New Advances in HIV Research

As Peace Corps in Botswana, our primary mandate is HIV/AIDS, which normally centers around prevention. For us, that is closely tied to gender, since gender-based violence is the leading driver of HIV in Botswana. Hence, we feel that projects that empower young women and girls through literacy or job preparation and encouraging forums to discuss relationships, especially girl's rights within those relationships are really important. Still, occasionally we also get to see the other side of fighting HIV: treatment and care. Sometimes, those are synonymous. An ongoing study by The Botswana-Harvard partnership called "Ya Tsie" includes one of the villages in our reporting district. It is one of the most comprehensive studies to date about treatment as prevention (ARVs both treat and prevent transmission) and combination prevention strategies (like opt-out instead of opt-in testing, and HIV/TB concurrent testing). 

This last week, we got to see some of the results of this year's Conference on Retroviruses and Opportunistic Infections (CROI), where some of the most cutting-edge research on HIV is presented. Here is a short interview from UNAIDS about some conference highlights and a link to the website where you can find abstracts, posters, webcasts and photos for more in-depth information. 

Highlights from the annual Conference on 

Retroviruses and Opportunistic Infections 

New advances in HIV research and development 

The annual Conference on Retroviruses and Opportunistic Infec-tions (CROI) was held in Boston, U.S. from 3-6 March 2014. Every year CROI provides an opportunity for researchers from around the world to come together and share the latest developments in HIV research and development. Several interesting areas of research were presented at this year’s conference (http://www.croi2014.org) and UNAIDS spoke to Professor Salim S. Abdool Karim, Director of the Centre for the AIDS Programme of Research in South Africa and Chair of UNAIDS Scientific Expert Panel, for an overview of the main highlights in HIV prevention, treatment and cure research. 

Q. Professor Karim, we heard of many exciting developments coming out of this year’s conference what did you see as the main advances in HIV prevention research? 

A. The conference hosted a range of great presentations on AIDS treatment, prevention and cure. There was a strong theme on HIV prevention at this year’s CROI, focusing on how to im-prove effectiveness of antiretroviral (ARV) pre-exposure prophylaxis (PrEP). Studies over the last 3 years have provid-ed enough evidence to demonstrate that antiretroviral drugs like tenofovir are effective. However, the ARVs being used for PrEP are not taken as prescribed. At this year’s CROI, we saw a concerted move to find formulations that would have better adherence. To this end, a study of GSK-744LA, a long acting injectable which could transform PrEP from daily pill-taking to 3 monthly injections, showed good protection in monkeys. Another strategy to improve adherence is the development of a new vaginal ring, which has both the contraceptive and anti-HIV properties. 

Q. There was also much talk about cure for HIV—what was your take on that? 

A. The Mississippi baby is now just over 3 years old and has been off ARVs for more than 2 years but re-mains negative on the highly sensitive ELISA and PCR tests, strength-ening the evidence that this child may be cured. The second child presented at the meeting is a 9 month baby who was thought to be cured. Unfortunately, it is not a possible to de-termine whether this child is indeed cured because the child is still on ARVs and it is not possible to determine if negative HIV tests are due to temporary viral suppression or to viral eradication. 

Q. Vaccine development also seems to be advancing—what do you see as the next major step in vaccine research? 

A. In vaccine science, several broadly neutralizing antibodies have been identified and some have even been shown to be effective in preventing, treating or curing infection in mon-keys. The next step is to assess what effect these antibodies would have in the human body. 

Q. Is there anything else in the pipeline we should look out for? 

A. Yes, I am very impressed in the findings of gene modification approaches to treating HIV. I think this new technology has great potential. 

Books Books Books

For the past couple of months, we have been coordinating with the Botswana Book Project, which works with an international organization based out of St. Paul, MN called Books for Africa. The latter works to get good quality books (new hardcovers, floor maps, big picture books, classic children's literature, etc) donated and the former raises money for the shipping cost to send the books by ship to Durban and on to Botswana.

