Appendix B (current research): Population-specific HIV/AIDS status report: Women

Appendix B: Current HIV/AIDS Research on Women in Canada

Project R1

Aboriginal two-spirit and LGBTQT migration, mobility and health

Principal investigator: Janice Ristock, Department of Women Studies, University of Manitoba

Abstract: This project is part of a larger research team grant: Sexuality and Gender: Vulnerability and Resilience (PI: Danielle Julien, UQAM)(see website http://www.svr.uqam.ca/index.asp). This pilot project will explore trajectories of migration and mobility of Aboriginal people who identify as two-spirit, lesbian, gay, bisexual, queer and/or transgender and the impact on health and wellness. This may include migrating from reserves to urban centres or rural communities (and back and forth) as well as staying or moving within one place. We are interested in the intersection between sexual and gender identities with cultural/Nation and other identities within the historical and present context of colonization in Canada. This purpose will be met through the following objectives: to explore the migration paths and experiences of LGBTQT Aboriginal peoples, their experiences of health/wellness in that context, and their interactions with health and social services (including mainstream, Aboriginal and LGBTQT services); to generate new knowledge that may lead to future research that will be of direct benefit to LGBTQT and Aboriginal communities, Aboriginal service providers and health/social service agencies.

Dates: 2006-2011

Funder: CIHR

Reference: HIV Research in the Prairies: A Compendium

Topic: Aboriginal two-spirit and LGBTQT

Project R2

Advancing HIV services research: Expanding Andersen's health service utilization framework

Principal investigator: Catherine A. Worthington

Abstract: HIV services research and evaluation have shown that in order to be effective, HIV services need to be tailored to the specific contexts, cultures and locales of infected populations and at risk for infection to HIV through collaborative research endeavours, particularly since many of these populations are vulnerable or marginalized. The goal of this five-year program of research, supported by a CIHR New Investigator Award, is to conduct a series of collaborative and interdisciplinary research projects to improve HIV health services for specific groups. Two projects focus on services for those living with HIV, and two projects focus on services for vulnerable populations. The first project (funded by CIHR for 2003-2005) will provide rehabilitation and HIV professionals with information on the ways in which rehabilitation services could improve health care for those living with HIV. The second project (funded by SSHRC for 2003-2006) will provide HIV clinicians with information on ways to improve clinical research practices for HIV patients. The third research project (submitted to CIHR) will provide information to Aboriginal and HIV service providers on the knowledge, attitudes, experiences, and beliefs of Ontario Aboriginal women about HIV and HIV risks to assist in services development for this vulnerable population. The fourth research project (to be prioritized for funding by Health Canada for 2004) will provide a team of HIV and street youth agencies with information on the spectrum of street youth in Calgary, their HIV and health risks, strengths, coping mechanisms, and service needs. All of these projects are collaborative in nature with direct participation of service providers and/or members of the populations under study to ensure knowledge exchange and timely uptake of research result.

Dates: July 2005 - June 2010

Funder: Canadian Institutes of Health Research (CIHR) - Clinical Research Initiative/Institute of Health Services and Policy Research New Investigator Award

Reference: CIHR database

Topic: Aboriginal women

Project R3

Antiretroviral therapy as an additional HIV prevention tool for serodiscordant couples in Uganda

Principal investigator: David M. Moore, University of British Columbia

Abstract: Despite widespread prevention efforts over the last 20 years, HIV continues to spread around the globe. Uganda is one of the few countries where the number of people with HIV has fallen in recent years. Some surveys have shown reductions in HIV risk behaviour, presumably as a result of HIV prevention campaigns. However, these changes in sexual behaviour have not resulted in reductions in the estimated numbers of new HIV infections occurring each year. It is clear that other prevention measures are needed in addition to providing counselling and condoms for individuals who may be at risk of becoming infected with HIV. Much prevention research has been focussed on developing new technologies, such as vaccines and microbicides. Antiretroviral therapy (ART) has been in use for the last decade in North America and Europe and has been shown to dramatically improve survival in HIV-infected individuals. However, because ART reduces the level of HIV in the blood, it may also have a significant role to play in preventing HIV infections. Several studies, including one from the British Columbia Centre for Excellence in HIV/AIDS have concluded that ART may have been responsible for preventing large numbers of new HIV infections in North America, East Asia and Europe, where access to ART has widely been available since 1996. However, it is not known how effective ART may be in protecting individuals from HIV infection above the protection offered by condoms and counselling. HIV-uninfected individuals who live with their HIV-infected sexual partners are amongst the most at-risk populations for acquiring HIV in Uganda. Transmission within such couples is thought to account for large numbers of new HIV infections. We, therefore, wish to study the effectiveness of ART in preventing HIV transmission among such individuals, where the HIV-infected partner is already accessing HIV basic care and/ or ART.

Dates: October 2008 - September 2011

Funder: Canadian Institutes of Health Research (CIHR) - Operating Grant

Reference: CIHR database

Topic: HIV/AIDS biomedical research (insight for Canada)

Project R4

Building capacity to reinforce adherence to antiretroviral therapy and sexual prevention for patients in or from resource-limited settings

Principal investigator: Vinh-Kim Nguyen, Lady Davis Institute, Jewish General Hospital (Montreal)

Abstract: This project aims to respond to the challenges raised by expanding access to antiretroviral therapy (ART) in Africa and the growing epidemic in women from endemic countries in Canada. Specifically, we are concerned with providing knowledge to more effectively sustain treatment effectiveness and improve prevention measures in patients on treatment, particularly for women in or from endemic countries. Our study will be a prospective multicentre cohort study in 6 sites prescribing ART in Burkina Faso and Mali. We will enrol 800 patients starting ART. In this cohort, we will describe treatment effectiveness using immunologic and clinical outcome measures (CD4 response, AIDS defining illness and death); describe adherence to HAART, using questionnaires we have previously validated in this population, by calculating time to non-adherence; and describe adherence to sexual behaviours that reduce HIV transmission risk by calculating time to consistent condom use for people with regular sexual partners and time to notification of sexual partners for those patients who have not yet notified partners of their HIV+ status.

Gender-specific models will be developed to identify factors that influence adherence and preventive behaviour for women and men separately.

Dates: July 2006 - March 2009

Funder: Canadian Institutes of Health Research (CIHR) - Capacity Building through Enhanced Operating Grants in HIV/AIDS

Reference: http://www.hivresearch.ca/index.asp?navid=18&csid1=1838

Topic: Women from countries where HIV is endemic

Project R5

Cellular immune control of HIV-1 in the female genital tract

Principal investigator: Dr. Anuradha Rebbapragada, University of Toronto

Abstract: not available

Dates: September 2004 - August 2006

Funder: Ontario HIV Treatment Network (OHTN)

Reference: http://www.hivresearch.ca/index.asp?navid=17&csid1=1162

Topic: HIV/AIDS biomedical research (insight for Canada)

Project R6

CIHR team in HIV therapy and aging

Principal investigator: Hélène Cote, University of British Columbia

Abstract: Globally, there are ~18 million women living with HIV. The vast majority of these women are of child-bearing age and ~3 million give birth annually. Treatment of HIV-infected pregnant women with antiretrovirals (ARV) reduces the rate of perinatal transmission from ~25% to <1% and is critical for the health of women who are at risk for serious opportunistic infections and/or death. Current treatment guidelines recommend combination ARV therapy for all pregnant women infected with HIV. The international community is rapidly scaling up the accessibility of ARVs in the developing world and million of infants will be soon born having had in utero ARV exposure. While it is clear that ARVs are very effective at preventing HIV transmission, very little is known about the potential adverse effects of exposing developing fetuses and infants to these drugs. HIV ARVs may have an adverse effect on the developing embryo, fetus or infant. Any potential effects of the drugs are expected to be greatest when exposure occurs during rapid development and growth. Consequently, it is of particular importance to investigate the impacts of ARV on these children. In humans, we already know that HIV ARV can cause DNA molecular changes that are strikingly similar to those occurring with aging, and that are associated with genetic diseases or conditions whose prevalence increases with age, such as degenerative illnesses and heart diseases. The goal of this Emerging Team proposal is to develop a research program focussed on the potential effect of HIV ARVs in modulating aging-related biological phenomena in the paediatric population, namely HIV-uninfected infants exposed to HIV drugs perinatally (before and after birth) and of HIV-infected children receiving ARV therapy. To our knowledge, ours is the only group in Canada working on issues related to the toxicity of perinatal and paediatric HIV ARV exposure and is uniquely positioned to undertake the research program supported by this Team grant

Dates: October 2007 – September 2012

Funder: Canadian Institutes of Health Research (CIHR) – Emerging Team Grant Program – HIV/AIDS

Reference: CIHR database

Topic: Vertical transmission

Project R7

Comparative analysis of the visibility of infected men and women in HIV/AIDS discourse and media messages

Principal investigator: Maria N. Mensah, Université du Québec à Montréal

Abstract: Not available

Dates: January 2005 – January 2008

Funder: Social Sciences and Humanities Research Council of Canada (SSHRC)

Reference: http://www.hivresearch.ca/index.asp?navid=18&csid1=1541

Topic: Gender analysis (feminist studies; comparative study; Women and men living with HIV)

Project R8

Constructing HIV risk: Sexual and drug use networks and increased vulnerabilities among survival sex workers

Principal investigator: Kate Shannon, University of British Columbia

Co-investigators: Dr. Mark Tyndall, Dr. Thomas Kerr

Abstract: not available

Dates: January 2006-December 2006

Funder: Michael Smith Foundation for Health Research Student award

Reference: http://www.hivresearch.ca/index.asp?navid=18&csid1=1379

Topic: Survival sex workers; injection drug users; women

Project R9

Correlates and control of HIV shedding and transmission in semen

Principal investigator: Rupert Kaul, University of Toronto

Abstract: The HIV-1 pandemic has claimed over 20 million lives, and 43 million people are currently infected. Sexual contact with HIV-infected semen is the major driving force behind the global pandemic, but many aspects of HIV transmission through semen are completely misunderstood. Much work is needed to lay the groundwork for the development of rational public health policy and novel therapeutic strategies. Our research group has a long-standing interest in the virology, immunology and clinical correlates of HIV shedding and transmission in the genital tract, and we propose to expand our studies of HIV semen shedding to define the correlates of virus transmission within an established cohort of HIV-infected men from Toronto, as follows: to understand the clinical and biological correlates of disproportionately high and low semen HIV shedding in HIV-infected men, both on and off antiretroviral therapy; to study the transmission of HIV in semen across the epithelium of the female genital tract, and to study the impact of specific host and viral factors; and to prospectively examine differences in the characteristics of HIV in the semen and blood of HIV-infected men.

These studies will help us to understand why HIV levels in semen are so variable, how levels are affected by host and viral factors, and to develop better public health and therapeutic tools to prevent HIV semen transmission.

Dates: October 2006 – September 2011

Funder: Canadian Institutes of Health Research (CIHR) – Operating Grant

Reference: CIHR database

Topic: HIV/AIDS biomedical research (insight for Canada)

Project R10

Defining effective anti-viral combinations in order to decrease the sexual transmission of HIV

Principal investigator: Susan M. Schader, Jewish General Hospital (Montreal)

Abstract: The HIV epidemic continues to spread at a rapid rate in underdeveloped countries. Women represent a growing percentage of new HIV infections and currently encompass nearly half of all infected adults. In the regions worst affected by the epidemic, almost 60% of all adults living with HIV are women, with those of age 15-24 years being 3 to 4 times more likely to be infected than men of the same age. The lack of widespread, affordable anti-retroviral therapy means that many of these women will have little chance for long-term survival. Thus, there is an urgent need for effective, low cost preventives against new HIV infection. The effort to develop a low-cost topical gel or cream to prevent the sexual transmission of HIV is gaining momentum. Termed 'microbicides', this type of preventative represents a potential means by which women in underdeveloped countries can effectively protect themselves from HIV infection without the use of a condom or other cooperative measures by the male or his knowledge or consent. The success in treating systemic HIV-1 infection in North America and Europe may be largely attributed to the design of treatment regimens. By including a variety of anti-viral drugs in treatment regimens, the patient is provided with an arsenal against HIV replication. A combination of drugs works better than any single drug because it prevents multiple steps in the virus life cycle, rather than targeting just one. This makes it more difficult for HIV to adapt or 'learn' how to retaliate or, in other words, develop 'resistance'. Likewise, microbicides may be more effective if a combination of drugs is included in formulations, especially since the transmission of drug resistant HIV is increasing. Furthermore, combinations of drugs can lower toxic side effects and have the potential for synergy. Therefore, this study will seek to define the most effective combinations of microbicide compounds to prevent the sexual transmission of HIV.

Dates: May 2008 – April 2011

Funder: Canadian Institutes of Health Research (CIHR) – Frederick Banting and Charles Best Canada Graduate Scholarships – Doctoral Award

Reference: CIHR database

Topic: HIV/AIDS biomedical research (insight for Canada)

Project R11

Determining the effectiveness of antiretroviral therapy in preventing heterosexual transmission of HIV among HIV serodiscordant couples in Eastern Uganda

Principal investigator: David M. Moore, University of British Columbia

Abstract: While HIV prevalence in Uganda has fallen dramatically since the early 1990s, it remains unacceptably high with 7.3% of adult women and 6.3% of adult men infected in 2005. There is concern that HIV incidence has remained largely unchanged in Uganda over the last decade and indeed may be on the increase. In this setting, antiretroviral therapy (ART) has become increasingly available in Uganda, beginning in 2003. Uganda is still only treating about 8% of the total HIV-infected population in the country. Recently, the largely unrecognized value of ART in preventing new HIV infections in industrialized countries has been highlighted with population-based studies. However, the estimates of the added preventive value of ART in sub-Saharan are limited by the lack of data on the effectiveness of ART in reducing HIV transmission through heterosexual contact. In theory, HAART should be highly effective in reducing heterosexual transmission as the risk of HIV transmission is very dependent on the level of HIV in an infected individual’s blood. However, only two studies have derived estimates for the effectiveness on reducing ART. We propose to conduct an observational study of two groups of HIV serodiscordant, co-habiting heterosexual couples; one group where the HIV-positive partner is on ART because of meeting clinical or laboratory eligibility requirements and the second group will be composed of individuals where the infected partner is not ART eligible. We propose to conduct this study among clients of The AIDS Support Organization in Mbale and Soroti districts in Eastern Uganda.

