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Dr. Richard Marlink and Dr. Pride Chigwedere

Chat about medical care for HIV patients in Africa

March 3, 2000
Web posted at: 1:44 p.m. EDT

(CNN) -- Dr. Marlink and Dr. Chigwedere joined the chat room on March 2, 2000 as part of the Global Challenges chat series on AIDS. They participated in the chat by telephone from the Harvard AIDS Institute in Boston, Massachusetts. provided a typist for them.

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Chat Moderator: Welcome Dr. Richard Marlink and Dr. Pride Chigwedere!

Dr. Richard Marlink: Hello, it is nice to be here

Dr. Pride Chigwedere: Hello, it is a pleasure to be here.

Question from hello: Doctor, can you tell me why Africa is worst affected, especially the central area?

Dr. Richard Marlink: Well Africa has been suffering from an AIDS epidemic basically over the same time the US and Europe has been affected by this same epidemic. The central and eastern parts of the continent originally had been most effected, but now the epidemic has spread virtually throughout Africa. But what is most striking of late is the dramatic spread to southern African countries.

Chat Moderator: What is the state of medical care for HIV patients in Africa?

Dr. Richard Marlink: I could go into that but perhaps it is best to introduce my colleague who trained in medicine in Zimbabwe and is here on a research fellowship. He is familiar with medical care in that country.

Dr. Pride Chigwedere: Our problem with the medical care of AIDS patients, the rates of HIV infection are very high. We don't have adequate facilities for the patients we are seeing. We are flooded with patients.

And internal medicine is essentially where the AIDS patients go, but it extends to all the other specialties. For example, in pediatrics, the presentation of disease is failure to thrive in babies, in gynecology, and pelvic inflammatory disease, complicated by pelvic abscesses is a major presentation.

The surgical wards are full of patients who once operated on do not heal. It is therefore all the departments in our hospitals fighting hard to combat the disease and the services are strained to the limit.

Question from guest: What factors account for the widespread prevalence of HIV in Africa?

Dr. Richard Marlink: There's always a balance in infectious disease between the host (thatís us) and the infectious agent (the virus HIV). Throughout the world, HIV is a sexually transmitted disease. On top of that like most epidemics, it is disproportionately affects those with less access to preventive services, education services, and other health resources. On top of that the infectious agents, i.e. HIV, may also be more infectious in certain subtypes of the virus. This is being researched now... but is a hypothesis.

Question from guest: How is AIDS care prioritized, when basic medical care is such a challenge?

Dr. Richard Marlink: Thatís a good question. Issues concerning priorities are important especially in resource for regions. It is extremely important for outsiders such as us researchers or bilateral or international agencies to be cognizant that we are hosts in African settings. And the priorities, although difficult to set, must be set by Africans. Maybe Pride has something to add.

Dr. Pride Chigwedere: No nothing. :)

Question from WTO: Why try to "treat" an incurable disease, which is virtually 100% preventable? Shouldn't your resources be spent on prevention in the first place?

Dr. Richard Marlink: That question reminds me of a similar situation when if someone would ask, should we treat someone with cancer? Or should we put the money into anti smoking campaigns? Both are obviously important.

One should not rob to pay for the other. There are literally millions of people infected with HIV who can benefit from even small improvements in care of even supportive care, or even in treatments to control pain. We at the Harvard AIDS Institute have strived in several initiatives that help improve care for people living with HIV in specific African settings. The one initiative, entitled The Enhancing Care Initiative, is funded by the MERCK Company Foundation.

This initiative creates local AIDS care teams made up of local AIDS care experts from different disciplines. That answers those tough questions about how to send scant resources to the many people living and perhaps dying of HIV.

Dr. Pride Chigwedere: It is true that AIDS is not curable. But many diseases are also not curable. For example hypertension and diabetes. Treatment, however, enables patients to lead a normal life.

Similarly there is a lot we can do for AIDS patients. This includes treatment of opportunistic infections, like PCP and TB. We can also have palliative care to enable our patients a dignified death. We can control diarrhea, vomiting, incontinence and pain. This improves the quality of life for AIDS patients. We agree however, that prevention is very important.

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Question from guest: Pride, do researchers in Zimbabwe feel frustrated at the resources available in the West, but not in Africa?

Dr. Pride Chigwedere: There are some frustrations indeed. But to say that we direct them to the countries in the west would probably be inaccurate. We see a lot of opportunities for meaningful research that could lead to better care of our patients. We, however, are unable to test most of the hypotheses that we come up with. It is important that the west is helping, especially in training us and setting up collaborations with institutions in Africa. We therefore combine our clinical experience from the situation on the ground with the technology and resources from abroad. And that way we make meaningful progress.

Question from guest: Why such an explosion of cases now, and not earlier in southern Africa?

Dr. Richard Marlink: Some relates to movements of people and the "host factors" related to how this virus is spread. But we think that also the subtype of this virus in southern Africa is distinct in its ability to spread more quickly. We have evidence of this, not just in the laboratory, but also in the fact that this subtype, subtype C, is also replacing the other subtypes found in east Africa and spreading throughout the horn of Africa, and also in the subcontinent of India. This is a fairly recent, essentially new, epidemic compared with a decade ago. We think it is related to this subtype of HIV.

Chat Moderator: Dr. Marlink, how did you and the Harvard AIDS Institute, become involved with care of AIDS patients in Africa?

Dr. Richard Marlink: Well, our research group here at the Harvard AIDS Institute began researching similar viruses found in animals prior to knowing that there was an AIDS epidemic. There are similar viruses in animals that cause immune suppression. This was in the Ď70s. Then in Ď84 or Ď85, our group, along with collaborators in West Africa, discovered evidence of a 2nd AIDS virus in humans, now called HIV2. We began what is now known as the longest follow-up of individuals with HIV in Africa.

But more importantly, a solid long term friendship and commitment to help those in Senegal. This includes help for those not only doing research, but also for those caring for patients. We at the Harvard AIDS Institute utilize this same approach to create partnerships that are long term, and based on what is best for the public health of the countries with which we collaborate. Lastly, the determination of what is best for the public health of those countries is determined by those countries for us. We now have long term commitments and friendships in several African countries, and we are trying to expand.

Question from t: How do you think doctors in America can help the AIDS epidemic in Africa?

Question from tdr: What can we, as individuals in the U.S., do to help the situation?

Dr. Pride Chigwedere: There is a lot that Doctors in America can do. They can, for example, set out research collaborations with institutions in Africa to study how AIDS affects their particular specialty. They can even visit Africa and help with the clinical work for short periods of up to 6 months or a year.

Dr. Richard Marlink: We have a number of programs that can benefit from people's expertise or financial support that goes directly either the research or the care of those involved in the communities where we work in Senegal, Tanzania, Ethiopia, Zimbabwe, Botswana, and South Africa. Our website can give information on how to help or donate.

Chat Moderator: Thank you Dr. Richard Marlink and Dr. Pride Chigwedere for joining us today.

Dr. Richard Marlink: Thank you for the very tough but on the money questions.

Dr. Pride Chigwedere: Thank you very much for the engaging discussion.

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