The adverse impacts of HIV/AIDS worldwide are concentrated among women and among the poor. Although treatment scale-up has improved access to HIV antiretroviral therapy in resource-limited settings, the primary barriers to sustained treatment adherence and fully optimized health outcomes are structural in nature: even when treatment is provided free of charge, structural barriers such as food insecurity and inability to pay for transportation to clinic remain the Achilles'heel of treatment in resource-limited settings. Furthermore, although HIV antiretroviral therapy can lead to rapid restoration of physical function, HIV treatment alone is insufficient to reverse the economic decline and household asset depletion that have typically occurred by the time people enter treatment. Economic interventions including microfinance have increasingly been promoted for poverty alleviation, and key multilateral organizations have advocated for interventions to address economic inequalities between men and women to alleviate HIV-related gender disparities. However, there is currently little evidence to support widespread implementation of economic interventions among women, much less HIV+ women, or to elucidate the specific mechanisms through which these interventions improve health behaviors or HIV outcomes. My long-term career goal is to become an independent investigator with expertise in understanding how economic interventions affect HIV+ women's empowerment, health behaviors, and health outcomes. In order to achieve research independence I need additional mentorship and training in gender studies, behavioral science theory, qualitative research, and global health intervention research. I will draw upon this training and leverage the resources of my primary mentor's extensive research infrastructure in Mbarara, Uganda to accomplish my scientific objective: to develop and evaluate the effectiveness of a poultry microenterprise intervention to improve HIV+ women's health-related behaviors and health outcomes. The poultry microenterprise program (but not a formal research evaluation, which is proposed here) is funded by my primary mentor through a grant from a philanthropic program, indicating a high level of institutional commitment. My central hypothesis, supported by preliminary data, is that the intervention will cause improvements in health-related behaviors, and that these effects will be mediated by positive changes in economic well-being and women's empowerment. I will test my central hypothesis by pursuing 3 specific aims: (1) use qualitative research to elaborate a theoretical model about how economic gains improve women's health;(2) develop and validate a scale to measure women's empowerment;and (3) pilot test the preliminary effects of a poultry microenterprise intervention on economic well-being, food security, women's empowerment, HIV treatment adherence, and HIV outcomes. I am well-positioned to accomplish these aims, given my five first-author peer-reviewed articles directly related to the content of the proposed K23 award. I will also draw on the expertise of an internationally-renowned mentoring committee of experts in HIV, women's health, behavioral science, qualitative research, and economics while creating my own distinct research trajectory. My approach is innovative in its use of mixed methods to test theoretically-driven hypotheses about the extent to which poultry microenterprise empowers HIV+ women and enables them to engage in desired health behaviors. The proposed research is significant because it is expected to lead to the development of a unique class of interventions to improve the health of millions of HIV+ women in resource-limited settings.

Public Health Relevance

The proposed research is relevant to public health because it is aimed at reducing poverty and improving the health of 13.1 million HIV+ women living in sub-Saharan Africa, which is also home to 390 million food- insecure persons. Understanding whether and how structural interventions affect the health of HIV+ women will lead to the development of more effective interventions to address structural barriers. Thus, the proposed research is relevant to the mission of the NIH, described in the FY 2011 Trans-NIH Plan for HIV-Related Research, pertaining to assessing the barriers to delivery of effective health care for HIV disease;supporting research on approaches to facilitate better adherence to HIV antiretroviral therapy;and evaluating interventions to reduce adverse economic consequences for women infected with HIV/AIDS.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
1K23MH096620-01A1
Application #
8329921
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Stirratt, Michael J
Project Start
2012-09-01
Project End
2017-06-30
Budget Start
2012-09-01
Budget End
2013-06-30
Support Year
1
Fiscal Year
2012
Total Cost
$186,521
Indirect Cost
$13,221
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Conroy, Amy A; Tsai, Alexander C; Clark, Gina M et al. (2016) Relationship Power and Sexual Violence Among HIV-Positive Women in Rural Uganda. AIDS Behav 20:2045-53
Venkataramani, Atheendar S; Chatterjee, Paula; Kawachi, Ichiro et al. (2016) Economic Opportunity, Health Behaviors, and Mortality in the United States. Am J Public Health 106:478-84
Tsai, Alexander C; Venkataramani, Atheendar S (2016) Syndemics and Health Disparities: A Methodological Note. AIDS Behav 20:423-30
Tsai, Alexander C; Wolfe, William R; Kumbakumba, Elias et al. (2016) Prospective Study of the Mental Health Consequences of Sexual Violence Among Women Living With HIV in Rural Uganda. J Interpers Violence 31:1531-53
Chan, Brian T; Tsai, Alexander C (2016) HIV stigma trends in the general population during antiretroviral treatment expansion: analysis of 31 countries in sub-Saharan Africa, 2003-2013. J Acquir Immune Defic Syndr 72:558-64
Tsai, Alexander C; Tomlinson, Mark; Comulada, W Scott et al. (2016) Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa. Soc Sci Med 151:69-77
Rouhani, Shada A; O'Laughlin, Kelli N; Faustin, Zikama M et al. (2016) The role of social support on HIV testing and treatment adherence: A qualitative study of HIV-infected refugees in southwestern Uganda. Glob Public Health :1-14
Chan, Brian T; Tsai, Alexander C (2016) Reply to "Trends in responses to DHS questions should not be interpreted as reflecting an increase in 'anticipated stigma' in Africa". J Acquir Immune Defic Syndr :
Tsai, Alexander C; Tomlinson, Mark; Comulada, W Scott et al. (2016) Intimate Partner Violence and Depression Symptom Severity among South African Women during Pregnancy and Postpartum: Population-Based Prospective Cohort Study. PLoS Med 13:e1001943
Siedner, Mark J; Kim, June-Ho; Nakku, Ruth Sentongo et al. (2016) HIV infection and arterial stiffness among older-adults taking antiretroviral therapy in rural Uganda. AIDS 30:667-70

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