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Harvard Partnership Fights HIV/AIDS in Botswana

By Pooja Podugu, Crimson Staff Writer

As Harvard School of Public Health professor Myron “Max” Essex begins his day in his office in Boston, his mind is already thousands of miles away. Essex—a renowned immunobiologist and virologist—spends much of his time on conference calls with partners in Botswana, chairing the Harvard-Botswana Partnership for HIV/AIDS research from afar.

Since the onset of the HIV/AIDS epidemic in the 1980s, Essex has focused his career on researching the disease. His discovery that HIV is a retrovirus earned him the Lasker Award, one of the most prestigious prizes in the medical field.

Today, Botswana­—a small nation in southern Africa­—is the object of almost all of Essex’s research.

As in many countries in the region, HIV/AIDS remains a dramatic problem in Botswana. But, thanks in part to the Harvard’s collaboration with the government, conditions on the ground have improved in the past decade as the partnership employs methods that combine vaccination, prevention efforts, and treatment.

‘THERE TO HELP’

In 1996, executive director of Harvard’s AIDS Initiative Richard G. Marlink worked with Essex to forge a partnership between Harvard and the Botswanan government using a framework that had been implemented in similar programs in Senegal, Tanzania, the former Zaire, and Nigeria. Since the 1980s the AIDS Initiative—a program dedicated to AIDS research—had operated as an extension of the School of Public Health.

But the situation in Botswana was different than that in the Initiative’s other base countries. The infection rate of the small, sparsely populated country in southern Africa was higher than that of most of its counterparts and showed no signs of leveling off.

Seeing this anomaly led Essex to hypothesize that the strain of AIDS affecting southern Africa, specifically Botswana, was a different type than the typical strain encountered in the United States or other parts of Africa.

The Botswana-Harvard Partnership began to expand rapidly between 2000 and 2001. Today, more than 250 people work in the partnership, most of them Botswanan researchers, technicians, and support staff. The organization is based on the campus of the Princess Marina Hospital, one of the largest hospitals in Botswana.

Describing the spirit and strategy of the endeavor, Marlink explained three stringent rules for employees that have allowed the partnership to operate successfully over the years.

“We want this relationship to be almost familial,” he said. “This is their country, their money, and they will be able to implement solutions to the problem in the most sustainable way possible. We are only there to help.”

REDUCING THE NUMBERS

The Harvard-Botswana Partnership’s research procedure is complex and varied, according to Essex, and is unified only by its reliance on asking questions that have thus far remained unanswered.

“We have done research on pregnant women almost since day one,” Essex said. “Over time we’ve perfected combinations of drugs—free drugs—to give to pregnant women starting at the beginning of the third trimester.”

The success of the strategies developed by Essex and his team have been recognized by international organizations. The World Health Organization adopted guideline recommendations developed by the team to reduce maternal transmission of HIV in developing countries, according to the Harvard AIDS Initiative’s website.

Beyond reducing transmission between mothers and children, the project ultimately aims to cut the number of new infections to the point below the number that would be needed to maintain the epidemic permanently, Essex said.

In the short term, the program hopes to raise awareness about the infection and increase access to the necessary drugs.

“It’s probably reasonable to say that in more developed countries, HIV/AIDS can be treated now as a chronic infection like hypertension and diabetes so that people don’t have to die from it,” Essex said. “But obviously that’s not the case in much of Africa because it’s dependent on having drug options available. Our immediate goal is to try to get everyone onto the cause so that they can live normal lives and not die from their infections.”

Essex predicted that success in this aim would occur in Botswana before other sub-Saharan African nations, largely because of its cooperative and forward-thinking government.

Nonetheless, Essex said that the research is far from complete.

“We’ve not yet done everything we need to do...to make that level of progress [to reduce] sexual infections in adults,” he said. “We didn’t know how to do it until recently, but now we do. We need to start implementing trials to put the strategy into action.”

LOOKING BACK

Both Essex and Marlink emphasized that the Harvard-Botswana Partnership is as much about educational enrichment as it is about researching solutions to the HIV/AIDS epidemic in Botswana. They lauded the project’s ability to provide students with three key firsthand experiences: working in a laboratory setting, living in a developing country, and tackling a problem with significant real world implications.

“We work a lot on education of AIDS experts who live in the country and, of course, some education of Harvard students at all levels,” Essex said. “We have undergraduates who go to Botswana for summers or several months for a semester, doctoral students who go there for a year, and postdoctoral fellows who are there even longer.”

Students involved with the partnership shared positive memories from their time in Botswana.

“It was such a unique experience because Harvard has such a presence there,” said Kelsey H. Natsuhara ’13.

Natsuhara also recalled the motivation of the staff, almost all of whom were Botswanans with a personal connection to the disease because of its consequences on their family and friends.

“I think that working at BHP was one of the most formative experiences I’ve ever had, both from an intellectual standpoint and in terms of personal growth,” said Natsuhara.

“I learned a lot in terms of the science, kind of from a research standpoint, but also about how an epidemic like this can affect so many people and how a country can rally together in the face of such an obstacle.”

Marlink said that the Harvard name and its reputation as a world-class educational institution has augmented the partnership’s success.

“I’ve found in my experience that the farther away you get from Boston, the more people respect and know [Harvard]. That recognition and trust is what helps us create projects like this,” he said. “We ensure the government they can trust us and that we won’t leave their citizens. We are more like a family and we work together.”

—Staff writer Pooja Podugu can be reached at podugu@college.harvard.edu. Follow her on Twitter @PoojaPodugu.

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