Global Health Spotlight: Eric Armstrong
Eric Armstrong (he/him) is a 4th year PhD student in Dr. Rupert Kaul’s lab at the University of Toronto’s Institute of Medical Science. His current research focus is to investigate probiotic and antibiotic-based strategies to reduce HIV risk among women.
How did you become interested in HIV/AIDs research?
I became interested in HIV research during my undergraduate studies where I was fortunate to work with some amazing researchers, namely Dr. Robb Travers and Dr. Todd Coleman. At the time, I was particularly interested in exploring how the social determinants of health contribute to health disparities among racial, gender, and sexual minority groups. So, I jumped at the opportunity to do my senior thesis project looking at behavioural predictors of HIV risk among gay, bisexual, and other men who have sex with men in the Waterloo region. From there, I was exposed to the depth and complexity of HIV research and became even more interested in exploring it from a biomedical perspective, as I’m doing now in Dr. Rupert Kaul’s lab.
In the general public’s mind, HIV is not the death sentence it used to be because of antiviral drugs. From your perspective, why is HIV/AIDs research still important today? Do you have any predictions regarding the future of HIV/AIDS research?
Where do I begin! At a broader level, two of the biggest HIV research goals nowadays are arguably cure and vaccine strategies, neither of which exist in scalable forms. Even in settings where antiretroviral therapy (i.e., HIV treatment) is fairly accessible, there is a large body of work investigating the negative health outcomes associated with chronic HIV infection and the side effects of long-term antiretroviral therapy use, with the goal of improving these long-term health outcomes and ultimately, quality of life and life expectancy. In settings where antiretroviral therapy is much less widely available, such as resource-limited settings in Sub-Saharan Africa, research foci can differ quite a bit. In these settings, there is much more emphasis on developing and optimizing scalable HIV prevention strategies. Given the reduced accessibility of preventative antiretroviral therapy (i.e., pre-exposure prophylaxis, or PrEP), there is greater attention placed on alternative prevention strategies that are relatively scalable and affordable, such as the treatment of other sexually transmitted infections and bacterial vaginosis (the latter being my current research focus). With this said, this is certainly not an exhaustive list of where the field is currently focused. Regarding the future of HIV research, I believe there will be greater focus on “functional” cures, which would include antiretroviral therapy that only requires dosing every few months rather than every day. While this might not be a “one and done” solution, it has significant implications for the accessibility of HIV treatment in both here in Canada and in resource limited settings. I may be biased since this is my current research focus, but I think the future of HIV research will also include more efforts to develop affordable prevention strategies, and eventually, working towards scaling these strategies up in different settings.
How do HIV diagnosis and treatment differ in countries around the world? Are there existing systemic barriers preventing certain countries from accessing treatment?
As I alluded to in the last question, the accessibility of antiretroviral therapy (and diagnosis) for HIV varies widely around the world. While the stigma associated with HIV in Canada and exclusion of BIPOC and 2SLGBTQ+ individuals from the healthcare system remain major barriers to diagnosis and treatment, the relatively wide availability of antiretroviral therapy and PrEP and clinical capacity to provide testing services, particularly in medium to large-sized cities, is a major step in the right direction. However, this is not the case all over the world. In resource-limited settings in regions like Sub-Saharan Africa, there are substantial financial and sociocultural barriers to antiretroviral therapy/PrEP and diagnostic tools. Even things like transportation to clinics for HIV testing can represent a major barrier to HIV testing and treatment in settings where there is not a nearby clinic that has the capacity to provide these services.
Have there been any efforts towards developing an HIV vaccine? Is it possible to ensure equitable distribution of the vaccine? If it is possible, what are some ways that we can accomplish this goal?
There have been many efforts to develop an HIV vaccine, but as of now there is not an effective one. Regarding the equitable distribution of an HIV vaccine, I would certainly hope that there would be equitable distribution, but I have my reservations as well. As we saw with the rollout of the COVID-19 vaccine, there was an enormous gap in the availability of the vaccine between countries like the US or Canada and resource-limited settings. Even within Canada, barriers to care faced by minority populations like the 2SLGBTQ+ community and African, Caribbean, and other Black individuals (all of whom are disproportionately affected by HIV in Canada) would undeniably have implications for the accessibility of an HIV vaccine. But that’s not to say all hope is lost, there are many things that we can do to make the distribution of an HIV vaccine more equitable. In Canada, this could include close collaboration with leaders of communities disproportionately affected by HIV to facilitate culturally competent distribution of the vaccine to these communities. Worldwide, this could include the prioritization of resource-limited settings and investment in other social determinants of health, such as the transportation to clinics providing the vaccines.
How do the social determinants of health contribute to HIV/AIDS vulnerability? Have there been any efforts to address the social risk factors of HIV/AIDS that disproportionately affect BIPOC, 2SLGBTQ+, and low-income communities?
There are a number of ways that we can think about vulnerability to HIV, including risk of acquiring HIV among HIV negative individuals and resistance to serious non-AIDS events among people living with HIV, all of which are affected by the social determinants of health. For example, employment and housing status can have important implications for the availability of antiretroviral therapy and PrEP, both in terms of affordability and proximity to clinics. However, it’s important to remember that these relationships are multidirectional. For example, HIV infection itself can negatively impact social determinants of health such as one’s social environment. In line with this, HIV prevention strategies that focus on individual behaviours have shown some benefit (e.g., individual-level counselling, promoting condom use, etc.), but tend to be much more successful when they address the broader social factors (i.e., the social determinants of health) that contribute to the elevated HIV risk faced by BIPOC, 2SLGBTQ+, and low-income communities. Fortunately, we’re now seeing more HIV prevention initiatives incorporate (or focus entirely) on the social determinants of health, like peer-driven HIV prevention strategies among sex workers and needle exchange programs. In any case, it’s important to remember that HIV vulnerability is complex and multifactorial and requires equally multifactorial interventions to adequately address.