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Hannaway: So the technology transfer was back to the United States in this instance?
Quinn: Yes, it was. Actually, it was tested out more in Africa and then brought back to the U.S. to put to more practical purposes.
Hannaway: I think we have covered most of the situation in Africa, unless you have anything else that you wish to add about that.
Quinn: I am sure we could talk for hours about Africa. I think we should bring Africa up to the present date, because we have talked about the history: Where are we now? The situation has not really improved very much. Even after 15 years of working in Africa, we are faced with an epidemic that is still spreading, still increasing.
There are hopeful signs that condom distribution programs can work, that treatment of sexually transmitted diseases can work, and one of those studies–actually, both of those were done in Kinshasa, one in Tanzania, and we are doing one in Uganda now–shows that with an aggressive educational campaign linked with a treatment campaign of sexually transmitted diseases, one can limit the spread of HIV. But, unfortunately, it is only happening in very select areas that it is being piloted in. Whether the rest of sub-Saharan Africa will be able to afford these kind of campaigns is not clear, and it is probably not realistic to think so.
What is really needed for Africa is a vaccine. In my heart of hearts, I know the only way we are going to beat this in Africa is with a vaccine. We can do all these other things, they will have modest effects in slowing the epidemic. But when you already have 20 percent of your population infected, in places like Uganda, Rwanda, and Malawi, no matter how effectively you slow the transmission, it is still going to be there because there is just such a critical mass of people carrying the virus and who are infectious to their sex partners or through the blood donation system or through dirty needles. It will only be with a vaccine, I believe, that we will be able to stem the tide of this particular epidemic.
It does not mean we should not work on the other aspects. I think we need to keep the education level up and all the other interventions. But I think we are at a critical stage now in Africa where so many people have become infected that it will have a tremendous demographic impact, it will shorten the lifespans of people, it will have an enormous economic impact. That is, the people who contribute to the economic health and well-being of a country are going to die before they can contribute to that well-being. You will end up with declining economies, which increases the poverty situation, which, again, is part of the vicious cycle that seems to spur on the spread of HIV, sexually transmitted diseases, and civil unrest, as we saw in Rwanda, and the cycle continues.
What is scary about Africa right now for me is that we are seeing this virus emerge in countries where it had been relatively quiescent. Nigeria is the most recent example of that. Nigeria is the most populous country in Africa. In the 1980s, there was nothing going on there. We looked. There was very little virus, and we never understood why, with so many people there. But it was very limited. In the 1990s, it is a very different story.
Hannaway: And South Africa?
Quinn: South Africa is the next scenario. Then you have tuberculosis as the second leading epidemic, linked onto HIV. Both are steadily increasing. The tuberculosis epidemic is very problematic because we are getting drug resistance, it is occurring in people who are HIV-infected, and it is probably the leading opportunistic infection in Africans who are HIV-infected. I think we are at a very dangerous, if I can use that word, point in time with the AIDS epidemic, because it has gotten up to such high levels in this population that unless we come up with something very dramatic–I do not mean a little something, I mean very dramatic, and that is the vaccine–the situation is only going to get worse. In terms of the world, on a per population basis, when you talk about the magnitude of the epidemic, Africa will always have the greatest burden in terms of prevalence of the population infected. We will talk about Asia in a minute.
Quinn: Asia may have a lot more infected people in the next few years, if you weigh it, but there are 2 or 3 billion people in Asia, and there is only half a billion in Africa. Even though the numbers of people with HIV will be greater in Asia, per 100,000 population, it will still be worse in Africa, and I think people have to keep that in mind. And the countries do not have the resources to fight it without help.
Hannaway: Maybe we should now talk about AIDS in other developing countries.
Hannaway: You started publishing on AIDS in India back in 1986?
Quinn: 1986 was my first trip to India. In the context of what we have been talking about, Haiti was 1983, I guess, and so was Africa. Both occurred in 1983. In 1984, we got Project SIDA up and going. I started working in Nairobi along with the Canadians and other Americans there. We also started doing some work in the Caribbean as well–besides Haiti, also in Trinidad and Jamaica, with some other Americans in those settings. It was clear that these were the areas hard-hit with HIV.
But nothing was happening in Asia. It was very quiet. There was some talk about it going on in the Philippines, but it was the American servicemen in the military that were infected, and there was a concern it might spread. But it was very limited. There just was not much going on.
Then I was asked in 1986 to take a look at some blood samples from people to see if they were carrying HIV infection. I said, “Who are these people? Who is it coming from?” It was from some prostitutes in Bombay, in Madras. I said, “Sure, I would be glad to look at them.” I was asked because the blood was coming to the NIH and I had an established laboratory that had done work in Africa and could deal with these “auto-antibodies” that might give you false positive reactions. So people said, “Why don’t we have Quinn’s laboratory take a look at the samples, because if it is anything like Africa, he will be able to tease out who is truly positive and who is not.”
