SOCIAL AND STRUCTURAL IMPACT OF HIV/AIDS 

RELEASE DATE:  November 14, 2002

PA NUMBER:  PA-03-027

EXPIRATION DATE:  August 2005, unless reissued. 

National Institute of Child Health and Human Development (NICHD) 
 (http://www.nichd.nih.gov)
National Institute of Mental Health (NIMH) 
 (http://www.nimh.nih.gov)
 
THIS PA CONTAINS THE FOLLOWING INFORMATION

o Purpose of the PA
o Research Objectives
o Mechanisms of Support 
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Where to Send Inquiries
o Submitting an Application
o Peer Review Process
o Review Criteria
o Award Criteria
o Required Federal Citations

PURPOSE OF THIS PA

This Program Announcement (PA) calls for research examining the social, 
demographic, economic, and other structural impacts of HIV in populations 
around the globe.  As of the end of 2001, 40 million adults and children 
worldwide were living with HIV/AIDS.  Fourteen million children under 15 had 
lost one or more parents to AIDS.  In 2001 alone, five million new infections 
and three million deaths are estimated to have occurred.  An epidemic of this 
size and scope not only affects the immediate victims of disease but also 
their families, communities, and many aspects of the larger society as well.  
Research on the nature of these effects and the mechanisms driving them is 
crucial to addressing them effectively.  

RESEARCH OBJECTIVES

Background

Illness, disability, and death associated with the HIV/AIDS epidemic affect 
populations at multiple levels and in multiple ways.  Families experience the 
death and incapacity of loved ones and providers and must cope, in addition, 
with the burden of caring for the sick and dying.  Businesses, schools, 
hospitals, and other institutions lose valuable personnel; absenteeism 
increases and productivity declines.  Food security is threatened, the result 
of effects on the production of food and the ability of households to afford 
a nutritious diet.  School enrollments decline and the payoffs to investments 
in education are undercut by high death rates among young adults.  The 
economic costs of addressing HIV and its effects, both in the health sector 
and in other sectors of the economy, divert resources from other important 
needs and from investments critical to economic development.  The demographic 
structure of the population is affected, challenging systems for supporting 
dependent populations such as children and the elderly.  In many cases, the 
impact of the HIV/AIDS epidemic on families, communities, and countries has 
feedback effects that influence the course of the epidemic –- for example, 
poverty and the breakdown of social and economic systems impair community 
systems that could help to stem the spread of infection.

Many factors are likely to have important influences on these effects as well 
as the ability of populations to respond to them.  Resources initially 
available to combat the epidemic are likely affected by characteristics of 
the age structure, economic systems, cultural and political systems, and 
institutions present in a country before the epidemic gathers momentum.  The 
geographic, demographic, and social characteristics of the epidemic -– how 
infection and death rates are distributed over geographic and social space 
and the dynamics of change in that distribution -- have important 
implications for how societies experience and respond to the impact of 
HIV/AIDS.  

Concern about the current and potential future impact of the HIV/AIDS 
epidemic around the globe has increased dramatically in recent years.  Many 
in the international community are recognizing the need for research that 
measures different kinds of impacts and improves our understanding of them. 
Such studies have great potential to inform policy makers and planners as 
they formulate responses to the epidemic.  

Modeling, based on surveillance data, is a primary tool for assessing the 
size and future of the epidemic itself, and existing advances in modeling 
will be essential to studying HIV/AIDS impact.  However, other data and 
approaches will also be necessary for informing policy and evaluating 
responses to the epidemic.  This PA seeks to stimulate innovative approaches 
to understanding the complex mechanisms underlying the multiple impacts of 
HIV/AIDS in a variety of populations across the globe.

Research Scope

Applications submitted in response to this PA should examine the social, 
demographic, economic, or other structural impacts of HIV in populations. 
Research may focus on how populations, societies, communities, and families 
and other institutions are affected by the epidemic and how they adapt.  
Applications may also address the consequences of particular ways of 
adapting, and the supports or strategies that might help to protect the 
viability of social and economic systems, families, and other social units. 

Research grant applications should be grounded in a theoretical model that 
traces the mechanisms through which the HIV/AIDS epidemic has its impact.  
For example, some effects may be a function of age structure changes; others 
may be the result of changes in the health status of the population; others 
may relate to the geographical distribution of the disease; others may relate 
to the cultural, economic, or social structural characteristics that 
influence how the impact of the epidemic is experienced. 

