Part 6: Ending the Epidemic

African Prostitutes May Play a Crucial Role in Developing an HIV Vaccine

But even if the scientific obstacles are overcome, another hurdle will remain.

Vast, impoverished, and riven by civil war, the Democratic Republic of the Congo is the hardest place on earth to conduct a vaccination campaign. But three times this year, thousands of health workers went out into the countryside, squirting the life-saving pink liquid into the mouths of millions of Congolese babies. In a village outside the town of Mbuji-Mayi, proud mothers held up their vaccinated babies as the whole village celebrated the immunizations. Despite war, the World Health Organization predicts that within a year, the Congo and the world may be polio-free. This is the dream of AIDS-vaccine workers.

But it is also the nightmare, because despite a cheap and effective vaccine, polio is being wiped out only now, about four decades after it was banished from America. Once an AIDS vaccine is developed, will Africa have to wait 40 years for it?

After testing negative for 11 years, Selina got infected. Was stopping prostitution a risk factor?
illustration: Katherine Streeter; photo: Mark Schoofs
After testing negative for 11 years, Selina got infected. Was stopping prostitution a risk factor?

If the vaccine based on the Pumwani prostitutes works, Africa will get it soon. That's because its development is sponsored by the International AIDS Vaccine Initiative (IAVI), which is laying the groundwork for something that has never happened before: simultaneous delivery of a vaccine to the developed and developing worlds.

IAVI president Seth Berkley, who worked in Uganda during the early days of the AIDS epidemic, is a man in perpetual motion. He has lobbied the World Bank, the EU, the G-7, and any other deep pocket that will listen to create a fund for distributing an AIDS vaccine in the developing world. In addition, IAVI is making sure the vaccines it bankrolls will be available in poor countries.

Berkley has convinced Bill Gates to give his organization $26.5 million and the British government another $23 million; IAVI invests these funds in promising vaccines, fast-tracking them through the pipeline. "We are like a venture-capital firm," Berkley says. "But instead of demanding 50 percent of the profits, we want access for the poor."

Essentially, IAVI negotiates agreements that give the manufacturer the option to make the vaccine affordable for developing countries. But if they don't, says Berkley, "We retain a series of rights that allow us to get the vaccine out there."

At the Pumwani clinic, Kimani, the young doctor, says, "We promised the women that anything that came out of the research will benefit them. And they are already asking about the vaccine." In fact it will be years before the vaccine is ready for large-scale efficacy trials, let alone before researchers know whether it actually protects people. Even when pushed, science crawls.

Meanwhile, Kimani explains what happens as the women approach death. "When they are clearly deteriorating, we call them in. They ask, 'Am I not doing well?' And we say, 'Maybe it's time to go home to the village.' " Kimani pauses. "We have money we can give them to go home to their family." That statement sinks in, and then Kimani says—shouts, almost—"We desperately need a vaccine!"

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