SA unit leads in Aids research

7 June 2004

The trendy offices of the Perinatal HIV Research Unit at Chris Hani Baragwanath Hospital in Soweto are a far cry from the poky broom closet its directors James McIntyre and Glenda Gray started out in when they embarked on their mission 10 years ago to find ways of preventing mother-to-child infection of HIV.

Now the unit, which occupies several floors of the hospital’s New Nurses Home, a large square building west of the hospital, employs 200 staff members, conducts myriad research programmes and is an international player in the field of HIV/Aids research.

Just getting an interview with McIntyre and Gray is something of a feat – and chatting to both of them together, a major feat.

Given the cutting-edge nature of their work, they are much in demand, and the awards that line their offices are testimony to their incredible success in the field of HIV/Aids: the Nelson Mandela Award for Health and Human Rights (2002) and the Heroes in Medicine Award from the International Association of Physicians in Aids Care (2003) are just two.

The Perinatal HIV Research Unit, under the auspices of Wits University, is one of the largest Aids research centres on the continent, and has grown into an impressive multi-disciplinary research centre, partnering with many other organisations and engaging in research across the spectrum: preventing mother-to-child transmission, conducting vaccine trials, researching diaphragm use as a barrier to HIV, exploring sexual practices of men and women in Soweto, examining the economic impact of HIV/Aids on families, and researching the best treatment, care and support of people living with Aids.

Both Gray, a paediatrician, and McIntyre, an obstetrician, are candid about the success of their work. “What we’ve spearheaded here has changed the lives of millions of women worldwide – essentially finding affordable interventions to prevent mother-to-child transmission of HIV”, says Gray. “And we’ve been quick to translate research into action.”

“We’ve been a central player in international research in the field that started 10 years ago”, chips in McIntyre. “We’ve helped develop that research agenda.” The two directors, who have worked so closely for all these years, constantly finish off each other’s sentences.

The unit was pivotal in changing the mindset of the World Health Organisation, which prescribed that HIV-positive women in developed countries should formula feed while those in developing countries should breastfeed, in the belief that the health risks for formula feeding in Third World countries outweighed the risk of HIV transmission.

“We said that women had a right to make that decision themselves and needed to be properly informed first”, says Gray.

The unit was one of the first in the country to investigate triple therapy for HIV-positive black South Africans. What began as research into mother-to-child transmission soon spread to treatment for all HIV/Aids patients.

“Women would say: ‘You’ve saved my baby but what about saving me and my partner?'”, says Gray. The unit was also one of the first to treat HIV-positive children.

To what do they attribute their incredible success? “Our team is dedicated and passionate about trying to eradicate paediatric HIV. And relentless in its commitment”, says Gray.

“We’ve been able to convince funders that we can do the job, and we’ve established a track record in research and delivery”, adds McIntyre.

The unit is the first in the country to have set up a functional HIV vaccine trial site, and began administering the first vaccines in October last year.

“We’re not likely to see a vaccine for the next 10 years, but we are developing long-term capacity to do the trials”, says McIntyre. The unit is in the process of expanding to additional premises in Soweto for its vaccine trials.

After 10 years of intimate research with Soweto residents, strong relationships have been forged with the community, which has in turn benefited further research initiatives.

With a massive “research bank” of people on their doorstep, and based at one of the largest hospitals in the world, not to mention their team of top-rate medical practitioners and researchers, it is not surprising that the unit is not short of funding for its research projects.

McIntyre is the principal investigator for a wide-ranging five-year project on HIV/Aids which has been given a massive US$21-million grant from the United States National Institutes for Health – one of their largest awards and part of their Comprehensive International Programme on Aids (Cipra).

The programme brings together several partners in the field, including the Reproductive Health Research Unit, also based at Bara, and Wits University’s Clinical HIV Research Unit.

The many other cutting-edge research projects on all aspects of HIV/Aids being conducted by the unit and its partners make for fascinating reading, but are too lengthy to document here.

Over the years, McIntyre and Gray have seen a lot. Amid the success and the accolades lurks plenty of sadness too, as anyone up close to the killer epidemic can testify to. “We have seen a lot of people die. But we have also given life to many people. We’ve seen both sides of the story,” says Gray.

Some of the children of HIV-positive mothers who are healthy today because their mothers received nevirapine on the unit’s mother-to-child-transmission programme “still run around here. They come to visit us”, chuckles Gray.

For Gray and McIntryre, who glow with pride and confidence, the rewards of being at the helm of groundbreaking research initiatives to save people’s lives clearly outweigh the negatives.

Source: City of Johannesburg

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