A wide range of extant data may be useful for studies submitted in response 
to this Program Announcement.  They include, but are not limited to, local 
and national censuses, surveys, and administrative records such as death 
certificates or bequests.  Innovative uses of extant data are encouraged.  
New data collection is permitted in cases where extant data are not adequate 
to meet the aims of the proposed study.  Studies are sought from all parts of 
the globe where the HIV epidemic is having an increasing or substantial 
impact, and across a variety of domains (family, business, government, etc.)  
International and cross-disciplinary work is encouraged. 

Studies are called for to address the impact of HIV/AIDS on outcomes such as:

o Mortality and morbidity, especially the HIV-related morbidity and mortality 
of working-age adults.  This includes but is not limited to: 

1. Ramifications of HIV-related mortality on the numbers and conditions of 
orphans, siblings, surviving grandparents, and extended families. 

2. How HIV-related mortality is related to changes or declines in the labor 
force, through changes in qualifications of employees, age structure of labor 
force, and/or expenditures for benefits.

o Population movement, e.g., changes in temporary migration and remittance 
flows; migration to seek or provide care.  

o Fertility, including but not limited to:  

1. Changes in fertility due to HIV infection. 

2. Effects of HIV-related child mortality on fertility. 

3. Effects of HIV infection on fecundity in both men and women.

o Other demographic effects, including changes in age structure, dependency 
ratios, and changes in the spatial distribution of populations

o Household/family structure characteristics and processes, including:  

1. Changes in household and family structures, burdens of dependency within 
households and extended families, and patterns of household headship.

2. Provision of basic necessities (e.g., shelter, clothing, nutrition).

3. Changes in the nature and quantity of family resources (money income, 
home-produced food and goods, social ties and social capital).

4. Parenting, childcare, elder care.

5. Household decision-making and the distribution of power within households 
and families.

6. Changes in the allocation of family resources.

o Community processes and characteristics, such as increasing poverty and 
widening income inequality, changes in local infrastructure, job 
opportunities, or social interaction; changes in abilities of traditional 
sources to provide for social, emotional, or economic support; declines in 
the social cohesion of communities.

o Specific sectors of the economy or society, such as:

1. Health, including loss of workers and declines in productivity and morale 
among workers at all skill levels; allocation of health sector resources to 
various aspects of HIV (prevention, VCT, treatment, care) and other health 
needs; changes in the organization, staffing, and delivery of health 
services; changes in health service financing. 

2. Government and political systems, including effects on levels of civic 
participation, policy, and law, and the availability of qualified personnel 
for civil service and political positions. 

3. Education, including declines in the supply of teachers and administrators 
and changes in demand for education as a consequence of impoverishment or 
population decline in certain areas. 

4. Agriculture, food production, and land tenure.

5. Defense sectors, national security, military training and readiness.

6. Business and industry, including changes in investment, productivity, and 
profitability as a result of absenteeism, or as changing hiring practices are 
implemented to avoid increasing health insurance obligations. 

7. Tourism.

8. Prisons, civil unrest, and crime rates. 

9. Social and religious institutions.

o Intervening mechanisms producing specific impacts; for example, the role of 
poverty, disability, and multiple demands on healthy individuals in producing 
effects on the economic and social health of communities.

o Measurement issues in studying the impact of the HIV/AIDS epidemic, with 
particular attention paid to:
  
1. Methods to compensate for incomplete vital registration data. 

2. The appropriate uses of verbal autopsy data for examination of death by 
cause. 

3. The use of GIS to examine land use in relation to HIV rates.

4. Appropriate measures of the cost-effectiveness of interventions to 
ameliorate the impact of HIV/AIDS, examining both the input and the outcome 
of such studies at differing levels of HIV prevalence within a society.

5. The utility of antenatal surveillance as a predictor of HIV incidence in a 
population.

MECHANISMS OF SUPPORT 

This PA will use the NIH Research Project Grant (R01) and Small Grant (R03) 
award mechanisms.  As an applicant, you will be solely responsible for 
planning, directing, and executing the proposed project

This PA uses just-in-time concepts.  It also uses the modular budgeting 
format (see http://grants.nih.gov/grants/funding/modular/modular.htm).   
Specifically, if you are submitting an application with direct costs in each 
year of $250,000 or less, use the modular format.  Otherwise follow the 
instructions for non-modular research grant applications.

