'Greatest burden': Why one doctor battles South Africa's HIV epidemic

In quest to find vaccine, attracting and retaining talented researchers is tougher than ever
Dr. Fatima Laher
Fatima Laher, right, leads the Soweto vaccine clinical research site of the HIV Vaccine Trials Network. Photo by Robert Hood / Fred Hutch News Service

When Fatima Laher was a medical school student at the University of the Witwatersrand in Johannesburg, South Africa, a career focused on HIV/AIDS was not on her radar.

But after graduating in 2003, Laher went to work as a community service doctor at Chris Hani Baragwanath Hospital in Soweto -- a heavily populated area of Johannesburg -- and saw the nation’s AIDS epidemic up close.

Treating adults and children wasting away in the last stages of the disease at a time when antiretroviral drugs were not yet routinely available in South Africa profoundly affected the young doctor.

“Seeing that changed my path in medicine,” said Laher, 33, who was born and raised in Johannesburg.

Laher is still working at the hospital a decade later, but in a radically different role. Based in the hospital’s Perinatal HIV Research Unit, Laher is leading the Soweto vaccine clinical research site of the HIV Vaccine Trials Network (HVTN). The site is one of three in South Africa overseen by the HVTN, an international effort based at Fred Hutch dedicated to developing a safe and effective vaccine for HIV.

The HVTN is preparing to launch two large-scale HIV vaccine trials in South Africa and neighboring countries starting in 2015. Laher’s work ranges from developing protocol for the trials to interpreting the resulting data, and she also works on vaccine trials around human papillomavirus, tuberculosis and influenza.

‘How can you not be excited every day?’

Her mentor for the HIV vaccine work is Dr. Glenda Gray, the HVTN’s co-principal investigator. Learning from people who have dedicated their careers to HIV is inspiring, Laher said.

“I have this great opportunity to be surrounded on an international level by people who are really fantastic vaccine scientists,” she said. “What a privileged position to be in. How can you not be excited every day?”

As a young HIV vaccine researcher, Laher represents what may be the best hope for addressing HIV in the place where it has hit harder than anywhere else in the world. An estimated 6.1 million people are living with HIV in South Africa, according to UNAIDS. The crisis has attracted some of the world’s most renowned HIV experts, including Dr. Linda-Gail Bekker, who launched the Desmond Tutu HIV Foundation in 2004 with her husband, Professor Robin Wood, to conduct research and provide treatment, counseling and testing for HIV and tuberculosis.

Bekker, a native of Zimbabwe, estimates there are between 100 and 200 early-career HIV researchers in South Africa. Since developing a vaccine can take decades, there is an urgent need to cultivate the next generation of researchers.

“I think this is critical,” Bekker said. “We have the greatest burden of HIV and TB in this country, more than any other country in the world. So there is relevance, clinical material and motivation. That should be a great reason to have many researchers in the field.”

But attracting those researchers is challenging. South Africa has long struggled with doctors departing for more lucrative careers in the U.S. and Canada – including, Laher said, many of her medical school peers. For those who remain, there is an expectation that they will work in clinical settings to help mitigate the country’s staggering disease burden.

“We have epidemics of HIV and TB sitting side by side, and spiraling epidemics of diabetes and heart disease,” she said. “Research is not prioritized in that context. It’s almost seen as indulgent – you’re spending your time not serving, not helping people who are imminently going to die.”

Tenacity, unwavering resolve required

The HVTN has launched two initiatives in an effort to attract greater numbers of doctors into HIV research. The South African/HVTN AIDS Vaccine Early Stage Investigator Programme (SHAPe), which Bekker chairs, was launched in 2010 and provides three-year mentored research awards that include salary and research-related costs. The program pairs SHAPe scholars with established HIV researchers in South Africa to pursue studies around HIV vaccine development.

The HVTN Research and Mentorship Program (RAMP), also launched in 2010, is open to African-American and Latino medical students in the U.S. and provides mentorships of up to a year with researchers at the HVTN’s sites in the U.S. and abroad, including South Africa.

For Laher, the road to research started with treating HIV patients, witnessing their improvement as antiretroviral drugs became available in South Africa, and then gradually realizing that solving the problem required attacking it at the core.

“Over time, my patients became better. But then you kind of take a step back and have this frustration about needing a better solution to end the epidemic and prevent new cases,” she said. “It’s exhausting to chase after infections without finding the solutions.”

Unlike the quicker gratification of clinical work, research is a long-term game requiring tenacity and unwavering resolve. There are no easy answers, but that’s fine with Laher. She’s focused on a goal she thinks is worthy of dedicating her own career to: helping to take an HIV vaccine to licensure.

“If I devote a small portion of my life ending HIV,” she said, “I can’t think of anything better.”

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