Joseph Sirrah looked forward to receiving his first injection on last Tuesday as part of Uganda’s Aids vaccine trials, despite the reservations of his wife and members of his community.
The pastor of the Centurion Faith Centre in Kitintele, a small village between Kampala and Entebbe in Uganda, is joining 35 other volunteers in the first phase of a trial that began in February.
Sirrah watched with pride at the official opening of the research facility in Entebbe on July 25, when delegates from a partnership between the Ugandan government and the International Aids Vaccine Initiative (IAVI) inaugurated the building. The vaccine being tested is for the type A strain of HIV.
“This vaccine is being tested as part of a multi-centric effort, currently including sites in Kenya and the United Kingdom — and hopefully soon in South Africa,” said Seth Berkeley, president of the IAVI. “Doing so many sites in parallel is more complicated and expensive. However it dramatically shortens the timelines for the completion of testing vaccines.
“A vaccine is our best hope to end the spread of the epidemic.”
The group submitted an application to run the tests in South Africa 18 months ago, but is still waiting for approval from the Medicines Control Council.
South Africa may begin trials on a different vaccine this month and 150 volunteers have already been recruited and screened. The South African trial will run concurrently with another in the United States to test Alphavax, a vaccine targeting the C strain of HIV that infects more than 90% of South African victims.
The US volunteers received the vaccine this week and the South African tests are expected to follow within eight weeks.
Back in Uganda, Sirrah said he believed he was fulfilling his duty to the community and God by taking part in the trials and contributing to curbing Aids. “Everyone in my church has lost someone or has been affected by Aids.”
He said his participation as a pastor would help squelch rumours that the trials were but another way to spread Aids in his community.
Organisers struggled to recruit subjects for the tests in this suspicious community with strong cultural and religious beliefs. A community advisory board consisting of a priest, an imam, other local leaders, an HIV-positive woman and opinion leaders was established a year ago. They advised the researchers about local beliefs and held seminars in their community.
Sirrah said the community ostracised him when they heard about the tests, but he has since gained the support of his congregation.
Said Sheik Rashid Muyingo from the Entebbe Mosque: “Islam has no problem with this kind of vaccination. We have a chance to work with these scientists and a vaccine will help us control Aids.”
The trial needed 50 volunteers, but after screening 185 candidates the researchers found only 35 who met their criteria.
Monica Balyeku-Tende, an Aids vaccine counsellor, said many of the volunteers feared they would be infected with HIV. “When they come to know the vaccine is artificially made in the laboratory and does not contain material from infected blood, they are convinced that it is safe.”
She said that in her culture women could not make independent decisions and many of their husbands barred them from participating in the trials. Only four of the volunteers are female. “We also get more men than women because the criteria stipulate that they should not have a child for 18 months.”
Rose Tumusiime, a counsellor in Entebbe who explains the vaccine trials to women, said few African women participated as they needed their spouses’ consent. “This may create suspicion among couples if the woman is not HIV-positive.”
The trials require the subjects to use condoms, which are unpopular because they are seen to promote unfaithfulness and extra-marital affairs.
More women will be needed in the second phase of the trial when the vaccine is tested for safety on a wide range of subjects.
“If only men participate, we may not know at the end of the day that the HIV vaccine also works on women — who are the most vulnerable to infection,” says Tumusiime.