ELIGIBLE INSTITUTIONS 

You may submit an application if your institution has any of the following 
characteristics:

o For-profit or non-profit organizations 
o Public or private institutions, such as universities, colleges, hospitals, 
and laboratories 
o Units of State and local governments
o Eligible agencies of the Federal government  
o Domestic or foreign
o Faith-based or community-based organizations 

INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS

Any individual with the skills, knowledge, and resources necessary to carry 
out the proposed research is invited to work with their institution to 
develop an application for support.  Individuals from underrepresented racial 
and ethnic groups as well as individuals with disabilities are always 
encouraged to apply for NIH programs

WHERE TO SEND INQUIRIES

We encourage your inquiries concerning this PA and welcome the opportunity to 
answer questions from potential applicants.  Inquiries may fall into two 
areas:  scientific/research and financial or grants management issues:

o Direct questions about scientific/research issues to:

Susan Newcomer, Ph.D.
Demographic and Behavioral Sciences Branch
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8B07, MSC 7510
Bethesda, MD 20892-7510
Telephone:  (301) 435-6981
Email:  Snewcomer@nih.gov 

Willo Pequegnat, Ph.D.
Center for Mental Health Research on AIDS
National Institute of Mental Health
6001 Executive Boulevard, Room 6-205, MSC 9619
Bethesda, Maryland 20892-9619
Telephone:  (301) 443-1187 
FAX:  (301) 443-9719
Email:  WPequegn@mail.nih.gov 

o Direct questions about financial or grants management matters to:

Kathy Hancock
Grants Management Branch
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8A17M, MSC 7510
Bethesda, MD 20892-7510
Telephone:  (301) 496-5482 
Email:  hancockk@nih.gov

William F. Caputo 
Grants Management Branch
National Institute of Mental Health
6001 Executive Boulevard, Room 6115, MSC 9605
Bethesda, MD 20892-9605
Telephone:  (301) 443-0004
FAX:  (301) 443-6885
Email:  wcaputo@nih.gov

SUBMITTING AN APPLICATION

Applications must be prepared using the PHS 398 research grant application 
instructions and forms (rev. 5/2001).  The PHS 398 is available at 
http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive 
format.  For further assistance contact GrantsInfo, Telephone (301) 435-0714, 
Email:  GrantsInfo@nih.gov.

APPLICATION RECEIPT DATES:  Applications submitted in response to this 
program announcement will be accepted at the standard application deadlines, 
which are available at http://grants.nih.gov/grants/dates.htm.  Application 
deadlines are also indicated in the PHS 398 application kit.

APPLICATION INSTRUCTIONS FOR SMALL GRANT (R03) APPLICATIONS:  Application 
instructions described in PAR-99-126, available at 
http://grants.nih.gov/grants/guide/pa-files/PAR-99-126.html, should be 
followed. 

SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS:  All applications for 
small grants (R03) and R01 applications requesting up to $250,000 per year in 
direct costs must be submitted in a modular grant format.  The modular grant 
format simplifies the preparation of the budget in these applications by 
limiting the level of budgetary detail.  Applicants request direct costs in 
$25,000 modules.  Section C of the research grant application instructions 
for the PHS 398 (rev. 5/2001) at 
http://grants.nih.gov/grants/funding/phs398/phs398.html includes step-by-step 
guidance for preparing modular grants.  Additional information on modular 
grants is available at 
http://grants.nih.gov/grants/funding/modular/modular.htm.

SPECIFIC INSTRUCTIONS FOR APPLICATIONS REQUESTING $500,000 OR MORE PER YEAR: 
Applications requesting $500,000 or more in direct costs for any year must 
include a cover letter identifying the NIH staff member within one of NIH 
institutes or centers who has agreed to accept assignment of the application.   

Applicants requesting more than $500,000 must carry out the following steps:

1) Contact the IC program staff at least six weeks before submitting the 
application, i.e., as you are developing plans for the study; 

2) Obtain agreement from the IC staff that the IC will accept your 
application for consideration for award; and,
  
3) Identify, in a cover letter sent with the application, the staff member 
and IC who agreed to accept assignment of the application.  

This policy applies to all investigator-initiated new (type 1), competing 
continuation (type 2), competing supplement, or any amended or revised 
version of these grant application types.  Additional information on this 
policy is available in the NIH Guide for Grants and Contracts, October 19, 
2001 at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-004.html. 

