Senegal: 'This Is My Whole Life'- A Scientist's Dedication To Defeating AIDS

4 July 2001
allAfrica.com
interview By Ofeibea Quist-Arcton

Dakar — Senegal's low HIV infection rate is the envy of other African nations and has been attributed to excellent and early planning as far back as the early 1980s. One thing that has helped Senegal to focus on, and take pride in, its national anti-AIDS campaign is the involvement of prominent and homegrown scientists, such as Souleymane Mboup.

Mboup is a Professor of Microbiology at the University of Dakar, Senegal, and is known in the field of AIDS worldwide for his specialist work on the HIV2 strain of the AIDS virus.

Professor Mboup is in charge of the AIDS Sentinel Surveillance Programme in Senegal and of his country's National AIDS Programme. He also coordinates the Convention of Research between Senegal and Harvard University in the United States. In addition, Mboup is the current president of the African AIDS' Research Network. He is a serving member of the Armed Forces of Senegal and, in that capacity, is the continental coordinator for Africa of the Civil-Military Alliance Against HIV/AIDS.

For many, Professor Mboup's commitment to the fight against AIDS, and the regional and international respect for his research and findings, sends a strong message within Africa that the continent can draw on its own resources and capacities to tackle HIV/AIDS.

"We are not waiting. We too are contributing. This is my whole life," Professor Souleymane Mboup told allAfrica.com's Ofeibea Quist-Arcton in the Senegalese capital, Dakar. We reproduce below extracts of her interview with Professor Mboup as part of our continuing series on Senegal's long struggle against AIDS.

Professor Mboup, you wear many caps. I believe you are also the person, or one of a team in Senegal, who identified HIV2 as a separate strain of the AIDS virus and the one prevalent in this region?

Exactly. Yes, with the collaboration of the Harvard Institute, we were really the originators of this discovery along with others. We were able to be the first to document the presence of this new strain of HIV in the region. [The French AIDS' specialist] Montagnier's group was the one to isolate it, but we were the first to describe and document this strain.

Since 1985, we have also conducted many studies of HIV2 and I can say that most of the knowledge of HIV2 in the world is coming from this collaboration.

How do you see the current situation of HIV/AIDS in Senegal. Everyone talks about a success story, and the low rate of HIV infection here, but how successful is it and is there room for improvement?

Through different programmes and a programme of evaluation and assessment, we have been able to document the growth of AIDS. And, for at least ten years, we have been able to maintain a stable prevalence rate of about one percent. There are many contributing factors.

First: the structural situation and stability of the country, also a blood transfusion programme started in the 1970s and a Sexually Transmitted Diseases (STDs) programme and the registration of prostitutes.

Secondly, an early response to the (AIDS) epidemic. The national AIDS programme in Senegal was the first one of its kind in Africa.

Also, three, political will has been very strong since the beginning and we also have a regular budget from the government and its involvement and support.

Another factor was the response of all sorts of organisations and the involvement of groups in the community, such as religious leaders, women etc and awareness and education programmes that targeted certain sectors of the population, commercial sex workers, the youth etc.

Another factor is the evaluation and assessment through a Sentinel Surveillance Programme, a behaviour surveillance programme and research. I think through these, we have been able to document the progress of AIDS in Senegal and , yes, I think there has been some success. But, despite the low HIV/AIDS prevalence rate, we still have to strengthen all efforts being developed to maintain this situation.

So what are the greatest challenges ahead for Senegal?

To maintain the prevalence level of about 1 percent (of HIV infection among adults) and avoid any increase. There are still other factors, migration, behaviour changes and many other challenges to tackle. But when you see, as I say, how widespread the response has been to the problem, we are encouraged, but we must work out at maintaining our progress.

With high risk areas such as prostitution, commercial sex workers etc, how are you coping?

Senegal has had a programme of registration of female sex workers since 1970. This was really important, because it allowed us, first, to have an idea of the prevalence rate in this population. Also, because of the system in place, we were able to conduct considerable research to document HIV1 and HIV2.

Prostitution has been regulated and this is important, because people can practise prostitution as long as they satisfy two criteria - that they are older than 18 and are having regular check ups for sexually transmitted diseases. This was a good opportunity also for us to educate this population.

In our new strategies, we would like to focus more on this core group (commercial sex workers) as a bridging group to the population. We started this 16 years ago, but we still continue to educate them. This has enabled us to document a very important decrease of STDs and HIV in this population. Also there is widespread knowledge, at least 100 percent, of HIV/AIDS and prevention measures (ie condoms - high condom usage) among prostitutes. So, I think this is a very important programme and this was done in (the capital) Dakar and other regions (of Senegal). This is important and allows us to have this type of success.

Professor Mboup, what about drug treatments and anti-retroviral medication for HIV/AIDS?

We have been able to start an initiative, over the past two years when these drugs were beginning to be available in many developing countries, with the aim of showing that it was possible to treat people in Africa (with anti-retrovirals) with the same outcome as found elsewhere in the world.

