Students see AIDS up close

While her classmates in Cambridge were shivering through a New England February, Sandy Bolm was sweltering in the heat of a Botswana summer, staring her future in the face in the labs of the Botswana-Harvard Partnership.

“I’m pre-research. I’ve known that I want to do research for a very long time,” said Bolm, a junior biochemical sciences concentrator.

Bolm and two other Harvard undergraduates are spending the spring semester in Gaborone, the capital of the African nation of Botswana. They’re taking part in a unique study abroad program sponsored by the Harvard Initiative for Global Health that puts them in the midst of one of the world’s greatest health crises — the AIDS pandemic raging across sub-Saharan Africa.

Bolm, Sarah Ashburn, a junior evolutionary biology concentrator, and Nathan Leiby, a sophomore molecular and cellular biology concentrator, take classes at the nearby University of Botswana in the morning and work in the partnership’s modern laboratory facility on the grounds of Princess Marina Hospital in the afternoon.

The lab, opened in 2001, is a rarity in southern Africa: a modern three-story facility conducting cutting-edge research on HIV, the virus that causes AIDS, and on how best to prevent and treat the disease’s spread.

The partnership began in 1996, when the government of Botswana invited the Harvard School of Public Health AIDS Initiative, headed by Lasker Professor of Health Sciences Max Essex, to come to Botswana.

Work done at the lab has informed government policies almost from the start. The partnership’s Tshepo study, begun in 2002 and named for the Setswana word for “hope,” evaluated different antiretroviral drug regimes even as Botswana became one of the first African nations to begin a nationwide campaign to distribute antiretroviral drugs to its citizens in need.

Since then, the partnership has conducted several other studies, examining everything from mother-to-child HIV transmission to transmission within couples to trials of possible HIV vaccines.

The partnership’s work is just one example of an enormous and diverse body of global health research, education, and training across Harvard. Researchers toil away to understand everything from the genetic code of the malaria parasite to the impact of air quality on human health, instructors impart the latest in medical knowledge to top students, and colleagues at Harvard’s many affiliated institutions not only teach and conduct research of their own, they also put that knowledge into action to improve people’s lives — in Boston and around the globe.

While the government of Botswana has been among the most aggressive in Africa in attacking the disease, HIV has taken a terrible toll. Life expectancy plummeted through the 1990s, from 64 in 1990 to just 40 in 2002. Campaigns to expand antiretroviral drug treatment appear to be having an effect, however, with life expectancy climbing back up again in recent years. It reached 50 in 2007. HIV prevalence in the nation — one of the world’s highest — has fallen from more than one in three adults in 2003 to about one in four in 2005.

Essex said that education and training are a major emphasis of the partnership. The disease is so widespread, he said, that bringing in a new generation of scientists and training health care workers is an important step in fighting it.

“A big part is training people at every level in Botswana and people from the U.S. who go there,” Essex said.

Each year, Essex said, the lab hosts a group of undergraduates, as well as two or three medical students and a doctoral student or two. In addition to the work in the laboratory, the students get the experience of living in one of the nations hardest-hit by AIDS, which can’t be replicated back home.

“They can’t begin to imagine the extent of the AIDS burden without experiencing the situation,” Essex said. “You recognize that virtually everybody you talk to has had experience with AIDS. Their parents are dead. Their siblings are being treated. You can learn about specific AIDS patients in [the U.S.], but you can’t appreciate the magnitude of the epidemic unless you’re there [in Botswana]. You can’t read about it in a book.”

Ashburn said that she wanted to travel to a developing country and was interested in Africa before she heard about the study abroad opportunity. She shares a room with three other students, from Botswana and Lesotho, at the University of Botswana. She’s taking a class in the nation’s history as well as a Setswana language class, though she says the opportunity to work in Essex’s lab is a highlight.

“Lab work is definitely one of my main interests in coming here,” Ashburn said. “I’ve loved it. I definitely know I want to spend time in places like this.”

One of the things about the experience that appeals to Bolm is the chance to work on a specific disease in the lab. The study abroad program also gives her a chance to travel overseas without having to take time off from her studies, she said.

“I didn’t want to take a semester off, so this opportunity — in an area of the world that interests me — was perfect,” Bolm said. “I love Botswana … working in the lab here is very exciting.”

Essex said the research experience is as important for the students as the cultural one. The study abroad program exposes them not just to a nation in the midst of the AIDS pandemic, but also to serious medical research. Together, he said, the program provides an invaluable experience to young people determining their path in life.