Entering the world's HIV?Aids Mission Control

2013-09-12 00:00

THE wide glass window of the office of Professor Salim S. Abdool Karim, director of the Centre for the Aids Programme of Research in South Africa (Caprisa), has a panoramic view of the central atrium of the new seven-storey glass research building within the precincts of the Nelson R. Mandela Medical School on Durban’s Umbilo Road.

You could be in New York or London. Sounds are subdued and the lighting is subtle. Lifts operate with a near silent hiss. In reception areas, LED screens flash up pages detailing the work and research that has emanated from this building.

Abdool’s office is mission control of the global battle against HIV/Aids, right on the front line thanks to South Africa having the highest number of people infected with HIV/Aids in the world. Abdool Karim, an epidemiologist who has conducted research on HIV/Aids epidemiology, pathogenesis, prevention and treatment over three decades, was recently appointed chair of the newly established UNAids Scientific Expert Panel.

As well as being president of the Medical Research Council of South Africa, Abdool is also professor of Clinical Epidemiology at Columbia University, adjunct professor of Medicine at Cornell University and associate member of the Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT) and Harvard University. So it’s not surprising that he and his wife, Quarraisha, keep an apartment in New York and that his favourite app is the New York Times.

“I’m a global scientist,” he laughs, then recalls Lorne Street in Durban’s central grid, where he was born in 1960.

On reaching school age, Abdool attended the Hindu Tamil Primary School in the city centre. In 1970, forced removals saw the Abdool family relocated to Chatsworth, where he attended Excelsior Primary School.

But when the time came for high school, Abdool decided he wanted to go back to the city and study at Gandhi Desai High School, despite a daily two-hour bus journey. He still enthuses about how happy he was at high school.

“I had a brilliant science teacher, Cassim Seedat.”

He also recalls his maths teacher, Ashik Hansraj. “I loved school because of those teachers. My high school career is what defined what I really became and my love for science.”

Abdool’s first choice for tertiary study was engineering, with medical school as a fall-back option. Coming from a relatively poor family background meant a scholarship was vital. None was forthcoming for engineering, but he obtained three scholarships for medical school.

“So I went to medical school by default. The scholarships paid for fees for books and also provided me with pocket money.”

His pocket money was also boosted by a weekend job in a supermarket. Hard work and multitasking has been a constant feature of Abdool’s life.

“I worked from the age of four — with my father, who was a clerk in a clothing factory. He worked for I.M. Lockharts. I had to put six shirts in a box and stack the boxes six high — I learnt to count to six and I could do my job.”

Following the move to Chatsworth, Abdool learnt how to make socks while working with his uncle at a sock factory in Clairwood during school vacations, and later as a salesman in a supermarket.

“I learnt the importance of the work ethic — you worked hard and you were rewarded for it.”

This work ethic extended to his studies and while at medical school — right next door to where he works now — Abdool fell under the spell of the big main-frame computer used for analysing data in the Shepstone building on the main Howard College campus.

“I was fascinated and decided to study computer science via Unisa while studying medicine.”

During the eighties, the medical school was a centre for political activism and Abdool was soon caught up in the struggle against apartheid.

“In my third year, I became very involved with the anti-apartheid movement. A highlight was when I had the opportunity to attend the launch of the United Democratic Front in Mitchell’s Plain in 1983 — that experience left an indelible mark on me, as I felt that we had a chance to make a real difference. There were three students in my medical school class who are now government ministers — Siyabonga Cwele [State Security Minister] Aaron Motsoaledi [Health Minister] and “Joe” Phaahla [deputy minister of Arts and Culture].”

During the early eighties, the disease that would become the main focus of Abdool Karim’s life was yet to have a name.

“I went through the whole of medical school without hearing about HIV/Aids. Now I’m working on it virtually every minute.”

In 1983, the word got round among medical students that there was a patient in Addington Hospital, an airline steward, presenting with a rare form of skin cancer — Kaposi’s sarcoma.

“Apart from that, we didn’t think much of it,” says Abdool, only later would this disease become a marker for HIV/Aids.