Dates: July 2008 – June 2013

Funder: Canadian Institutes of Health Research (CIHR) – New Investigator Award in Area of HIV/AIDS Services/Population Health Research

Reference: CIHR database

Topic: HIV/AIDS biomedical research (insight for Canada)

Project R12

Development and validation of interventions targeted to women living with HIV: Being in control of your personal, interpersonal, sexual and social life

Principal investigator: Joanne Otis, Université du Québec à Montréal

Abstract: For women living with HIV, quality of life is greatly impacted by the lack of control they experience in their day-to-day lives. In light of the extensive knowledge acquired from a study on the experiences of Montreal-area women living with HIV (Trottier et al., 2005), as well as the low number of interventions that appear to respond to the specific needs emerging from this study, this pilot project seeks to develop, implement and conduct a formative evaluation of an intervention (Intervention Mapping, Bartholomew et al., 2000) targeted to women living with HIV, with a view to giving them greater control of their personal, interpersonal, sexual and social lives. The pilot project will be launched in collaboration with representatives of 14 community collaborator groups. Next, the feasibility of a potential summative evaluation research project for documenting the direct and indirect effects of this intervention will be explored. The targeted intervention will be offered to four different groups of women living with HIV (n=32), who will participate in workshops focussing on various aspects of life (personal, interpersonal, sexual and social). A variety of data collection methods (trainer’s log, direct observation of workshops, a plenary with all the women following each workshop, and self-administered questionnaires beforehand and afterward) will help us adjust the intervention along the way, document the intervention’s implementation and the conditions influencing it, and ascertain the women’s assessment of the intervention in terms of structure, process and meeting objectives. Consistent with The Federal Initiative to Address HIV/AIDS in Canada, the pilot project will help women living with HIV develop their potential and improve their quality of life.

Dates: March 2006 – February 2007

Funder: Canadian Institutes of Health Research (CIHR) – Pilot Project in HIV/AIDS

Reference: http://www.hivresearch.ca/index.asp?navid=18&csid1=734

Topic: Women living with HIV

Project R13a

Development of an HIV/AIDS prevention intervention for indoor sex workers and their partners

Principal investigator: David Michael Patrick, BC Centre for Disease Control

Abstract: Women who work as commercial sex workers (CSW) in indoor sex venues (e.g. massage parlours and escort agencies) represent a large, hidden population at risk for HIV/AIDS in Canada. We will conduct a community-based research project with the goal of developing a culturally- and gender-appropriate, feasible HIV/AIDS prevention intervention for indoor CSW and men who purchase sex (clients) in the Vancouver area. Peer researchers (ex-CSW) will help conduct a survey of 300 indoor CSW and clients. We will also conduct in-depth interviews to explore the nature of how indoor CSW and clients make decisions related to HIV/AIDS risk behaviour (e.g. condom use). Using the research results, we will work with community members to develop the HIV/AIDS prevention program. The population of indoor CSW and their clients is large, but they comprise only a part of a much larger network of sexual contacts that includes members of the general population (wives, girlfriends, husbands, boyfriends, and other non-commercial sex contacts). Therefore, the findings from this research have enormous potential to reduce the overall HIV/AIDS risk to the greater population of CSW, men who purchase sex, and all of their other, non-commercial sex partners.

Dates: January 2006 – March 2009

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Operating Grant

Reference: http://www.hivresearch.ca/index.asp?navid=18&csid1=744

Topic: Sex workers (Vancouver)

Project R13b

Development of an HIV/AIDS prevention intervention for indoor sex workers and their partners

Principal investigator: Caitlin Johnston

Abstract: As we begin to prepare for Phase 3 of the ORCHID project, investigator activities will include a series of face-to-face community consultations (workshops and meetings) with peers (women with sex work experience), community leaders, service providers, sex establishment owners and managers, and male sex buyers. The purpose of the series of meetings will be to reflect on the findings of Phase 2, and discuss how they might best be put to use for development of an HIV/STI prevention initiative for CSW and male sex buyers. In collaboration with project investigators, community consultations will produce a first draft of an intervention strategy. Although the content of this draft will depend on the direction taken through community consultation, it may include documentation outlining steps required to gain access to indoor CSW and men who purchase sex; prototype educational tools (for example, posters, comic strips, pamphlets, or videos); HIV and STI training manuals for peers; and basic communication strategies that appreciate and reflect the language and culture of the population. As part of our ongoing KT activities, we will work to ensure that the ORCHID model is available to CBOs in other national or international contexts. We will continue to consult with researchers at the Center for AIDS Prevention Studies, University of San Francisco, and their community partners at the Asia and Pacific Islanders Wellness Center. Furthermore, we will expand our current network of CBO contacts by seeking out connections through postings on the Internet, presentations at national and international conferences, and the preparation and submission of manuscripts for publication in peer-reviewed journals. We will continue to develop and maintain a 'methods manual,' which is to include detailed descriptions of study methodologies, resource and education materials, and peer training modules used throughout the ORCHID project.

Dates: January 2009 - December 2009

Funder: Canadian Institutes of Health Research (CIHR) - Meetings, Planning and Dissemination Grant: Knowledge Translation Supplement

Reference: CIHR database

Topic: Sex Workers (Vancouver)

Project R14

A developmental CBR study to investigate factors leading to pregnancy and HIV risk among female street youth in Toronto

Principal investigator: Dr. Allison Scott, St. Michael's Hospital

Abstract: not available

Dates: February 2007 - January 2009

Funder: Ontario HIV Treatment Network (OHTN)

Reference: http://www.hivresearch.ca/index.asp?navid=17&csid1=2287

Topic: Female Youth (Toronto)

Project R15

Economic and equity dimensions of preventing mother-to-child transmission of HIV/AIDS in Guatemala: A pilot study with methodological insights for Canada

Principal investigator: Mira Johri, Université de Montréal

Abstract: Guatemala recently received a large disbursement of funds from the Global Fund for HIV/AIDS, TB and Malaria (GFATM) for its HIV/AIDS strategy. An urgent national priority is to conduct operational research designed to identify best practices for the newly proposed program to prevent mother-to-child transmission in Guatemala and to inform policy design as the programme is scaled up at the national level. Based on analysis of comprehensive health, behavioural and socio-economic data from 3,400 mother-child pairs, we propose to work with policy makers to identify options for enhancing programme cost-effectiveness. In so doing, we will extend and test methodological tools for economic evaluation using the net benefit regression framework, so as to address both cost-effectiveness and equity concerns. Results of the policy analysis will prove useful for Guatemala and other resource-constrained low prevalence settings. Methodological developments will be of benefit nationally for Canada as well as elsewhere.

Dates: April 2006 - March 2007

Funder: Canadian Institutes of Health Research (CIHR) - Pilot Project in HIV/AIDS

Reference: http://www.hivresearch.ca/index.asp?navid=17&csid1=1814

Topic: Vertical transmission (insight for Canada)

Project R16

Effect of antiretroviral therapy on maternal blood cell mitochondrial DNA levels during pregnancy in HIV-infected women and mitochondrial DNA damage in infants exposed to HIV antiretroviral drugs in utero

Principal investigator: Dr Deborah Money, Children and Women's Health Centre of British Columbia

Abstract: The great benefit of HAART in pregnancy must be tempered by an understanding of the risks these potential toxic medications entail for the mother, the foetus, and ultimately the HIV uninfected but in utero drug-exposed child. This study will utilize a novel assay for the determination of mitochondrial DNA (mtDNA) levels to evaluate a cohort of HIV-infected pregnant women receiving HAART, and their infants, for evidence of previously unrecognized mitochondrial toxicity.

Dates: December 2004 - July 2007

Funder: Canadian Foundation for AIDS Research (CANFAR)

Reference: http://www.hivresearch.ca/index.asp?navid=17&csid1=1435

Topic: Vertical transmission (women living with HIV)

Project R17

The effect of common genital co-infections and their therapy on HIV transmission and susceptibility

Principal investigator: Lucy Yun Young Shin, University of Toronto

Abstract: not available

Dates: September 2007 - August 2010

Funder: Canadian Institutes of Health Research (CIHR) - Doctoral Research Award in the Area of Biomedical/Clinical HIV/AIDS Research

Reference: CIHR database

Topic: HIV/AIDS biomedical research (insight for Canada)

Project R18

Effect of maternal inflammation on drug efflux transporters: Impact on fetal drug exposure

Principal investigator: Vanja Petrovic, University of Toronto

Abstract: Treating HIV infection in pregnant women requires the use of potent antiretroviral therapy to prevent both disease progression in the mother and vertical transmission to the newborn. While drug therapy is essential, there is insufficient information on the disposition of antiretroviral drugs in pregnant women and their fetuses. This information is critical as effective drug concentrations are required for the mother's health yet could pose harm to the fetus. The placenta serves as a protective barrier against xenobiotics and blood-borne toxins between the mother and the fetus. Several ATP-binding cassette (ABC) transport proteins are highly expressed in the placenta and have been found to limit the passage of many antiretroviral agents into the fetus; thereby altering fetal drug exposure. Studies in our laboratory have revealed that inflammatory responses, generated in many disease conditions, decrease the expression and activity of these ABC transporters in numerous tissues, such as liver, intestine and brain. Maternal infection is a prevalent obstetric complication associated with an inflammatory response. To date, virtually nothing is known about the impact of infection on the regulation and activity of the placental drug transporters. Therefore, the primary objective of this study is to explore the influence of bacterial and viral infections on the ABC drug efflux transporters and predict how these changes may affect the placental transfer and fetal exposure of antiretroviral drugs used in pregnant women. The results of this project will provide critical information for prediction of potential drug-disease interactions, drug selection and dosing in pregnancy and may eventually be used to minimize fetal drug exposure.

Dates: September 2008 - August 2010

Funder: Canadian Institutes of Health Research (CIHR) Doctoral Research Award

Reference: CIHR database

Topic: Vertical transmission (insight for Canada)

Project R19

Effect of toll-like receptor activation on susceptibility to HIV in human female genital tissue

Principal investigator: Kenneth L. Rosenthal, McMaster University

Abstract: Forty-five million individuals worldwide are now infected with HIV. Most have been infected following sexual transmission with this lethal virus, and almost half of those infected are women. Since HIV is sexually transmitted, the first cells to come in contact with the virus are those that line the genital tract, so-called genital epithelial cells. Recent advances in our understanding of how our innate immune system recognizes and protects us against infection are leading to a new era of disease prevention. Recently, we showed that delivery of molecules that activate our innate immune system to the genital tract of female mice completely protected them against sexual transmission of a virus. Here, we propose to study whether activating innate immune defence in human genital epithelial cells can protect against HIV infection. These studies may lead to the development of substances that women can apply vaginally to protect against HIV and other sexually transmitted infections through activation of natural innate immune defences in the female genital tract.

Dates: October 2004 - September 2007

Funder: Canadian Institutes of Health Research (CIHR) Operating Grant - Priority Announcement: HIV/AIDS Research Initiative - Biomedical / Clinical Stream

Reference: CIHR database

Topic: HIV/AIDS biomedical research (insight for Canada)

Project R20

Enhancing uptake and sustainability of HIV care and antiretroviral therapy among survival sex workers

Principal investigator: Dr. Mark W. Tyndall, University of British Columbia

Abstract: The introduction of highly active antiretroviral therapy (HAART) has dramatically changed the clinical course of HIV infection for many thousands of Canadians. It has been nearly a decade since effective medications have been available, and current treatment is highly effective, well tolerated, and has manageable toxicities. The benefits of these impressive treatment gains, however, have not been shown among marginalized populations, including sex workers and illicit drug users, who increasingly are feeling the impact of HIV. The uneven distribution of antiretroviral therapy to eligible HIV-positive people represents one of the largest disparities in Canadian health care. Although this situation presents a major challenge for health care providers and policy makers, it also provides an opportunity to develop, implement and evaluate a comprehensive program in HIV care and treatment that can greatly improve the health of this population and decrease HIV transmission. The lessons learned from this project have the potential to go beyond Vancouver's Downtown Eastside community, to become a model for other urban communities where HIV treatment is under-utilized.

Dates: July 2005 - March 2009

Funder: Canadian Institutes of Health Research (CIHR) - Reducing Health Disparities and Promoting Equity for Vulnerable Populations

Reference: http://www.hivresearch.ca/index.asp?navid=18&csid1=865

Topic: Survival sex workers (on women; publication- 2009, AIDS Patient Care STDS, Aug (23) 8: 603-9) (DTES)

Project R21

The epidemiology of sexually transmitted infections and blood-borne pathogens in an inmate population

Principal investigator: Dr. Carole Beaudoin, University of Manitoba

Co-principal: Dr. John Wylie

Co-investigators: Dr. Magdy Dawood, Dr. Trina Larsen, Dr. Marilyn Sloane, Dr. Paul Van Caeseele, Dr. Michelyn Wood

Abstract: The aim of this study is to inform effective and innovative prevention efforts in reducing the transmission of sexually transmitted infections (STI) and blood-borne pathogens (BBP) among an inmate population. The need to identify and quantify STI and BBP prevalence and related risk behaviours among individuals incarcerated in correctional facilities is necessary to inform prevention and harm reduction activities. As such, this study will engage in a collaborative research project between the University of Manitoba, the provincial health and justice ministries in Manitoba (Manitoba Health and Manitoba Justice, respectively), and the Public Health Agency of Canada to assess within an inmate population: the seroprevelance of HIV, Hepatitis C, gonorrhea, chlamydia, and syphilis; the behaviours engaged in by inmates which may put them at risk for transmission of an STI/BBP; the knowledge (or lack thereof) of disease risk behaviours; and the social and environmental barriers to disease prevention that exist within a correctional setting.

