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Radiology:
Catching Cancer Before It Takes Hold |
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Social Medicine:
AIDS Study in Africa Shows Decline Amid Growing Epidemic
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Cell
Biology:
Gene Related to Tumor Suppressor Linked
to Stem Cell Pool |
Education:
Soma Weiss Day |
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Study Finds Two Thirds Of Breast Cancer Symptoms Require
Follow-up Care
Crystal Structure Solved for Tumor-Associated Complex
ECMO Shows Promise in Some Adults
Eating an Egg a Day OK for the Heart
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HMS Community Meets on Gay and Lesbian Issues
Deans Make Case for Meeting on Gay and Lesbian Issues
Wilson Outlines $20 Million Study of Welfare Reform
A Preview of Alumni Week
The Robert H. Ebert Lecture on April 15
In Memoriam: David Smith, Thomas Morris Jr., Eugene Sullivan
Memorial Service for John Penney
Honors and Advances
News Brief
The Fay Golden Kass Lecture on May 4
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Mining Information from Mountain of Scientific Data |
Front
Page
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SOCIAL MEDICINE
AIDS Study in Africa Shows Decline Amid Growing Epidemic
 |
| As Carnegie
fellow at HMS, Japhet Killewo and colleagues have addressed
the AIDS epidemic in Tanzania and are generating data
to determine and implement the most effective interventions. |
|
A study of HIV-1 infection in Tanzania
led by Japhet Killewo, a returned Carnegie fellow in the Department
of Social Medicine, is helping to define the nature of the epidemic
in that country—part of sub-Saharan Africa, a region that has the
highest HIV/AIDS prevalence in the world. The data show that infection
is declining, but they do not yet reveal a thorough explanation.
Killewo and three colleagues, also returned Carnegie
fellows, presented their research on April 14, the first day of
a two-day conference in Cambridge marking the 10th and final year
of the department's Carnegie Fellowship Program in Health and Behavior.
The long-term, population-based study focuses
on the Kagera region of Tanzania, south of Uganda, between Lake
Victoria on the east and Rwanda and Burundi on the west. The country's
first AIDS cases were identified there in 1983.
Killewo, the principal investigator, and colleagues
collected data for 1987, 1993, and 1996, representing a cross section
of the population. The researchers also carried out sentinel surveillance
of pregnant women in 1990, '93, and '96 to see if this group could
serve as a proxy for the population at large. Their methods were
described during the conference by Gideon Kwesigabo, who, along
with Killewo, is from the Department of Epidemiology and Biostatistics
at Tanzania's Muhimbili University College of Health Sciences. The
goal is to determine the magnitude and trends of HIV infection,
the risk factors associated with its spread, the social and anthropological
context, and the impact of interventions.
|
Age-Specific HIV-a Prevalence Bukoba Town,
1987, '93, '96
Males
| |
|
Year |
|
| Age
Group |
1987 |
1993 |
1996 |
| 15-24 |
11.1 |
6.5 |
16.4 |
| 25-35 |
22.4 |
18.9 |
16.4 |
| 35+ |
19.3 |
27.6 |
15.2 |
| Total |
17.1 |
17.3 |
10.4 |
Females
| |
|
Year |
|
| Age
Group |
1987 |
1993 |
1996 |
| 15-24 |
27.5 |
11.2 |
7.3 |
| 25-35 |
35.8 |
33.1 |
21.4 |
| 35+ |
18.7 |
13.3 |
17.7 |
| Total |
29.2 |
18.7 |
14.4 |
|
| Though AIDS prevalence shows
an overall decline in Bukoba, the rate has increased among young
men. And except for young women, females have a higher prevalence
than males. |
Promising Numbers
The most urbanized area of Kagera, the town of Bukoba, has the
highest prevalence. In 1987, 24.2 percent of the population was
infected, a proportion that declined to 18.0 percent in 1993 and
12.8 percent in 1996. Females had generally higher rates than males
(see charts). The 1989 incidence rate of HIV infection in Bukoba
was 47.5 new cases per 1,000 people per year and, in 1996, 5.6 new
cases per 1,000 people per year. (The rates represent 16 new cases
found in 1989 and seven in 1996.)
What accounts for the steep decline? Though the
percentage of men using condoms increased from 22.6 percent in 1993
to 30.3 percent in 1996, the average number of sexual partners in
the past year also increased (though slightly) from 1.2 to 1.3.
But these findings do not adequately answer the question.
In another of the presentations, Joe Lugalla,
now of the Department of Anthropology at the University of New Hampshire,
suggested that the maturation of the epidemic, improvement of medical
services, and government and nongovernment programs may have contributed
to the decline. Another factor, he said, is "AIDS agony," people
witnessing the suffering, dying, and destitution due to AIDS and
social changes like the rising number of single parents and orphans.
Patrick Masanja, of the Department of Sociology at the University
of Dar es Salaam, said that in 1997 the number of orphans under
age 15 in Tanzania was an estimated 620,000 out of a population
of 31,507,000.
According to Killewo, the researchers
are generating 1999 figures for the prevalence and incidence of
HIV infection, working closely with Tanzania's National AIDS Control
Program to ensure that the most effective interventions are implemented.
"Although infection rates have declined in this
region of Tanzania, other countries are still experiencing a rapid
expansion of HIV," says Max Essex, chair of the Harvard AIDS Institute
at HSPH. "In countries such as Zimbabwe and Botswana, HIV has already
infected more than a third of young adults. Sub-Saharan Africa now
accounts for 85 percent of all new HIV infections in the world."
AIDS is an outstanding example of a disease that
demands multidisciplinary approaches. Killewo says the Kagera project
was initiated by a group of Swedish researchers looking for collaborators
to study the epidemic, who met with Tanzanian scientists in 1986.
Funding came from the Swedish and Tanzanian governments. After starting
the project, Killewo spent nine months at HMS in 1991–92 as
a Carnegie fellow. "We found we needed a major collaboration in
the social science disciplines," he says.
The Carnegie fellowship program began in 1989,
the first fellows coming to HMS the following year. The principal
investigator of the program is Arthur Kleinman, chair of the Department
of Social Medicine. The fellowships support interdisciplinary training
for faculty in the biomedical and social sciences in East Africa,
fostering a broad, collaborative approach to public health problems.
—Robert Neal
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