Sunday, March 05, 2006

Celebrating AIDS Research Accomplishments at Wits

From time to time, I want to call some attention to the amazing and life-changing research accomplishments in HIV/AIDS stemming from the work of scholars and doctors at the University of the Witswatersrand (Wits). I think we can expect to see some (more) Nobel Prize winners in the near future, but more importantly this is cutting-edge scholarship at its most humble and necessary: scholarship with the potential and demonstrated ability to save thousands of lives. First up... Dr. James McIntyre and Dr. Glenda Gray.
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The trendy offices of the Perinatal HIV Research Unit at Chris Hani Baragwanath Hospital in Soweto are a far cry from the poky broom closet its directors James McIntyre and Glenda Gray started out in when they embarked on their mission 10 years ago to find ways of preventing mother-to-child infection of HIV.

Now the unit, which occupies several floors of the hospital's New Nurses Home, a large square building west of the hospital, employs 200 staff members, conducts myriad research programmes and is an international player in the field of HIV/Aids research.

Just getting an interview with McIntyre and Gray is something of a feat - and chatting to both of them together, a major feat.

Given the cutting-edge nature of their work, they are much in demand, and the awards that line their offices are testimony to their incredible success in the field of HIV/Aids: the Nelson Mandela Award for Health and Human Rights (2002) and the Heroes in Medicine Award from the International Association of Physicians in Aids Care (2003) are just two.

The Perinatal HIV Research Unit, under the auspices of Wits University, is one of the largest Aids research centres on the continent, and has grown into an impressive multi-disciplinary research centre, partnering with many other organisations and engaging in research across the spectrum: preventing mother-to-child transmission, conducting vaccine trials, researching diaphragm use as a barrier to HIV, exploring sexual practices of men and women in Soweto, examining the economic impact of HIV/Aids on families, and researching the best treatment, care and support of people living with Aids.

Both Gray, a paediatrician, and McIntyre, an obstetrician, are candid about the success of their work. "What we've spearheaded here has changed the lives of millions of women worldwide - essentially finding affordable interventions to prevent mother-to-child transmission of HIV", says Gray. "And we've been quick to translate research into action."

"We've been a central player in international research in the field that started 10 years ago", chips in McIntyre. "We've helped develop that research agenda." The two directors, who have worked so closely for all these years, constantly finish off each other's sentences.

The unit was pivotal in changing the mindset of the World Health Organisation, which prescribed that HIV-positive women in developed countries should formula feed while those in developing countries should breastfeed, in the belief that the health risks for formula feeding in Third World countries outweighed the risk of HIV transmission.

"We said that women had a right to make that decision themselves and needed to be properly informed first", says Gray.

McIntyre is the principal investigator for a wide-ranging five-year project on HIV/Aids which has been given a massive US$21-million grant from the United States National Institutes for Health - one of their largest awards and part of their Comprehensive International Programme on Aids (Cipra).

The programme brings together several partners in the field, including the Reproductive Health Research Unit, also based at Bara, and Wits University's Clinical HIV Research Unit.
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How amazing to almost single-handedly change WHO orthodoxy on the "necessity" of breast-feeding for developing world women! I am particularly struck by the inter-disciplinary nature of their work and in fact, the entire Wits approach to HIV/AIDS research- that doctors have to work in collaboration with economists, for instance, and remembering that socio-economic conditions influence disease transmission risk, but equally important, medical advances yield other key challenges for economists and policy makers. On this point, see Nicoli Nattrass' (from the University of Cape Town) most recent article about the despair of those receiving HAART (Highly Active Anti-Retroviral Treatment) and improving their HIV condition but subsequently losing disability grants. Must the unlucky choose between rapid death or poverty?
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Another South African hero is Kami, the HIV-positive Muppet appointed by UNICEF as its special advocate for children living with HIV/AIDS or orphaned by parental AIDS deaths. Kami is humble and sweet, and made out of yellow shaggy fur. She talks gently about coping with illness and loss; her parents died of AIDS and she is a 5 year-old orphan. I love Kami so much!

And, more heart-breaking than Kami's story, is the number of children who NEED to relate to her, who can only understand a life at age 5 without any parents. Here's an excerpt from a 2002 interview with Kami:

Kami: At my school, at first children did not want to play with me because they thought they would catch HIV by just playing with me. But my friends Zuzu and Zikwe and Moshe told them. They talked to them and told them, "you cannot get HIV by just playing with me".

Interviewer: And they believe you? And, now they act nice to you?

Kami: Oh, yes. They are very nice to me. We play together.

Interviewer: And do you hug and do you kiss? And is that nice?

Kami: Yes. I hug my friends and they hug me back.

Kami can be seen on Takalani Sesame, the South African version of Sesame Street, but she works with children all over the world. She always wears a cute light green vest (looks good with the yellow fur!) with an AIDS red ribbon and a happy white daisy. Kami also keeps a "memory necklace" around her neck in honor of her biological mother who died of AIDS-related causes.

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