammation persists at levels higher than in uninfected people, yet the inflammatory stimuli and the mechanisms by which inflammation persists and promotes disease pathology are not completely understood. Many mechanisms likely contribute to chronic immune activation including persistent antigenemia, depletion of T regulatory cells (Tregs), and stimulation of toll-like receptors.

My research has consistently focused on the effects of poverty and of social/cultural context on the health of our most disadvantaged youth, particularly homeless youth in San Francisco and street children in Kisumu, Kenya. Through my work in San Francisco since 2001, I demonstrated the feasibility of longitudinal epidemiological work with street youth, demonstrated the role of street culture, social networks and race in HIV risk of street youth, and developed a community collaborative project for street-based STI testing of street youth.

CD4+ T cell depletion is a hallmark of HIV infection and the CD4+ T cell count is useful for staging patients as they progress to AIDS. However, a bulk lymphocyte count does not take into account the diversity of recognition specificities these T cells have. Using a novel quantitative assay of T cell receptor (TCR) genetic diversity, called AmpliCot, we have found that untreated HIV infection is associated with an order of magnitude decrease in blood T cell diversity and that these decreases correlate with CD4+ counts.

One reason HIV-1-infected subjects fail to control viremia is due to the high rate of mutation of HIV-1, with consequent escape from the immune response, especially from neutralizing antibodies. Approximately 8% of the human genome is composed of human endogenous retroviruses (HERVs). Most HERVs are fixed in the human genome, defective in replication, and transcriptionally silent in normal cells. Previous studies have shown members of the HERV-K (HK) family are reactivated during HIV-1 infection.