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 entrée 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: ‘€œHow could we be doing research on drugs that would never be affordable in this country’€? And we said: ‘€œWell, 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 ‘€œwe 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.