Nebraska researcher finds AIDS in Africa is a medical and cultural challenge

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February 9, 2012 - 6:00pm

The NET Television documentary Hearts of Zambia puts a face on the struggle against HIV/AIDS in Africa, by visiting a hospice that treats people suffering from side-effects of the illness and schools helping children who were made orphans in the epidemic. The film also visits a clinic in Lusaka, Zambia led by Dr. Charles Wood, director of the Center for Virology at the University of Nebraska-Lincoln. Wood has studied the AIDS virus from the early days of the epidemic in the 1980s. Grant Gerlock of NET News spoke with Wood about the HIV/AIDS situation in Zambia and how the virus presents more than just a medical challenge.

Watch a trailer for Hearts of Zambia

From Hearts of Zambia

UNL's Dr. Charles Wood, with a young family receiving treatment from the Lusaka clinic

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The Lusaka clinic is located on the campus of the University Teaching Hospital.

DR. CHARLES WOOD, DIRECTOR OF UNL CENTER FOR VIROLOGY: Zambia is part of Sub-Saharan Africa, and that really is the hotbed for HIV/AIDS. It has been shown that the lifespan of people had dropped since the HIV epidemic. It was down into the 30s, the average lifespan. But now it is better because of the treatment program that's been implemented. It touches every single person in the country because you cannot get away from someone having someone die in their family. There are funerals all of the time that people go to.

GRANT GERLOCK, NET NEWS: At one point, at least one in five in Zambia were infected. What is the situation now? Is it getting better?

WOOD: Yes, I think things are getting better, and that is because of the scale-up of the anti-retroviral treatment program. The U.S. has provided billions of dollars for that and it's really helping. We're seeing impact. When we first started to work in Zambia back in the late 1990s, we have studies within the hospital in the capital in Lusaka, a University hospital, where we were seeing an infection rate around 30 percent, 1-in-3. Now the official number is below 20 percent. Around 16 percent or so. But of course, it varies from place to place. It tends to be higher in the urban setting. Of course in Lusaka, the capital, one tends to see higher infection. But on the average it's dropping, which is great. There are many less deaths due to AIDS.

We were used to seeing the clinics all full, the hospital all full of sick people, but now it's pretty empty. So it's really a dramatic change since the implementation of the treatment program. It's going down, and hopefully it's going to keep going down.

GERLOCK: The capital is where you operate a clinic with doctors there for research and treatment. What do you learn from operating that clinic that you can't learn from just working with the virus in a lab?

WOOD: Well, you're really seeing the human face of the laboratory, because you can see patients actually infected and affected by the disease. You can see people who are really sick, and you really see the impact of the infection. And it gives us the opportunity to study a disease and to see how we can actually prevent people from getting sick. And that's really the important thing - how we can translate what we learn from the laboratory into the community, and also to prevent infection.

GERLOCK: What is the situation medically with HIV/AIDS? For years, the course of action has been the cocktail of drugs people take for their treatment. Is that the basic model that is followed in Zambia?

WOOD: Yeah, the treatment program is basically similar to what's being done in developed countries like the U.S. They're using cocktails, a combination of two or three drugs. It's working very well. It hits the virus at different parts of the life cycle. So it provides much less chance for the virus to mutate and change. That's why it's very effective.

Of course, the challenge is the virus will still change. You have to monitor the infected individuals to make sure the virus did not develop resistance. And if that's the case, then you will have to change drugs, change the cocktails.

Some of the newer drugs are available in the U.S. but may not necessarily be available in that setting yet. So they're still using a smaller panel of drugs in developing countries, mainly because of the cost. I mean, some of the new drugs being developed are very expensive. These are all patented so they could not produce generic drugs until the patent runs out. So it's still a challenge in terms of the cost. For the availability of drugs to so many people, the cost really adds up.

GERLOCK: One of the moments that stood out for me in the program Hearts of Zambia was a scene with a group of school children reciting a lesson on AIDS that they've learned. They're reciting it from memory. So AIDS is definitely a big topic in the schools, but are there still cultural barriers to advancing that message in Zambia and advancing ideas of how it can be treated and how it can be prevented?

WOOD: Yes, I think they're doing the right thing. Education starts from the children, because they need to learn about the disease before they actually come into contact with the virus. So I think they're doing the right thing with education from the ground up. But as you point out, there are some cultural habits which are very hard to change.

The AIDS virus is a sexually-transmitted infection and we all know about sexually-transmitted diseases - it's impossible to prevent all of them. It's very hard to change the behavior of people, and that's why it's still transmitted. Especially in Africa, the culture is different even from tribe to tribe and from country to country. So how do you adapt a cultural change in that setting? It is a challenge.

And in a setting like that, you have mostly a male-dominated society and a lot of heterosexual transmission occurring, and it is difficult for the women to prevent infection, to say "no," basically. It's a male-dominated society. That's why we still have a challenge empowering the woman. How do we empower the woman to say no and protect themselves from being infected? And a lot of it has to do with the economic situation, because these young women have to rely on the spouse for their living. Those that are well off could have mistresses and bring the virus back home. So many of these issues need to be dealt with: social, economical, it's all tied together.

GERLOCK: For as long as you've been working with the AIDS virus, does the fight against complacency become part of the fight against AIDS either for you or for the country of Zambia?

WOOD: I don't think people get complacency about disease because it's pretty much with us. However, there are certain complacencies developed even in the U.S., especially in the gay population. Back, if you remember, in the late 1980s or 1990s in the full blast of the AIDS epidemic, people were aware of it because they're seeing their friends or relatives dying, but now with the drugs, it is thought that now everything is under control. So they don't see the people dying anymore. The awareness is not as acute. So that is a concern. We don't see that in Africa yet because we're still seeing a lot of deaths, because the treatment program is not reaching to all infected people.

I think it's a concern when you think that we've conquered the virus but yet the infected people are still able to transmit the virus and you can get new infection. And one good indication is that even through the deaths are going down because of the treatment, the number of new infections are staying level. For everyday people, you don't hear the news anymore, you don't see the television anymore, you don't read it in magazines anymore because of the treatment. But I think if we're not careful, it's going to bounce back with drug resistance and that will be disastrous.

GERLOCK: Is a vaccine still the key? Is that still what all the focus is on?

WOOD: Yes, I think a vaccine is still a key, but there's still a lot of challenges developing a vaccine. But there's a lot of excitement recently in terms of prevention, using drugs as prevention. So prophylaxis is a big push, the preventing of infection. Preventing infection, vaccine is one way. Behavioral modification is another way. And a third is to develop prophylaxis for HIV. Vaccine is only one of the keys for prevention. But it is a very important key because if it works, you are basically protected.

GERLOCK: Dr. Charles Wood, Thank you very much.

WOOD: Thank you very much.



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