To this end, seroprevalence screening for gonorrhea, chlamydia, syphilis, Hepatitis C, and HIV, in addition to in-depth interviews, will be conducted with 400 incarcerated study participants over a six-month period. In addition to conference presentations and peer-reviewed publications, knowledge translation of the behavioural risks and the social and environmental influences on those risks will be conducted with local community organizations that support prevention, harm reduction and health services, and with both federal and provincial Health and Corrections Departments to support the development of evidence-based policy and programs

Dates: November 2007 - October 2009

Funder: Canadian Institutes of Health Research (CIHR)

Reference: http://www.hivresearch.ca/index.asp?navid=17&csid1=2134

Topic: People in prison (both male and female specified) (Manitoba)

Project R22

Evaluation of Pouvoir partager/Pouvoirs partagés, a program run by and for women living with HIV that tackles the issue of disclosure

Principal investigator: Joanne Otis, Université du Québec à Montréal

Abstract: Pouvoir Partager/Pouvoirs Partagés (PP/PP) is an empowerment program that aims to give women living with HIV the resources to disclose their HIV-positive status in a variety of contexts. The program was developed as a pilot project in 2006-2007 with the active participation of 26 women living with HIV and four workers in the Montreal area. The validation study demonstrated the relevance and usefulness of PP/PP, but it also highlighted the importance of consolidating the process whereby the workers and the women living with HIV take ownership of the program; conducting a more convincing evaluation of the project’s effects; and providing written statements of the women’s experiences with PP/PP.

The purpose of this three-year study is to mobilize women living with HIV and the people working with them and to describe their trajectory of empowerment in the context of the PP/PP evaluation. The evaluation involves the following: designing, implementing and evaluating provincial training for trainer/co-facilitator pairings; introducing and evaluating PP/PP, which the pairs will have facilitated for 11 groups of 8 to 10 participants each; and organizing and carrying out knowledge-sharing activities (community forum and producing a collective work).

The principles of Empowerment Evaluation are an inspiration for this study, which rests on the use of multiple qualitative (coordinator’s log, shared assessment groups, Web discussions, etc.) and quantitative (self-administered questionnaires) data collection methods. The purpose of this project is to help achieve the objectives of the fight against HIV that pertain to improving the quality of life of women living with HIV, as indicated in The Federal Initiative to Address HIV/AIDS in Canada.

Dates: April 2008 – March 2011

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Operating Grant

Reference: CIHR database

Topic: Women living with HIV (Montreal)

Project R23

Evaluation of the implementation of a community program aimed at improving the quality of life of Montreal-area women living with HIV

Principal investigator: Sarine L. Hovsepian, Université de Montréal

Abstract: With regard to the HIV epidemic, while antiretroviral treatments increase life expectancy, quality of life remains a concern. The proposed project will evaluate the implementation of a community program in six organizations and communities that is aimed at helping women living with HIV feel more in control of their lives. We will first evaluate the degree to which each intervention has been implemented by comparing the activities that are actually implemented to those that have merely been proposed. Next, we will outline the contextual factors influencing the implementation of the program by observing community interest and involvement, the level of project appropriation by the community, and the dynamics between actors. This will be done by observing participants and workers, interviewing key contacts and consulting activity reports. We will then evaluate how variations in implementation impact effectiveness by comparing the degrees of implementation to the outcomes of each program. This will be measured by administering questionnaires to participants before and after intervention. Finally, we will conduct quantitative and qualitative analyses to evaluate how the contextual and implementation-related factors jointly influence the program’s effectiveness. By evaluating the implementation of a community program aimed at helping women living with HIV feel more in control of their lives, we will be able to evaluate how effectively this program improves their quality of life and to gain a greater understanding of the conditions that yield positive results. This information is essential for directing the choice of environments and contexts in which similar community programs can be effectively implemented.

Dates: May 2006- April 2009

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Doctoral Research Award

Reference: http://www.hivresearch.ca/index.asp?navid=18&csid1=1811

Topic: Women living with HIV (Montreal)

Project R24

Examining the complex role of social, environmental and structural factors as barriers and facilitators for HIV risk and prevention among substance-using women in survival sex work

Principal investigator: Kate Shannon, University of British Columbia

Abstract: Women engaged in survival sex work in Vancouver’s Downtown Eastside (DTES) face multiple vulnerabilities that directly enhance their risk of HIV transmission, including entrenched poverty, homelessness, repeated episodes of violence and assault, substance abuse, and social marginalization. In addition, the illegal, clandestine and largely unregulated nature of sex trade work in Canadian cities increasingly pushes street-entrenched women to the outskirts of society, limiting their means to protect themselves and access to supportive health services. Despite increasing evidence of gender differentials in new HIV infections facing women – particularly youth and women of Aboriginal ancestry – and extensive harm reduction and public health efforts focussing on illicit drug use in this community, little information exists about the complex social, environmental and structural factors that facilitate prevention, harm reduction practices, and access to care. Kate Shannon’s research will use participatory-action research methodologies to explore the social and environmental barriers and facilitators to HIV prevention among survival sex workers. While several individual factors have been shown to elevate HIV and STI (sexually transmitted infection) risk among female substance users in this setting, far less attention has been paid to the role of social and structural violence and power relations in facilitating HIV risk through both sexual and drug use pathways. Using social mapping, focus group discussions and interview-questionnaires, research will aim to demonstrate the social and environmental factors that mitigate the HIV risk environment of survival sex workers, and, in particular, the role of violence and power relations in the negotiation of HIV prevention behaviours among drug-addicted women and their intimate and working partners. This research will provide valuable information about a population that has remained largely on the periphery of public health and about harm reduction strategies and services. It is anticipated that the research will also foster capacity building among survival sex workers and help inform evidence-based policy and be practice tailored to this population.

Dates: January 2006 – December 2006

Funder: Michael Smith Foundation for Health Research

Reference: http://www.msfhr.org

Topic: Survival sex workers, IDUs (Vancouver- DTES)

Project R25

Examining the effectiveness of a case management intervention for improving the well-being of women with HIV/AIDS: A community-based research approach

Principal investigator: Dr. Adriana Carvalhal, Voices of Positive Women (Toronto)

Abstract: Women represent one of the fastest growing groups of people infected with HIV in Canada. Woman living with HIV/AIDS face not only a chronic illness and complex medical demands, but also extensive social challenges. Research on evidenced-based behavioural interventions designed specifically for women has been neglected so far in the literature. Objectives: to determine whether 6 months of proactive strength-based case management is effective in increasing physical and mental health-related quality of life, compared to a 'usual care' general health promotion program, in women living with HIV; and to evaluate whether the case management intervention decreases depression levels, improves coping skills, and increases social support.

The proposed study will employ a mixed methods approach that combines quantitative and qualitative methods. Quantitative methods will be used to test the effectiveness of a proactive case management community-based intervention. The hundred and sixty participants will be randomized to one of two groups: A proactive case management intervention ("wHEALTH") that will include bi-weekly one-hour individual sessions; and A 'usual care' health promotion program that consists of bi-weekly one-hour group sessions. Measurement times include baseline, 1, 3, and 6 months; durability of the intervention will be assessed at 9 months.

The primary outcome will be overall physical and mental health-related quality of life. The secondary outcomes include depression, social support, coping skills, and satisfaction with services. Qualitative methods consist of in-depth interviews, conducted with a subset of 40 participants, to probe the contextual factors related to the quantitative outcomes. This CBR study is a partnership between Voices of Positive Women, Women's Health in Women's Hands, and McMaster University. Our dissemination plan will ensure that outcomes of the study will be made available to CBAOs, policy makers, and women living with HIV/AIDS.

Dates: April 2007 - March 2010

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Operating Grant

Reference: http://www.hivresearch.ca/index.asp?navid=17&csid1=2143

Topic: Women living with HIV

Project R26

Examining the relationship between intimate partner violence and human immunodeficiency virus among immigrant women in Toronto

Principal investigator: Ajitha V. Cyriac, University of Toronto

Abstract: The emergence of the AIDS global pandemic has necessitated an increased understanding of the sexual networks of core transmitter populations (e.g. female sex workers (FSWs) and their sexual partners) in order to make informed predictions about the spread of HIV. A specific limitation is the availability of information on sexual networks not involving paid sex, such as male regular partners of FSWs. My study will attempt to determine whether the harder-to-reach, male regular sexual partners of FSWs may be equally critical targets for preventative interventions. This study will be focussed in three states in India with a high burden of HIV infection (Maharashtra, Andhra Pradesh, and Karnataka). Our collaborators in India will administer questionnaires to 300-400 FSWs and collect biological samples. The FSWs in our study will direct us to interview 150-200 of their male regular partners regarding their numbers of sexual partners and other sexual behaviour patterns. With the collected data, I will help define and describe correlates of HIV infection and possibly its transmission dynamics in the three states of India hardest hit by HIV.

Dates: September 2006 – April 2010

Funder: Canadian Institutes of Health Research (CIHR) – Doctoral Research Award Area of Health Services/Population Health HIV/AIDS Research

Reference: CIHR database

Topic: Immigrant, sex workers, partner violence

Project R27

The experiences of HIV seropositive mothers living in rural Alberta

Principal investigator: Jean Groft, Faculty of Nursing, University of Alberta

Abstract: The goal of this study is to learn about the health of mothers in rural Alberta who have HIV. HIV infection rates have been increasing among Canadian women for the last 10 years. Little is known about the impact of HIV on women’s roles as mothers. Women infected by HIV face challenges as they attempt to care for themselves and their children in a society that may question their ability to be mothers. The thoughts and concerns of rural women on health issues in general are often invisible to authorities. The health of rural Canadians is poorer than that of urban Canadians. Many factors such as poverty, lack of access to resources and lack of power affect rural women and increase their risk of infection with HIV and other illnesses. Through the process of interviewing HIV-infected mothers, we will develop a better understanding of their health concerns and their ideas for addressing these issues. Approximately 20 mothers will be asked to participate in in-depth interviews. The interviews will be carefully reviewed for important themes. The findings will be shared with the women themselves and with rural communities, health care workers and volunteers, service agencies and government workers. This process will allow greater understanding of women’s experiences and the development of better ways to improve the health of women and their children.

Dates: 2005-2008

Funder: CIHR

Reference: HIV Research in the Prairies: A Compendium

Topic: Women living with HIV, mothers, rural

Project R28

Exploring the impact of cultural constructions of disease on community and health care support for immigrant women living with HIV/AIDS in Toronto

Principal investigator: Françoise Guigné, McMaster University (Hamilton)

Abstract: not available

Dates: January 2006 – January 2007

Funder: Social Sciences and Humanities Research Council of Canada (SSHRC)

Reference: http://www.hivresearch.ca/index.asp?navid=17&csid1=1601

Topic: Immigrant, Endemic (Toronto)

Project R29

The female condom: A global ethnography

Principal investigator: Amy Kaler, University of Alberta

Abstract: not available

Dates: January 2002 - January 2005, January 2006 – December 2006

Funder: Social Sciences and Humanities Research Council of Canada (SSHRC), Michael Smith Foundation for Health Research

Reference: http://www.hivresearch.ca/index.asp?navid=18&csid1=1532

Topic: Prevention

Project R30

Functional correlate of mucosal antibody response to HIV infection in blood

Principal investigator: Denis P. Snider, McMaster University

Abstract: Most infections with HIV worldwide are sexually transmitted and women are the most frequently infected. In order to protect against HIV infection and AIDS, vaccines must be effective at blocking entry of the virus. In sexual transmission, HIV enters through the mucosal surfaces of the body. These surfaces can respond with a specific type of antibody, the IgA type. Thus, when developing new HIV vaccines, we must be able to measure the amount and quality of mucosal IgA antibody against HIV. Studies have shown that women who are able to resist HIV infection have IgA antibodies against HIV, while those that become infected have little or no IgA. Unfortunately, many such studies have conflicting results or are hampered by the difficulty in sampling and testing for these IgA antibodies, using fluid samples from the mucosal surfaces. A blood test would be much more simple, reliable, and useful. We propose to use the circulating immune cells in blood responsible for IgA antibody production, as a reliable means to measure the amount and quality of mucosal IgA antibody against HIV. In our proposal, we will be able to determine if the IgA antibody was produced, how much response is evident, and how well the IgA antibody can inhibit the virus. We will look at HIV-resistant and HIV-infected people to see if any differences exist in mucosal IgA antibodies, obtained from the blood cells. These studies will provide valuable data and will prove the feasibility of measuring mucosal IgA responses, using blood samples.