SENDING AN APPLICATION TO THE NIH:  Submit a signed, typewritten original of 
the application, including the checklist, and five signed photocopies in one 
package to:

Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD  20892-7710
Bethesda, MD  20817 (for express/courier service)

APPLICATION PROCESSING:  Applications must be received by or mailed on or 
before the receipt dates described at 
http://grants.nih.gov/grants/funding/submissionschedule.htm.  The CSR will 
not accept any application in response to this PA that is essentially the 
same as one currently pending initial review unless the applicant withdraws 
the pending application.  The CSR will not accept any application that is 
essentially the same as one already reviewed.  This does not preclude the 
submission of a substantial revision of an application already reviewed, but 
such application must include an Introduction addressing the previous 
critique.

PEER REVIEW PROCESS

Research project grant (R01) and small grant (R03) applications submitted for 
this PA will be assigned on the basis of established PHS referral guidelines.  
An appropriate scientific review group convened in accordance with the 
standard NIH peer review procedures (http://www.csr.nih.gov/refrev.htm) will 
evaluate all applications for scientific and technical merit. As part of the 
initial merit review, all applications will:

o Receive a written critique
o Undergo a selection process in which only those applications deemed to have 
the highest scientific merit, generally the top half of applications under 
review, will be discussed and assigned a priority score
o Receive a second level review by the appropriate advisory council. 

REVIEW CRITERIA

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  In 
the written comments, reviewers will be asked to discuss the following 
aspects of your application in order to judge the likelihood that the 
proposed research will have a substantial impact on the pursuit of these 
goals: 

o Significance 
o Approach 
o Innovation
o Investigator
o Environment
  
The scientific review group will address and consider each of these criteria 
in assigning your application's overall score, weighting them as appropriate 
for each application.  Your application does not need to be strong in all 
categories to be judged likely to have major scientific impact and thus 
deserve a high priority score.  For example, you may propose to carry out 
important work that by its nature is not innovative but is essential to move 
a field forward.

(1) SIGNIFICANCE:  Does your study address an important problem? If the aims 
of your application are achieved, how do they advance scientific knowledge?  
What will be the effect of these studies on the concepts or methods that 
drive this field?

(2) APPROACH:  Are the conceptual framework, design, methods, and analyses 
adequately developed, well integrated, and appropriate to the aims of the 
project?  Do you acknowledge potential problem areas and consider alternative 
tactics?

(3) INNOVATION:  Does your project employ novel concepts, approaches or 
methods? Are the aims original and innovative?  Does your project challenge 
existing paradigms or develop new methodologies or technologies?

(4) INVESTIGATOR: Are you appropriately trained and well suited to carry out 
this work?  Is the work proposed appropriate to your experience level as the 
principal investigator and to that of other researchers (if any)?

(5) ENVIRONMENT:  Does the scientific environment in which your work will be 
done contribute to the probability of success?  Do the proposed experiments 
take advantage of unique features of the scientific environment or employ 
useful collaborative arrangements?  Is there evidence of institutional 
support?

ADDITIONAL REVIEW CRITERIA:  In addition to the above criteria, your 
application will also be reviewed with respect to the following:

PROTECTIONS:  The adequacy of the proposed protection for humans, animals, or 
the environment, to the extent they may be adversely affected by the project 
proposed in the application.

INCLUSION:  The adequacy of plans to include subjects from genders, all 
racial and ethnic groups (and subgroups), and children as appropriate for the 
scientific goals of the research.  Plans for the recruitment and retention of 
subjects will also be evaluated. (See Inclusion Criteria included in the 
section on Federal Citations, below.)

DATA SHARING:  The adequacy of the proposed plan to share data. 

BUDGET:  The reasonableness of the proposed budget and the requested period 
of support in relation to the proposed research.

AWARD CRITERIA

Applications submitted in response to a PA will compete for available funds 
with all other recommended applications.  The following will be considered in 
making funding decisions:  

o Scientific merit of the proposed project as determined by peer review
o Availability of funds 
o Relevance to program priorities

REQUIRED FEDERAL CITATIONS 

INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH:  It is the policy of 
the NIH that women and members of minority groups and their sub-populations 
must be included in all NIH-supported clinical research projects unless a 
clear and compelling justification is provided indicating that inclusion is 
inappropriate with respect to the health of the subjects or the purpose of 
the research. This policy results from the NIH Revitalization Act of 1993 
(Section 492B of Public Law 103-43).

