The HIV/AIDS epidemic has an all-too-familiar face in the South African province of KwaZulu-Natal. There, HIV rates in young women spike from less than 1 percent at age 15 to 66 percent at age 23. Violent crime is also staggeringly common: A girl in KwaZulu-Natal is more likely to be raped than she is to read.
Massachusetts General Hospital infectious disease specialist Krista Dong, MD, sees in this community an opportunity to study HIV immune response while addressing social issues among its most vulnerable populations.
Dr. Dong is the principal investigator of the FRESH (Females Rising through Empowerment, Support and Health) program which embodies the community-oriented mission of Mass General ‘s Center for Global Health. Drawing from the hospital’s long history of innovation in medical care, research and education, the Center seeks to improve the health of the vulnerable populations around the world.
Breaking the Silence on Painful Issues
The FRESH program focuses on these young HIV-negative women at a high risk of infection. They are tested for HIV twice weekly for one year to learn about immune response at the earliest point of infection. It is believed that this initial immune response determines how well we are able to fight the virus and is critical information that will guide the development of an HIV vaccine. Participants receive a small stipend but there is much more to the program than blood tests.
FRESH uniquely combines basic scientific research with social intervention. The program is designed to take the participants on a journey of personal exploration and self-discovery.
FRESH uniquely combines basic scientific research with social intervention. The program in South Africa is designed to take the participants on a journey of personal exploration and self-discovery. Silence is broken on painful issues such as abuse, rape and neglect. As the girls begin to heal, they focus on career and educational goals. They learn practical skills to help them forge brighter futures. Among the group’s activities are: field trips to local businesses, workshops on resume and cover letter writing and seminars on how to open a bank account and stick to a budget. Punctuality and attendance are enforced to prepare the girls to be valued and productive employees.
“I agreed to do this study, with the pioneering support of Mass General, only if we could also give back to these women,” Dr. Dong says of her related work in South Africa. “When I conduct a study, my main criterion is: Will there be a sustained benefit long after I’ve left?”
An HIV Treatment Model for South Africa
Dr. Dong began studying HIV after losing friends to AIDS in the 1980s, which ultimately set the course for her career in global HIV and tuberculosis work. In 2001, Dr. Dong relocated to South Africa to set up a pediatric HIV study and co-founded one of the country’s first HIV treatment sites – The iThemba Family Care Center. There, HIV-positive adults and children received free lifesaving antiretroviral (ARV) drugs before they were available from the government.
The three-session ARV training program for patients developed by Dr Dong and her team was replicated throughout South Africa in what is now the largest government HIV treatment program in the world.
In KwaZulu-Natal — a region of South Africa with 40 percent unemployment, a 30 percent school dropout rate and an exceptionally high HIV burden — poverty is as pervasive as any disease. After launching FRESH in 2012, Dr. Dong insisted on underscoring the importance of education to achieve independence.
Setting Audacious Goals
In KwaZulu-Natal — a region of South Africa with 40 percent unemployment, a 30 percent school dropout rate and an exceptionally high HIV burden — poverty is as pervasive as any disease
“These girls, in particular, bear unique scars of extreme poverty,” she says. “Many are forced to drop out of school due to responsibilities at home. Some are heads of households after losing their own parents to AIDS. The majority of them are victims of abuse as children and too frequently enter into abusive relationships as young adults. Many can’t even think of escaping to a better life; they are without hope.”
No longer. FRESH gives hope to girls by setting an audacious goal of 100 percent sustained, meaningful employment or returning to school. By addressing the effects of poverty and providing real tools to enable them to break the cycle, it is hoped that program participants can achieve financial independence.
Initially, many of the FRESH girls were skeptical. “For the first few months, they just wanted their stipend and to get the heck out,” Dr. Dong says. “But there came a point where they realized the value had nothing to do with a cash stipend. It had everything to do with knowledge. It’s like a light went off. They see a future now.”
‘It’s Like They’re Building Us Again’
The young women have been transformed from fragile and tentative to strong and ambitious. “Acting is my passion, and I’m going to embrace my dreams,” vows 20-year-old Thobile, who says the program has helped her conquer difficult emotions. “If you’re a black person in South Africa, poverty invades your mind,” she explains. “You think less of yourself. At FRESH, we’ve gotten our voices back.”
“We don’t get this support and love at our home,” adds Swazi, 22, another participant. “FRESH told us that we always have powers to choose, to create. It’s like they’re building us again.”
A poem written by one of the FRESH girls is evidence of that:
I am a FRESH gal
I am free
I am strong
I am loving & caring
I fear no challenges
I face the world with pride & confidence
I see beyond today
I am a FRESH gal
I love me
I love sharing life experience
With other gals
I rise above all
I respect and value all women
I am a young proud woman
I am Nokwazi Hlengwa
FRESH, which is partially funded by a grant from the Bill & Melinda Gates Foundation, is part of a larger Ragon Institute project to study the development of broadly neutralizing antibodies (bNAbs) in HIV-1 infection and following immunization. Ragon investigators believe these antibodies may provide clues in the elusive search for an HIV vaccine.