Piecing the Puzzle: The Genesis of AIDS Research in Africa

Book spine

by Larry Krotz
University Of Manitoba Press, 2012

At Vaughan Road Academy’s 85th anniversary reunion a few of us commented on the men who were missing – our gay friends, dead from HIV/AIDS. Soon after, I met Larry Krotz, a Toronto-based writer and film maker. He told me about his trips to East Africa and his research for an upcoming book — a little-known story that changed the way we think about HIV/AIDS. The book is full of revelations.

Thirty years ago, in the West, gay men were dying of a rare cancer that would eventually be identified with HIV/AIDS. In East Africa, heterosexuals were dying of an undiagnosed condition that caused the sufferer to waste away. In Nairobi they called it ‘slim’.

Two doctors, head of medical microbiology at University of Nairobi, Herbert Nsanze, and Allan Ronald, an infectious diseases specialist from Canada, brought together an international team of doctors. Their work made the connection between the two diseases and helped unravel the mystery behind the HIV/AIDS virus.  They developed preventative strategies, educational programs, and treatments.  They saved lives.

What A Story It Is

Krotz, who has been following the research since 1992 says “Piecing the Puzzle has all the elements of a good story – improbability, luck, serendipity, stick-with-it-ness.”

Tragedy, comedy, and heroes are also part of the story. Krotz describes the doctors’ medical research and their hard-won insights into HIV/AIDS while going head-to-head with number-crunching bureaucrats and skeptical politicians. He introduces us to the community workers who got the ball rolling with a baraza, a shantytown party that cemented the relationship between the researchers and the sex workers and brought hundreds of women on-board.

We visit a dying mother in a shanty, her only medicine is consolation. A nervous young man waits to be circumcised; he’s part of a clinical trial. A determined nurse, props in hand, heads to a brothel to teach women how to use condoms. And we meet the sex workers who are now grandmothers but were young women when they signed up for the studies and treatments.

It’s not come-and-go Safari Science

At a book launch organized by the University of Toronto’s Graduate Students for Global Health, team members Dr. Kelly MacDonald and Dr. Rupert Kaul, talked about safari science. That’s when researchers fly into a community, do their thing, and leave. They discussed ethical questions around short-term and long-term capacity building, leadership, and collaboration. Krotz was impressed with the team’s on-going commitment to collaboration and continuity. The doctors remembered the early years and how much things have changed.

Twenty-six years ago, when Piecing the Puzzle begins, there was no internet and no cell phones. Often there were no land lines. A Commodore 64 computer was state-of-the-art technology. Blood samples were sent from Kenya to North America for HIV/AIDS testing. It took 8 months to get the results. Today, a clinic in Kenya can have the results in 15 minutes. The team’s “stick-with-it-ness” has paid off.

World Health Organization (Statistics for 2011): 

  • 34 million living with HIV/AIDS worldwide
  • 1.7 million died of AIDS related illnesses worldwide
  • 2.5 million were newly infected with AIDS
  • 70 million people have been infected with the HIV virus, since 1981
  • 35 million people have died of AIDS since 1981
  • 67% (1 in 20 adults) of all those living with HIV reside in sub-Saharan Africa
– Elizabeth Cinello