Dates: March 2009 – February 2010

Funder: Canadian Institutes of Health Research (CIHR) – Catalyst Grant: HIV/AIDS Vaccine Discovery Research (Canadian HIV Vaccine Initiative)

Reference: CIHR database

Topic: HIV/AIDS biomedical research (insight for Canada)

Project R31

Galactosylceramide and sulfogalactosylceramide as receptors for HIV-1 on the vaginal epithelia

Principal investigator: Nongnuj Tanphaichitr, Ottawa Hospital Research Institute

Abstract: Despite an ever-growing understanding about HIV-1 infection and the development of very effective therapies, the spread of this virus continues at alarming rates. This highlights the need for new preventive strategies that will efficiently block HIV-1 infection. The vaginal mucosa is the site in the female body where the HIV-host cell interaction first takes place. HIV-1 is first captured onto the mucosal surface followed by its entry through the vaginal epithelial cells to reach and infect T cells and derived dendritic cells that intersperse within the mucosa. Some of these infected cells migrate to the lymph nodes, allowing further spread of HIV-1 to lymphocytes at these sites. Rapid propagation of HIV-1 then leads to its presence in the blood stream. Therefore, blocking of the initial interaction of HIV-1 with the vaginal epithelial cells would be a logical strategy to prevent viral infection at initial contact. However, information on the mechanisms of HIV-1-vaginal epithelial cell interaction is still limited. Recently, we have shown that the glycolipid, galactosylceramide (GC) and its sulfated form, sulfogalactosylceramide (SGC), both known for their ability to bind HIV-1 proteins, gp120 and gp41, are present on the vaginal epithelial cell surface. Therefore, GC and SGC may be involved in the initial HIV-1 binding to the vaginal mucosa. Antibodies that specifically block GC and SGC, as well as synthetic analogs of GC and SGC, will be used as tools to determine if blocking the interaction between HIV-1 and the vaginal epithelium can prevent HIV-1 infection of local CD4+ T cells. If capable of blocking HIV-1 binding to vaginal epithelium in the laboratory, this approach may lead to the development of compounds that can be administered into the vagina for the prevention of HIV-1 infection.

Dates: November 2007 – October 2010

Funder: Canadian Institutes of Health Research (CIHR) – Operating Grant: HIV Prevention

Reference: CIHR database

Topic: HIV/AIDS biomedical research (insight for Canada)

Project R32

Gender inequality and young, heterosexual women’s sexual agency

Principal investigator: Jennifer Whitten, Brock University

Abstract: not available

Dates: January 2007 - January 2008

Funder: Social Sciences and Humanities Research Council (SSHRC); Canada Graduate Scholarships Program - Masters Scholarships

Reference: http:www.outil.ost.uqam.ca/CRSH/Detail.aspx?Cle=53985&Langue=2

Topic: Gender; gender not specified; power; sexual negotiation; Youth

Project R33

Girl power? Studying Canadian female adolescents' sexual health, relationships and practices

Principal investigator: Marion J. Doull, University of Ottawa

Abstract: There is a clear lack of research and data on adolescent sexual health, relationships and practices in Canada. The consequences of our current narrow understanding are real; rates of sexually transmitted infections and HIV amongst youth in Canada continue to rise, with young women increasingly at risk. The proposed project will examine the sexual health, relationships, and practices of young female Canadians and will question their ideas about power and “traditional” gender roles within these relationships. Some important questions include: How do young people conceptualize power in the context of their sexual relationships? Do young women identified as sexually aggressive feel empowered? Does this supposed power translate into other areas outside the sexual realm? If power dynamics are shifting, what are the effects on young men? How are health risks (i.e. HIV, sexually transmitted infections) understood in this context? Improved understanding of sexual health, relationships and practices will allow for the creation of responsive programs that address adolescent realities with the aim of decreasing risk-taking behaviours and improving adolescent health as a whole. Adolescence is a time of great transition and the development of healthy sexual relationships creates a solid foundation for future health and well-being.

Dates: July 2005 – June 2008

Funder: Canadian Institutes of Health Research (CIHR) Institute of Gender and Health Doctoral Research Awards

Reference: CIHR

Topic: Female youth

Project R34

Global Ottawa AIDS Link (GOAL): Facilitating a learning community for innovative practice in HIV/AIDS prevention education in local ethnocultural and ethnoracial communities

Principal investigator: Carol A. Amaratunga, University of Ottawa

Abstract: Health Canada reports that the rates of HIV/AIDS among immigrants and refugees from endemic countries are among the highest in Canada, and are increasing rapidly. Yet in Ottawa, as in many communities across Canada, many people from specific cultural and racial communities do not seek treatment or support for HIV/AIDS because local programs are not sensitive to their values, beliefs, and customs. Prevention programs for these groups often fail for the same reasons, often a combined result of powerful socio-cultural taboos and systemic racism. In Ottawa, a research partnership of community members, service providers and academics called GOAL (Global Ottawa AIDS Link) has been created to build the capacity of the local community to respond to the needs of ethnoracial and ethnocultural communities regarding HIV/AIDS prevention and intervention. The group proposes to examine how race, culture and gender influence population health in relation to HIV/AIDS, and how communities develop and share knowledge around these issues. First, however, the GOAL group proposes to conduct extensive community consultation to develop a more specific research plan and mechanisms for community participation.

Dates: April 2005 – March 2006

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Catalyst Grant

Reference: CIHR database

Topic: Gender

Project R35

Health and social characteristics among female crack cocaine users in Victoria

Principal investigator: Michelle A. Coghlan, University of Victoria (British Columbia)

Abstract: In the context of illicit drug use in urban communities in Canada, the use of crack cocaine is a neglected yet increasingly relevant public health problem. Crack use has dramatically increased in cities across Canada, with Victoria reporting peak prevalence rates compared to other cities. One key aspect of the problem is user’s involvement in high-risk sexual behaviours (e.g. sex work) which increase the risk for infectious diseases, including the Hepatitis C Virus (HCV) and HIV. One population where these health risks are amplified by dynamics of gender marginalization are female crack users. Women who use crack and who are involved in sex work are at risk for poor health outcomes not only because of substance use and physical, sexual and reproductive health factors, but also due to women’s vulnerability to assault, marginalization, criminalization and exclusion from mainstream health and social institutions. Very little is known about the dynamics and harm consequences of crack use and sex work among women in Canada. Such knowledge is important for the development of targeted interventions. Using quantitative and qualitative research strategies, the aim of this research is to identify key characteristics of and dynamics related to substance use, health, social, and sexual risk behaviours among female crack users in Victoria. The research will help to widen the knowledge base on risk behaviours and risk-taking contexts by focussing on women, including protective behaviours and contexts in addition to risks. Such knowledge is essential for needs- based intervention planning and for improving the health of this high-risk population.

Dates: September 2006 – August 2009

Funder: Canadian Institutes of Health Research (CIHR) – Doctoral Research Award in the Area of Addictions and Substance Abuse

Reference: CIHR database

Topic: HIV risk factors

Project R36

HIV/AIDS Experience of Alberta women who are from countries where HIV is endemic

Principal investigator: Aniela M. Dela Cruz, University of Alberta

Abstract: The purpose of this study is to explore and understand the experiences of HIV-positive Alberta women who are from Sub-Saharan African countries where HIV is endemic. The objectives of this study are to understand how women experience their HIV diagnosis, treatment and support in their community; and to understand how women's HIV illness impacts their social and familial relationships. There are a number of women from Sub-Saharan African countries living and working in Alberta who may be infected with, or affected by, HIV. The literature shows relatively few studies which explore HIV/AIDS among immigrants to Canada from Sub-Saharan Africa. With evidence showing increased number of positive HIV tests and AIDS diagnoses in Sub-Saharan African Canadians, there is still little known of the contextual factors that contribute to this problem, or the experiences of women who are HIV positive and who are living outside of large metropolitan communities. In 2005, there were 15 documented studies or reports completed in Canada which are specific to HIV and AIDS among people from African and Caribbean countries; all have been completed in Eastern Canada and in larger metropolitan centres, such as Toronto or Montreal. Further, there are no completed studies or studies in progress that explore or document the experiences of Alberta women from Sub-Saharan African countries who are infected with, or affected by, HIV.

Dates: May 2007 – April 2010

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Doctoral Research Award

Reference: CIHR

Topic: Endemic (Alberta)

Project R37

HIV/AIDS, maternal health and motherhood: Health-related behaviours, programming implications and narrative constructions

Principal investigator: Pamela J. Downe, University of Saskatchewan

Abstract: This three-year, community-based research will identify and analyze the interrelationship between women’s experiences with motherhood and Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS). In 2006, AIDS Saskatoon identified mothers as a significant and growing constituency among those who access their services but for whom no programs were specifically designed. Twenty-one months of community-based collaboration with 17 organizations and university researchers led to the development of three research objectives: to identify the interrelationship between motherhood and HIV/AIDS; to assess how motherhood affects health-related behaviours of women accessing the services of AIDS Saskatoon; and to determine and build capacity to enhance the HIV/AIDS-related services that are identified positively by research participants.

Adopting a narrative-based approach, this research is participatory in design and will be guided by AIDS Saskatoon and a 14-member Community Advisory Committee. This project will involve the participation of Aboriginal and non-Aboriginal women who identify as mothers in two sets of interviews, a photovoice project, a two-phase programming analysis, and focus groups. Given that the increasing rates of HIV/AIDS among women are occurring primarily in those of childbearing age and that fewer than 4% of the organizations registered with the Canadian AIDS Society offer maternal health programs, this research will have far-reaching significance to the health and well-being of Aboriginal and non-Aboriginal women who have children and who are living with, affected by, and/or vulnerable to, HIV/AIDS.

Dates: April 2008 – March 2011

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Operating Grant

Reference: CIHR database

Topic: Women living with HIV; maternal child health

Project R38

HIV-positive women’s reproductive decisions: social and psychological contributors and their implications for health care delivery

Principal investigator: Anne Wagner, Ryerson University

Abstract: not available

Dates: September 2008 – August 2009

Funder: Canadian Institutes of Health Research (CIHR) – Federick Banting and Charles Best Canada Graduate Scholarships – Master’s Award

Reference: CIHR database

Topic: Women living with HIV

Project R39

HIV prevention in Canada: A meta-ethnographic synthesis of current knowledge

Principal investigator: Dr. Jacqueline Gahagan, Dalhousie University (Halifax)

Co-principal: Dr. Randy Jackson

Co-investigators: Dr. Barry Adam, Dr. Margaret Dykeman, Dr. Judith Mill, Dr. Tracey Prentice

Abstract: Over the last 25 years Canadian researchers, policy makers, and non-governmental organizations have made significant strides developing our understanding of and response to the impact of HIV/AIDS, particularly through qualitative research efforts. Yet, there has been a lack of attention to integrating findings into a cohesive synthesis. This has important implications for future knowledge and development needs and for the utilization of qualitative research in HIV prevention practices and policy development. This research synthesis grant proposal was developed with a goal to systematically review the published qualitative evidence focussed on HIV prevention health systems and to compare experiences across select populations. To support evidence-informed decision-making in three broad areas, the objectives of this proposal are: 1) to comparatively assess qualitative understanding of (a) HIV prevention for specifi ed groups affected by HIV/ AIDS in Canada; and (b) where specifi c knowledge of prevention needs may be lacking; 2) to provide useful information and recommendations where research fi ndings may not be well integrated into work undertaken at a federal/provincial policy level or at the local practice implementation level by providing information related to the effectiveness of prevention initiatives; and 3) to improve effectiveness and effi ciency of the research response regarding research areas and researcher roles.

To accomplish the goal and objectives, research team members are proposing a participatory meta-ethnographic method to guide a structured systematic review of findings that will include an initial scoping exercise to select appropriate literature, conducting a quality appraisal of relevant studies for inclusion in a synthesis of HIV prevention research, and a main interpretive review guided by a meta-ethnographic approach informed by both a gender-based and Indigenous research perspectives.

Dates: February 2008 - January 2009

Funder: Canadian Institutes of Health Research (CIHR) – Knowledge Synthesis Grant

Reference: http://www.hivresearch.ca/index.asp?navid=17&csid1=2168

Topic: Gender-based perspectives; Aboriginal women and non-Aboriginal women

Project R40

HIV risk behaviours and barriers to prevention and treatment among Aboriginal women engaged in survival sex work

Principal investigator: Kate Shannon, University of British Columbia

Abstract: Women engaged in survival sex work in Vancouver’s Downtown Eastside (DTES) are particularly marginalized and face multiple vulnerabilities including violence, predation, and increased likelihood of engaging in high-risk sexual and drug-related harms. In addition, the illegal and clandestine nature of sex trade work in Canadian cities increasingly renders street-entrenched women to the outskirts of society, limiting their access and uptake of supportive health services. While Aboriginal peoples represent only 2.8% of the general population in Canada, and approximately 4-5% of the total population of British Columbia, women of Aboriginal ancestry account for over 50% of survival sex workers in the DTES. The proposed research, through a cyclical process of community consultation and active peer participation, will explore the dynamics of HIV risk behaviours among women sex workers; and barriers to HIV prevention and treatment unique to Aboriginal women; and inform the development of an HIV prevention and care model. Given the historically oppressive nature of research in this population, a collaborative and participatory research approach through an urban drop-in centre will be highly valuable in providing women sex workers a true voice in HIV prevention and care. The social context of these women’s lives present multiple barriers that place them at high risk for HIV transmission, including power dynamics of pimps, dates, and intimate partners in safe sex negotiation, the cycle of addiction and survival sex, ongoing violence and sexual assault, entrenched poverty and high levels of mobility between rural reserves and the DTES. Using social mapping, focus group discussions, and structured interviews, this study will explore HIV risk behaviours and obstacles through the key themes of mobility, violence and addiction. The participatory approach engaging peers at all levels will provide capacity building, as well as foster community ownership and leadership in this research.

