Hope for Aids cure as prostitutes defy virus in the slums 

John Carlin reports from Nairobi on the inspirational doctor who turned his back on Oxford and dedicated his life to the desperate search for a drug that will spell the end of a continent's holocaust 

Sunday November 23, 2003 The Observer 

Little children playing naked in pools of viscous water; rows upon rows of rusty tin shacks, implausibly teeming with human life; a man in the crowd wearing an Arsenal shirt. 
These are some of the images that catch the eye as you drive through the labyrinthine alleyways of Majengo, Nairobi's giant slum. But it is the shoes that linger. Thousands upon thousands of shoes, piles of them for sale on rickety market stalls - on every corner, more piles. 
It is a puzzling spectacle. A nurse riding with me in a minibus packed with medical workers offered a compelling interpretation. They are dead people's shoes. 'People who have died of Aids.' 
People compare the Aids disaster in Africa with the fourteenth-century plague in Europe, but here is an image recalling a more recent horror, the shoe mountains which Allied soldiers found in the Nazi extermination camps. Except that the African holocaust continues, under our noses, at a searing pace; except it is impossible to claim ignorance of what is going on. 
The statistics have been recited so often they deaden the mind. But, at a time when the resources of the rich countries of the world are focused on what are, in numerical terms, the relatively innocuous consequences of terrorism, one should force oneself to pay attention. To reflect on the fact that 7,000 die of Aids each day in Africa, that 17 million have died since the disease first appeared two decades ago, that more than 30 million Africans are living with HIV/Aids, most without access to the anti-retroviral drugs that have contained the disease in the United States and Western Europe. 
Here in Kenya, in a continent synonymous with catastrophe, there is some good news on what ought to be the great cause of our time, a cure for Aids. Barely six months ago Kenya emerged from 40 years of corrupt single-party rule to initiate a new era of democracy. The US and Britain's chief concern here is that al-Qaeda operatives may be hiding out on Kenyan soil. For Kenyans, the big issue is an enemy that has orphaned 1,250,000 of its children. 
Majengo is the main battleground and a woman called Agatha is on the front line. Her life is sordid beyond imagination. A prostitute who works out of one of Majengo's tin shacks, smaller than a double bed, she makes an unlikely medical heroine. Agatha is 52 and a grandmother, but still has sex - when she is lucky, she says - with 40 clients a day. What makes her even more remarkable is that, in tests systematically conducted over two decades, she has never tested positive for HIV. 
She is one of a group of 50 prostitutes from Majengo who have demonstrated a miraculous resistance to an illness that has decimated their clients and killed off 95 per cent of the female competition. Studied by researchers from the University of Nairobi and the University of Oxford, they were all found to have an inordinate quantity of white blood cells perfectly honed to kill HIV-infected cells. The information obtained from the women has been converted in laboratories at Nairobi University's Faculty of Medicine into a trial vaccine. The first tests on humans began this year. No other project in the world is more advanced or offers more hope that the holy grail, a lasting solution to Aids, may be found. 
Africa, always the problem, could turn out to be a large part of the solution. It is symbolic of Kenya's new determination to achieve political health that Africans are doing it for themselves. In the ground-breaking research they are providing not just the 50 miracle women but also the scientific expertise. 
'We are at the cutting edge,' said Dr Omu Anzala, project manager of the Kenyan Aids Vaccine Initiative (KAVI). 'Earlier trials in the US looked at the possibility of finding a vaccine using antibodies, but that has not worked. We're pursuing the cellular route, which is the way to go. We are in the world vanguard.' 
This is no idle boast. KAVI, in collaboration with the researchers at Oxford, receives funding from the world's leading non-governmental organisation in the field, the International Aids Vaccine Initiative (IAVI), to which Bill Gates has contributed mightily. 'When we first contacted IAVI in 1998 they were sceptical,' said Anzala, 'arguing that vaccine trials of this kind had not been done before in Africa. I said, "Yes, but give us a chance." And they did.' 
The Americans have put up the money for an impressively modern research unit, labs equipped with the latest technology in Nairobi University's otherwise Spartan medical faculty. 
With a PhD from Canada and a post-doctorate degree from Oxford, Anzala has the confidence of a man who has overcome great obstacles to get where he has. Brought up in a family of 13, his mother died of asthma when he was 19. Appalled that she died of an illness so innocuous, he decided that his country needed more and better doctors. 
A muscular 40-year-old who combines the lithe movement of an athlete with a slightly abstracted air, Anzala is a man on whom the hopes of many millions rest. 
'My family tried to persuade me to stay in Canada or the UK, because they told me I would have made a lot more money there,' he says. 'And this is true. There is no private pharmaceutial company involved with us here. We and Oxford and IAVI have the patent on the vaccine, but it is a deal based on the idea of no financial gain. 