Out of the several hundred samples that we tested, 10 were positive, and he was very disturbed by this fact. He said, “We do not have any AIDS cases in India. How can we have infection?” He said, “I want to see the blots.” I remember this very distinctly. So I came down to NIH with the blots and I showed him. I said, “These are all HIV-1 infected. There is a concern about this new virus; HIV-2 could also be here, and we are going to work on that.” It did later turn out that there was also some HIV-2 in India. But in these samples, they were all HIV-1 infected.
The samples had come to me from a leading scientist in Vellore, India, and that was Dr. Jacob John. He was the one who actually originally obtained the samples. So we communicated the results to Dr. John, and Dr. Ramalinga Swami went back to India and announced to Parliament that HIV infection had arrived. The reaction was, “It can’t be. There are no AIDS cases here. How can we have HIV?” We would try to explain, “That is because after you first get infected, it takes 9 or 10 years, and then you develop AIDS.” We already knew by 1986-87 that there was a prolonged period of infection. They just said, “It can’t be. Your tests are wrong. False positives. We have heard about this malaria cross-reaction. We do not believe it.” We said, “Well, then, allow us to continue testing, and we will see if it is true or not.”
By 1987, we had proposed a prospective study of female prostitutes in several cities in India, and this was done in collaboration with a colleague named [Dr. Richard] Dick Kaslow, who was here with NIH and just left a year ago. He is now at the University of Alabama. We put together the proposal and submitted it to both the United States and Indian government for funding. The United States government approved it, and would have given us funding. The Indian government said, “No way. We do not have AIDS, we do not have an HIV problem. Your tests are all wrong, and we are closing the door on this. Our policy will be, we will keep foreigners out of our country. By keeping foreigners out, we will prevent HIV from getting into this country.” Period, end of story.
That was 1987, and nothing happened for probably two or three years, literally nothing, except HIV continued to spread, but unknowingly, to the Indians, or to anyone else, for that matter.
Meanwhile, in Bangkok and in Thailand, the American military, the Army, was doing some prospective studies, and they found the same thing that we found in India, which was, in 1987, a very low level of infection. But by 1990, it had already risen to 10 percent of sex workers and 10 percent of injecting-drug users. By 1992, it was up to 40 percent, so it was really escalating in Thailand.
There were some Indian scientists back in the late 1980s who were believers that these original tests were right but who were prevented from doing anything because of this government shutdown on HIV. But by 1991, they were becoming a little more forceful, saying, “We really need to do something.” And I happened to go there in either 1991 or 1992 for a scientific meeting, and I was approached by the Indian government. It had changed over. There were new people in the ICMR. They said, “Remember that project you wanted to do back in 1987?” and I said, “Yes.” They said, “We are ready. Can you put it into place?” We said, “Four years have gone by. But, yes.” We answered yes, we would do it. Then the question was, where? Where should we set up a project with the Indians to study this epidemic?
I was in Bombay at the time, and I went into the hospitals to see what kind of patients they had, and it was like revisiting Haiti, back in 1983. It was the same scenario. Here were all these AIDS cases, all these Kaposi’s sarcoma patients, all these people with herpes that was eating away at genitalia; tuberculosis was running rampant. They already had a TB problem, but now with HIV, it was much worse. The Indian government said, “No. Bombay would be one place, but we want you to look at another place where we have a big commitment to virologic research, and that is in Pune.
Pune had an institute called the National Indian Virologic Institute, or NIV for short, so I traveled up there and visited with the director, who was very willing to set up a project. So we sat down to talk. Now, the timing of this was very interesting for me as an individual, because Project SIDA was closing out as a long...
Harden: In ninety what?
Quinn: 1991. It was closing out, and here I was in India and the Indian government was saying, “We want you to set up another Projet SIDA, but here in India with us.” Here I had committed my life’s work to the Zairian project. Now that was nonexistent except for getting specimens out to continue the work. So I had time and energy, and I had some staff that were willing to work in India.
So I remember calling–this is a funny little story–but I called up one of my former fellows who was working at Hopkins. His name was Dr. [Robert] Bob Bollinger. I forgot the time difference [between Pune and Baltimore] and I reached him at 4:00 a.m. I said, “Bob, would you like to come out to India and do a project here?” He had previously worked in India. He knew a little Hindi. So he immediately said, “When can I get there?” and I said, “How about in a week. Pick up a portable computer on your way and we will write a grant while you are out here.”
He arrived within two weeks, sat down with the director of this institute, punched out and submitted a grant, and it was due within about two months. It was ranked number one of all the grants submitted for doing international AIDS research. He was listed as principal investigator. I again played the role of facilitator and helped to establish the laboratory aspect of the project. It got started, I guess, in 1992 in Pune. And we have been working there ever since.
After the first year, a Dr. Tripathy, a very senior individual, became the director of the Indian Medical Council for Research, or the Indian Council for Medical Research, ICMR. He said, “Let’s build an AIDS institute. This is enough. We are going to have a big, big problem.” So he had the foresight to see that. In fact, we do not have an AIDS institute here. And he wanted it centralized. He wanted one AIDS institute to start out with, and then, depending on the epidemic, he would set up other ones in other countries.
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