Centers in Africa Fight HIV/AIDS

At an orphanage in Botswana, a 14-year-old girl lost her mother to AIDS last year, quietly resigning herself to what must have been a catastrophic blow in the life of a child.

Her mother was one of 11,000 to fall victim to HIV/AIDS in Botswana that year.

Facing the second highest HIV infection rate in the world, the Botswanan government has taken steps in recent years to increase access to antiretroviral drugs.

Of the roughly 350,000 living with HIV/AIDS—or one-third of the country’s adult population—56 percent received treatment in March 2005, according to the Kaiser Family Foundation.

Since the mid 1990s, Harvard faculty and students have flown out to two outposts in Botswana and Tanzania—the cornerstones of Harvard’s presence in Africa—to conduct ground-breaking HIV/AIDS research.

But earlier this year, Harvard’s two HIV/AIDS research centers in Africa each spun off limited liability companies, a strategic move that will open up funding streams that had previously been off-limits due to federal restrictions.

For the 120,000 AIDS orphans living in Botswana, the potential funding increase could speed further advances in research as well as public health initiatives.

When JJ Diah ’10 visited the SOS Children’s Villages orphanage last spring during her semester in Gaborone, she found that this young girl—whose name Diah does not remember—managed to keep an outlook on life defined more by hope than by despair.

“She didn’t expect her mother to die, but she knew that it was a possibility—it was that HIV/AIDS is a reality,” Diah says. “For them it’s like, we know which family members have HIV/AIDS, and we know people are going to die from this.”

A TOWERING FIGURE

The biography of Harvard School of Public Health professor Myron “Max” Essex reads much like the history of HIV/AIDS research.

Essex was one of the first to link retroviruses to AIDS, to discover that HIV could be transmitted through bodily fluids, and to identify the protein now used world-wide to screen for the disease.

Despite Essex’s protests (“I don’t like to use the word ‘breakthrough,’” he says), the founder of Harvard’s facility in Botswana has overseen multiple major advances in the field, saving countless lives in the process.

With the creation of limited liability companies, the research centers—which had been funded primarily through grants from the National Institutes of Health—will gain access to grants from European entities as well, says Jorge I. Dominguez, the University’s vice provost for international affairs.

It remains unclear how much funding the African centers will receive, but Wafaie Fawzi, who directs the program in Tanzania, says he expects an increase in funds available for research.

In describing the future of the centers, Dominguez says that he expects them to partner with a local nongovernmental organization, drawing a parallel to Harvard Medical School’s relationship with its affiliate hospitals.

“We’ve committed ourselves to do the capacity building necessary so we can turn all assets over to a nongovernmental organization in Botswana that will ultimately receive the funding from the federal government,” Dominguez says.

LOCALIZING CARE

Max L. Dougherty ’10 could not help feeling slightly panicky when he first arrived in Botswana to work in Essex’s lab last spring.

“I didn’t really know what to expect,” Dougherty says. “What struck me is the dryness of the land—any sort of open space is just dirt.”

“It’s in the desert,” Dougherty adds. “The country just looks very brown.”

But once Dougherty joined Essex’s lab, the foreignness of the African country began to fade.

“When I first got there I was impressed,” Dougherty says. “It looked like a lab you would expect to see anywhere.”

Interviews with students who worked with Essex last spring paint a picture of a close-knit scientific community holed up in the lab, decoding genomes, analyzing drug resistance, and researching HIV transmission from infected mothers to their children.

Carlos C. Becerril ’10 recalls working late in the lab, analyzing the transmission of drug-resistant HIV.

His research yielded results—the drug-resistant HIV strain typically found in Botswana is usually not transferable. Botswanans infected with HIV can begin treatment immediately upon diagnosis, since the strain they contracted is likely not to be drug-resistant, which would require a different course of treatment, Becerill says.

This finding means that drugs can be delivered faster, increasing health practitioners’ success rates.

“Now that I look back, I’m happy that I spent as much time in the lab as I did,” Becerill says. “It showed me that if you put the work into it, you can really accomplish something.”

Several Botswanans work in Essex’s lab, which is located next door to the capital city’s main hospital, and Essex is quick to emphasize that his facility is not meant to provide care for area residents, but to conduct research.

Health clinics in the developing world face the challenge of striking a balance between bringing in outside experts and building up local expertise to set up long-term care structures.

And Essex doesn’t expect to reach the ultimate goal of establishing locally operated HIV/AIDS clinics any time soon in Botswana.

“We have students for research training and a number of medical students who are training clinical fellows at the hospital, but in relation to turning it over the people of Botswana—certainly that’s a long term goal in 10 or 20 years,” Essex says.

On the other hand, the establishment of the Africa Academy in Tanzania has made progress in training Tanzanians to give medical treatment.

The research and teaching hub for health professionals hopes to apply lessons learned from the University’s research endeavors to improve health infrastructure in the region—an effort that may have long-term positive repercussions for health in sub-Saharan Africa.

“These organizations will allow us to have a better chance to develop initiatives to address public health problems in Tanzania and the region and to tap into our resources,” Fawzi says.

—William N. White contributed to the reporting of this article.

—Staff writer Elias J. Groll can be reached at egroll@fas.harvard.edu.