Ending the Epidemic

Nairobi, Kenya — In this city’s Pumwani slum, everything seems inverted. Pumwani is one of the Kenyan capital’s red-light districts, but the action happens during the day. After dark, it gets too dangerous even for prostitutes. Then there’s the way the women advertise: no hip-high skirts or brazen busts. Instead, says Joshua Kimani, a charismatic young doctor who runs a research clinic for sex workers, a prostitute is “whoever sits outside their doorway looking clean.”

But the most profound turnabout centers on women like Joyce, who lives in a room hardly big enough for her bed. Joyce, who asked that her real name not be used, came to Nairobi from Tanzania. With three children to feed, she turned to prostitution within a year. That was 1983.

No one knows exactly when HIV entered Nairobi. But in 1985, Canadian researcher Frank Plummer was studying gonorrhea and chlamydia among Pumwani sex workers, and almost as an afterthought he decided to add an HIV test. Two-thirds of the women tested positive. He shifted his focus to HIV.

Joyce was one of the lucky uninfected women — in fact, her luck was nothing short of astonishing. Fourteen years have passed since her original HIV test, and she has spent half those years servicing up to 10 johns a day. Yet she has remained HIV-negative even as the percentage of infected prostitutes topped 90 percent. She contracted other STDs, proving that her partners didn’t use condoms and that she was almost certainly being exposed to HIV. But Joyce didn’t get it.

Joyce was certainly unusual, but not unique. Indeed, Plummer made a curious discovery: If a sex worker didn’t contract the virus after five years, she was unlikely ever to get it. The simplest explanation was that women like Joyce were resistant to HIV — almost uninfectable — and that’s why these sex workers electrified the scientific community. They were, in the understated language of researchers, “multiply exposed but uninfected.”

Prostitutes have been the scapegoats for AIDS in Africa, where the disease is spread mainly by heterosexual sex, and where men blame sex workers for bringing down AIDS. But, in the richest of ironies, Joyce and other prostitutes have provided researchers with valuable clues to the intricate workings of the immune system, and especially how it might be able to fend off the virus. In fact, the knowledge researchers gained from these women has been translated into a promising vaccine that is about to be tested in humans. The scapegoats of Africa’s epidemic just might turn out to rank among its saviors.


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