Hutch in South Africa

Creating a future without HIV

Dr. Salim S. Abdool Karim

Dr. Salim S. Abdool Karim, president of the South African Medical Research Council, speaks at the closing of an HIV conference co-hosted by the council and Fred Hutch's HIV Vaccine Trials Network.

Photo by Robert Hood

South African government partners with the Hutch’s HIV Vaccine Trials Network to find an effective HIV vaccine

By Deborah Bach

Dr. Salim Abdool Karim can envision a world without HIV, the virus that has hit his country of South Africa harder than anywhere else in the world. When he looks into the future, he can see a time when AIDS no longer exists, when children no longer are orphaned by parents who have been struck by the pandemic.

“The end of AIDS is possible and within our grasp,” said Karim, the president of the South African Medical Research Council (MRC) and the director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA).

To that end, the MRC has partnered with the Fred Hutch’s HIV Vaccine Trials Network (HVTN) to work toward an effective vaccine. That collaboration is integral to two large-scale HIV vaccine trials the HVTN plans to launch in 2015.

In October the MRC and HVTN also co-hosted a meeting in Cape Town, signifying not just the organization’s first meeting outside the United States, but also an enhanced level of collaboration with the South African government.

The HVTN works with world-class researchers in South Africa to realize the goal of an effective HIV vaccine. The South African researchers have clinical trial sites in communities most affected by HIV and have developed strong community engagement processes to ensure meaningful participation in HIV vaccine research. Together with local laboratory scientists, they are pivotal to the expansion of HIV vaccine research in South Africa.

Dr. James Kublin

Dr. James Kublin is the executive director of the HVTN.

Photo by Robert Hood

“The legacy of the South African Medical Research Council’s contribution to research and investments in HIV prevention strategies is world-renowned,” said Dr. James Kublin, the HVTN’s executive director.

“The MRC, as the research council constituted to address pressing health needs of South African citizens and a leader in developing sub-type C HIV vaccines, is the obvious partner for this endeavor,” said Glenda Gray, director of the Office of AIDS Research at the MRC and the HVTN’s co-principal investigator.

Gray is charged with the HVTN’s expansion into southern Africa and will lead an upcoming phase 3 HIV vaccine licensure study in South Africa. She is surrounded by many talented scientists who include the world-renowned adolescent expert and HIV prevention specialist Linda Gail Bekker; Gavin Churchyard, a clinical epidemiologist and physician with expertise in clinical trials design and tuberculosis; as well as emerging scientific leaders such as Drs. Fatima Laher, Surita Roux and Kathy Ngadi.

“To be partners with the MRC in these future HIV vaccine clinical trials is a testament to South Africa’s commitment to finding an HIV vaccine,” said Larry Corey, president of Fred Hutch and the HVTN’s principal investigator.

The HVTN, together with local partners such as the MRC and South African universities, is committed to continue to grow the existing HIV vaccine research expertise in South African.  Through the South African/HVTN AIDS Vaccine Early Stage Investigator Programme (SHAPe), which provides mentoring and funding to young South African physicians interested in careers in HIV research, the program will build the next generation of researchers needed to conduct HVTN studies in South Africa.

South African researchers conducted the first study to show that a topical microbicide gel could reduce the risk of contracting HIV. Conducted by Dr. Karim at the CAPRISA site, the study involved close to 900 women between 2007 and 2009 and found that those who used tenofovir gel had 39 percent fewer HIV infections than women who received a placebo gel.

Beyond its collaboration with the HVTN, the South African government has made strides in recent years to combat the nation’s HIV epidemic. According to UNAIDS, an estimated 6.1 million South Africans – more than 10 percent of the population – are currently living with HIV. The rates are highest among women aged 15 to 24, who are three times more likely to become infected as men in the same age group.

But the tide seems to be changing. Two years ago, the South African government launched a multipronged initiative to reduce HIV infection that includes testing and counseling, efforts to prevent mother-to-child transmission, education around prevention methods and promotion of male circumcision.

Rates of child HIV infection dropped by 63 percent in South Africa between 2009 and 2012, according to UNAIDS, and the nation now has the largest number of people worldwide – more than 1.4 million – enrolled in antiretroviral drug treatment.

Dr. Erica Lazarus

Dr. Erica Lazarus is a program advisor on vaccine research at the Perinatal HIV Research Unit.

Photo by Robert Hood

Dr. Erica Lazarus, a program advisor on vaccine research at the Perinatal HIV Research Unit, situated at the Chris Hani Baragwanath Hospital and affiliated with the University of the Witwatersr, commended the South African government for its efforts to fight HIV. Minister of Health Dr. Aaron Motsoaledi has been a vocal proponent of circumcision, vowing to perform 1,000 circumcisions himself, Lazarus noted.

“He’s very proactive and supportive of the HIV fight,” she said. “He’s really changed things.”

Speaking at the HVTN meeting, Karim said it is critical that the momentum toward reducing HIV rates over the past few years is not lost. Effectively fighting AIDS, he said will require a response that is tailored to the populations most impacted and helps reduce vulnerability.

Karim said ending AIDS is possible and depends on the development of new technologies, particularly a vaccine to prevent HIV infection.

“There are challenges, but that should not deter us,” he said. “We won’t end AIDS tomorrow, but that has to be part of our long-term vision.”

The term “uhambo” – which means “opportunity” in Shona and “journey” in Xhosa, two languages native to sub-Saharan Africa – has been adopted to describe the work the HVTN will continue to do in southern Africa.

Kublin said the word also aptly characterizes the partnership between the HVTN and South Africa

“South Africans have engendered a level of trust and confidence with local communities that enables us to do our work there,” he said. “They really are walking hand-in-hand with us.”

Fred Hutch’s HIV Vaccine Trials Network opened a lab in Cape Town as we continue our quest to find a vaccine and end the march of AIDS. Follow our stories and photographs at www.Fredhutch.org/SouthAfrica.