KHOPOTSO: In their individual careers as a paediatrician and obstetrician at Chris Hani Baragwanath Hospital in the 1980s, Drs Glenda Gray and James McIntyre have seen first-hand the incidence of mother-to-child HIV transmission. In 1996, the pair partnered together to establish the Peri-natal HIV Research Unit, a research project of the University of the Witwatersrand, in Johannesburg. The unit operates in the Soweto community, and is based at Chris Hani Baragwanath Hospital.
Dr GLENDA GRAY: We started it because we were interested in interrupting mother-to-child transmission. We heard, first of all in 1991 or 1992, that breast-milk could transmit HIV. And immediately after those reports came out UNAIDS and WHO convened a meeting and came up with some breast-feeding strategies so that if you were living in a resource-rich area you should formula-feed your baby and if you live in a poor area you should breast-feed your baby. And we thought that was unfair and that they hadn’t really consulted much with African women or women who may have HIV infection in poor countries.
KHOPOTSO: The concern gave birth to their first major trial.
Dr GLENDA GRAY: Our first study that we set out to do was to look at whether women in Soweto could safely bottle-feed their babies ‘ whether bottle-feeding instead of breast-feeding was a better alternative. That was our entrÃ©e into work with HIV ‘ trying to prevent breast-milk transmission.
KHOPOTSO: At around the same time, years of work involving mono and combined drug therapy and Vitamin A to prevent mother-to-child HIV transmission followed ‘ and met with great resistance from an unexpected quarter ‘ their peers in medical research.
Dr GLENDA GRAY: When we started triple therapy studies a lot of our other investigators and scientists in the country criticised us and said: ‘How could we be doing research on drugs that would never be affordable in this country’? And we said: ‘Well, it will be affordable and when it happens we want to be the ones who know how to treat people with HIV infection’’¦ I can remember having some altercations with fellow researchers saying that ‘we were doing unethical research because these drugs would never be available to Africans’.
KHOPOTSO: Although shunned by their peers, their belief in the search for better alternatives never faded. Today that is something to take pride in. Dr James McIntyre.
Dr JAMES McINTYRE: It was a dream for most people. Many people thought it would never happen. This was ten years ahead, almost, of what’s happening.
At the time treatment was so expensive that even people on private medical aids couldn’t afford (it). Most medical aids wouldn’t cover it. Unless you were independently wealthy’¦ treatment was just not an option. And I think that is one of the things that we’re proud of in the unit. We’ve shown in studies that using antiretrovirals in low-resource settings works. We’ve been at the cutting-edge of moving some of that forward. And now that’s widely accepted. That’s what we’re seeing all over Africa. That’s what we’re seeing with nearly a quarter of a million people on treatment in this country. That’s a great success.
KHOPOTSO: What first began as an effort to reduce the incidence of mother-to-child HIV transmission in South Africa has now become a world-class research institution whose work extends into treatment trials in adults and children, treatment and prevention and psychosocial research and policy development. The earlier objective, however, still remains a big priority. The work is not complete and it is, after all, what made James and Glenda the darlings of many Soweto women and families.
Dr JAMES McINTYRE: We’ve learned a number of lessons from the Soweto MTCT programme that are replicable elsewhere. There are about 30 000 deliveries in Soweto each year between the clinics and the hospital’¦ We have a very high uptake of testing and counseling and that’s the one contrast to many places in the country, still. And I think it’s because we’ve put extra resources. We supply counselors into those clinics. It’s not just left to a nurse to try and do in between whatever they do during the day’¦ But our next challenge is to move to more effective regimens. We are still sitting with a transmission rate of around 8% in Soweto and that should be half. We can get that down to less than 5%.
KHOPOTSO: If that can be achieved the pair look forward to some good times.
Dr JAMES McINTYRE: Hopefully, we don’t have another 25 years’¦ I think I could work very hard at reading a book on the beach. How’s that? (chuckles)
KHOPOTSO: For Dr Gray, her love of children will continue keeping her hard at work.
Dr GLENDA GRAY: When I became a paediatrician we were at the brink where, in fact, child survival was improving in this country. And I’ve just watched the clock turn and see that we’re back to the stages where we were in the ‘50s in this country. Children die like flies because of HIV. I want to be back in 1988 where we were beginning to achieve the kind of levels of survival that you got in America and Britain and Sweden. I want to be back there. And I want to be running Well Baby Clinics, instead of Sick Baby Clinics.