The books arrived last week, and Owen and I had the rare privilege of attending a reception with some of the project's founders, Unity Dow (a long time hero of mine, Botswana's first woman serving as Justice of the High Court, and author of Saturday Is for Funerals, Far and Beyon', and other powerful books about Botswana), and a new friend and author Bontekanye Botumile (expert in Botswana's oral traditions and author of Tlou- The Elephant Story, Patterns in the Sky, The Seed Children, and The two Kingdoms). Check out Bonty's website here: botswanastories.com.

Unity Dow's collection of stories that unravel some of the effects of HIV/AIDS on families.

 After one of the more complicated logistical scenarios we have dealt with, Owen and Mma Motlabane, our assistant librarian, coordinated transportation in a truck that was on errands with some of our district officers to pick up 22 boxes of excellent secondary and primary leisure reading books. As the books get processed, our once sparse library is growing by leaps and bounds. I wish some of you could see the faces of kids who are learning about marine wildlife, the northern lights, and archaeology for the first time. Books really are a window into the world. Please pray that the ability to read and a love of reading will be contagious!

Photos of Life's Changes

This is what the short rainy season looked like. It took less than a minute to fill our barrel. Woot!

The two ladies in the middle have been Becky's interim counterparts in the absence of the Monitoring and Evaluation Officer. Mma Machaba is on the left (holding the mug) and Mma Matome is on the right.

Owen and Mma Kwedi (standing) screening a STEPS film at one of the junior secondary schools.

Becky reading to a few of the children's literacy club members at the Ramotswa Public Library. Thank you all "thatha thatha" (so much) for the book shower. The kids are thrilled to have some books that feed their curiosity about the world. You all know who you are. Thank you!

Many Men will Drink the Rain and Turn to Thank the Clouds

So much has changed in the last couple of weeks, most notably the end of the rainy season (It was fast. It was furious. It’s over.) and the beginning of winter, but a lot of personal things as well. We thought it was time to stop for a moment to be thankful.

Life can be shifty and scary. The elections in South Africa and the kidnappings in Nigeria have really hit that home this week. But, we have confidence and hope in One who has already overcome and we’re thankful in the midst of changes.

Some of the changes have been subtle, right under our noses, but it took a trip to Mozambique and returning home to realize it. I found that we were actually more settled and integrated than I had thought. This has been a challenge for me in a series of challenges (“dikgwetla”). I feel like the settling in and integration bit has taken me longer than it has in the past. Partly, that’s the nature of the work, and partly its actually not having a car and the social exhaustion that comes with that. As much as the environmentalist in us enjoyed biking and walking around Manhattan, KS, a car has been a safety blanket and comfort to me. It’s more than transportation. It’s dignity, flexibility, efficiency, anonymity, safety, spontaneity, control, and status. Sometimes, with an axe and firewood in the backpack, you’re sweaty and tired and just have a hankering for power tools, and the ability to throw that all in the trunk and not have to be social for the rest of the afternoon. You’re tired and you feel like your people energy is always zapped and you’re doing a bad job of living the communal village life. Anyway, surprise of surprises, coming home to Ramotswa felt just like that-coming home. We walked to the hardware store that’s run by our neighbor, Florence, to buy some lumber to build frames for our new artwork, and we knew all three of the customers inside who welcomed us back warmly. Our friends, Moses and Wendy (who train volunteers for the Botswana Red Cross) invited us over for a barbecue (“braii”) and walked us home in the dark. Ramotswa is big by village standards, but it is the smallest town we’ve ever lived in and belonging to that is something special.

Work changes have been a bit more obvious. Owen’s work at home-based care had been slow at best. In fact, when we arrived, it was hardly functioning at all, which is a challenge for someone whose entire role in development work is capacity building- which means there needs to be some enthusiasm or actual service happening to begin with (the whole perpetuating patterns of inequality and forcing unsustainable projects from the outside). Still, he spent an important couple of months building relationships, teaching computer skills, and just being present (a hard thing for our American minds and bodies to get accustomed to). Recently, he has found a niche working with Mma Kwedi (his counterpart) on a project called STEPS. This is a series of films produced around southern Africa, focusing on issues like multiple concurrent partners, stigma, discordant couples, HIV status disclosure, relationships, children as caregivers, etc. They are provocative true stories that are meant to bring out discussion of issues related to HIV that tend to be secretive and buried here- something that perpetuates stigma and transmission in itself. Owen and Mma Kwedi have been invited into all the junior secondary schools (middle schools) in the district, where they show these films and then facilitate discussions and health talks. Talk about an open door! Owen has met hundreds of young people in the last week and has been able to bring really important issues to light. Ps. much respect to all middle school teachers across the world.

