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Kenyan Doctor Saves Lives Through AIDS Research

Kenyan Doctor Saves Lives Through AIDS Research, Outreach

By Burton Bollag
Special Correspondent

Washington - With a mix of fierce dedication and a practical, results-based approach, Dr. Frederick Sawe has shown that much can be done in sub-Saharan Africa to stem the spread of HIV/AIDS. Sawe is deputy director of the Kenya Medical Research Institute/Walter Reed Project HIV Program, a prevention, research and treatment project run jointly by his home country of Kenya and the U.S. military's international HIV program.

Based in the town of Kericho, in the southern Rift Valley region, the program is one of the country's most comprehensive initiatives against HIV infection, which causes AIDS. Funding comes from the President's Emergency Plan for AIDS Relief (PEPFAR), a U.S. government program established in 2003.

The program has registered more than half of the estimated 100,000 people infected with HIV in the region of 2.5 million. A little less than half of those infected receive anti-retroviral medication - a treatment that has turned the once deadly illness into a treatable condition. The others - infected, but healthy - undergo regular checkups and are put on the medicines if their health starts deteriorating. To bring care close to where patients live, medicines are provided at 347 local public health facilities throughout the region.

The program provides a level of care considerably better than what is available in many other parts of Africa. For example, the program reaches a large majority of the region's pregnant women to counter the risk of their infecting their infants. Last year, 84,000 of the region's 100,000 pregnant women were tested for HIV infection. Those who tested positive receive counseling and inexpensive medicines to prevent transmission of the virus to their newborns.

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Sawe said the program follows procedures that researchers have demonstrated are pretty effective in preventing mother-to-child transmission of the virus. "There is really no reason for childhood HIV cases," Sawe said.

Sawe's program has improved the effectiveness of the widely used treatment. Research he co-authored that was published in the New England Journal of Medicine showed that a combination of drugs - ideally administrated regularly from the 14th week of pregnancy - is much more effective and safe for the mother than the single dose of the inexpensive drug nevirapine during labor. This method has been used since its development in 1999 by researchers in Uganda. The treatment also avoids the risk of the mother building up a resistance to nevirapine and compromising future treatments.

Another focus of Sawe's program has been reducing the transmission of the virus by prostitutes. Those "infecting the most people are the commercial sex workers," Sawe said.

Typically, prostitutes and some others who might have been exposed to the virus have felt embarrassed to go to a clinic to be tested. So Sawe started a campaign of "moonlight HIV testing and counseling." After a radio and leaflet ad campaign, health workers spent several nights on the streets of "red light" districts, offering testing and education on safe sex. In many areas, Sawe said, 50 percent of prostitutes tested positive.

"We teach them to use condoms, and how to negotiate with clients [for safe sex]," said Sawe. "For example, some now charge double for having sex without a condom."

One of the goals of Sawe's program is to train local health workers "so that people see their sons and daughters rather than some strangers" providing treatment. This is essential to winning the support of the population, Sawe said.

The program is also developing and testing new treatments and vaccines. The search for a vaccine against HIV received a major boost last year when, for the first time, a vaccine formula being tested in Thailand was shown to be partially effective.

The recently released annual report of the United Nations Programme on HIV/AIDS also had some good news. As a result of prevention and treatment programs around the world, at least 56 countries have stabilized or reduced the number of new HIV infections.


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