Day two in Africa: Visiting an “academic institute and an agent for social change”

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Director of  The Center for Global Health Policy Christine Lubinski is blogging today from Johannesburg, South Africa. This is her second entry from her visit to South Africa and Zambia, where she and other Center staff are hosting five congressional staff members on tours of U.S. government funded programs to address HIV and TB. 

Dr. Helen Rees describes the University of the Witwatersrand, Johannesburg (Wits), Institute for Sexual and Reproductive Health, with its myriad activities and programs, as both an academic institute and an agent for social change. 

While we and our congressional colleagues were visiting the Institute, a four-week residential course on research methods was underway. Five thousand health care workers each year are trained here on issues related to HIV, TB and reproductive health.  The Institute also does work on gender-based violence and is beginning to address the so-called lifestyle diseases—diabetes and hypertension—that also contribute substantially to morbidity and mortality in South Africa.  The program of the Institute includes health services provision, policy development, and advocacy and pioneering research.  The Institute was the first group to integrate prevention of mother to child transmission (PMTCT) programs with the provision of HIV treatment to women. They are currently engaged in 60 different active research programs funded by a range of donors including the U.S. through the National Institutes of Health and the President’s Emergency Plan for AIDS Relief, or PEPFAR.

Dr. Rees and her colleagues are also busy working with the government and other key civil society players on the development of a prevention research agenda for South Africa for the next five years.  They will partner with the South African AIDS Council to host a meeting with civil society groups to discuss the results of the CAPRISA microbicide trial and what it might mean down the line as a prevention intervention for South Africa. 

Dr. Francois Ventner joined our meeting and talked about the epidemic of tuberculosis.  He serves as president of the South African HIV Clinicians Society and noted that not a single country in southern Africa is seeing a reduction in TB rates, reflecting the dangerous synergy between HIV and tuberculosis.  Drug resistant tuberculosis is a huge problem.  Most of those who survive the disease and its grueling treatment regimen have lasting serious and debilitating side effects.  Fifty percent become deaf.

Certainly an intriguing part of our visit was to learn of Dr. Rees’ vision of marrying health research and health services with a plan for urban renewal.  We also were able to see some of its evolution.   The Institute is located in a refurbished historical building in the heart of Hillbrow—widely considered one of the most dilapidated and crime-ridden neighborhoods of Johannesburg.  Many of the buildings have been abandoned and are occupied by squatters living without electricity or running water. 

Step by step the Institute is working to renovate surrounding buildings.  Today, the street hosts an active sexually-transmitted infections (STI) clinic that has been renovated and offers HIV testing services.  Around the corner is a large community-based HIV treatment clinic—one of the largest HIV treatment providers outside a hospital setting, which currently serves 13,000 patients and enrolls 600 new patients each month.  Another renovated building hosts a VOICE trial site – a randomized clinical trial testing oral antiretrovirals (ARV) for prevention against a topical ARV-containing microbicide.  The study will ultimately enroll 600 HIV negative women and monitor them for three years.

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