My work at DHMT has gone on a bit of a hiatus. My counterpart, the Monitoring and Evaluation officer for the district left for graduate school in Zambia back in November, leaving me and Mma Machaba frantically working to take his place. We have developed a good system and some effective data processing tools. Then, just before our trip, a new M&E officer was hired. Soon, the two of us will work closely together, but during the training and settling in stage, I have had something entirely new on my plate: Training Design and Evaluation for the next set of Peace Corps workers who will arrive in country in August. This has been a week-long set of meetings in Gaborone with Peace Corps staff- a painful and exhaustive, but hopefully valuable, process so that the next group will get the best language, cross-cultural, and select technical training possible. Training is a funny word for preparing people for almost endless possibilities of jobs and projects under the HIV framework- but maybe a little context helps!

Mozambique

Our little bungalow on the beach in Tofo.

Where we bought a barracuda for our nightly cookout.  Our friend, Joseph, cleaned and filleted it skillfully.

Relaxing at Mara and Anis' place just down the beach.

Sunset over the peninsula

Barracuda and crayfish dinner- seasoned with fresh lime, garlic,  and onion.

Four of these guys work to push the boat over the breaking waves, one works nonstop with a bucket to bail out water from the leaky boat, how many are the fishermen?

Solidarity with Melissa, Clint, Belen, and Robby, who are also on a beach just to the east/west and north/south of us.

A true classic of Anis (We can't take credit for this one. Mara is the brilliant photographer)

Boats

Making some thatching with the tassel. Fancy.

Ok. The bus ride from Maputo to Tofo was a bit extreme, especially compared to the rather tame buses in Botswana (whose primary adventure is breaking down). These were packed with people, chickens, cargo, the occasional motorcycle (see figure 1). They also served as UPS carriers. Occasionally, the bus would slow down through a village, some passenger would shout something like "Alaina!!!" out the window. Someone (presumably Alaina) would run up to the window and a package would be tossed into her waiting arms. Fun! Not to mention all the cashew, nail polish, and coconut vendors who hawked their wares through the windows at every stop (I'll take it over the gravity defying boots in SkyMall any day). Entertaining, but long. We were planning for maybe 4 hours- this was an 11 hour trip.

Maputo Victoria's Secret. 

Pun'kin Patch (There were no pumpkins and Owen does not approve this title)

Its harvest time in Botswana after a particularly heavy rainy season, which means the ground is completely littered in the husks and rinds of the deliciousness that abounds right now.

Most Batswana have “lands” or “mase mmu.” These are separate from the cattle post (although in some cases, not by much distance) and allocated by the government land board (which is, incidentally, the agency that invites us to screen “STEPS” films and talk about issues relating to HIV at their weekly staff meetings), not by private ownership. It’s a lot more complicated than we totally understand, but as far as we know, most families hold a 100-year lease on their lands. This land is used to grow crops and also usually has a crude residence within a compound.

By contrast, the cattle post is the site of the family’s wealth. I say “wealth” and not “income” because many Batswana families also earn an income. Income earning (whether in an office or through farming) is usually the women’s domain. Because of wealth being held in cattle, and because of a lack of financial management, sometimes huge debt, substantial wealth, and practical poverty exist in the same household. Back to the cattle post- this is the domain of men. And, like a bank account, it is rude to inquire into the size of someone’s herd. Outside of the actual corral or “kraal” (Afrikaans), the cattle roam over the land that is basically everybody’s. We are told that everyone knows their cattle on site, so there is no need for branding, ear-tags, or fences. The cattle are collected on foot and herded into the kraal. The goats or “dipudi”, on the other hand, know exactly where their kraal is located and will return home at night of their own fruition. When driving through Botswana, I have often assumed that open land on the right and left was just a vast expanse without many inhabitants. However, if you know what to look for, and you venture off the road, you will find all the men that seem conspicuously missing from the villages. They hang out in huge social groups, tending the cattle posts, drinking “bujalwa”, and playing in highly organized football tournaments. Although their huts are often thatched, and rarely electrified, some sport solar panels, connecting to all the necessities for relaxing in high style (extremely large speakers). Interestingly, some people balk at the use of solar power, except at the lands and cattle posts, because of a social stigma related to poverty and being unable to afford being connected to the grid and buying units from foreign-provided electricity. Too bad- if there is one thing that Botswana has a lot of, its sunshine!

