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PUBLIC HEALTH Harvard Reports Efforts Against AIDS in Africa The devastation wrought on Africa's youth by AIDS--through the infection of children and the loss of parents--is only going to become steadily worse until the international health community can dramatically improve HIV prevention and treatment. Kenneth Kaunda, former president of Zambia, told the audience at HSPH's AIDS in Africa symposium that children must be at the center of the continent's HIV prevention and treatment efforts. (Photo by Kent Dayton) That dire theme emerged at the HSPH symposium "Harvard Programs on AIDS in Africa: A University Responds," held Nov. 25 in Snyder Auditorium. The event highlighted research and programs in this area throughout Harvard. Max Essex, chairman of the HSPH Department of Immunology and Infectious Diseases, provided some shocking statistics in his introduction. Ninety percent of the world's HIV-infected infants are in sub-Saharan Africa, he said. And if the current trend continues, 70 to 90 percent of today's teenage boys in Botswana and Zimbabwe are likely to die of AIDS. Other participants and audience members expressed concern about what will be done for the ever growing numbers of AIDS orphans, expected to reach 40 million by 2010. If the current trend continues, 70 to 90 percent of today's teenage boys in Botswana and Zimbabwe are likely to die of AIDS. Special guest speaker Kenneth David Kaunda, president of Zambia from 1964 to 1991, now devotes most of his time to fighting AIDS and poverty in Africa. He is currently the Lloyd G. Balfour president-in-residence at Boston University. "Children must be at the center" of prevention and treatment efforts, Kaunda said, adding that "the solutions need to be multifaceted and involve all sectors [of society], not just the medical sector." The symposium's first session was devoted to overviews of national programs in Botswana, Nigeria, Senegal, South Africa, and Tanzania, which all involve Harvard collaborations. Jean-Louis Sankalé, senior research scientist in the Department of Immunology and Infectious Diseases, had some encouraging news. "Senegal is one of the few countries in sub-Saharan Africa that has a very low rate of HIV infection--under 2 percent--and has been widely acclaimed as a success," said Sankalé. This success is the result of a confluence of factors including a supportive government, which installed an AIDS prevention committee early in the epidemic, and the involvement of religious and community leaders. To Block Bridge Populations Phyllis Kanki, HSPH professor of immunology and infectious diseases, leads the AIDS Prevention Initiative in Nigeria, funded by the Bill and Melinda Gates Foundation. One goal of the program in that country--where HIV rates are also relatively low--is to identify and work with "bridge populations" that will largely determine the extent of the disease's further spread from the high-risk groups such as sex workers, who already have high rates of infection. Bridge groups include truck drivers, university students, and male clients of sex workers. "The real foundation of our program is to prevent transmission of HIV from bridge populations to the general population," she said. Bruce Walker, professor of medicine and director of the Division of AIDS at HMS (see Medicine story), discussed efforts in South Africa, focusing on a new research center in Durban. "We have an incredible talent pool as well as incredible need," he said, with one South African study finding 48 percent of pregnant women to be HIV-positive. "We realized that there was an opportunity to build a state-of-the-art research facility in the heart of the epidemic." One of its goals is to repatriate South African scientists who have been trained abroad. Importance of Local Leaders In a panel discussion on optimizing treatment, prevention, and care, Richard Marlink, executive director of the Harvard AIDS Institute, stressed the need for homegrown leadership. As outside collaborators, "We are not in charge," he said. "Local experts in charge of local problems are the most likely to come up with sustainable solutions." Pride Chigwedere, a Zimbabwean research fellow at the Harvard AIDS Institute, said African traditional medicines--both those sold as bogus AIDS cures and those being tested as legitimate palliative treatments--are a distraction from the most pressing issue. "What we really need are the antiretrovirals," he emphasized, drugs that currently are not affordable or available to many African patients with HIV or AIDS. The panel's final speaker, Leah Manongi, a nurse, midwife, and educator from Tanzania and MPH student at BU, described how subjugation of women leads to secrecy and hinders prevention. Other panels addressed vaccine research and economic, policy, and human rights issues. Later, University provost Steven Hyman addressed the question, What more can Harvard do? "President Summers and I are dedicated to making sure Harvard becomes a more international university," fostering true collaborations on an equal footing with African partners, he said. "Sub-Saharan Africa is suffering disproportionately from HIV and AIDS. But the consequences are shared by all of us in a world where microbes don't need passports." --Tom Reynolds