So much has changed, and so much has stayed the same.
A decade ago I travelled to Nairobi to see, firsthand, the work of Kenyan and University of Manitoba researchers who were studying a group of HIV-resistant sex workers. The U of M maintained a small clinic in Nairobi’s Pumwani district, a deeply impoverished place, and provided free medical treatment to both the non-infected sex workers, and those who had contracted deadly virus. In exchange, the researchers gathered valuable data on the lives and habits of the resistant women. That data has provided insight into the human immune system, and is being used in one of the world’s most promising vaccine initiatives.
But that was not all the U of M brought to Africa. The project grew, bringing public health education and preventative strategies to stop Kenyans from getting infected in the first place. It was at that time a unique approach, a blend of research, primary medicine and public health.
I met the Manitobans on the front line of the battle against HIV and AIDS. The founders of the project, doctors Allan Ronald and Frank Plummer. Researchers like Dr. Stephen Moses, who made history by linking circumcision to HIV prevention. And Kenyans like Dr. Joshua Kimani, who did much of his medical education and graduate training through the U of M and now leads the U of M’s work in Kenya.
A decade later, the U of M programs have grown both in size and sophistication. "Ten years ago, we focused our work on a couple of research initiatives and the Majengo clinic," said Dr. Keith Fowke, a professor of medical microbiology and one of the leaders of the Kenyan projects. "Now, we have reached out to other areas of Nairobi."
In addition to Majengo, the U of M operates four more clinics in other districts of Nairobi to both provide front-line medical care and education on how to prevent HIV infections, Fowke said. The clinics focus their work on sex workers, who have the highest infection rates among all Kenyans. Last year, more than 40,000 sex workers received medical treatment at U of M clinics, and more than two dozen medical and graduate students — Canadian and Kenyans — trained in these programs.
Perhaps the biggest change experienced by the U of M researchers is the type of treatment they are providing. A decade ago, only a handful of Kenyans had access to anti-retroviral medication (ARVs), the principal drug therapy for suppressing HIV. While ARVs had become standard for victims in developed countries, those in developing countries were essentially denied access on economic grounds. However, a global campaign put increasing pressure on developed countries to make ARVs available to all.
This ultimately led to ARV programs through UNAIDS and the Global Fund to Fight AIDS, and the creation of the U.S. President’s Emergency Plan for Aids Relief (PEPFAR). Together, these and a few other smaller programs are providing drug therapy to more than five million HIV/AIDS victims in the poorest countries. The U of M has accessed funding through the Gates Foundation and PEPFAR to expand its network of clinics, and to bring its unique blend of prevention and research to other countries including Columbia, India, Pakistan and China.
The progress is undeniable, but Fowke admits there is very little sense that they are anywhere close to winning the war on HIV/AIDS. Although prevalence rates are down, the total number of people living with the disease — in large part because more victims are living longer while on ARV therapy — has nearly doubled to two million. Of greater concern, new infections continue at an alarming rate. And looming over the global fight against the disease is a precipitous drop in international funding.
In large part because of the global recession, the countries that support the programs that treat victims and fund research into a vaccine fell by approximately 10 per cent. This has led to a drop in funding to specific projects around the world.
The challenges remain but there is a sense of optimism. Dr. Allan Ronald, one of the founders of the U of M’s projects in Kenya, said there have been many positive consequences. New infection rates are down in most African countries by as much as 40 per cent from peak levels in 2004-2005, he said.
Other advances include building a greater capacity in Kenya for medicine and research. Ronald noted that the U of M programs in Kenya are now, for the most part, overseen by Kenyan doctors. This is a huge advantage to a country struggling with such an enormous public health crisis, he added.
On the vaccine research side, Ronald said he and many other of the founders of the program are somewhat disappointed that the secrets of the HIV-resistant sex workers has not been decoded. "There have been some small advances, but we’ve not had that big breakthrough I think we all thought would come," he said.
Overall, Ronald is still encouraged by the work in Africa. "You can get discouraged at times," Ronald said. "But in the end, there is enough to make us encouraged. The glass is definitely half full."