Ok, back to the lands. Matlhogonolo grew beans and healing weeds for teas on her lands in the winter. Her lands were located about 1 hour drive from her home compound in Serowe, so she hired a Zimbabwean boy (paid P500/60USD per month, the minimum wage) to tend the crops. Her cattle post was a short walk down the dirt road from her lands. She made a very clear distinction between the lands- a type of free-form farming, and her meticulous “go lema merogo”- or gardening of spinach, rape, tomatoes, and beets, in her compound in the village. You can find some fun pictures of her at her lands and cattle post in “the cattle post” blog post.

The lands surrounding us here in Ramotswa grow a mixture of maize (which I am told is most similar to American feed corn, but here it is grilled or steamed in the husk and sold as “mmidi” on the streets- delicious), sorghum, “lerotse” (a sour melon), watermelon (sort of), squash, gourds (used for making traditional beer mugs – the “calabash”), and sweet reed, in the summertime. Much to our relief, the summer is over and winter is well on its way- brr, it’s starting to dip below 80F! The harvest is so plentiful, and the street food it provides is so wildly popular, that it is not uncommon to see businessmen unable to shut their modern office door because they need the space for the 10-foot stalk of sweet reed the end of which they are happily munching. Add cleaning the midi out of the computer’s keyboard to my morning tasks.

Our friend from working at the library, Mma Ramautu, noticed us walking in the evenings near her lands and invited us out to load up on all that we could carry. Wielding a kitchen knife, and wading through a jungle of weeds and crops intermixed amongst a cornfield, she showed us how to pick the best lerotse, how to chew reeds and twist them into a rope for bundling, and explained to us the etiquette of eating mmidi and sweet reed. In case you were wondering, you rip the corn off the cob with your fingers then pop it into your mouth. With sweet reed, you peel away the woody part with your teeth. That’s the opposite of what I would do- I would prefer the splinters in my fingers than in my lips…but that’s just me.

All protocol aside, we were overwhelmed by her and others’ generosity, and have been well stocked for nightly “braiis” (barbecues) ever since.

Mma Ramautu, Molemi, and Owen

Just bein' classy

Happy that Mom could join us

The pro demonstrates sweet reed peeling.

Molemi ties the knot...just kidding. Still single :)

Safari Pictures from up North

Becky's parents are visiting, so we've been able to do some traveling with them!  We stayed at Khama Rhino Sanctuary, the Okavango River Lodge, and Planet Baobab.  We saw lots of animals, so here are a few pictures to give you a taste.  Come visit us sometime, and we'll make sure you see them in person!

Baby Impala 

Our Guide brought the animals to us…by hand.

While we were playing with the turtle, the rhino decided to come check us.

Gemsbok/Oryx (I think they have face paint on)

This zebra wanted a new Facebook profile pic.

Lots of Giraffe, figured we'd take the stereotypical safari picture.

This Franklin was interested in helping Becky fill out her bracket for March Madness.

The Hornbills are very vain.

Dave on a typical workday, digging up grass.  Boring, but it's his life...

A few of the many rhino.  So many animals, it's impossible not to have other variety in the background!

This monitor lizard (~4 feet long) lived right by our tent at the lodge.  He liked to sprint past us when we weren't watching.

We took a flight above the delta to view game from the air.  Our cruising altitude was 500 feet.  Saw lots of animals, and was a great experience.

Becky and I volunteered to be bait for the crocs, the water was great and very clear.

Our Pilot posed with us in front of his plane, after the flight.

A cluster of 4 Baobab trees.  These things are huge, and very old.   The oldest one in Botswana is 5000 years old.