How a community joined the hunt for an HIV vaccine

An extra from The sex workers who are stopping HIV

In the fight against HIV, outreach programmes don’t just provide health support. In Durban in South Africa, local women are getting involved in innovative research. Rob Reddick reports.

Twice a week in Umlazi township, just south of Durban, classes of 30 or so women meet for a programme of personal development. Today’s lesson could be on writing a CV. The next could cover what to wear to a job interview or how to use a computer. The cost of attending? Nothing. Just a quick finger prick at the start to draw a blood sample.

These women are part of the Acute HIV Infection Cohort run by Females Rising through Education, Support and Health (FRESH). Like Mozambique’s Corridor Project, it’s a community-based programme reaching out to those at risk from HIV. But unlike in Mozambique, the primary focus here is on research – to spur the development of an HIV vaccine.

“It is an innovative attempt to combine a basic science research programme with a socioeconomic empowerment programme,” says Professor Thumbi Ndung’u, Scientific Director of the HIV Pathogenesis Programme at the University of KwaZulu-Natal and one of the programme’s leaders.

The programme enrols local women who are HIV negative. After each class, their blood samples are promptly tested to see if anyone has recently contracted the virus. If they have, they start antiretroviral therapy and, in turn, provide further samples for the study.

The reason behind the programme’s unusual fusion of disciplines is simple. To study what happens immediately after HIV arrives in the body – the ‘hyperacute’ phase of infection – you need to monitor people closely. And to get people to agree to this, you need to provide incentives.

“A lot of these are young disadvantaged women and a lot of them are out of school,” Ndung’u says. But through the programme “they can get economic opportunities, or even go back to school”. A cohort graduates after nine months, and at that point 80–85 per cent of participants start jobs or return to education.

Even so, in a country where over 6 million people have HIV/AIDS, recruitment can be a challenge. “Anything related to HIV research has an aspect of stigma to it,” Ndung’u says. “We have tried to overcome that by working with the community, understanding the community.” Recruiting participants through an established network of peers and counsellors therefore is key, and sits at the heart of the programme’s work.

According to a 2009 study conducted at an Umlazi antenatal clinic, by the age of 22, two out of three women in the township are HIV positive. Simply being young and female here makes you part of an at-risk population – and thus a prime candidate for helping with this sort of before-and-after research. Hence, the recruitment pool is broad: any sexually active HIV-negative woman aged 18–23 is eligible.

What this all creates is “a very unique cohort of people that are treated with antiretroviral therapy very, very early,” Ndung’u says, and that offers new perspectives. Researchers can study the characteristics of the virus and the immune response during the very first days of infection, as well as what happens if you start antiretroviral therapy in this hyperacute stage.

There are some interesting preliminary findings. For example, HIV usually depletes a person’s CD4 immune cells – but not so in these women if they are treated early. The team is looking to study whether this has long-term benefits.

Back in the classroom, there’s one more lesson: how to prevent HIV infection, complete with free condoms. But despite the programme’s best efforts, infection among the cohort still occurs at a rate of 8 per cent of people per year, which Ndung’u describes as “quite high”. Progress may be on the horizon, but for the women of Umlazi, the risk of HIV remains part of everyday life.

Professor Thumbi Ndung’u leads a research group at the Africa Health Research Institute, which receives funding from Wellcome, Mosaic’s publisher.