Life Projects and Antiretroviral Therapy: The Social Impacts of Scale-up

Hirsch, Jennifer

Abstract

We propose here a one-year planning grant to support the development of a competitive proposal to conduct comparative social scientific research on the experiences of individuals living with HIV. The proposed planning grant will intensify the start-up phase for the work proposed in grant application HD057792-01A2, accelerating the progress of the science proposed in that study. That comparative work would (1) examine and understand how the experience of ART affects family and peer relations, sexual behaviors, marital intentions and trajectories, and reproductive goals and practices;(2) investigate and evaluate how the intersection between ART and life projects shapes sexual and reproductive practices, adherence to treatment and care, and disclosure to social and sexual contacts;and (3) develop program strategies to enhance the clinical and population-level impacts. In this one year our specific aims would be: 1) To further develop the project's conceptual framework;2) To use that conceptual framework as a guide for the development of ethnographic instruments and sampling matrices;3) To design and develop the necessary collaborations and community advisory panels ensuring both that the research contributes to the building of local research capacity and that it is framed by the buy-in of key stakeholders in order to maximize the translational impact of the research;4) To build the capacity to apply for and receive IRB approval for the subsequent long term study, a complex process which requires the review of 10 separate institutional review boards, and 5) to prepare an application to NIH for funding as a competitive continuation to conduct comparative ethnographic study on the social impacts of the provision of anti-retroviral therapy.

Public Health Relevance

In this project, anthropologists at four leading US universities will conduct critical preparatory work which will enable them subsequently to develop and submit to NIH a proposal to conduct research in New York City, with four international comparative sites, studying the relationship between ART, people's overall goals for their lives, and their sexual and reproductive behavior. In both domestic and international settings, more information is needed about how access to these powerful medications influences risk and protective behaviors. This information will be used to improve ART services both domestically and internationally.