DURBAN, SOUTH AFRICA —Here at the Warwick Avenue Triangle every form of land transportation into the city converges — trains, buses, trucks, taxis — bringing three million people a day through this intersection. This makes it a convenient spot for a TB clinic which is one of the services offered here at the Centre for the AIDS Program of Research in South Africa (CAPRISA) site at Prince Cyril Zulu Communicable Diseases Clinic. Less stigmatized than sexually transmitted diseases, as one of our guides put it, tuberculosis can serve as the explanation of why patients wait in the shelter of an open air corridor starting at 6 in the morning, but it is not the end of the story of what goes on here.
Epidemiologists determined that HIV arrived in South Africa in the late 1980s, with the AIDS epidemic here peaking in the late 1990s, our guide tells us. While the connection between the two went unacknowledged by the South African government well into the first decade of this century, TB flourished. Now, TB and HIV care are linked at the government-run clinic here, while CAPRISA researchers explore questions of when to start antiretroviral treatment for patients ill with TB, as well as how to prevent HIV transmission. This also is where researchers reviewed findings from the CAPRISA 004 trial that showed that an antiretroviral gel, applied before and after sex, reduced HIV incidence by 39%, providing proof-of-concept that an antiretroviral agent can prevent sexual transmission of HIV in women, as well as from the VOICE (Vaginal and Oral Interventions to Control the Epidemic) trial, which showed that researchers still had work ahead to discover ways to deliver that agent that women could, and would be willing to use. Research now is underway here on a vaginal ring, a longer-term means of delivering preventive medicine to women.
Progress here, in short, comes quickly and slowly, with researchers and clinicians backed by U.S. PEPFAR funding as well as South African government support and community members, confronting challenges to find answers. At the end of a tour last week, a patient spoke of what those answers had given him. Co-infected with HIV and tuberculosis, he had undergone treatment for TB twice, and more treatment lies ahead for him. He has developed a hump on the back of his neck, a side-effect from his HIV treatment. At one point, he gave up, and bought an herbal solution that he was told would cure him and end his need for antiretroviral medicine forever. When his condition worsened he returned to treatment, and shares the lesson he learned with anyone he thinks needs to hear it. None of it has been easy, but he is smiling broadly, even laughing as he recounts his experiences, saying that he is happy that he is alive.