Dates: September 2005 – August 2008

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – Aboriginal – Doctoral Research Award

Reference: CIHR

Topic: Aboriginal survival sex workers (DTES)

Project R41

HIV, sexually transmitted infections, and massage parlour workers: Application of social network analysis and mathematical modeling to assess the potential for disease propagation

Principal investigator: Valencia Remple, University of British Columbia

Abstract: Women who work in massage parlours participate in paid sex work and may be at risk for HIV infection and sexually transmitted infections (STI). The purpose of this study is to apply two new research methods, social network analysis (SNA) and mathematical modeling to the evaluation of HIV and STI risk in this vulnerable, hard-to-reach group. SNA and mathematical modeling can also be used to identify central, at-risk groups or individuals and can help in the planning and evaluation of prevention and treatment programs. The study will be conducted in partnership with community groups that provide outreach services to sex trade workers. Women with past experience working in massage parlours will be hired and trained as "peer research assistants." In-depth interviews will collect information on demographics, sexual behaviour, STI history, sexual partners, and sexual networks from women working in massage parlours in the BC Lower Mainland area. Blood will be tested for HIV and urine will be tested for chlamydia. This is the first study to examine the sexual health status and risks of this population, and will help health care providers develop targeted, socioculturally sensitive HIV and STI prevention and intervention programs

Dates: January 2004 – December 2004, March 2005 – February 2007

Funder: Michael Smith Foundation for Health Research, Canadian Institutes of Health Research (CIHR) – CIHR Doctoral Research Award (HIV/AIDS) – Health Services/Population Health

Reference: http://www.hivresearch.ca/index.asp?navid=17&csid1=784

Topic: Sex workers (BC)

Project R42

The impact of antiretroviral care on the health and well being of persons infected with HIV/AIDS

Principal investigator: Dr. Robert S. Hogg, BC Centre for Excellence in HIV/AIDS

Co-investigators: Dr. Thomas Kerr, Dr. Julio Montaner, Dr. Evan Wood

Abstract: The primary objective is to establish a new population-based cohort of 500 HIV- infected men and women accessing antiretroviral therapy via the BC HIV/AIDS Drug Treatment Program. Investigators will evaluate the impact of supportive health service (like methadone treatment, MAT/DOT, physician care, pharmacy supervision, and addiction services) and ancillary services (quarterly CD4 and viral load test, and drug resistance testing as required) on adherence and response to antiretroviral therapy.

Dates: July 2006 - March 2009

Funder: Canadian Institutes of Health Research (CIHR) – Capacity Building through Enhanced Operating Grants in HIV/AIDS

Reference: http://www.hivresearch.ca/index.asp?navid=17&csid1=1810

Topic: People living with HIV (both male and female specified)

Project R43

Impact of policy decisions and service delivery models on HIV/AIDS prevention: ensuring comprehensiveness and accessibility for female adolescents

Principal investigator: Charlene Cook, University of Toronto

Abstract: not available

Dates: January 2006 – January 2009

Funder: Social Sciences and Humanities Research Council of Canada (SSHRC)

Reference: http://www.hivresearch.ca/index.asp?navid=18&csid1=1560

Topic: Female youth (women health policy)

Project R44

Impacts of social isolation and oppressions on the health of female-to-male transsexuals (FTM)

Principal investigator: Marcus S. Greatheart, University of British Columbia

Abstract: not available

Dates: September 2008 – August 2009

Funder: Canadian Institutes of Health Research (CIHR) – Frederick Banting and Charles Best Canada Graduate Scholarships – Master’s Award

Reference: CIHR database

Topic: Trans issues

Project R45

Improving access to an HIV post-exposure prophylaxis (HIV PEP) program in a sexual assault setting: Translating evidence-based findings to promote standardized health care practices

Principal investigator: Dr Sheila Macdonald, Ontario Network of Sexual Assault/Domestic Violence Centres

Co-principal: Dr. Mona Rafik Loufty (article published in 2008)

Abstract: Victims of sexual assault in Ontario receive care and treatment from a network of 34 specialized Sexual Assault and Domestic Violence Care and Treatment Centres (SATCs) based in hospitals across the province. A study, evaluating a program, which offers counselling and HIV post-exposure prophylaxis (HIV PEP) to sexual assault victims was implemented in 24 of Ontario’s 34 SATCs, 2003 – 2005. For various reasons, 10 SATCs did not implement an HIV PEP Program. In November 2005, recommendations regarding the optimal HIV PEP program for Ontario SATCs will be presented to the Ontario Women’s Health Council. It is anticipated that the release of study recommendations will prompt sustained funding from the Ministry of Health and Long-Term Care for the SATCs’ HIV PEP Program. To ensure that HIV PEP is equally accessible across Ontario, we propose a Knowledge Translation initiative to: exchange experiences of the HIV PEP Program with SATCs that implemented and those that did not; develop strategies for resolving implementation and maintenance barriers.

Integrating evidence-based findings into Ontario’s sexual assault health care, this research will improve Ontario's health delivery system by increasing access to a program of HIV prevention after sexual assault.

Dates: February 2006 – January 2007

Funder: Canadian Institutes of Health Research (CIHR) – Knowledge to Action (KTA), Phase 1: Development Grants for Local Researcher User Interaction

Reference: http://www.hivresearch.ca/index.asp?navid=18&csid1=666

Topic: Sexual assault (male and female specified; although, 97.1% women population) (Ontario)

Project R46

Intervenir AVEC les filles, pour la VIE

Principal investigator: Françoise Côté, Laval University

Abstract: The community resource Point de Repères (PdR) promotes optimal access to HIV prevention methods by distributing free condoms and sterile syringes. However, the service is unable to reach some of its clientele effectively. Workers consider this situation less than ideal, because the people whom PdR cannot reach directly are cutting themselves off from PdR’s other services. At present, it is difficult for PdR to penetrate these subgroups (which include female injection drug users and street prostitutes). Nevertheless, one natural avenue could be explored - peer intervention. The results of discussion groups with these women have shown that they would be interested in getting involved in their community. The goal of this project is to strengthen the capacities of peers involved in an intervention, help them carry out preventive actions, and evaluate the process and the effects. In an egalitarian atmosphere, women, community workers and a research team will join forces to develop an intervention continuum. In this way, this community will also be able to join the effort to prevent the spread of HIV, improve living conditions and redefine its identity.

Dates: March 2007 – March 2010

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Operating Grant

Reference: CIHR

Topic: Sex workers and IDUs

Project R47

The intracellular itinerary of HIV-1 in human trophoblasts

Principal investigator: Sonia Gauthier, Laval University Hospital Centre

Abstract: The mother-to-child transmission of human immunodeficiency virus is the primary cause of infant HIV infection. Because of HIV testing on pregnant women and the use of antiretroviral drugs, mother-to-child transmission has dramatically dropped in the last 10 years. However, worldwide statistics are more dramatic: 2.4 million pregnant women are infected and 1,600 infants acquire HIV infection every day. Mother-to-child transmission can occur at three stages: transplacental passage, exposure of the infant's skin and mucous membrane to maternal blood, vaginal secretion and breast milk. The mechanism of in utero transmission is poorly understood but the placenta seems to be implicated. The trophoblastic cells, which form the placenta, normally serve as a barrier between the mother and the foetus. However, HIV is able to infect these cells by various endocytic mechanisms. Thus, the central aim of my doctoral project will be to characterize the exact mode(s) of HIV endocytosis (macropinicytosis, clathrin-dependent endocytosis and/or clathrin/caveolae-independent endocytosis), dissect the post-entry pathway(s), and identify the mechanism(s) used by HIV to escape the endocytic compartments in polarized trophoblast cells. In order to do so, I will use virions harboring eGFP-Vpr or mRFP1-Vpr to infect trophoblast cells and then characterize those events in these cells. The proposed project will yield more detailed information on the intracellular trafficking and fate of HIV in polarized trophoblasts. This information should not be underestimated considering that the human polarized trophoblast barrier is seen as a primary target for maternal blood-borne HIV infections. The understanding of these mechanisms may help to find less expensive drugs that will prevent trophoblast infections by HIV and may be used in developing countries.

Dates: April 2005 – March 2008

Funder: Canadian Institutes of Health Research (CIHR) – Doctoral Research Award in the Area of Biomedical/Clinical HIV/AIDS Research

Reference: CIHR

Topic: Vertical transmission (insight for Canada)

Project R48

Involvement of DC-SIGN and DC-SIGNR in mother-to-child transmission of HIV-1

Principal investigator: Geneviève Boily-Larouche

Abstract: Two million children in sub-Saharan Africa are living with HIV. The majority of these infections occur as a result of mother-to-child transmission, and the rate of infection in the absence of treatment ranges from 15% to 45%. DC-SIGN, a C-type lectin expressed on the surface of dendritic cells (DC), and its homologue, DC-SIGNR, have been named as a possible means of in utero HIV infection. These molecules’ ability to bind to HIV has revealed their involvement in both cis (macrophages or DC) and trans (T-cells) virus transmission. However, their function as antigen receptors may also play a role in eliminating the virus. Since DC-SIGN/R are present at the mother-child interface and since they interact with HIV, the gene polymorphisms affecting the structure and expression of these receptors could affect the risk of vertical HIV transmission. The objectives are: 1) to determine the extent of DC-SIGN/R polymorphism in the population of Zimbabwe; 2) to determine the relationship between the polymorphisms and the risk of vertical HIV transmission; 3) to determine the impact of these polymorphisms on the structure and expression of DC-SIGN/R receptors; and 4) to study the impact of these modifications on DC-SIGN/R’s ability to cause cis and trans HIV infection and their effect on immune response.

We have studied the extent of DC-SIGN/R polymorphism and identified new variants that are significantly associated with a risk of vertical HIV transmission. The variants’ influence on protein expression and structure will be studied. Our preliminary results lead us to believe that the new variants have a major impact on the function and regulation of the DC-SIGN/R receptors and promote virus transmission. This study will provide a greater understanding of the mechanisms involved in HIV transmission and may lead to the development of innovative prevention strategies.

Dates: May 2008 – April 2011

Funder: Canadian Institutes of Health Research (CIHR) – Frederick Banting and Charles Best Canada Graduate Scholarships – Doctoral Award

Reference: CIHR database

Topic: Vertical transmission (insight for Canada)

Project R49

Involving Ontario HIV-positive women and their providers in determining their research needs and priorities

Principal investigator: Dr. Mona Loutfy, Maple Leaf Medical Clinic

Co-principal: Dr. Wangari Tharao

Co-investigators: Dr. Louise Binder, Dr. Trevor Hart, Dr. Danielle Layman-Pleet, Dr. Lynne Leonard, Dr. Janet Raboud

Abstract: Historically, there has been a deficiency in collaboration and lack of trust between academic researchers and community groups. Accordingly, there is a need for better communication and for increased input from community members and affected individuals into what research questions should be addressed. This is particularly important in the field of women and HIV/AIDS as women are continuously underrepresented in many decision-making and study design processes and the majority of research done to date has focussed on male populations. This project aims to determine what research topics interest Ontario women living with HIV/AIDS and to strengthen community-academic research, knowledge transfer and exchange partnerships. A Community Advisory Board will be formed and HIV-positive women and their service providers will be asked to participate in interviews, focus groups and surveys to generate qualitative and quantitative data.

Dates: March 2007 - September 2009

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Operating Grant

Reference: http://www.hivresearch.ca/index.asp?navid=18&csid1=2204

Topic: Women living with HIV (Ontario)

Project R50

Life at the margins: An interdisciplinary analysis of the social determinants of HIV/AIDS and women’s health

Principal investigator: Susan G. Berkhout, University of British Columbia/BC Centre for Excellence in HIV/AIDS

Abstract: Vancouver’s Downtown Eastside community has the highest rates of HIV infection and the poorest health outcomes in Canada. Female sex workers in the community are among those at highest risk of infection. The limited success of public health programs and harm reduction interventions in this population reflect the multiple barriers that compromise their access to care. This includes socio-economic factors such as poverty and unstable housing, the stigma associated with sex work, multiple addictions, and limited autonomy and personal choice. Disease control and harm reduction measures typically focus on individual responsibility, and often do not accommodate the influences that can increase HIV risk and diminish autonomy among women in the Downtown Eastside. Susan Berkhout is utilizing an alternative framework developed from contemporary feminist and bioethics literature on ”relational autonomy” to more accurately characterize HIV risk, and to produce more effective prevention and treatment strategies aimed at reducing HIV risk behaviour among female sex workers. This model considers the socioeconomic and cultural influences, and relationships involved in sex work and injection drug use. The findings should contribute to new harm reduction strategies tailored for this population, provide ethical guidance for researchers working with members of vulnerable populations, and help health care providers enhance autonomy in female sex workers.

Dates: March 2005 – February 2011, January 2006 – December 2006

Funder: Canadian Institutes of Health Research (CIHR) – MD/PhD Program Studentship; Michael Smith Foundation for Health Research

Reference: http://www.hivresearch.ca/index.asp?navid=18&csid1=404, http://www.hivresearch.ca/index.asp?navid=18&csid1=1377

Topic: Sex workers, including IDUs (SoD)

Project R51

Lipodystrophy, stigmatization and identity: A study of the identity transformation process in women living with HIV/AIDS

Principal investigator: Marilou Gagnon, University of Ottawa

Abstract: The introduction of Highly Active Antiretroviral Therapy (HAART) in 1996 transformed the prognostic of people living with HIV/AIDS. This therapeutic innovation led to a dramatic decrease in morbidity and mortality rates in the HIV population. However, we are now confronted with the new face of the HIV epidemic regarding the daily management of a disease that contains a strong social, psychological, emotional and physical burden. What is emerging from the literature and the clinical settings is that HIV-positive individuals experience the oppressiveness of a new reality, one that captures the chronicity of HIV and the concurrent re-emergence of bodily manifestations of the disease. Recent data demonstrate that people living with HIV/AIDS are willing to forego up to 15 years of life expectancy to avoid HAART-related body shape changes. This Canadian study reports the consequences of an insidious process that thrives from the physical manifestations of lipodystrophy. A number of cross-sectional studies report a high prevalence rate of lipodystrophy in people living with HIV/AIDS, reaching 80% in some populations. However, few studies have examined the biophysical, psychological, emotional, sexual and social burden of this metabolic complication. Qualitative studies report that lipodystrophy contains a strong social component. Morphological manifestations of this syndrome become the source of a multidimensional stigmatization process. This social dynamic suggests that lipodystrophy not only transforms the body, but also the identity of people living with HIV/AIDS. The present grounded theory aims at exploring this phenomenon in women living with HIV/AIDS. The main research goals will be to understand the experience of HIV-positive women who live with a disfigured body and to describe the identity transformation process that is indirectly induced by HAART.

