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Dose of Prevention Where HIV Thrives

Nigeria Brothel Is Test Site for New Pill

By Craig Timberg
Washington Post Foreign Service
Wednesday, December 22, 2004; Page A15

IBADAN, Nigeria -- Crude paintings of women and rows of dimly lit bedrooms make clear the purpose of a shabby building just off a main road in this sprawling city. But for the next year, this brothel will have another function as well: testing a drug that could help stop HIV infections before they begin.

About 125 prostitutes here are pioneers in a U.S.-funded study that will ultimately involve 5,000 volunteers in seven nations. The study seeks to determine whether a single daily dose of an AIDS drug called Tenofovir can prevent infection from taking hold in healthy people, the way birth control pills prevent conception.

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If the pills work -- and if such high-risk groups as prostitutes, soldiers and truck drivers can be persuaded to take a pill every day even though they are not sick -- researchers said it could slow a disease that is devastating Africa and much of the developing world. There are roughly 40 million people with HIV, the virus that causes AIDS, and there were 5 million newly infected people in 2003, according to the United Nations.

"Even if it works for 20 percent of the population, it's an improvement over nothing," said Isaac F. Adewole, provost of the University of Ibadan College of Medicine, who is overseeing the drug trial.

The drug raises a number of scientific and ethical questions, any one of which could prevent it from ever being widely administered. But Adewole and other researchers say if those questions can be resolved, Tenofovir could dramatically curb the spread of HIV by blocking infection in people who are most likely to catch the virus and pass it on.

A 1995 trial using Tenofovir blocked the transmission of the simian strain of HIV in monkeys. A similar approach has already succeeded in preventing infection in rape victims and medical workers exposed to HIV.

Like other antiretroviral drugs, Tenofovir works by keeping HIV from reproducing. Researchers say that a daily dose could interrupt the crucial first step of HIV, when the virus turns host cells into factories that make millions of copies of the virus.

Tenofovir trials are beginning in Nigeria, Ghana, Cameroon, Malawi, Botswana and Thailand, as well as in Atlanta and San Francisco.

Among the most appealing aspects of a drug taken daily to prevent HIV, say researchers, is that women could take it privately at a time of their choosing, without a husband or other sexual partner knowing. Married women -- even those who are monogamous -- are among those most vulnerable to AIDS because husbands who have sexual relations with other women may be unlikely to take precautions or alert their spouses.

"World over, it is much more difficult for somebody in a long-term, supposedly faithful relationship to use a condom," Helene Gayle of the Bill & Melinda Gates Foundation, which has contributed $6.5 million to Tenofovir trials, said from the foundation's headquarters in Seattle.

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