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KwaZulu-Natal, Durban | McCord Hospital
The emaciated young man, his immune system weakened by HIV infection, recently battled a case of tuberculosis and now has come down with cryptococcal meningitis; he complains about a burning sensation in his feet. Walker turns to the attending physician and they discuss a change in medications. He holds the youth's right hand, pats his shoulder, and offers encouragement.
The patient doesn't know it, but the man helping him is a leading international authority on HIV/AIDS treatment and research who has collaborated with stakeholders in South Africa, and elsewhere, to develop innovative programs that introduce antiretroviral (ARV) drugs for treating the devastating disease. Walker's high-wattage research, genuine concern for patients, and ability to communicate complex science have impressed and motivated people from Boston to the green hills of South Africa to the ancient imperial capitals of China (see sidebar, page 6). As a result, he has been able to forge international research collaborations and policy relationships and has convinced deep-pocketed donors to help. And he has made a significant difference in the fight against HIV/AIDS—at both the research and the clinical levels.
One place Walker's efforts are paying off is in KwaZulu-Natal, where iThemba—the Zulu word for hope—is gaining a foothold in HIV/AIDS programs. These days, Africans whose future once might have seemed hopeless—an estimated 5.4 million in South Africa alone are infected with HIV—are now learning that the infection can be managed with ARVs.
KwaZulu-Natal has the highest HIV/AIDS prevalence in South Africa; infection rates in high-risk age groups are more than 40 percent, including half the pregnant women in some communities. Here, Walker pursues his campaign to help on several levels: improving treatment; building African research capacity; and conducting research that sheds light on the virus, human susceptibility to it, and the potential to develop a vaccine. These goals apply at his home base in Boston as well as in South Africa, though the daily challenge of HIV infection in this part of the world is much more daunting.
"When I first came to KwaZulu-Natal, in 2002, the magnitude of the problem was almost incomprehensible," says Walker as he moves through the crowded hospital wards. "It was quite a shock to see the conditions in the hospitals at that time—I thought I was prepared, but the sheer numbers of persons filling hospital rooms and lining corridors were overwhelming." The most difficult part, he says, was knowing that HIV infection had become a treatable chronic disease back home, but in Africa the life-extending AIDS-drug treatments were rarely available.
KwaZulu-Natal was not only ripe for improved access to known treatments, it was also a critical place to study the virus. Nearly all infections there involve subtype C—the major group of HIV variants fueling the global epidemic. "I realized there was plenty of interest in AIDS research, as well as talented and motivated scientists," says Walker, "if we could just provide resources to study the epidemic in the place where it was wreaking the most havoc."
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