Shahin Lockman is a research associate at the Harvard AIDS Institute.	-

Update: What kind of research are you conducting in Botswana, and what are some of the challenges you confront?

SL: In 1999 we began seeking new methods for prevention of mother-to-child transmission (MTCT). My work compares infants from the two feeding arms of the Moshi cohort—formula-fed only versus breast-fed and receiving prophylactic zidovudine (ZDV)—to determine any differences in respiratory and bloodstream infections.

I have lived and worked primarily in Molepolole, one of two very rural location sites. About two thirds of pregnant women consent to HIV testing, a little more than half of HIV-infected women choose to participate in our study, and most prefer to breastfeed. Formula-feeding is seen as an indication of HIV status, and women may confront stigma if they do not breastfeed their infants. Our staff counsels each woman, explaining the study and other options available to them such as the National Program—which provides ZDV and free formula—to women who decide not to participate in our study.

A similar study has found that breastfeeding HIV-infected mothers have lower chances of survival than those who formula-feed. We have not yet determined whether the metabolic needs of breastfeeding accelerate HIV disease or whether malnourishment is also a contributing factor in HIV-infected women. To better understand this, we plan to monitor the volunteer’s CD4 counts, viral load and clinical status and eventually correct higher mortality rates. The findings from these studies may have an impact on HIV and AIDS policy. For example, studies conducted in Thailand and Uganda have influenced policy decisions in countries such as Botswana, which now offers the ZDV/formula National Program to prevent MTCT. Botswana should be commended for its commitment to offer triple antiretroviral (ARV) therapy as part of a national program to confront AIDS.

Update: What other advantages do you see in this type of study?

SL: Many women choose to participate in our study because they receive medical attention from a care team including a physician, several nurses, midwives, educators and counselors. Standard care for mothers in our study also includes prophylaxis for several opportunistic infections. We are also able to diagnose, monitor, and provide care for treatable illnesses in the mothers and their children.

We are returning to Botswana in the spring to help set up programs for administering ARV therapy to women living with AIDS at our study sites, and hope to add Gaborone as a future site. The goal for the Mashi study is to enroll about 1,200 women and infants; it’s a very ambitious project, but we are looking forward to the opportunity to provide ARV therapy for women living with AIDS, which will benefit the country of Botswana as a whole.