Dates: May 2007 - April 2010

Funder: Canadian Institutes of Health Research (CIHR) – Doctoral Research Award Area of Health Services/Population Heath HIV/AIDS Research

Reference: http://www.hivresearch.ca/index.asp?navid=17&csid1=2167

Topic: People living with HIV (male and female specified; description targets women)

Project R52

MAKA initiative: HIV prevention and care among women survival sex workers

Principal investigator: Mark W. Tyndall, B.C. Centre for Excellence in HIV/AIDS

Abstract: Women survival sex workers living in Vancouver are highly vulnerable to a wide range of acute and long-term health problems, including HIV/AIDS. Many women live in poverty, and with homelessness, drug dependency, and violence. Standard health interventions have been largely ineffective. It is conservatively estimated that there are over 1,000 sex trade workers and 25% are HIV-infected in the Downtown Eastside (DTES) neighbourhood alone. In order to improve quality of life, to extend life expectancy, and to reduce the transmission of HIV in this community, it is imperative to find novel methods of community-based prevention and treatment specific to women. This project will use a cyclical process of ongoing community consultation and active participation. It will build community-based research (CBR) capacity by training and supporting a team of Peer Researchers. The project will use social mapping, focus groups, and the MAKA Women's Health survey to develop a framework for HIV prevention and care for women sex workers.

Dates: April 2005 – March 2008

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Operating Grant

Reference: CIHR

Topic: Survival sex workers (DTES)

Project R53

Maternity experiences and antiretroviral treatments among Aboriginal, Haitian and African Quebec women living with AIDS

Principal investigator: Isabelle Toupin, University of Montréal

Abstract: Few studies in Canada and Quebec, in particular, have focussed on HIV-infected women’s perceptions of antiretroviral treatments and their impact on their day-to-day lives. Even fewer studies have been done on African, Haitian and Aboriginal women in a migratory context (Gallant, 2000; Lévy et al., 2000; Rogers et al., 2000; Sendi et al., 1999). The experience of maternity, which few studies have considered, seems key to constructing the relationship to HIV infection, adherence to treatment plans and secondary prevention. Since there are few studies aimed at understanding the experiences of women living with HIV/AIDS who are on antiretroviral treatment, including their relationship to children (desire to have children, pregnancy, birth, maternity, vertical transmission), this study will help improve our currently limited knowledge. Once the study is completed, we will be able to launch secondary HIV/AIDS prevention strategies and better understand the issues related to adherence to antiretroviral treatments within the ethnocultural communities studied in this project.

Dates: September 2006 – August 2009

Funder: Canadian Institutes of Health Research (CIHR) – Doctoral Research Award Area of Health Services/Population Health HIV/AIDS Research

Reference: CIHR

Topic: Women living with HIV (Aboriginal, Endemic, Maternity, Treatment)

Project R54

Mitochondrial DNA damage in infants exposed to HIV antiretroviral drugs in utero

Principal investigator: Hélène Côté, University of British Columbia

Abstract: HIV therapy with antiretrovirals has been very successful at reducing mother-to-child transmission of HIV. If possible, HIV-infected pregnant women start HIV therapy in their second or third trimester to avoid exposing their developing baby to the drugs during early development to minimize toxicity. As women in Africa are about to receive large-scale HIV treatment, many will conceive babies while on therapy. We know that antiretroviral drugs can damage DNA, especially mitochondrial DNA (mtDNA) which is necessary for the body's energy production. This project will study the effect of HIV drug exposure at the time of conception on the mitochondrial DNA of infants born to HIV-infected mothers who were on therapy at the time they became pregnant, and compare it with that of infants exposed only later during the pregnancy, as well as unexposed HIV-negative controls. We hypothesize that infants exposed early during their development will have more mtDNA damage than those exposed later. We currently do not know what the long-term effect of exposing embryos to HIV drugs is. This research will provide crucial information that may influence how HIV-infected women of child-bearing age, as well as pregnant ones, are treated worldwide, both in terms of what drugs are used, and the timing of the therapy

Dates: April 2006 – March 2009

Funder: Canadian Institutes of Health Research (CIHR) – Operating Grant

Reference: CIHR

Topic: vertical transmission; treatment

Project R55

MSM and WSW in sexual networks in Winnipeg, Manitoba: Exploring changes in network dynamics and HIV risk

Principal investigator: Dr Stephanie S. Harvard, University of Manitoba

Abstract: not available

Dates: September 2006 – August 2008

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Master's

Reference: HIV Research

Topic: WSW (comparative with MSM) (Manitoba, Winnipeg)

Project R56

Negotiating international health policy on a local level: HIV-positive women and their experiences with infant feeding in Vancouver, Canada

Principal investigator: Françoise Guigné, Simon Fraser University (Vancouver)

Abstract: Medical research currently debates what infant feeding method should be recommended to HIV-positive mothers. Studies indicate that antiretroviral treatment effectively reduces transmission of HIV through breast milk by approximately at least two thirds by lowering the amount of HIV in the blood. However, Canadian health policy strongly discourages breastfeeding regardless of a woman’s HIV viral status after giving birth, and encourages formula feeding as the alternative. Avoiding breastfeeding may eliminate the risk of HIV transmission, but is “replacement feeding” with formula the safest most viable option?

Dates: January 2007 – December 2007

Funder: Michael Smith Foundation for Health Research

Reference: Michael Smith Foundation for Health Research web site

Topic: HIV-positive mothers and infant feeding (Vancouver)

Project R57

The Ontario Women's Study: What women have to say about HIV prevention: Implications for policy and program development

Principal investigator: Dr. Lynne Leonard, University of Ottawa

Abstract: Thematic analysis of four community consultations with distinct groups of women yielded a number of barriers to effective HIV prevention. Common themes included: lack of accessible HIV prevention information and misinformation, stigma and discrimination, social pressures, inadequate health and social services, abuse, concerns about HIV testing and difficulties in negotiating safer sex. Many of the reported experiences varied according to particular social and demographic situations. For example, inadequate health care was expressed by women from Northern areas, for Aboriginal women, physicians having limited knowledge of traditional medicines, and for Spanish-speaking women, a lack of Spanish-speaking physicians and/or the use of interpreters. These findings point to the need to consider different experiences of women in the design of prevention programming rather than considering women as one discrete homogenous vulnerable community. This project will explore how to improve targeted HIV prevention programs for women living in Ontario. In 2004, interested Ontario-based service providers and researchers started talking about the need for a community-based research project asking women to describe their HIV prevention needs. There was concern over the ‘big gap’ on women and HIV prevention research in Canada, as well as the tendency to group ‘women’ into a discrete group, with little appreciation of the diversity of their lived experiences and subsequent HIV prevention needs. The HIV Prevention Research Team at University of Ottawa was invited to help develop this study and secured a development grant from CIHR that enabled the research team to speak to service providers from around the province. Our team identified 16 unique groups of women with specific HIV prevention needs. We were also able to identify and engage key service providers and researchers working with each of the identified groups of women at risk. We are now ready to move forward with the next step of the project, which will involve conducting focus groups with our target populations. The main objectives of this study are to document among different populations of women in Ontario their understanding of HIV acquisition and the social, structural, racial, gender-based and economic factors that influence women's individual HIV-related risk behaviours; and to determine, from the perspectives of the different populations of women, best practices for reducing HIV and to transfer this knowledge to decision makers at all levels of government to drive enhanced HIV prevention policies and programming for women in Ontario and Canada.

Dates: April 2008 - March 2010; 2009-2011

Funder: Ontario HIV Treatment Network (OHTN)

Reference: HIV Research

Topic: Gender; women’s study (Ontario)

Project R58

Optimizing effective treatment strategies for antiretroviral therapy in vulnerable groups in Vancouver’s Downtown Eastside: A mathematical modelling study

Principal investigator: Kathleen N. Deering, University of British Columbia

Abstract: Study objectives: Within a cohort of female sex workers (FSWs) in Vancouver's Downtown Eastside (DTES), we aim to:

  1. understand transmission dynamics of human immunodeficiency virus (HIV) through both sexual and drug injection routes; and
  2. determine optimal treatment strategies for effective delivery of highly active antiretroviral treatment (HAART).

We will answer the following research questions:

  1. which characteristics of FSWs contribute to sustaining the HIV epidemic; and
  2. what are the optimal treatment strategies for HAART on a population level in Vancouver's DTES?

Results from this project will help direct scarce public health resources to have the greatest impact on reducing the severity of the HIV epidemic in the DTES, and help direct HIV/AIDS policy in Vancouver and similar areas. Methods: Transmission dynamics models, which account for infection biology, behavioural and demographic characteristics of the population and describe the spread of infection over time, will be used to compare treatment strategies for HAART under different assumptions for transmission reduction, HIV risk behaviour change and uptake and adherence to HAART. A series of ongoing cohort studies (BC Centre for Excellence in HIV/AIDS) will provide strong data to parameterize and build models. Multivariate statistical methods will be used to understand which parameters are the most important and explain heterogeneity in model results. Outcome of project: The following data will be collected from modelling simulations to evaluate treatment strategies under different treatment strategy assumptions (i.e. potential impact 5, 10, 15 years after HAART is introduced, versus no HAART): incidence of HAART-resistant HIV; numbers of new infections averted (acquired and transmitted); changes in HIV prevalence. Results from this analysis will provide valuable HIV treatment and care recommendations that will help maximize the use of HAART among the most marginalized groups in the DTES and Canada.

Dates: May 2008 – April 2011

Funder: Canadian Institutes of Health Research (CIHR) – Doctoral Research Award Area of Health Services / Population Health HIV/AIDS Research

Reference: CIHR database

Topic: treatment; sex workers

Project R59

Pathophysiological determinants of drug disposition: Effect of obstetric complications on placental drug transporters and its impact on fœtal drug exposure

Principal investigator: Micheline R. Piquette-Miller, University of Toronto

Abstract: Treating HIV infection in pregnant women requires the use of potent antiretroviral therapy to prevent both disease progression in the mother and vertical transmission to the newborn. While drug therapy is essential, there is a scarcity of information on the disposition of antiretroviral drugs in pregnant women and their foetus. This information is critical as effective drug concentrations are required for the mother's health yet could pose harm to the foetus. The placenta serves as a protective barrier for the foetus. Several ATP-binding cassette (ABC) transport proteins are highly expressed in the placenta and are believed to limit the passage of many antiretroviral agents into the foetus; thereby altering foetal drug exposure. Studies in our laboratory have revealed that inflammatory responses, generated in many disease conditions, decrease the expression and activity of these ABC transporters in numerous tissues including the placenta. Infections, as well as many prevalent obstetric complications (i.e. gestational diabetes), generate an inflammatory response. To date, virtually nothing is known about the impact of maternal disease on the regulation and activity of these drug transporters. Therefore, the primary objective of this study is to explore the influence of highly prevalent maternal complications on the ABC- drug transporters and determine how these changes may affect the placental transfer and foetal exposure of antiretroviral drugs used in pregnant women. This will be done by studying the expression of these transporters in placental tissues collected from women and from studying animal models of these obstetric complications. Animal models will be used to determine the disposition of these drugs in the mother and her foetus. The information generated from these studies will assist in the rational selection of drugs and dosing in pregnant women and could eventually be exploited to prevent drug exposure risks to the fœtus.

Dates: October 2005 – September 2010

Funder: Canadian Institutes of Health Research (CIHR) – Operating Grant

Reference: CIHR

Topic: HIV-positive pregnant women; HIV/AIDS biomedical research (insight for Canada)

Project R60

Perinatal exposure to antiretroviral therapy in infants born to HIV seropositive mothers: Evaluation of toxicity using mitochondrial DNA and lactate levels

Principal investigator: Dr Susan King, Hospital for Sick Children (Toronto)

Abstract: While the use of HAART in pregnancy has significantly decreased rates of mother-to-child transmission of HIV, many questions remain regarding the safety of these therapies, and their potential impact on the uninfected infant. To investigate the impact of combination ART exposure in the perinatal period on infants born to HIV-infected mothers, a novel quantitative assay for mitochondrial DNA (mtDNA) will be used in comparison to venous lactate levels and clinical signs. We hypothesize that this exposure during the perinatal period constitutes a potential risk of mitochondrial toxicity for the infant.

Dates: June 2003 – October 2006

Funder: Ontario HIV Treatment Network (OHTN)

Reference: HIV Research

Topic: Vertical transmission (treatment); exposure to treatment

Project R61

Perinatal outcomes in a provincial-based cohort of HIV-positive mother-infant pairs

Principal investigator: Tessa Chaworth-Musters

Abstract: Every year, 2.4 million HIV-positive women worldwide deliver infants. In Canada, increasingly complex highly active antiretroviral therapy (HAART) regimens are widely used by pregnant women to improve maternal health and reduce transmission to fetuses. However, there are concerns about maternal and fetal complications with HAART. Oak Tree Clinic, British Columbia’s provincial referral centre for maternal-infant care of HIV-positive women and their families, maintains a longstanding comprehensive perinatal database. Tessa Chaworth-Musters is investigating, updating and expanding this database to determine complication rates in HAART-exposed pregnancies. Chaworth-Musters is adding new data fields to reflect questions in the current literature and, where available, she is making comparisons to a provincial data set from the BC Reproductive Care Program and using statistical models to determine if specific variables impact outcomes. The findings will guide Oak Tree physicians in their treatment of pregnant HIV-positive women and contribute to improvement of provincial and national antiretroviral therapy guidelines and pregnancy practices. Chaworth-Musters also aims to clarify inconsistencies in already published data. Her overall goal is for the research to facilitate understanding of optimal, safe, effective and non-toxic treatment during pregnancy of HIV-positive women.

