HIV AIDS in Africa

HIV/AIDS continues as a major health crisis in sub-Saharan Africa, where over two-thirds of the world’s HIV-infected population resides. Antiretroviral treatment (ART) represents a potential turning point in combating the epidemic. ART has proven effective in treating HIV-infected populations, and its use has increased dramatically in recent years. As of the end of 2008, nearly 3 million people in sub-Saharan Africa had received ART, yet this represents less than half of the people in urgent need of treatment.

Policymakers face the challenge of scaling up ART not only in sub-Saharan Africa but also in other parts of the developing world. Attempts at scale-up will be truly effective only if they address both efficiency of treatment delivery and the broader social and economic requirements for fully reintegrating HIV/AIDS patients back into their communities. RAND’s work is providing vital information to address those requirements.

Cooperative Research on HIV/AIDS in Uganda

Formation of a partnership between Makerere University in Uganda, RAND, and care provider organizations in Uganda. The primary goal of this consortium is to strengthen the research infrastructure and capacity of Makerere University and its local community partners to enable its investigators to conduct rigorous social and behavioral HIV research that will begin to address the challenges Uganda faces with regard to HIV prevention and ART scale-up. Contact: Glenn Wagner, PhD (Glenn_Wagner@rand.org)

Depression's Role in Health Outcomes of HIV Clinic Patients

A collaboration with Ugandan investigators to examine the role of depression and its treatment in moderating multiple health outcomes of patients receiving antiretroviral therapy at two HIV clinics in Uganda. Few studies have examined this relationship in sub-Saharan Africa. If depression and its treatment are found to impact health outcomes, then effective diagnosis and treatment of depression may play a major role in maximizing the cost-effectiveness and sustainability of ART scale-up. Contact: Glenn Wagner, PhD (Glenn_Wagner@rand.org)

Microcredit and Economic/Social Outcomes of HIV Clients'

An exploration of how microcredit (small, collateral-free loans) affects the economic status of HIV clients and their households in Uganda, and how changes in economic status are associated with physical and mental health, social well-being, and sexual risk behavior. No systematic evaluations exist of microcredit programs that specifically target people living with HIV, yet they can play a critical role in enabling clients to provide for themselves and their families, improve quality of life, and protect against potential risks, as well as indirectly affect social outcomes (e.g., school attendance, HIV disclosure, household continuity) and sexual risk behaviors (e.g., trading sex for money or protection, negotiation of condom use) that are influenced by economic factors. Contact: Glenn Wagner, PhD (Glenn_Wagner@rand.org)

Social Network Dynamics and HIV Care Retention and Adherence

A longitudinal study of people living with HIV/AIDS in urban and rural Uganda to examine the extent to which social networks change over time and how network characteristics (supportive or stigmatizing) are related to HIV disclosure and treatment retention and adherence. Substantial evidence shows that stigma is a significant barrier to seeking and adhering to treatment, while social support is associated with safer sex, HIV testing, initiating and staying in HIV care, and disclosure of HIV status to family and friends. A more thorough understanding of the composition and structure of social networks has important implications for developing new and innovative public health HIV/AIDS interventions. Contacts: Hank Green, PhD (Hank_Green@rand.org), Gery Ryan, PhD (Gery_Ryan@rand.org), or Glenn Wagner, PhD (Glenn_Wagner@rand.org)