Profile: Director of New AIDS Initiative
When Phyllis Kanki, professor in the Department of Immunology and Infectious Diseases, began her one-year leave of absence from HSPH last year in California, she could not have imagined how the leave would unfold. In August, she was asked to direct a new program to help stem the AIDS epidemic in Nigeria. At the time, the project still needed funding, which came in November in a big way.
The Gates Foundation approved $25 million to establish the AIDS Prevention Initiative in Nigeria (APIN), and since the announcement, Kanki's pace has been hectic as she and her colleagues develop a multi-level public health program in the most populous country in Africa. Just two months after announcing the grant, Kanki has already found data that may change the breadth of the initiative.
The rates of HIV infection in Nigeria are much higher than previously thought, said Kanki. Just last year, the Nigerian Ministry of Health estimated that fewer than six percent of Nigerians are HIV positive. Although that figure may be true taking the country as a whole, the rates of infection in certain urban centers seem to already be as high as 20 percent.
"We thought we were intervening in populations with lower rates," said Kanki. "An important first step will be to measure and monitor high-quality HIV surveillance data to see what the true situation is--then we will be able to better design and develop multiple intervention strategies."
APIN is sponsored by HSPH in collaboration with the Harvard Center for International Development at the Kennedy School of Government. Arese Carrington, HSPH alumna, is associate director. Working with Nigerian officials, the initiative leaders designated three states in which to develop the program: Lagos, Oyo, and Plateau. Representatives of APIN and well-established Nigerian non-governmental organizations have already defined some state-level activities and have established administrative and financial channels.
APIN will stress prevention strategies that are tailored to each state based on surveillance data, said Kanki.
"We are working in a few places in a big country," said Kanki. "We need to be very specific in our interventions so that we customize them to the people we are trying to help. Then we have to give the interventions a chance to work and monitor their progress."
A
Discovery of a Lifetime
Kanki knows what she is talking about. Along with Max Essex of
the Harvard AIDS Institute (HAI), Kanki helped establish an AIDS research
collaboration in Dakar, Senegal in 1985 with other scientists from HAI,
the University Cheikh Anta Diop in Dakar, and two universities in France.
Since that time, her lab group and Senegalese collaborators have established
the longest-standing AIDS study in Africa while developing prevention
strategies and public health policies.
The researchers are tracking the spread of HIV among more than 1,000 Senegalese female prostitutes. The work has yielded landmark results, including the discovery of HIV-2. The finding gave Kanki international recognition while still in her late-20s and propelled her down a career path that continues to provide her with ripe opportunities to reverse a scourge of the 20th century.
Kanki trained as a veterinarian before coming to Essex's laboratory in 1985. Her knowledge of comparative animal pathology would prove crucial in the ensuing months as Essex, Kanki, and others tried to figure out why the Rhesus monkeys she was working with were dying of an AIDS-like syndrome.
Her work along with others allowed Kanki to help uncover and characterize Simian Immunodeficiency Virus, or SIV, virtually on the heels of the discovery that HIV causes AIDS in humans. It was the first time that an AIDS-like virus was identified in primates, and the groundbreaking discovery became the basis of Kanki's doctoral thesis. SIV was later found at high rates in African primates, suggesting a possible origin for the disease.
Kanki's next step was to see if a similar virus could be found in humans, a sort of bridge virus between HIV and SIV. On her request, Kanki received blood samples from a colleague in France that was also working on AIDS.
The
samples came labeled as B, T, or S, without explanation about what the
letters stood for. After testing them, Kanki figured out that B stood
for Burundi and the samples were taken from HIV-infected people. The T
stood for "temoin," or "control" in French.
Kanki suspected that the S stood for "singe" (monkey in French), and the samples tested positive for SIV, but then came a shocker. The "S" blood samples did not come from monkeys. They came from people in Senegal, whose blood was now testing positive for a virus that closely resembled SIV. The discovery was the first evidence of an SIV-like virus in humans, said Kanki. With Essex, Kanki had identified a second strain of the AIDS virus, HIV-2.
"I felt like I was one of the luckiest grad students around," remembered Kanki.
In 1985, she, Essex, and their colleagues launched the Senegal study of HIV-1 and HIV-2 in sex workers to investigate this new strain that had some people fearing a second AIDS pandemic. The doomsday scenarios were staved off. Kanki found that people infected with HIV-2 take much longer to become ill than those with HIV-1, and the symptoms are not as severe. HIV-2 also spreads more slowly than HIV-1, suggesting that it is harder to infect others with it.
But the best bit of news came when the researchers realized that people with HIV-2 are almost 70 percent less likely to become infected with HIV-1 than people not infected, a development that may prove critical in developing an AIDS vaccine. Developing and testing an HIV-2 based vaccine for Senegal remains a major goal of the Kanki lab effort.
A Model Guide
Kanki
and her colleagues have stressed working with Senegalese medical and government
officials to create public health campaigns and prevention strategies
while training a new generation of Senegalese scientists. The collaborative
effort seems to be working, with Senegal having the lowest rate of HIV
infection in sub-Saharan Africa.
While Kanki would like to model APIN on her experience in Senegal, she is careful not to draw too many parallels. With 36 states, Nigeria is much larger and more diverse than Senegal, giving the initiative a completely different scale.
Also, the media now play a larger role in Africa since the Senegalese effort launched 15 years ago, and Kanki plans to use news outlets to deliver public health messages. Talking about AIDS is an important first step in all information and prevention programs, she said, but people need accurate information. Part of the initiative's mission will be to help educate people and promote such discussions.
Kanki recognizes that "the HIV epidemic is well underway in Nigeria,
but in a short time we have already established the foundation for our
programs. We have every reason to believe that successful HIV intervention
and education programs will have an impact on the epidemic."