Dates: January 2007 – December 2007

Funder: Michael Smith Foundation for Health Research

Reference: Michael Smith Foundation for Health Research web site

Topic: HIV positive pregnant women (treatment impact) (B.C.)

Project R62

Phase II - Support for service development for HIV-positive women living in Scarborough, East York, York, North York and Etobicoke

Principal investigator: Dr. Kathryn van der Horden, Casey House

Abstract: not available

Dates: September 2007 - July 2008

Funder: Ontario HIV Treatment Network (OHTN)

Reference: HIV Research

Topic: Support for women living with HIV (GTA)

Project R63

Planning and evaluation of provincial training for workers implementing Pouvoir partager, a program for women with HIV

Principal investigator: Caroline Racicot, University of Québec in Montréal

Abstract: Not available

Dates: September 2008 – August 2009

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Master’s Award

Reference: CIHR database

Topic: Women living with HIV (Montreal)

Project R64

The post-card project: Arts-based approaches to HIV/AIDS discourse, theory and secret shaming

Principal investigator: Sarah Switzer, University of Toronto

Abstract: not available

Dates: January 2007-January 2008

Funder: Social Sciences and Humanities Research Council (SSHRC)

Reference: SSHRC Awards Search Engine

Topic: Gender; women’s studies

Project R65

Predictors of antiretroviral pharmacokinetics in HIV-infected women with virologic suppression on combination antiretroviral therapy

Principal investigator: Mona Loutfy, Women’s College Hospital (Toronto)

Abstract: Women constitute the fastest rising population group at risk for infection with HIV and AIDS in Canada. Women now constitute approximately 20% of cases in Canada. This alarming statistic is compounded by the fact that women have been routinely underrepresented in both clinical trials assessing antiretroviral (ARV) therapy and clinical HIV studies in general. There are few particular areas of HIV research on women, which are crucial to their care and quality of life that have been under-evaluated. Two of the most important areas are:

  1. How ARV therapy requirements and responses differ in women from men and
  2. ARV adverse events (AEs) and how they differ in women from men. Many small studies have suggested that HIV-infected women taking ARV treatment have more adverse events (AEs) than men.

The occurrence and management of AEs is currently the most important issue in the treatment of HIV. Understanding the differences of AEs in HIV-infected women is critical and has yet to be evaluated within a large cohort. Some studies have found that ARV drug levels are higher in women and that these higher drug levels are associated with the increased toxicity. The objective of this study is to assess ARV pharmacokinetics (Cmin and Cmax) in HIV-infected women and to determine if they are higher as compared to the mean drug levels in the historical general population (which is primarily men); as well as to assess if ARV drug levels, particularly Cmin, are associated with body weight in women; and if higher ARV drug levels, particularly Cmax, are associated with higher frequency and severity of adverse events. If funded, this study will be the largest study done assessing ARV pharmacokinetics in HIV-infected women.

Dates: April 2006 – March 2008

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Bridge Funding – Biomedical/Clinical Stream

Reference: CIHR

Topic: Women living with HIV; treatment

Project R66

Responding to gaps in HIV prevention and access to care among women in survival sex work

Principal investigator: Kate Shannon, University of British Columbia

Abstract: Our current request for additional support around knowledge translation (KT) for the Maka Project partnership will focus on responding to gaps in HIV prevention and access to care among women in street-level sex work. Our primary activity will be the facilitation of working groups that will provide a rarely existing interface for sex workers, community organizations, policy makers and researchers to exchange knowledge through a "two-way bridge". The working groups will play a lead role in identifying and drafting actionable messages specific to key target audiences (program and policy decision-makers) and planning research dissemination. Key KT strategies and outcomes of the working groups will be the creation of accessible resources based on actionable messages (both print resources and interactive website development) and a community forum launch, supported by a Health Night at the WISH Drop-In Centre. Additionally, peer workshops on KT will help to support active involvement of women in survival sex work in the working groups. Our proposed KT strategy will primarily target two key audiences: managerial decision makers (both community organizations and health authorities), and policy decision makers (both at local and federal levels), in addition to facilitating ongoing dialogue with sex workers both as active participants and recipients of program and policy changes. Although our messages will not be explicitly targeted at the general public, it is anticipated that by influencing federal decision makers through contributing to policy discussions and debate, we will be disseminating our research to a wider public audience.

Dates: January 2008 – December 2008

Funder: Canadian Institutes of Health Research (CIHR) – Meetings, Planning and Dissemination

Grant: Knowledge Translation Supplement

Reference: CIHR database

Topic: sex workers (Vancouver); access to care

Project R67

The roots of risk: How sex, drug use, and gender structure HIV risk among female sex workers in Vancouver, British Columbia

Principal investigator: Dr. Treena Orchard, BC Centre for Excellence in HIV/AIDS

Abstract: not available

Dates: January 2006 – January 2008

Funder: Social Sciences and Humanities Research Council of Canada (SSHRC)

Reference: HIV Research

Topic: sex workers (Vancouver)

Project R68

The separation of HIV from sexual and reproductive health: Social constructions of sexual citizenship

Principal investigator: Erin Connell, Carleton University

Abstract: not available

Dates: 2005-2006; 2006-2007 (fiscal year)

Funder: Social Sciences and Humanities Research Council of Canada (SSHRC)

Reference: SSHRC Awards Search Engine

Topic: gender (gender not specified; keyword-gender)

Project R69

Our search for safe spaces: A qualitative study of the role of sexual violence in the lives of Aboriginal women living with HIV/AIDS

Principal investigator: J.K. Barlow, Canadian Aboriginal AIDS Network (CAAN) (Ottawa)

Abstract: Using a combined visual/in-depth interview methodology, the Canadian Aboriginal AIDS Network will focus attention on the issue of sexual violence in the context of HIV/AIDS service provision. This exploration will ask the following research questions: (1) How do women represent and then interpret the impact of sexual violence on their lives in the context of HIV/AIDS through visual means? Visual methodology is a unique approach to research often used to explore difficult concepts that people may be unable to verbalize. (2) How does gender, culture and HIV/AIDS status manifest itself for Aboriginal women when accessing services? (3) What cultural tools or methods are being utilized by Aboriginal women living with HIV/AIDS to manage their health? (4) What policy/program implications arise when considering issues of sexual violence, gender, culture and HIV/AIDS?

Dates: April 2006 – March 2009

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – Aboriginal – Operating Grant

Reference: CIHR

Topic: Aboriginal women; sexual violence

Project R70

Sexuality, public health and citizenship

Principal investigator: Dr Robert R. Lorway, McGill University (Montreal)

Abstract: not available

Dates: January 2005 – January 2007

Funder: Social Sciences and Humanities Research Council of Canada (SSHRC)

Reference: HIV Research

Topic: lesbian identity; women’s reproductive health

Project R71

Social, structural and environmental factors mediating access and adherence to ART among HIV-positive women in low-, middle-, and high-income countries

Principal investigator: Kate Shannon, University of British Columbia

Abstract: Despite extensive efforts globally to curb the HIV epidemic, the number of new HIV infections continues to rise, particularly among women, and only 30-40% of medically eligible HIV-infected individuals are currently accessing life-saving antiretroviral therapy (ART) drugs. With women accounting for over half of the 33 million people living with HIV worldwide, and now unequivocal evidence documenting the 'feminization' of the HIV pandemic due to both increased social and biological susceptibility to HIV infection, ensuring access and adherence to ART for HIV-positive women has become a public health imperative. Unfortunately even in settings where ART is distributed free of charge, increasing evidence suggests the hidden costs of treatment (travel costs, childcare) are highly gendered. Furthermore, while growing research has identified individual clinical and behavioural predictors of access and adherence to ART, there is now some evidence to suggest that social (partner dynamics), environmental, and structural (gender, cultural and economic inequities) factors known to drive increased HIV infection risk among women in low-resource settings and marginalized populations may also reduce access and adherence to ART. In the proposed research project, I will use social epidemiology and GIS mapping, supported by qualitative methods to examine the social, structural and environmental factors that mediate access and adherence to ART programs among HIV-positive women. Drawing on data from three HIV-positive cohorts housed within the BCCfE, this research will provide a comparative analysis of the prevalence and types of barriers to ART access and adherence among women in settings with both low prevalence/concentrated (Canada, Argentina) and generalized epidemics (South Africa). It is anticipated that this research will be highly valuable in informing gender-specific community and structural level interventions that ensure improved health and survival of HIV-infected women.

Dates: August 2008 – July 2011

Funder: Canadian Institutes of Health Research (CIHR) – CIHR Bisby Fellowship

Reference: CIHR database

Topic: Women living with HIV (insight for Canada); access to care

Project R72

Strengthening community-based approaches to HIV/AIDS education, screening, and treatment among Canadian Inuit youth

Principal investigator: Dr. Jeanette Doucet, Pauktuutit Inuit Women of Canada

Co-principals: Dr. Jacqueline Gahagan, Dr. Aideen Reynolds, Dr. Audrey Steenbeek

Co-investigators: Dr. Chris Archibald, Dr. Pitsulala Lyta

Abstract: This project will begin to explore the complex interplay between culture, youth health, and gender empowerment regarding HIV/AIDS risk within Inuit communities, and determine research priorities for a multi-year study. There is an urgent need for a clearer picture of the dynamics and epidemiology of HIV risk among Inuit in Canada. Current Inuit HIV data tend to get lost among Aboriginal or broader Canadian statistics and under-represents the true situation for Inuit in Canada. This research seeks to contribute to this understanding and hopes to guide the development of sustainable community-based participatory options for HIV/AIDS interventions that are sensitive to the challenges of health promotion and health care provision in Northern communities. The project employs a community-based research methodology involving direct participation of Inuit organizations and community members. Moreover, on account of the barriers related to testing in small remote communities (lack of anonymity, stigma and discrimination, lack of access to care upon receipt of a positive test, lack of AIDS Service Organizations in the North), this community-based research methodology provides an important opportunity to build capacity for health care providers and to improve access to education, testing (anonymous testing with pre- and post-test counselling), diagnosis, care, treatment and support.

Dates: April 2007 - March 2008

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – Aboriginal – Catalyst Grant

Reference: HIV Research

Topic: interplay between culture, youth health, and gender empowerment regarding HIV/AIDS; both male and female specified

Project R73

A study of an HPV VLP vaccine in a cohort of HIV-positive girls and women

Principal investigator: Deborah M. Money, University of British Columbia

Abstract: In 2006, the first vaccine to protect against Human Papillomavirus (HPV) was approved in Canada. This vaccine protects against HPV which is the known cause of cervical cancer and genital warts. HIV-positive women have higher rates of HPV infection which progresses faster in them to cervical cancer. While HPV vaccine has been well studied in healthy young women, it is not known how well it will work in girls or women with HIV infection. This study will evaluate the HPV vaccine response in HIV-positive females from across Canada providing important data on immune responses, side effects and long-term protection against HPV in this group of women. These data are necessary to inform appropriate vaccination programs in Canada for this vulnerable group. In turn, the information from this study will also be valuable towards implementing HPV vaccine programs in the developing world where HIV infection is widespread. Although, most cases of cervical cancer in Canada are prevented by early detection via Pap smear screening, this is not the case in the developing world where access to Pap screening is limited. This vaccine has great promise to prevent both HPV infection and its serious consequences in Canada and can be life-saving on a much larger scale in the developing world where cervical cancer is a leading cause of death among women.

Dates: April 2008 – March 2013

Funder: Canadian Institutes of Health Research (CIHR) – Operating Grant

Reference: CIHR database

Topic: Women living with HIV

Project R74

Studies of host factors and HIV-1 determinants during pregnancy

Principal investigator: Dr. Hugo Soudeyns, Sainte-Justine Hospital (Montréal)

Abstract: Women living with HIV face unique challenges related to their gender. As HIV evolves into a chronic, cyclical illness, there is a need for understanding factors which enable their full participation in society. This research uses qualitative methods to identify promoters and barriers to participating in Canadian society experienced by women living with HIV. Thirty women with HIV will be recruited from the community to participate in in-depth interviews. As part of the interpretation process, the results of the interviews will be discussed with six key informants to determine how the findings might inform future action agendas for reform. The identification of women’s unique promoters and barriers to participation will assist in the development of gender- specific social and health services to optimize participation.

Dates: April 2005 – March 2009

Funder: Canadian Institutes of Health Research (CIHR) – Operating Grant – Priority Announcement: HIV/AIDS Research Initiative – Biomedical/Clinical Stream

Reference: HIV Research

Topic: Women living with HIV (pregnancy)

Project R75

Survey to access the fertility desires and needs of Ontario HIV-positive women of reproductive age

Principal investigator: Dr Mona Loutfy, Maple Leaf Medical Clinic (Toronto)

Co-investigator: Dr. Gina Ogilvie

Abstract: not available

Dates: March 2006 – March 2008

Funder: Canadian Foundation for AIDS Research (CANFAR)

Reference: HIV Research

Topic: Women living with HIV (fertility; reproductive age) (Ontario)

Project R76

The survival capacities and perceived health care needs of women involved in the sex trade who use injection drugs

Principal investigator: Victoria A. Bungay, University of British Columbia

Abstract: This study will investigate health behaviours and survival capacities of women who use injection drugs and work in the sex trade in Vancouver's Downtown Eastside. These women are at significant risk for HIV, AIDS, violence, death due to drug overdose and a series of other health-related problems. Programs designed to minimize their risk for health problems, such as increased law enforcement and needle exchange facilities have been met with little success. Factors that may contribute to these failures are: 1) these women have not been included in the decision making about what health care services they require; and 2) the emphasis of programs has been on their risk behaviours as opposed to the actions they take to keep themselves safe and promote their own health. This qualitative study uses an ecological approach to investigate personal, organizational and social systemic factors that influence women's health behaviours who are involved in the sex trade and injection drug use. In-depth face-to-face interviews will be conducted with 40 women who work in the sex trade in Vancouver's Downtown Eastside. Twenty interviews will be conducted with street nurses who provide services to this population. These two sets of population data will allow for an understanding of women's health care behaviours, the resources they perceive they need to promote their health and a comparison of these factors with the actual health and social services provided. Understanding the health behaviours of women who work in the sex trade and use injection drugs and the current resources available will allow for better harm reduction strategies to be designed and implemented thereby potentially reducing the morbidity and mortality among the study population.

