Research partnership improves life for vulnerable women

A social welfare programme for women at risk of HIV has helped build trust between this vulnerable group and a team of scientists who are seeking new treatments and a cure.

9 February 2017

robertharding/ Alamy Stock Photo

Umlazi, a township south of the South African city of Durban, has one of the world’s highest HIV infection rates. Seventeen out of every 200 young women are likely to become infected each year. Two out of three women attending the township’s antenatal clinic are HIV positive by age 22.

A partnership between scientists and the local community hopes to change these statistics. The project, which tracks young HIV-negative women, serves two purposes. It lets medical researchers study a community where HIV is rampant to gain insights into how the virus overcomes the immune system. And it provides participants the opportunity to improve their future.

Women enrolling in the Females Rising Through Education, Support and Health (FRESH) study—a partnership launched in 2013 between the Ragon Institute in Massachusetts and the University of KwaZulu-Natal in Durban— visit the clinic regularly for HIV and blood tests, and undergo pelvic exams. They also enrol in a one-year course to learn skills to help them find jobs and boost their self-esteem. In this way, the project aims to have an impact on the community that make the researchers’ studies possible.

“The women we enrol are some of the most vulnerable and at greatest risk of HIV, and those with the fewest opportunities and least hope,” says Krista Dong, FRESH programme director. Women in the course learn how to present themselves in job interviews, how to use computers and basic accounting skills. They also get access to local employers, such as Hilton hotels and clothing chain Mr Price, who consider the cohort for prospective employees.

The intervention is already having an impact. All of the women are unemployed when they enroll, and up to half lack high school diplomas. But of the nearly 500 who have completed the course, 84% are in jobs or internships, have started their own business or returned to school. The programme organizers cannot say whether it reduces the rate of HIV infection, because the study does not compare women in the programme with others.

For the women, the benefits are clear, says Dong. “In addition, it has allowed the investigators insights into the challenges of poverty, and offers a model for combining social interventions with basic science research,” she says.

Insights for scientists

Collecting data frequently from the participants means the scientists can detect HIV infections early and offer patients life-saving treatment. Researchers can also study the virus in real-time, which helps them understand how it evades the body’s defences. Frequent data from the participant’s pelvic exams has also given the team insights into the role the vagina’s microbiology plays in HIV risk.

In a paper published in January in Cell Immunology, Douglas Kwon, a clinical researcher based at the Ragon Institute in Massachusetts, and his colleagues found that some bacteria common in the cohort translated into a four-fold higher risk of acquiring HIV.

While this could be one of the contributing factors to Umlazi’s high HIV levels, Kwon and his colleagues are looking for other factors that may influence the virus’ spread, including why domestic violence incidence increases HIV risk, and seeing whether the practice of ‘drying’ by many women in the area — whereby traditional remedies, antiseptics or household detergents are introduced into the vagina to increase men’s sexual pleasure — plays a role.

Broaching such personal topics with participants would be hard without the trust generated through the FRESH programme, says Kwon. “It’s easier for us to broach those sensitive questions and get reliable data.”

To date FRESH has enrolled more than 1000 women —about 300 participants enrolled at any one time. The FRESH coordinators want to keep the programme running for another five years at least. In January, it received a US$2.8m grant from US pharmaceutical company, Gilead Sciences.

Kwon says it feels good to give something directly back to the community he studies because beating HIV will not just involve medical interventions. “For these women, poverty is more of a threat than HIV.” They have had lots of education about HIV and how it’s spread, he says, but regard it as a less immediate threat than losing support from the men they depend on financially. “That’s what makes this such an extraordinarily difficult problem.”

Correction: An earlier version of this story incorrectly stated that the FRESH programme ran a two-year course for women at risk of HIV. The course runs for one year.