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46446 Spotlight SPOTLIGHT Volume 5 Issue 1 / Summer 2007 Focus: How the BHP Came to Be aybe it all started with Deeda Fast forward to June 1996. Maurice Tem- Consultant Physician, heading one of the M Blair, an early (and constant) sup- pelsman, now Chair of the HAI’s Interna- Medical Units at Princess Marina Hospital porter of the Harvard AIDS In- tional Advisory Council, was hosting a din- in Gaborone. As Essex remembers, Dr. stitute. She introduced Max Essex, Chair of ner at Washington’s celebrated Cosmos Joseph Makhema had already retired for HAI, to Maurice Tempelsman in the 1980s. Club. The dinner was in honor of President the night when he was roused by the Pres- Because of his business and personal in- Ketumile Masire of Botswana. Knowing of ident’s knock. Still wearing his bathrobe, terests in Africa, Mr. Tempelsman’s knowl- the growing AIDS crisis in Botswana, Mr. Dr. Makhema joined the two men for a edge and contacts were essential in helping Tempelsman invited Max Essex to the din- discussion about the growing AIDS crisis. establish HAI’s research and prevention col- ner and introduced him to President Masire. At the end of the conversation, it was de- laborations in Senegal. Studies with a cohort The two spoke briefly. The President asked cided that Essex would travel to Botswana of commercial sex workers yielded the iden- Dr. Essex if he could meet with him the next as soon as his schedule allowed. tification of HIV-2 and evidence that it was morning. Essex, who had a class to teach at A few weeks later, in the summer of less virulent than HIV-1. Senegal has been Harvard the next day, said no, but that he 1996, Max Essex landed in Botswana for cited by the World Health Organization as could meet later that evening. the first time. He was met by Ria Madison, a major success story, having the lowest rate When the meal was over and the formal who worked for Maurice Tempelsman as of HIV/AIDS in sub-Saharan Africa. The goodbyes said, President Masire and Dr. Personnel Officer at Lazare Kaplan program continues to this day, under Dr. Essex went back to the President’s hotel Botswana, a diamond polishing operation Phyllis Kanki, making it the longest suite. The President knocked on the door that employed several hundred people. prospective study of HIV in Africa. of his Personal Physician, who was also a Many of the employees were young women (continues on page 5) The Players. Top row: Deeda Blair, Dr. Max Essex, Maurice Tempelsman, President Masire. Bottom row: Dr. Joseph Makhema, Ria Madison, Dr. Ibou Thior, President Mogae. VViieewwppooiinnttss An Interview with Dr. Max Essex demic in southern Africa, we should do it The questions about how drug-resistant with the virus most representative of that variants develop and get transmitted among region, rather than accept what was done people to interfere with one program or an- for the West. other have not been addressed. If women We also made major progress in learning and infants are getting infected for the first how to prevent mother-to-child transmis- time with a drug-resistant variant, then the sion of HIV and we ran the first vaccine tri- standard chemoprophylaxis won’t work. We als in southern Africa. already know that if women and infants are getting chemoprophylaxis with one or two Spotlight: What else? drugs to block mother-to-infant transmis- sion, then the antiretroviral treatment that Essex: Building the Botswana-Harvard HIV they will need later may not work. Drug re- Reference Laboratory, the largest AIDS- sistance feeds off itself in different ways dedicated laboratory in Africa, was a major when you have a combination of chemo- accomplishment. prophylaxis and treatment going on in the Through the KITSO program, we same population at the same time. Photograph by R. Feldman trained more than 5000 clinical AIDS Spotlight: How long do you think the col- workers, including doctors, nurses, mid- Drs. Max Essex and Joe Makhema laboration between HAI and Botswana wives, counselors, pharmacists and lab will continue? workers. Approximately 80-90% of all Dr. Max Essex is Chair of the Harvard School healthcare workers who serve AIDS patients Essex: I think it will continue for a long, of Public Health AIDS Initiative (HAI), the in Botswana have received KITSO training. Lasker Professor of Health Sciences, and Chair long time. I hope it will continue for an- of the Botswana–Harvard Partnership for other 20 years at least because many of the HIV Research and Education (BHP). As the “Botswana is an example of what problems we are now addressing need great attention. Harvard has experts in different BHP celebrates its 10th anniversary, Martha hopefully will occur in much of Henry, Editor of Spotlight, asked Dr. Essex to aspects of these problems. We are