All investigators proposing clinical research should read the AMENDMENT "NIH 
Guidelines for Inclusion of Women and Minorities as Subjects in Clinical 
Research - Amended, October, 2001," published in the NIH Guide for Grants and 
Contracts on October 9, 2001 
(http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html); 
a complete copy of the updated Guidelines is available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm  
The amended policy incorporates: the use of an NIH definition of clinical 
research; updated racial and ethnic categories in compliance with the new OMB 
standards; clarification of language governing NIH-defined Phase III clinical 
trials consistent with the new PHS Form 398; and updated roles and 
responsibilities of NIH staff and the extramural community.  The policy 
continues to require for all NIH-defined Phase III clinical trials that: a) 
all applications or proposals and/or protocols must provide a description of 
plans to conduct analyses, as appropriate, to address differences by 
sex/gender and/or racial/ethnic groups, including subgroups if applicable; 
and b) investigators must report annual accrual and progress in conducting 
analyses, as appropriate, by sex/gender and/or racial/ethnic group 
differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS: 
The NIH maintains a policy that children (i.e., individuals under the age of 
21) must be included in all human subjects research, conducted or supported 
by the NIH, unless there are scientific and ethical reasons not to include 
them. This policy applies to all initial (Type 1) applications submitted for 
receipt dates after October 1, 1998.

All investigators proposing research involving human subjects should read the 
"NIH Policy and Guidelines" on the inclusion of children as participants in 
research involving human subjects that is available at 
http://grants.nih.gov/grants/funding/children/children.htm

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS:  NIH 
policy requires education on the protection of human subject participants for 
all investigators submitting NIH proposals for research involving human 
subjects.  You will find this policy announcement in the NIH Guide for Grants 
and Contracts Announcement, dated June 5, 2000, at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT:  The 
Office of Management and Budget (OMB) Circular A-110 has been revised to 
provide public access to research data through the Freedom of Information Act 
(FOIA) under some circumstances.  Data that are (1) first produced in a 
project that is supported in whole or in part with Federal funds and (2) 
cited publicly and officially by a Federal agency in support of an action 
that has the force and effect of law (i.e., a regulation) may be accessed 
through FOIA.  It is important for applicants to understand the basic scope 
of this amendment.  NIH has provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this PA in a public 
archive, which can provide protections for the data and manage the 
distribution for an indefinite period of time.  If so, the application should 
include a description of the archiving plan in the study design and include 
information about this in the budget justification section of the 
application. In addition, applicants should think about how to structure 
informed consent statements and other human subjects procedures given the 
potential for wider use of data collected under this award.

URLs IN NIH GRANT APPLICATIONS OR APPENDICES:  All applications and proposals 
for NIH funding must be self-contained within specified page limitations. 
Unless otherwise specified in an NIH solicitation, Internet addresses (URLs) 
should not be used to provide information necessary to the review because 
reviewers are under no obligation to view the Internet sites.  Furthermore, 
we caution reviewers that their anonymity may be compromised when they 
directly access an Internet site.

HEALTHY PEOPLE 2010:  The Public Health Service (PHS) is committed to 
achieving the health promotion and disease prevention objectives of "Healthy 
People 2010," a PHS-led national activity for setting priority areas. This PA 
is related to one or more of the priority areas. Potential applicants may 
obtain a copy of "Healthy People 2010" at 
http://www.health.gov/healthypeople.

AUTHORITY AND REGULATIONS:  This program is described in the Catalog of 
Federal Domestic Assistance No. 93.864, and is not subject to the 
intergovernmental review requirements of Executive Order 12372 or Health 
Systems Agency review.  Awards are made under authorization of Sections 301 
and 405 of the Public Health Service Act as amended (42 USC 241 and 284) and 
administered under NIH grants policies described at 
http://grants.nih.gov/grants/policy/policy.htm and under Federal Regulations 
42 CFR 52 and 45 CFR Parts 74 and 92.

The PHS strongly encourages all grant recipients to provide a smoke-free 
workplace and discourage the use of all tobacco products.  In addition, 
Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in 
certain facilities (or in some cases, any portion of a facility) in which 
regular or routine education, library, day care, health care, or early 
childhood development services are provided to children.  This is consistent 
with the PHS mission to protect and advance the physical and mental health of 
the American people.

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