Pilot Award

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.

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.

Between 2000 and 2009, the estimated global incidence of multidrug-resistant tuberculosis (MDR TB) more than doubled, and extensively drug-resistant tuberculosis (XDR TB) was newly verified in 57 countries. The lack of rapid drug susceptibility testing (DST) has been a major impediment to effective prevention, treatment and epidemiologic research of drug resistant TB.

Kaposi's sarcoma-associated herpesvirus (KSHV) is the viral etiologic agent of Kaposi's sarcoma (KS). In sub-Saharan Africa, the catastrophic intersection between underlying endemic infection with KSHV and the HIV epidemic has resulted in KS becoming the most common malignancy among adults in many countries and a growing cause of cancer in children.