By Joe Brown, Lecturer in Environmental Health, London School of Hygiene and Tropical Medicine (LSHTM) and AIDS 2010 Creative and Novel Ideas in HIV Research (CNIHR) grantee
IAS 2011 will be my second IAS conference. Last year, I received a scholarship to attend AIDS 2010 and a CNIHR grant to extend my work on environmental health in the context of HIV in Zambia.
I became interested in HIV through my work on water-related diarrheal disease. Improving access to safe drinking water, sanitation and hygiene (WSH) can save lives – diarrheal diseases are responsible for approximately 1.5 million deaths per year, and they are preventable – but we often do not think of this in the context of HIV.
I spent the last few years working on life-saving interventions for low-cost drinking water treatment in Latin America, Asia and Africa, where diarrheal diseases disproportionately affect the poor, the young, the old, the malnourished and those whose immune status increases their risk of acquiring opportunistic infections, including, for example,: people living with HIV/AIDS (PLHIV). We now know that improving environmental health can play a significant role in supporting the quality of life and potentially the long-term health of PLHIV.
Put simply, environmental health is perhaps most important among those with HIV: they have the most to lose. Opportunistic infections can decrease CD4 counts, which in turn may lead to greater susceptibility to other infections. Diarrhea – normally self-limiting in adults – can turn into a life-threatening, chronic condition, and environmental health-related microbes that do not cause disease in healthy adults can become dangerous pathogens.
The first phase of my project, funded by CNIHR, is study of 300 households to assess risk factors for diarrheal diseases in Misisi, an urban slum in Lusaka, Zambia. We’re looking particularly for differences in risk factors – access to treated water, sanitation and hygiene behaviors – for diarrhea and how these may differ by HIV status within the community. If risk factors can be identified, we can recommend specific intervention strategies to protect against disease.
The second phase is a one-year clinical trial of a safe-water intervention. Based on previous research conducted by our partners at the University of Zambia School of Medicine and in collaboration with us at LSHTM, we have identified post-collection recontamination of
water to be perhaps the most critical issue in terms of safe water access in this community. Ours will be the first clinical trial of safe water storage globally and among the first water quality intervention studies conducted specifically with the goal of assessing impacts among PLHIV.
We already know that safe water access is important to those with HIV, but showing how important – and demonstrating how it can be done effectively, at low cost – may help inform policy that will positively impact communities affected by HIV, like Misisi.
We have had a successful – if rather slow – start to our project, but data collection is now on track.. We are building significant capacity together with our partner institution, particularly within the tropical gastroenterology and nutrition group at the University of Zambia School of Medicine, led by Dr. Paul Kelly. We’re increasing local lab capacity for water quality testing and bringing in new methods. We hope this project is the beginning of a long-term, successful collaboration that will benefit our host community and others globally.
I felt very fortunate to have received the CNIHR grant and the scholarship to AIDS 2010 in Vienna. In addition to the main AIDS 2010 conference programme , I participated in a pre-conference seminar with leading scientists in the HIV field, organized to give grantees an overview of HIV science and an opportunity to share our projects.
AIDS 2010 was extremely valuable in helping me explore intersections between my area of expertise -- environmental engineering/environmental health -- and HIV. I’m thrilled to be returning this year and I look forward to adding in some small way to the conversation about how to improve the lives of PLHIV.
See you in Rome!