The US may have staked its claim in leading the charge against finding a cure for cancer with the new $6.3 billion “Moonshot” research bill, but when it comes to leading the way on finding a cure for HIV, we can give credit to South African professor Dr. Glenda Gray and her all-female team who are leading the world’s largest HIV vaccine trial in a bid to come up with breakthrough preventative research.
The announcement was made on World AIDS Day in 2016 however the results of this new trial won’t be released until 2020, to give researchers and participants enough time to complete this important work. And it makes sense that this trial is taking place in South Africa which is the global epicenter of the HIV/AIDS epidemic with roughly 6.5 million people infected.
According to an extensive 2-part report in the Seattle Times by reporter Nina Shapiro, HIV affects nearly a fifth of all 15-49 year-olds in the country. Seattle-based Fred Hutchinson Cancer Research Center is heading up the HIV Vaccine Trials Network (HVTN), working in conjunction with a number of public and private organizations such as the Perinatal HIV Research Unit (co-founded by Dr. Gray), the government-run South African Medical Research Council which Dr. Gray became the president of in 2014, and another research network based in North Carolina.
This is a massive, multi-faceted undertaking which will require the expertise of many organizations and healthcare professionals who have expertise in this area. The initial part of the study will be looking at antibodies, the protein in the body that fights infection and bacteria, in a unique way. They plan to inject the antibodies directly though an IV drip instead of through a vaccine. This study, will take place in a number of African countries along with South Africa such as Botswana, Kenya, Malawi, Mozambique, Tanzania and Zimbabwe. It will also concurrently be trialed in North and South America.
But is it the traditional vaccine trial which will take place exclusively in South Africa, and require 5400 participants. In total, the organizations will be working with 10,000 participants over the course of 5 years. $130 million is going into the vaccine trial, and an additional $144 million for the antibody study.
Dr. Glenda Gray is a multi-award-winning world-renowned pediatrician and HIV-prevention scientist, specifically known for her pioneering work in the area of mother-to-child HIV transfer. She started out as an activist and medical student fighting against apartheid in hospitals in the early 1990’s in South Africa, at a time when the HIV/AIDS crisis was exploding across the country.
There is no better person for the job than her, and the rest of the leadership team in the vaccine trial are all women, according to a press release.
Dr. Linda-Gail Bekker is the deputy director of the Desmond Tutu HIV Centre at the University of Cape Town and chief operating officer of the Desmond Tutu HIV Foundation. Dr. Fatima Laher is the director of the Perinatal HIV Research Unit at Chris Hani Baragwanath Hospital in Soweto. Dr. Mookho Malahleha is the deputy director of Setshaba Research Centre in Soshanguve.
Participants in the trial will be men and women between the ages of 18-25, but there is an emphasis on how a successful vaccine could alleviate the HIV burden disproportionately placed on women. They make up the majority of HIV patients who are subjected to cultural norms that often leave them more vulnerable to the disease than men.
Dr. Gray told Vice’s Broadly website that this ground-breaking research could be the “ultimate female empowerment”.
“Globally, women make up half of the 36.7 million people living with HIV, and 80 percent of infected women live in sub-Saharan Africa, the region hardest hit by the pandemic. Most infections in sub-Saharan Africa are transmitted heterosexually. For biological, socioeconomic and cultural reasons, women are more vulnerable than men to acquiring HIV during sex,” said the press release.
“In a culture in which men dominate relationships, women often can’t negotiate safer sex practices such as condom use or taking a daily antiretroviral pill known as PrEP to prevent infection. One of the appeals of a vaccine is that it can be used discretely, without a woman’s partner even knowing.”
In her in-depth report, Nina Shapiro shares some startling results of a recent South African government survey which emphasized the need to have women at the center of this trial.
“More than 17 percent of women ages 20 to 24 had HIV, while the infection rate for men in that age group was 5 percent. Among 15- to 19-year-olds, girls were eight times more likely to be infected than boys,” she wrote.
She also writes how this new trial was modeled off and inspired by an HIV vaccine study undertaken by the Thai government in the early 2000’s, which resulted in a 31% success rate. The South African trial hopes to achieve at least 50% effectiveness rate and capitalize on what the Thai experiment started.
The scale and even the possibility of a trial as large as this is no small feat. Nina Shapiro goes through the problematic history of HIV trials in South Africa, fueled by distrust toward Western institutions by the black population. During apartheid, as antiretroviral drugs started to become more widespread, many people infected with HIV did not choose to take them out of fear they were being poisoned or being lied to about what the medication did.
Skepticism of the “white man’s agenda” was compounded by the increasing knowledge of the wealth of many Western pharmaceutical companies, which resulted in more and more people dying, whose lives couldn’t potentially been saved.
“There were traffic jams in the cemetery and people would be crying at the wrong grave,” said Gail Johnson, founder of Nkosi’s Haven, a Johannesburg home for HIV-positive mothers, their children and AIDS orphans, as reported by the Seattle Times.
Eventually, antiretroviral drugs started to catch on, thanks in part to willing participants who went on to get married and have children who were HIV-free. This led to a movement to de-stigmatize those living with HIV, and allow people to publicly share that info without fear of being punished. ARVs also started being distributed among sex workers as a protection, showing how the perception of the drug started to change over the years.
Added to this was the long-term effects of widespread use of ARVs – life expectancy increased from 53 to over 60 during the course of a decade.
With Dr. Gray’s history of advocacy and determination to increase the livelihood of mothers and children, we could be on the verge of a major historical medical breakthrough.
“Biomedical interventions hold the fort while we try to win other battles for people, like poverty, like jobs, ending intimate partner violence, and making equity available. At the same time we are working in parallel to try and realize how to get the chemical into the community as soon as possible, she told Vice’s Broadly.
Although there are a number of areas needed to tackled in order ti improve people’s lives, she believes the HIV vaccine trial is part of the front lines battling for gender equality which can in turn help other people around the world. Watch the news report below where Dr. Gray and one of the first participants talk about this new trial: