Dr. Silvia Carlos on HIV Prevention in Africa

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TACOMA, Washington — HIV in the sub-Saharan region of Africa is a daily concern. However, there are many working to address the HIV crisis affecting vulnerable regions of the world. According to the World Health Organization Africa, in 2018, almost 26 million people are living with HIV. Out of this statistic, 69% live in sub-Saharan Africa. As the number of cases has risen, the pharmaceutical research industry has accepted its vital role in the fight against HIV. The Borgen Project interviewed Dr. Silvia Carlos, an investigator for the Institute of Tropical Health and the Institute of Society and Culture in the University of Navarre, on HIV research, Project OKAPI and HIV prevention.

Dr. Carlos and Project OKAPI

Dr. Carlos’ research focuses include epidemiology and HIV prevention in sub-Saharan Africa. Since 2010, Dr. Carlos has concentrated her studies in Project OKAPI, an HIV research initiative in Kinshasa, the Democratic Republic of Congo (DRC).

“What makes a hospital great is the human quality of the staff. It does not matter how much money you invest if you do not invest in its people,” said Dr. Carlos. For her, education is vital, whether it is training medical personnel or informing the African population about HIV and prevention efforts. She insists that a strong work ethic influences the population directly and has a positive effect on morale.

Surveying Populations’ View on HIV

Dr. Carlos conducted a study with almost 2,000 participants. The study consisted of a series of surveys taken by interviewers at the centers where Congolese people took HIV tests. The research inquired about specific high-risk sexual behaviors and the population’s knowledge on means of contagion.

However, the results proved that the lack of education was great and the number of risky sexual behaviors was high. “The illiteracy rate in Congo is elevated. Moreover, their knowledge comes from inheritance. They learn from traditions and myths. Some believe that HIV infection is the fruit of witchcraft or divine punishment. We want people to know the scientific explanation,” explained Dr. Carlos. Researchers concluded that in order to fight HIV in Africa, misconceptions must be eradicated.

Thus, the primary step toward an effective investigation is to understand the context of reception. The study not only focused on surveys but also initiated efforts to understand locals’ views of the world: their traditions, their beliefs and their way of life. Through this approach, researchers were able to achieve true communication with each patient. For instance, research demonstrated that elders were a respected authority in Congo. Thus, the message would be effective if elders transmitted it to their family members. Dr. Carlos’s initial studies were based on determining the characteristics of the population: how they communicated and formed bonds. By those means, communication did not equal imposition.

The Stigma Surrounding HIV in Africa

There is a strong stigma around HIV in Africa. Infected people do not usually reach out to medical assistance immediately. They keep it for themselves. Thus, the risk is higher and they continue infecting other people. Dr. Carlos’ investigation argues that contagion will decrease if Congolese communities are aware of the urgency that HIV demands on medical care.

In addition, in order to educate the population, it is necessary to determine what their main sources of information are. If the population cannot access a news channel or receive postal mail, the investigators must adapt to their lifestyle. That is the role of social workers; they must act as bridges between researchers and Congolese people. Their work consists of summoning the community and informing them of preventive campaigns.

The root causes of HIV in Africa are educational, social and cultural. Since sub-Saharan communities lack access to basic needs such as food or electricity, education is a luxury. However, Dr. Carlos insists that Project OKAPI aims to combat HIV from its genesis: “We would not need treatment if there were no diseases. We can avoid many diseases if we modify our behaviors: what we eat, our physical activity, the toxins to which we expose ourselves and our sexual behaviors.”

The Future of Project OKAPI

University students of Kinshasa are the new target population of the project. In order to reach them, investigators will contact the different universities of the area. The new research will find the question “which behaviors made you prone to infection?” insufficient. Instead, researchers will seek to tackle the problem from the angle of education and prevention, changing behaviors from the root. In order to complete that task, Dr. Carlos’ team aims to create an app in which students will receive messages and reminders about HIV education. The goal is to monitor and inform populations about HIV in Africa. Moreover, the study will cover other sexually transmitted diseases.

Since 2010, Project OKAPI has collected data from surveys and patients. And for Dr. Carlos, this is just the tip of the iceberg in HIV prevention in Africa. The database also contains blood samples from positive patients. This is key to determining which subtypes affect the population and in which ways the virus has gained resistance to drugs. This information will help treat the disease accurately.

Overall, Dr. Carlos’ team proves that a pharmacist’s work does not always take place behind a counter. It is not merely about dispensing medicine. “The duty of a pharmacist is to ensure the proper usage of medicine. However, we have a great responsibility on disease prevention,” said Dr. Carlos. For her, the pharmaceutical industry is an agent of change. This obligation was enhanced during the COVID-19 pandemic when the industry found itself responsible for administering drugs to developing countries. The educational role of HIV prevention in Africa is showing to be key to eradicate HIV worldwide.

Paola Arriaza Avilés
Photo: With permission from Dr. Carlos

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