Structural Determinants & Social Transitions among Adolescents and Young Adults in Rakai (SSTAR)

Department Receives a $3.5 Million Grant from National Institute for Child Health and Human Development to Study Factors Associated with HIV Incidence among Youth in Rakai, Uganda.

The Mailman School's Heilbrunn Department of Population and Family Health received a $3.5 million grant from the National Institute for Child Health and Human Development (NICHD) to study the influence of social structural determinants and social transitions among adolescents and young adults on HIV incidence among youth in Rakai, Uganda.

Over the past 9 years, Columbia investigators have been examining HIV risk among this age group through the Rakai Community Cohort Study (RCCS). Established in 1994, the RCCS is a population-based, open cohort which has provided the framework to conduct multiple studies including the Rakai Youth Project which investigated risk factors associated with HIV incident infections among young people. That project explored social context, adolescent development, biological and behavior risk factors, and the impact of changing HIV prevention and care policies. The Rakai Youth Project demonstrated particularly the importance of school enrollment and school leaving on HIV risk over time among adolescents. The finding from the Rakai Youth Project raises new questions: about how social and social transition influence HIV infection and the impact of HIV biomedical and behavioral interventions such male medical circumcision on HIV risk. 

Understanding the social processes that produce HIV risk and that protect young people from HIV infection will be critical to develop the next generation of HIV prevention programs for youth. Beyond individual characteristics and behaviors, social structural factors (e.g. socioeconomic status, educational opportunities, gender, AIDS orphanhood, public policies) and the timing of adolescent and young adult social role transitions (e.g. leaving school, initiation of sexual behaviors, migration and leaving home, marriage formation and dissolution) may be critical drivers of HIV acquisition and other reproductive outcomes among youth.

In SSTAR (Structural and Social Transitions among Adolescents and young adults in Rakai), investigators examine the influence of social structural determinants on transitions from adolescence to adulthood using RCCS cohort data. Innovative mixed quantitative and qualitative methods are being deployed to define risk factors for and trends over time in key social transitions (sexual initiation, school leaving, marital formation and dissolution, migration, initiation of childbearing), as well as to understand interrelationships among these transitions (ordering, timing, tempo) and their consequences (HIV risk behaviors, acquisition) among adolescents and young adults (15-24 years). Investigators also seek to understand the direct influence of social determinants on HIV acquisition as well as to identify indirect pathways as mediated by social transitions. Finally, the influence of social determinants and social transitions on HIV acquisition will be explored in three distinct community types: 1-hotspots with high HIV incidence, 2-trading and transport hubs with intermediate levels of HIV incidence, and 3-rural communities with low HIV incidence.

This innovative initiative brings together investigators from Makerere University, the Uganda Virus Research Institute, the Rakai Health Sciences Program (RHSP) in Uganda, Johns Hopkins University, and Washington University with researchers from Columbia University. The SSTAR project is led by Dr. John Santelli, professor with the Department of Population and Family Health and co-principal investigator Dr. Fred Nalugoda, an epidemiologist at RHSP. Senior investigators from the Mailman School of Public Health include Dr. Jennifer Hirsch, Professor with the Department of Sociomedical Sciences, Dr. Ying Wei, Professor with the Department of Biostatistics and Dr. Susie Hoffman, Associate Professor with NYSPI/RFMH.