Dates: August 2004 – July 2007

Funder: Canadian Institutes of Health Research (CIHR) – Frederick Banting and Charles Best Canada Graduate Scholarships – Doctoral Award

Reference: CIHR

Topic: IDU; sex workers (Vancouver)

Project R77

A systematic review of evidence linking sexual violence and HIV/AIDS

Principal investigator: Beverley J. Shea, CIET Canada (Ottawa)

Abstract: Despite the growing knowledge of evidence on HIV/AIDS very little is known about the relationship between interventions for the prevention of sexual violence and HIV/AIDS. Individuals who are HIV+ report experiencing violence directly attributable to their being seropositive. To date, there is no published high-quality systematic review summarizing this body of knowledge. This project will 1) systematically review and meta-analyze all studies conducted on interventions for the prevention of sexual violence and HIV/AIDS; 2) translate the findings and develop recommendations for their use by integrating decision makers into the review process; and 3) develop materials based on the findings for policy making and for front-line HIV/AIDS and sexual violence prevention. Research Plan: The title for this review is registered with the Cochrane Review Group on HIV/AIDS of the Cochrane Collaboration. We will follow the methods established by the Cochrane Collaborative Review Group on HIV Infection and provided by the Cochrane Collaboration Handbook for Systematic Reviews of Interventions. A protocol for the review will be submitted defining a priori the search strategy and data sources, the selection criteria, and the methods of analysis. Integrated throughout the research, beginning with formulating the research problem, are decision makers from the Public Health Agency of Canada and the Canadian Aboriginal AIDS Network who will help shape the review by providing guidance on the policy relevance, political context of the review, the inclusion criteria, and prioritizing outcomes for analysis; assist with interpreting the findings for use by addressing the strength and the applicability of the evidence, considerations, such as costs and current practice, and clarification of any trade-offs between the expected benefits, harm and cost of intervention; and develop and implement an end-of-grant translation plan to ensure the findings are accessible and useful.

Dates: October 2008 – September 2009

Funder: Canadian Institutes of Health Research (CIHR) – Knowledge Synthesis Grant

Reference: CIHR database

Topic: sexual violence (insight for Canada)

Project R78

The theory of planned behaviour: the effect of gender-related sociocultural factors on condom use intervention

Principal investigator: Jeffrey Eng, McMaster University

Abstract: not available

Dates: 2005-06 (Fiscal Year)

Funder: Social Sciences and Humanities Research Council of Canada (SSHRC)

Reference: SSHRC Awards Search Engine

Topic: gender-related (gender not specified)

Project R79

To each her own: sex work typologies, intimate relationships, and their impact on HIV risk for female sex workers in Vancouver’s Downtown Eastside

Principal investigator: Dr. Treena Orchard, University of Manitoba

Abstract: The estimated 1,000 female sex workers in Vancouver’s Downtown Eastside (DTES) live in Canada’s poorest neighbourhood, characterized by deplorable housing conditions and high rates of hepatitis C and HIV infections. HIV prevalence is an alarming 26 per cent, according to a recent study of 198 female sex workers in the DTES. Although violence, poverty and social marginalization have been identified as putting these women at risk, we know very little about two of the defining issues that characterize sex work and make these women vulnerable to HIV: types of sex workers, and the intimate relationships women form with boyfriends and regular clients. Treena Orchard is exploring whether there is a link between a particular type of sex worker and relationship structure that places certain groups of women at greater risk for HIV infection. Her hypothesis is that women with an established sex work status are more likely to form lasting relationships and avoid high-risk sexual practices. Treena’s research is examining how different types of sex workers are identified and organized, and how these women construct and attach meaning to their intimate relationships, especially in relation to the issues of sexuality, health and trust. This study will use individual interviews, focus groups and social mapping to determine the broader social processes and health determinants that structure the HIV risk of these female sex workers. Examining the social organization of sex work and relationships in this context is critical to improving the women’s health status and developing HIV prevention programs that are population and gender-specific. As one of the few qualitative studies to address these issues among Canadian sex workers, this research will be relevant to other researchers, health authorities and – through their participation – the women themselves.

Dates: January 2006 – December 2006

Funder: Michael Smith Foundation for Health Research

Reference: HIV Research

Topic: sex workers (Vancouver)

Project R80

The Toronto Black women’s HIV prevention and vaccine research forum

Principal investigator: Charmaine C. Williams, University of Toronto

Abstract: The Toronto Black Women's HIV Prevention and Vaccine Research Forum will bring together researchers, service providers, community advocates and service users to network, share information and develop strategies. The starting point for this discussion is the release of findings from the Sisters, Mothers, Daughters and Aunties (SMDA) project that investigated barriers and facilitators to the future dissemination of HIV vaccines. As successful vaccine dissemination depends on effective use of existing HIV prevention strategies including education, testing for the virus and safer sex practices, preparing Black women requires consolidation of benefits from existing prevention technologies and action to reduce barriers to existing services. This proposed initiative can contribute to these goals by disseminating knowledge from the SMDA project and research projects conducted by our collaborators that address HIV stigma and access to HIV/health care services for Black women. First, we will update the SMDA website to disseminate study findings, publicize the forum and maintain links to resources, relevant service information and related community and research projects by our collaborators. Next, we will develop fact sheets for distribution at the forum and through stakeholder groups' networks address the following topics: research findings re: barriers and facilitators to HIV prevention and HIV vaccines; education against HIV stigma and HIV misinformation; community-based HIV research - how and why to participate, how and why to reach out to communities. Finally, the forum will bring together stakeholders to strategize responses to issues identified in the SMDA project and others, develop priorities for future research and community intervention, and develop relationships that can facilitate successful execution of an education and research agenda to address HIV prevention with Black women. A summary of outcomes from this process will be distributed from the SMDA website.

Dates: September 2008 – August 2009

Funder: Canadian Institutes of Health Research (CIHR) – Meetings, Planning and Dissemination Grant: Knowledge Translation Supplement

Reference: CIHR database

Topic: prevention

Project R81

Touching knowledge, touching feeling: the question of implication and the difficult pedagogy of AIDS

Principal investigator: Alyson Hoy, University of British Columbia

Abstract: not available

Dates: 2006-2007, 2007-2008 (Fiscal year)

Funder: Social Sciences and Humanities Research Council (SSHRC)

Reference: SSHRC Awards Search Engine

Topic: gender; feminism

Project R82

Trans PULSE project: exploring HIV vulnerability in Ontario’s trans communities

Principal investigator: Greta R. Bauer

Abstract: HIV does not affect all groups equally. Studies from across North America strongly suggest that trans communities have higher than expected rates of HIV. This is perhaps not surprising considering evidence that many trans people experience violence and discrimination, and are having difficulty accessing the most basic of services. These include employment, health care, and housing. It is critical to consider these broader factors when trying to understand HIV in marginalized groups such as Ontario's trans communities. To address this, members of these communities - with partners from the Ontario HIV Treatment Network, Sherbourne Health Centre, the 519 Community Centre, the University of Western Ontario, and TGStation.com - have formed a community-based research project - The Trans PULSE Project. Trans PULSE will use a mix of qualitative and quantitative methods to provide the richest possible understanding of the ways that social marginalization may produce HIV vulnerability within trans communities and how social factors, such as health care access, as well as the source and stability of one's income, can affect quality of life for trans people who live with HIV. This project addresses a significant lack of relevant information, and reflects a desire by community members to see HIV within a broader context of trans lives and experiences. The project is made up of an eight-person Investigators Committee, five of whom are trans, who have worked together in identifying research goals, designing the study, and increasing community involvement to ensure that this research is relevant to the needs of trans communities. Community soundings, wherein trans community members in three different Ontario communities discussed their experiences around health, health care, and HIV risk, have been important in shaping the research.

Dates: April 2007 – March 2010

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – General – Operating Grant

Reference: CIHR database

Topic: Trans issues

Project R83

Two-spirit women's experience of homophobia in the context of HIV/AIDS service provision

Principal investigator: J. Kevin Barlow, Randy Jackson, Canadian Aboriginal AIDS Network (CAAN) (Ottawa)

Abstract: Adopting a community-based research design, the Canadian Aboriginal AIDS Network (CAAN) is pursuing a qualitative study of two-spirit women's experience of homophobia in the context of HIV/AIDS service provision. This study builds on a recent CAAN survey where trends are highlighted to asking more in-depth research questions:

  1. When two-spirit women access care and homophobic discrimination is encountered, how do they subjectively experience such situations? How do they understand the intersection between their identities as two-spirit, HIV/AIDS and as women?
  2. What is the impact of homophobia and heterosexism in terms of access to HIV/AIDS services? In other words, how do two-spirit women respond and what are the reasons they provide that guide their decision-making process?
  3. What are the best practice and policy features necessary to mitigate homophobia in service provision from this population's perspective? Underpinning the study, respecting principles of OCAP is essential to maximizing any potential benefit.

Dates: April 2006 – March 2009

Funder: Canadian Institutes of Health Research (CIHR) – HIV/AIDS Community Based Research Program – Aboriginal – Operating Grants

Reference: CIHR

Topic: WSW

Project R84

Understanding factors that promote and hinder participation of women living with HIV

Principal investigator: Dr. Patricia Ellen Solomon, McMaster University (Hamilton)

Abstract: Women living with HIV face unique challenges related to their gender. As HIV evolves into a chronic, cyclical illness, there is a need for understanding factors, which enable participation in society. This research uses qualitative methods to identify promoters and barriers to participating in Canadian society experienced by women living with HIV. Thirty women with HIV will be recruited from the community to participate in in-depth interviews. As part of the interpretation process, the results of the interviews will be discussed with six key informants to determine how the findings might inform future action agendas for reform. The identification of women’s unique promoters and barriers to participation will assist in the development of gender-specific social and health services to optimize participation.

Dates: October 2004 – September 2006

Funder: Canadian Institutes of Health Research (CIHR) – Operating Grant

Reference: HIV Research

Topic: Women living with HIV

Project R85

Understanding the interactions of sexually transmitted viruses in the female genital tract

Principal investigator: Charu Kaushic, McMaster University

Abstract: Sexually transmitted infections (STIs) are one of the leading causes of morbidity worldwide and a substantial burden on the health systems of both developing and developed countries. Clinical and epidemiological evidence shows that women are more susceptible to sexually transmitted pathogens compared to men. Vaccines against STIs are the only cost-effective way to control and attempt eradication of these diseases. However, extensive efforts in the last two decades to develop effective vaccines against STIs, such as Herpes simplex virus, type-2 (HSV-2), Human immunodeficiency virus, type-1 (HIV-1) and Chlamydia trachomatis have been unsuccessful. WHO figures at the end of 2004 showed that for the first time globally 50% of HIV-1 infected individuals are women. Very little is currently understood about the initial interaction of these pathogens with the genital tract in women, where they first come in contact following heterosexual transmission. Various factors in the female genital tract determine the outcome of local infection and the quality of the body's protective responses against these pathogens. Our research efforts will focus on understanding the microenvironment of the female genital tract and its interaction with sexually transmitted viruses and the immune system. These studies have important implications in women's reproductive health and will impact both STI vaccine strategies, as well as women who are currently on hormonal therapies.

Dates: September 2007 – August 2012

Funder: Canadian Institutes of Health Research (CIHR) – New Investigator Award in the Area of HIV/AIDS Biomedical/Clinical Research

Reference: CIHR database

Topic: HIV/AIDS biomedical research (insight for Canada)

Project R86

Vertical transmission of HIV-1: Tracking virus transport in trophoblasts

Principal investigator: Michel J. Tremblay

Abstract: Viruses exploit various cellular processes to infect and replicate in target cells. Although it was previously thought that, in order to lead to productive infection, entry of HIV-1 must occur after fusion with the plasma membrane, recent findings suggest that authentic cell infection can occur in some instances following entry by endocytosis. In support of this concept we recently reported that, in human polarized trophoblasts, HIV-1 is predominantly found in intracellular vesicles upon cell entry. This suggests that virus internalization is taking place mainly through an endocytic pathway in such cells. The proposed research project is aimed at gaining more information on the mechanism(s) through which HIV-1 is gaining access to human polarized trophoblasts. More specifically, we intend to define the mode(s) of HIV-1 endocytosis and dissect the post-entry pathway(s) taken by HIV -1 in this cell type. The proposed series of investigations will provide useful information on the biology of HIV-1 in trophoblast, a cellular constituent of the placenta considered as a key element in mother-to-infant transmission of HIV-1.

Dates: March 2007 – March 2010

Funder: Canadian Institutes of Health Research (CIHR) – Operating Grant – Priority Announcement: HIV/AIDS Research Initiative – Biomedical/Clinical Stream

Reference: CIHR database

Topic: HIV/AIDS biomedical research (insight for Canada)

Project R87

Women and HIV in Canada

Principal investigator: Janelle Hippe, Queen’s University

Abstract: not available

Dates: 2007-2008; 2008-2009 (Fiscal Year)

Funder: Social Sciences and Humanities Research Council (SSHRC)

Reference: SSHRC Awards Search Engine

Topic: women

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