After completing medical school, Abdool undertook three years of laboratory research studying Hepatitis B before going on to learn epidemiology in New York at Columbia University. He returned briefly to South Africa in early 1988 to get married, before going to London to study health economics at the London School of Economics.

From this point, Abdool and Quarraisha are almost interchangeable. Their names appear together on many a research paper. Last year, she was awarded the Order of Mapungubwe in recognition of her “outstanding work in the field of HIV/Aids and tuberculosis research and health policy development”.

They have three children: Safura, who is studying law; Aisha, who is in her first year at the University of Cape Town; and Wasim, who is in secondary school.

After they were married, the couple went to New York.

“There we learnt about HIV/Aids. It wasn’t just a disease, it was a social movement — the focus around which revolved social issues, medical research, gay rights, plus HIV/Aids.”

They returned to South Africa in 1989 and Abdool began working as an epidemiologist in HIV/Aids.

“Both Quarraisha and I were working on HIV/Aids by 1990, and we have been ever since.”

Looking for HIV/Aids, often connected with Hepatitis B, Abdool checked his old samples of the hepatitis virus expecting to find HIV/Aids. “There were hundreds of samples — but no HIV/Aids.”

There were a number of reasons for the absence, says Abdool Karim. “South Africa was going through an epidemic of HIV/Aids in gay men, haemophiliacs and blood transfusions. But it was a contained epidemic limited to these groups. However, we knew it was just matter of time before it jumped into the mainstream population. But it didn’t. The virus in the gay community was a separate subtype B virus.”

What was heading this way in the general population in South Africa was the subtype C virus: “It really took off in the nineties and it was a separate epidemic.”

Studies showed HIV/Aids had appeared in other sub-Saharan countries among the heterosexual population and, with South Africa being an economic draw card, many people carrying the virus came from these countries and brought the virus with them.

“Soon the virus was all over the place. We have viruses from every one of our neighbouring countries here.”

Since then, Abdool has been at the forefront of researching and combating the disease, including doing the first HIV/Aids vaccine trial in South Africa at the Hlabisa Rural Clinical Research Unit.

“The thinking behind the vaccine candidate was good, but unfortunately it didn’t work.”

In South Africa, the key to defeating HIV/Aids lies in combating the spread of this infection in young women. A study done by Quarraisha in 1990 had identified the social dynamic propelling the epidemic: older men — in their late 20s and early 30s — having sex with teenage girls.

“That’s the story of HIV/Aids in Africa and that’s why HIV/Aids is so serious in South Africa. Quarraisha and I decided we had to do something to slow the rate of new infections in teenage girls, otherwise we would be wasting our time. If we do something about young girls, we can do something to stop the epidemic.”

Despite years of research and studies on vaginal films and gels, success proved elusive until the appearance of an antiretroviral drug called Tenofovir.

“The early data showed it worked in killing the HIV/Aids virus in infected patients,” says Abdool.

Abdool negotiated funding from the South African and United States government funding agencies, and started the study in 2006. It was to prove a breakthrough moment in the fight against HIV/Aids. The microbicidal gel made from Tenofovir proved to be effective in preventing transmission of HIV in women, cutting the overall infection rate by 39%.

“Malcolm Gladwell is right about the tipping point,” says Abdool. “You have to put in the hours to get the success. We put in hundreds, thousands of hours. We had previously failed and failed and failed — at least eight times. Our successful study on Tenofovir came on the back of all those failures. You have to be stupid or mad to persist. But we never gave up, the need was too great.”

When the study findings were announced at the 2010 World Aids Conference they were met with several standing ovations, a rare occurrence in formal scientific meetings.

Is the end of HIV/Aids in sight? Could antibodies, which were found to have naturally developed in two women from KwaZulu-Natal, pave the way to a successful vaccine?

“Not in the next 10 years,” says Abdool. “But, for the first time, I think a vaccine is possible. If you had asked me that question three years ago, I would have said it was not likely. We didn’t have the science back then. But now we have to try harder to make a vaccine against HIV/Aids, it’s a real possibility.”

• feature1@witness.co.za

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