Grant: Fellowship: Bisby (Prize)

Outside of sub-Saharan Africa, at least one in three new HIV infections occurs among individuals who use illicit drugs, their sexual partners and other members of indigent and vulnerable populations. In the United States and Canada, HIV-positive members of these groups suffer from high levels of AIDS-related morbidity and mortality, even in areas where HIV treatment is delivered free of charge. Thus, medical evidence is urgently needed to identify the barriers to accessing and adhering to HIV treatment among members of these groups. In this research project, I will build on my doctoral research which identified strong links between social and environmental aspects of HIV treatment delivery among drug users, such as incarceration and homelessness, on treatment outcomes in British Columbia. My proposed post-doctoral research at Harvard University with Dr. David Bangsberg, an internationally-recognized expert in the provision of HIV treatment to vulnerable groups in the United States and Africa, will investigate the barriers to effective HIV treatment using data from a study involving indigent HIV-positive individuals in the United States. Focusing on the interrelated effects of poverty, illegal drug use and mental illness on HIV treatment outcomes in a setting without universal access to care, the findings from this research project will have implications for the effective scale-up of HIV treatment and care among vulnerable populations. Expanding access to HIV treatment not only holds the promise of reducing high levels of AIDS-related morbidity and mortality within these groups but also curbing the number of new infections and controlling the HIV/AIDS pandemic. Emerging research suggests that individuals receiving effective HIV treatment are far less likely to transmit the virus to uninfected individuals. Thus, my research seeks to contribute to the global efforts to address the ongoing HIV/AIDS pandemic.