commit- reflect on past accomplishments and future the rest of Africa.” ted to helping the situation in Botswana. goals of the BHP. - Dr. Max Essex Botswana is an example of what hope- fully will occur in much of the rest of Africa. It’s the first place where a large program was Spotlight: What major accomplishments launched to cover most of the affected pop- were achieved during the first ten years of Spotlight: What are the future goals of the ulation of a country, and in some ways an the Botswana-Harvard Partnership? Botswana-Harvard Partnership? easier case because of its good government and economic resources, but it’s clearly an Essex: We treated the first AIDS patients Essex: We need to develop better prevention example of what has to happen in the rest of with antiretroviral drugs (ARVs) in approaches for adults at risk of HIV infec- Africa to control HIV/AIDS. Botswana. Bill Wester and Hermann Buss- tion. We need to do more with vaccines, mi- mann, who work at the BHP, were the first crobicides and other biological approaches to prevention. physicians to administer ARVs through the SPOTLIGHT is published by the government health system. The Minister of We need to determine whether the es- Harvard School of Public Health AIDS Initiative Health at the time, Joy Phumaphi, wanted tablished drug regimens will work as well in 651 Huntington Avenue, 6th Floor Boston, MA 02115 USA to demonstrate that lives could be saved the medium and long term in Botswana, es- Phone: 617-432-4400 pecially if drug-resistant HIV variants begin Fax: 617-432-4545 through three-drug combinations. This led Email: [email protected] to a government program that is by far the circulating in the population. Web: aids.harvard.edu largest in Africa, setting the example that a Chair: Max Essex Botswana’s situation is unique. Nowhere Executive Director: Richard Marlink country can treat a lot of their AIDS pa- else in the world has a significant fraction of tients if they really want to. PUBLICATIONS STAFF the population been involved in both ARV Editor: Martha Henry In our research work we showed that the treatment for AIDS and chemoprophylaxis Print Designer: Kim Morrisseau Contributors: Michelle Schaan, Lendsey Melton, virus in Botswana and southern Africa is to prevent transmission of HIV/AIDS from Patricia Burns, Bukamu Hulela, Ameliah Sanders, different. This taught us that when making mothers to infants. This affects the kinetics Christine Bussmann, Erika Fardig, Michael Roy a vaccine or designing drugs for the epi- of transmission. 2 How the BHP Came to Be (continued from front page) whose small hands enabled them to do the After hours of discussions, planning and Makhema, who was present at that first precise work of cutting and polishing dia- negotiations, the idea of a collaboration be- meeting between President Masire and Dr. monds. Later, young women as a group tween HAI and the Republic of Botswana Essex, is the current Project Director of the were found to have one of the highest inci- became a reality. In October of 1996, an of- BHP. One of his long-term goals is to see dences of HIV/AIDS in Botswana. ficial agreement was signed. more African senior scientists employed by the BHP. After hours of discussions, planning and negotiations, the idea of a col- Botswana elected a new president in laboration between HAI and the Republic of Botswana became a reality. 1998, His Excellency Festus Mogae, who continues his government’s tradition of strong leadership and support in the fight On that first trip, Essex made presenta- Dr. Ibou Thior, a researcher who had against AIDS. President Masire is now chair tions about his research and met with gov- played an important role in HAI’s work in of the National BHP Advisory Committee. ernment officials to discuss potential areas Senegal, was appointed as the first Project As President Mogae said at the time of of collaboration. Blood samples from HIV- Director. Ria Madison formally became the BHP’s 10th anniversary, “Through positive individuals were collected for Essex the Project Administrator, the first official close collaboration with the BHP clini- to bring back to Boston. employee of the Botswana-Harvard AIDS cians, the first public ARV therapy clinic When the samples were analyzed back in Institute Partnership for HIV Research was piloted in 2001. This pilot provided the lab, researchers discovered that the virus and Education (BHP). Doctors, nurses, many valuable lessons and later grew into in Botswana was different from the virus lab researchers and pharmacists soon Masa, the first public and nationwide ARV found in the U.S. and Western Europe. “As joined the project. therapy program in the region. It is en- soon as we knew that the rates of HIV in- Fast forward ten years to the present.
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