AIDS 2016: Fred Hutch’s quest to wipe out AIDS in South Africa

Community engagement worker Puleng Nkase, center in white, works with a team of PHRU community advisory board members and colleagues, to invite neighbors in the Freedom Park township to a celebrate "HIV Vaccines Awareness Day." The team gives out a variety of materials, including syringe-shaped pens, like seen above, as well as pamphlets and fruit-flavored condoms. (Credit: Erika Schultz/The Seattle Times)

Editors note: As part of our coverage of the 21st International AIDS Conference, we are reposting part one of a series from the Seattle Times about the Fred Hutchinson Cancer Research Center’s effort to find an effective HIV vaccine. View the full report here.

He had only a few yards to cross – from the two-room shack he shares with his wife and three kids, past the “spaza” shop where he buys cigarettes for 13 cents apiece, to a slightly bigger shack that serves as a home, tavern, video arcade and meeting room – but he also had worlds to bridge.

Advanced education is as rare in this part of Khayelitsha as indoor plumbing (Madondile himself relies on a streetside water tap and toilet stall a five-minute walk from his home), yet his talk was unabashedly scientific. To describe how HIV drugs work, he projected slides with terms like “reverse transcriptase enzyme” onto battered pink wallboard.

Then, the 38-year-old educator with South Africa’s largest HIV activist group, the Treatment Action Campaign, ventured into new territory: a clinical trial that needs 1,500 women across southern and east Africa.

“Antibody mediated prevention study.” Madondile enunciated the words in English, before resuming his talk in Xhosa. “This is an idea of giving people antibodies to see if it can protect them from getting HIV.”

In South Africa, the global epicenter of HIV/AIDS, with roughly 6.5 million people infected, Madondile encouraged his neighbors to sign up – even as he anticipated their concerns. “Number one,” he said, “developed countries wanting to make us guinea pigs.”

It’s that deep-seated fear that Seattle scientists and their South African partners must confront as they work together in an international network of clinics headquartered at the Fred Hutchinson Cancer Research Center on two major HIV trials in Africa.

“It’s like the big secret of Fred Hutchinson,” said Jim Maynard, director of communications and community engagement for the HIV Vaccine Trials Network, known as HVTN. Most people think about cancer when they think about the famed Seattle institution. But since 2000, when the National Institutes of Health formed the network, Fred Hutch has been leading a quest to develop an HIV vaccine – a possible end goal of the antibody study.

What that means, Maynard said, is, “If a vaccine gets approved, it will come out of Seattle.” And HIV wouldn’t just be treated, it could be virtually wiped out, like polio.

It’s a big “if.” The past 16 years have seen repeated failure, including the worst-case scenario: One test vaccine appeared to cause a higher incidence of HIV.

The picture changed, however, with a promising trial in Thailand. The network led by Fred Hutch is now trying to build on that breakthrough by conducting trials in the part of the world most devastated by HIV; in South Africa, the virus has spread to nearly a fifth of 15- to 49-year-olds.

But scientific research in Africa carries challenges. An important one: overcoming skepticism, mistrust and cultural barriers that arise when a powerful and rich Western institution comes to the developing world and asks people to put foreign substances into their bodies.

To do that, Fred Hutch can’t “parachute in and say, ‘Hi, we need 4,000 people,’” Maynard said.

Instead, it must build relationships, put itself into the hands of African educators and recruiters such as Madondile – some of the “real heroes” of vaccine research, according to Maynard – who fan out across often impoverished and sometimes dangerous neighborhoods to give out information, allay fears and invite participation.

The people battling HIV include the scientists and doctors working in state-of-the-art labs in Seattle and Cape Town, and the volunteers in South African townships enrolling in clinical trials. (Erika Schultz & Corinne Chin / The Seattle Times)

Read more at the Seattle Times.

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