The Center for Interdisciplinary Research on AIDS at Yale University (CIRA) has selected Dr. Sunil Parikh, Yale Schools of Public Health and Medicine; Dr. Jennifer Sherr, Yale School of Medicine; and Dr. Roman Ivasiy, Yale School of Medicine, as recipients of the 2025 CIRA Pilot Projects in HIV Research Program, including the CIRA-Yale Institute for Global Health Joint Pilot Award. The awards provide funding for preliminary and feasibility studies that will lead to larger evaluations of novel interventions or implementation strategies. The CIRA-YIGH Joint Pilot Award specifically supports research addressing the syndemics of HIV/AIDS and non-communicable diseases (NCDs). Below is a summary of the projects:
Detangling the interactions of HIV, G6PD deficiency, and diabetes in a malaria endemic setting
- Sunil Parikh, MD, MPH, Professor of Medicine and Epidemiology; Department of Epidemiology of Microbial Diseases; Section of Infectious Diseases; Yale Schools of Public Health and Medicine
- Jen L. Sherr, MD, PhD, Professor of Pediatric Endocrinology; Medical Director, Pediatric Diabetes; Yale School of Medicine
The pressure exerted from malaria gave rise to G6PD deficiency, which, in turn, hampers the ability of those also afflicted with diabetes to monitor their sugars. This award will allow us to learn about how to best monitor glucose levels in G6PD deficient individuals with and without HIV living in Uganda.
Project Summary: Sub-Saharan Africa (SSA) bears the highest numbers of persons living with HIV (PLHIV), a group for whom holistic treatment also necessitates careful monitoring for noncommunicable diseases. SSA also bears the bulk of the malaria burden, and this pressure has led to the selection for alleles conferring G6PD deficiency (G6PDdef) which protect against malaria. Previous work by our group and others have found the presence of at least a single A- allele, the most common G6PDdef variant in Africa, to be as high as 20% among Ugandan children, though rates of other low activity alleles have been poorly documented. Recent work has revealed a surprising consequence of this adaptive selection. Hemoglobin A1C (HbA1c), a widely used measure to both diagnose and monitor treatment of diabetes, is unreliable in people with G6PDdef. Thus, in order to most effectively manage HIV in areas with the highest rates of G6PDdef (SSA), an alternate measure of glucose metabolism must be investigated and applied. The impact of G6PDdef on diabetes management in malaria endemic regions has been poorly studied, possibly due to the difficulty in establishing a feasible experimental design. The proposed study will leverage our recently funded R01 investigating therapeutic interactions between HIV and malaria (OPTIMAH trial), where metabolic assessments are already planned to evaluate for metabolic effects of dolutegravir in HIV-infected children. Ultimately, we hope to elucidate which glycemic metric is optimal in HIV infected and HIV-uninfected children with G6PDdef in a malaria-endemic region. These data will assist in implementing better ways to screen for diabetes in the sizable G6PDdef population residing in the highest HIV endemic region on the world.
Exploring War-Related Mental Health, HIV Risk Behaviors, and Barriers to HIV Services Among MSM in Ukraine
Roman Ivasiy, M.D., M.P.H., Associate Research Scientist; Department of Internal Medicine; Yale School of Medicine
I am thrilled to be awarded the CIRA 2025 Pilot Project grant to investigate how prolonged war exposure impacts HIV prevention among the key priority populations highly vulnerable to HIV. As the Russia’s full-scale war in Ukraine enters its third year, widespread displacement, exposure to violence, and forced isolation continue to disrupt access to essential health services. By examining these factors, my research will provide critical insights into how war influences mental health, health risk behaviors, and HIV-related outcomes. The findings will help shape more effective, context-specific interventions that address the realities of conflict settings, ensuring that HIV prevention and care strategies remain resilient in times of crisis.
Project Summary: HIV among men who have sex with men (MSM) in Ukraine is a significant public health challenge, with MSM accounting for a high proportion of new HIV diagnoses. High-risk behaviors, such as inconsistent condom use and multiple sexual partners, contribute to the ongoing spread of HIV. The full-scale Russian invasion has caused widespread displacement, further increasing health risks among key populations, including MSM. Conflict-related trauma, along with barriers to HIV prevention and treatment, exacerbates the situation. Additionally, mental health issues like depression, anxiety, and Post-Traumatic Stress Disorder (PTSD) are prevalent, with the war worsening these conditions. The disruption of healthcare services, stigma, and reduced access to HIV treatment and prevention services complicate the situation for MSM 12 and reduced HIV testing. This study seeks to address the critical gaps by examining the mental health and HIV risk factors for MSM in Ukraine, as well as the challenges they face in accessing essential services.