'Private companies are not interested in this - they would rather be making Viagra or something. Well, for me, this has more value than anything else.' 
There is an important principle at play here. Africa's other great sickness, apart from Aids, is its dependency on the developed nations. 'Look at food aid,' Anzala says. 'It has become institutionalised. People I know in Europe who came here 25 years ago say they are amazed to see the same people still receiving handouts. Lots of good intentions, but we become accustomed to it and the outcome is people all over Africa just sit! Waiting for the next handout. 
'Everybody is always saying that what we need to resolve the Aids issue is anti-retroviral drugs to be made available,' he said. 'They all cry, "ARVs! ARVs!" The rich countries should provide it free, or at cut-down prices. They have a point, of course. But what we don't want is for Aids prevention to follow the pattern of food aid. Free drugs, free help: great. But what happens on the day when, for whatever reason, help dries up?' 
Anzala considers it essential Africans are involved in developing a vaccine, and to be pioneering a new culture of research thrills him. 'There is nothing else quite like this on the continent. This is different and new. We are doing it by ourselves. This vaccine may or may not work out. If it does, we will probably have to wait another six or seven years to be certain. This is what research is all about. Painstaking, often frustrating. But even if it does not work, we will have begun a scientific tradition that we see spreading to young students coming through. We will have the know-how and confidence to explore other diseases crippling us.' 
Anzala began work in Majengo with the prostitutes in 1987. Today, reversing the historical pattern, doctors from all over the world come to Nairobi to learn from his work. 'We do have an amazing accumulation of data, unmatched in the world,' he says. 'The likes of Agatha have been monitored scrupulously for years.' 
The monitoring takes place at Majengo Clinic, a small, dusty, red-brick construction that in another setting would be entirely anonymous. But, after driving through the slum's almost impenetrable clutter of people, shacks and shoes, the little red house seems as majestic as the Taj Mahal. Agatha is not everyone's idea of a prostitute either. Not just because she is a grandmother, with five children of her own. Her entire demeanour suggests something else altogether. The sort of woman in whose care you would unhesitatingly leave your small children. Chubby-faced, she wraps her ample figure from top to toe in a green and yellow African cloth of rough cotton. 
She charges clients 35 pence and works by day, never at night. 'I have two girls at school. I don't want them to know that I am using our home as my office. They have no idea what I do for a living, and I want to keep it that way. I don't want them to end up as I have.' She shakes her head and a tear forms in one eye. 
Agatha is a simple woman with no formal education. Far from hardened by three decades of prostitution, she smiles at some of the questions with embarrassment. How does she keep going at her age? It is not easy, she confesses, looking at the floor. 'I feel these terrible pains in my chest. I am too old. I cannot bear the weight of these men on top of me any more. 
'Still some do not want to use condoms. Some refuse, and that is scary, especially as those tend to be already positive and don't care, or maybe want to infect you.' She allows regular clients not to use a condom. 'But if it is a new client and he wants to eat the sweet without a wrapper, I say no. If I have not had a client all day and I am broke I might end up agreeing.' 
One man who never uses a condom is her mdosi - her main man. 'Everyone needs an mdosi to help pay the bills,' she said. Her previous mdosi died of cholera in prison. When asked if there is any love in her relationship with her new mdosi, she squints up to see whether the question is a joke. When she sees it is not, she breaks out into the one and only laugh of an interview lasting an hour. 
Agatha's resistance to Aids is something she herself does not quite believe as she sees other prostitutes succumbing to the familiar agonising death - going blind, then deaf, then wasting away after losing the ability to eat. 'When the condom breaks, as it often does, I am filled with fear.' 
Farah, another of the resistant prostitutes and a 42-year-old Muslim, places her faith less in science: 'The father of my last two children died of Aids. I did not use condoms with him. God alone knows why I am resistant. It could be because my life has been so hard that God grants me this favour. 
'There is a big difference since 1985, when I began. Now people are scared of HIV and the economy is worse.' How does she advertise? 'I sit on a stool outside my house. But not like the whores in the city who are almost naked. Decently dressed.' 
She has five childen and two grandchildren and, like Agatha, her shack has no electricity or running water. But she has her dignity and refuses to let her suffering defeat her. 'I want God to give me a long life and to help us be the instrument to find a vaccine for HIV. That would make me so happy.' 
Agatha feels the same. She turns up conscientiously at the clinic for the required tests. 'My life has been terrible, I know it,' she says. 'But I am happy to participate in this research, if it contributes to find a cure for Aids. 
'I hate my job but it would make me happy to know I have helped other people, even if I do not know who they are.' 

[http://www.guardian.co.uk/aids/story/0,7369,1091381,00.html]