This national pilot programme allowed us to fulfil the criteria to have a reduction (in price of these drugs). The real challenge now is how we can maintain top quality for follow up and also expand this experience at country and sub-regional level. The trial with anti-retrovirals was with 130 people living with AIDS in Senegal.

So that's 130 people out of the 80 thousand estimated to be living with HIV/AIDS in Senegal, 3000 of whom have died? That was just a sample.

Yes. We need to go step by step. Of these 80 thousand, we need to know how many people are really accessible and whether they need and can take this medication. Because, even in developing countries, there are criteria for starting anti-retroviral HIV treatment.

So how do you identify the people and what are the criteria for joining the national programme to be allowed anti-retrovirals?

We defined some criteria which are very well documented worldwide, in other countries. You have to be asymptomatic, well non-symptomatic, with a CD count of less than 200 and a viral load of more than 100. Those are the people who really need it (anti-retroviral medication), but we need to follow up people on a regular basis and demonstrate that we can. The initial pilot programme documented the feasibility of Senegal to continue this programme.

Now it's done we are going forward and looking at how we can expand it around the country. But we really need to maintain the same quality of follow-up. So I think that even if all the conditions were in place, we need some time to expand this programme so that we can maintain the same quality of treatment for people, as well as follow-up and compliance, to avoid resistance.

This needs to be step by step, but I think we are on the road to accomplishing this objective.

What about the price, what about cost of anti-retrovirals?

The price is becoming more accessible because, as you know, in US dollars, in developing countries, the figure was about US$12,000 for (anti-retroviral) treatment for a person for a year. Now we can get it at US$1,800 per person annually and, subsidised by the government, some people have access to anti-retrovirals at US$10 a month.

This is very accessible and for some people who have no means, or for medical personnel, they are not paying at all for the medication. This is a system we need to maintain.

The highest cost for the treatment is about US$80 a month, that's the highest price you can pay in Senegal, so the price has decreased drastically.

So, Professor Mboup, people who are HIV positive or have AIDS in Senegal and fulfill the criteria for selection, when will they have access to anti-retroviral drugs? How soon will that be a reality?

I think that it is very difficult to give an exact date. But it is our objective, in the next one to two years, we would like to multiply by at least 16 to 20 the number of people receiving this (anti-retroviral) treatment.

I think maybe things will change as well, with an easier regimen and reduced prices and I think this will help. As I say, one of the conditions is not to rush too much, but to be sure to keep up the quality of follow-up for our patients. This will be the most important criterion and should be done through existing infrastructure. But the situation should evolve within one or two years and will help to accelerate developments.

What about research in Senegal for an AIDS' vaccine?

Yes, research for a vaccine is becoming very high priority now at all levels; at the international level, but even at country level. You must have heard that regional health ministries in the sub region are really pushing for that.

And also we have many groups and many initiatives. You heard about Bill Gates (founder of Microsoft) giving, I think, US$100 mn for AIDS vaccine research? So, I think this will really push things forward and maybe very soon things can evolve. And as you know also, there are some trials in the US and in Thailand and maybe this year we will have some idea of the results of these trials, which will be very valuable knowledge to establish if the vaccine can work or not or can be improved to work.

So I am very positive that things can go very, very fast in the next year.

Are you personally involved in the search for a vaccine that might be found to combat AIDS?

I would say yes, because we are working on many projects that can help, either towards understanding the situation to develop a vaccine or seeing what kind of vaccine will be available. We are not waiting, we too are contributing. This is my whole life.

As you know, we have a network of surveillance of different subtypes which show that here, in West Africa, the major subtype is a recombinant virus of two subtypes (A & G, which we call CRF02, CRF recombinant form circulating number 2). This was very, very important and also, through our research on HIV2, we were able to show that people previously infected by HIV2 have partial protection.

All those things are very important to help move in the direction of future vaccines.

Where has Senegal stumbled and fallen or failed in its AIDS' prevention programme?

It's difficult to perform 100 percent in all areas. And we still have some challenges. One is that we need to maintain this low prevalence rate. Also, we still have some risk situations, like migration - mobile populations -, spousal inheritance and other customs, and also we need to maintain a high level of commitment for funding and so on.

So there are challenges and one important message is that we need to be supported by organisations, because Senegal's can be a model to export to other countries. And also we must show that with this (HIV/AIDS) epidemic, it was very important to act very early. I think this can help many other countries which are not [yet] in this situation.

This can be done by many organisations, because unfortunately funding money mainly goes to support countries with high HIV/AIDS' prevalence rates. Of course, this is very important. But it's also important to support countries which reacted very early to the AIDS' threat, like Senegal, to help them to maintain the status quo.

It is a challenge for Senegal, but it is also a world challenge, that is why we need support to maintain this situation.

Other articles in the series:

Part 1: A Beacon of Hope in Africa's Fight Against AIDS

Part 2: Living With AIDS - Mabeye's Story

Part 3: Pop Stars and Youth Break Taboos to Spread AIDS Message

Part 4: Prostitution - Frontline of the War to Contain HIV

Part 5: Women - Vulnerable but Vital Campaigners Against AIDS

Part 7: Praise for AIDS Success - But the Struggle Continues

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