While World AIDS Day on Dec. 1 brings HIV/AIDS to the forefront of public attention, many University researchers are working to understand and combat HIV/AIDS every day of the year.
The Brown University AIDS Program, which includes more than 30 faculty members, works to address intersecting issues such as policies regarding vulnerable populations and access to healthcare. BRUNAP faculty members work in labs and training centers in regions affected by AIDS, according to the program’s website.
Clinical research plays an important role in offering the best therapy, said Timothy Flanigan, professor of medicine and BRUNAP faculty member. New findings, such as the suppression of HIV viral loads — the amount of the virus in the blood— and antiretroviral therapy developments have both contributed to a reduction in rates of transmission, Flanigan said.
The combination of substance abuse, particularly methamphetamine and cocaine, multiple sex partners and other high risk behaviors, often disproportionately affecting gay and bisexual men, is “the new face of the epidemic,” Flanigan said. The internet facilitates engagement in multiple partnerships, which has helped HIV go “viral,” he added.
Research is providing new approaches to combat the epidemic. Recent research efforts include the development of new technologies involving testing and treatment programs, research in prisons and jails and research into prevention of transmission in women, Flanigan said.
Flanigan added that Brown faculty and students have partnered with HIV/AIDS treatment programs in nations such as Kenya, Ukraine and India. Such global health work is “looking at innovations that have worked in places like Africa and applying them in this country,” Flanigan said.
HIV through a social political lens
Assistant Professor of Social Sciences Caroline Kuo primarily focuses on vulnerable populations that bear the burden of disproportionately high rates of HIV infection. Kuo started much of her research in South Africa, working with children orphaned or made vulnerable by AIDS as well as their caregivers.
Kuo’s research in South Africa is portrayed in her documentary “Manguzi: Raising Children in Rural South Africa,” which depicts families composed of many orphaned children and sick or disabled adults.
Many groups most vulnerable to HIV are susceptible to other diseases which can increase infection potential, such as sexually transmitted infections and tuberculosis, Kuo said. She also collaborated with colleagues at Brown and Oxford University to research HIV in incarcerated women, sex workers and men who have sex with men.
“HIV is not just a virus. I think it is a virus that almost tends to act as a social and political lens,” Kuo said. She added that the history of stigma and discrimination associated with the disease and political obstacles, such as medicine patent rights, complicate the issue.
A cure is “something that the HIV world is really hoping for,” she said, adding that “we can’t forget that that’s only one piece of what needs to be done.”
Broader work must also be done to address socioeconomic disparities of HIV/AIDS, Kuo said. Research should focus on the whole spectrum of HIV/AIDS — prevention, treatment, and longterm effects of the virus.
Exploring gender disparity
Assistant Professor of Behavioral and Social Sciences Abigail Harrison focuses on HIV’s prevalence among in women in Sub-Saharan Africa, specifically South Africa.
Harrison said she is interested in the social factors that cause gender differences in rates of infection. Women exposed to trauma such as relationship violence and women in relationships with older men are more likely to be exposed to the virus, she said.
“It touches on almost every aspect of society and people’s lives,” Harrison said, adding that different disciplines of research have different focuses. While an immunologist’s perspective might lean toward finding a cure, there are other issues to tackle while waiting for biomedical solutions, Harrison said. She said prevention options may involve behavioral strategies, especially for women.
Other prevention strategies involve products formulated from some of the same medications as HIV drugs that are used before exposure to the virus, Harrison said, citing pre-exposure prophylaxis and microbicides as examples.
“Zero new infections,” was a theme of this year’s World AIDS Day, Harrison said. “That’s a huge change from where the field stood even five years ago,” she added.
Understanding social context
On a social justice level, HIV/AIDS is “a compelling signal of how social inequality exists,” said Associate Professor of Social and Behavioral Sciences Don Operario. The disease “has a way of pointing its finger at sources of inequality,” such as gender-based oppression, sexual identity, sexual behavioral stigma and socially and politically disadvantaged groups, he added.
Operario studies the social factors affecting the HIV/AIDS endemic. He said he focuses on populations most at risk, such as men who have sex with men, young men, sex workers, communities of color and transgender populations. His research is based primarily in San Francisco and in other nations, but Operario said he hopes to do more work in Providence. “We consider the multiple layers of social context and community context that may determine factors related to HIV risk,” he added.
“We’ve had some really exciting successes in basic science around biomedical strategies for prevention and for treatment,” Operario said, adding that science has made major contributions to the quality of life of people living with HIV/AIDS. In the past five or six years, life with an HIV diagnosis has become longer, healthierand more satisfying, he said.
He said he hopes there will be greater integration of the biomedical with social and structural analysis, so that in the future the two fields of research “not only talk to each other, but work together.”
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