World-Class Research on the "Slim Disease"

They called it the "slim disease." Its victims became ill, lost weight and died. No one knew why. The year was 1982.

As a medical resident at the Uganda Cancer Institute in Kampala, David Serwadda was surprised to be presented with Kaposi's sarcomas on the chests of two young women. Before, he had seen such lesions only on the hands and feet of elderly men. More cases trickled in—all from Rakai or a neighboring district. Then he read about similar symptoms in the U.S. "But we just could not connect a disease in white, homosexual males in San Francisco to the thing that we were staring at," says Serwadda, MBChB, MMed, MPH '91, now director of the Institute of Public Health at Makerere University in Kampala.

When tests in the United Kingdom confirmed it was the same virus (soon to be known as HIV), the health ministry officials in Uganda refused to believe it. Conducting scientific research at the time was especially difficult for Serwadda, Nelson Sewan-kambo (now dean of Makerere's medical school) and colleagues because the nation was caught up in a brutal civil war. When a Columbia University researcher named Maria Wawer arrived in 1987, prospects for collaborative study seemed remote. "I took one look at the bombed-out airport and thought, I'm out of here," recalls Wawer, now a professor of Population and Family Health Sciences (PFHS) at the Bloomberg School. But after meeting Serwadda and Sewan-kambo, Wawer changed her mind. With funding from USAID, the team began a pilot study of the Rakai community in 1988, using for its headquarters a "bar-girl hotel" in the community of Kyotera.

Over the next 18 years, the Rakai Health Sciences Program secured funding from numerous U.S. and international organizations. The program has determined that: Viral load is a key determinant in the likelihood of transmission; reducing sexually transmitted diseases does not lessen HIV incidence in communities with a mature, generalized epidemic; circumcised men are less likely to be infected with HIV, etc. (Many of the findings have come from the 12,000-person cohort that has been followed since 1994.) "Much of what we know about HIV transmission comes from work done in Rakai," says Ron Gray, a Rakai principal investigator and a PFHS professor who joined Maria Wawer, his wife, in the program.

The program now has more than 400 employees (all but two are Ugandans) and a new $2 million research center that allows important lab work to be done onsite rather than in Kampala or the U.S. "The point is, you can establish in developing countries a world-class research entity that addresses both policy and questions appropriate for Africa as well as fundamental questions for control of disease around the world," says Gray. "You just need the resources."