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Q&A with Wafaa El-Sadr: Leading HIV expert on the global epidemic and its bearing in Egypt

Egyptian-born Wafaa El-Sadr  originally a graduate from Qasr al-Aini Medical School in 1975  is currently the director of the International Center for AIDS Care and Treatment Programs (ICAP), and the director of the Center for Infectious Disease Epidemiologic Research at Columbia University. She has been at the forefront of the battle against HIV since reports of the epidemic first surfaced in the 1980s.

In 2009, Scientific American listed her as one of ten visionaries ‘Guiding Science for Humanity,’ and the Utne Reader listed her as one of fifty ‘Visionaries Who Are Changing Your World.’

This week, El-Sadr was back in her hometown of Cairo to receive an honorary doctor of science degree from the American University in Cairo. Egypt Independent took the opportunity to speak with her about her current views on the HIV epidemic, both globally and in Egypt.

Egypt Independent: How far would you say we’ve come since the 1980s with regards to the treatment of HIV?

Wafaa El-Sadr: In the past three decades, HIV has been transformed from what people used to call a “death sentence” to now a chronic manageable condition.  In the early days of the epidemic, finding out that one had HIV often meant that over several years there would be a relentless weakening of the immune system making the body vulnerable to many infections. This often led to years of suffering and ultimate death.

But since the mid 1990s, discoveries of new treatments for HIV have been able to keep the virus in check and preserve the immune system. People living with HIV who take these medicines regularly can expect to lead many years of a normal productive life.

EI: Would you say that we are nearing a cure in any way, or is that still out of sight?

El-Sadr: While there has been great progress in the treatment of HIV, we do not have a cure yet. This has been very frustrating for people living with HIV. At the same time there have been intense research efforts to try to identify a cure, but no success thus far. Similarly, there has been little progress in identifying a vaccine that can prevent HIV infection, despite substantial scientific investment. 

Researchers recognize that the difficulties encountered in identifying a cure or a vaccine are due to the unique nature of HIV and the manner in which this virus incorporates itself into human cells where it can remain hidden from the immune system.

EI: What would you say are the most significant milestones that have been reached since the HIV epidemic began?

El-Sadr: I can think of several remarkable achievements since the advent of the epidemic. Firstly, there was the discovery of the cause of AIDS, i.e the virus itself, HIV. This allowed for the ability to actually develop a test to diagnose this infection. Secondly, there was the discovery of a way to quantify the amount of virus in the body systems like the blood. This test allowed for us to know how much circulating virus there was and to measure the effect of the various treatments on the virus. Thirdly, there was of course the discovery of treatments that work [to keep the life threatening aspects at bay]. This was likely the most significant milestone that changed the lives of millions of people living with HIV around the world.

EI: Any recent significant breakthroughs or achievements?

El-Sadr: Just this past year there was a major breakthrough in HIV prevention. For years, researchers had been seeking new ways to prevent HIV apart from screening of blood for transfusion, use of condoms and avoiding unclean needles. In a major study conducted by the HIV Prevention Network, a global research network focused on HIV prevention, HPTN 052 HIV treatment was found to also prevent HIV.  In couples where one person was HIV infected and the other was without HIV infection, it was found that treatment of the HIV infected person was 96 percent effective in preventing transmission to the HIV uninfected partner.  This is a huge advance as it offers the hope that as we improve treatment for people living with HIV, we could also prevent new HIV infections. Of course, the work continues to find other prevention strategies.

EI: Where does Egypt currently stand with regards to HIV? ie: statistics, issues, culture, treatment.

El-Sadr: Egypt is considered a low HIV prevalence country, meaning that it is estimated that less than 1 per cent of its population are HIV infected. UNAIDS estimates indicate about 11,000 persons are living with HIV in Egypt with the majority of transmissions due to sexual transmission. There is also indication of a concentrated epidemic among one subpopulation of men who have sex with men and there are concerns regarding a potential increase in number of cases among drug users and commercial sex workers. It is likely that there is underreporting due to cultural taboos and the stigma associated with HIV, as has been noted in other countries.

EI: What do you believe are the biggest hindrances, both nationally and internationally, with regards to addressing and treating HIV?

El-Sadr: Historically, one of the biggest challenges to responding to the HIV epidemic has been denial, stigma and discrimination. These factors combined in some settings with lack of effective leadership have hindered the response to the HIV epidemic. There have been many missed opportunities where countries and leaders have failed to act at a time when an epidemic could have been averted. At another level, the failure by communities to reach out and embrace and accept people living with HIV has also led to the suffering of many and the failure to provide the services and support that people with HIV need.

EI: How can these hindrances be overcome in a place like Egypt, for example, where discrimination and stigmas surrounding the disease are high?

El-Sadr: It is important that a multi-faceted response to HIV be pursued, one that focuses on engagement of communities at risk, that offers effective prevention and treatment interventions and that promotes openness and respect for human dignity. Experience has taught us again and again that ostracizing people or judging their behaviors can only fuel the epidemic and further disenfranchise populations like men who have sex with men, commercial sex workers and drug users who are most in need of understanding, accepting and supporting. It takes leadership, education, information and community engagement to achieve this.

EI: In June last year, Magid [no last name was given] became the first Egyptian to publicly come out and admit to having the HIV virus on Al Jazeera International. Do you see this as a step for Egypt? And considering that he is still the only Egyptian to have done so, what do you believe this says?

El-Sadr: The disclosure by one individual in Egypt that he has HIV is a very important milestone. This is a very brave act by a most courageous person. He should be applauded for humanizing the face of HIV and for demonstrating that HIV is just an infection that can be acquired by anyone, that people with HIV should not be condemned through ignorance and fear but embraced as members of our society that are most of our support.

One of the most important legacies of the HIV epidemic is the critical voice of people living with HIV. They were instrumental in pushing for energizing research efforts to find new treatment and prevention. They demanded access to treatment and to services around the world. Such a movement in Egypt would be enormously helpful in transforming attitudes regarding HIV and people with HIV.

The engagement of patients is informing movements by other patient groups to take charge of their destiny. Around the world, women with breast cancer, people with diabetes among others have learned from HIV activism and standing up for their own rights.

EI: With regards to HIV, both in Egypt but also globally, is it possible to assess whether or not the epidemic is getting better or worse?

Our work through the International Center for AIDS Care and Treatment Programs (ICAP) in sub Saharan Africa and central Asia has enabled more than one million individuals with HIV to get access to services and more than 500,000 have received HIV treatment that is life saving.  Overall, access to treatment in low and middle-income countries all over the world has dramatically expanded with about 100,000 who had access to such treatment in 2002 to more than 6 million currently. Additionally, there is encouraging news in several of the hardest hit countries in sub Saharan Africa that recently reported decreases in numbers of new infections. Yet we have to remain vigilant, particularly in continuing our efforts to prevent HIV infection among youths and others at risk and to promote human rights for all those affected by this epidemic globally.


Dr. Wafaa El-Sadr, director of both the International Center for AIDS Care and Treatment Programs and the Global Health Initiative, speaks at Boston University's Bacalaurette Service on Sunday, 16 May 2010, at Marsh Chapel before the University Commencement ceremony.  (Matt Kalinowski BU Photography)

Columbia University’s GlobeMed co-sponsored an event hosted by Dr. Wafaa El-Sadr, Director of the International Center for AIDS Care and Treatment at Columbia Mailman School of Public Health.

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