Worlds apart, yet united by common purpose, two very different South Africans choose to become part of the AIDS solution.
At face value, Mdu Nkosi and Joan McCosh have virtually nothing in common.
He is young, black and a student at Umlazi’s Mangosutho Technikon. She is probably double his age, white, middle-class and living in suburban Durban.
Yet this week, both Nkosi and McCosh pulled up their right sleeves and were injected with a vaccine that may just hold the answer to millions of wishes and prayers.
Quiet Nkosi becomes animated when he explains why he decided to volunteer to test the HIV vaccine: “I love my country and I love my community. If we don’t get a cure for this disease, the country is going to collapse.”
Despite being in the middle of exams for his electrical engineering course, Nkosi put down his books on Monday (10 Nov) and became the first person in Durban to be vaccinated. “I was scared and I felt a bit shocked to be the first person to be vaccinated. Most people don’t understand and they think we are HIV positive.”
McCosh followed a day later. She says that she volunteered to test the Alpha Vax vaccine primarily because she has two young grand daughters “and I hope that we have a vaccine by the time they reach adolescence”.
“I don’t think there’s anyone in South Africa who is not affected by HIV,” says McCosh. “A vaccine will be too late for my children, but there is still hope for the next generation.”
As personal assistant to Dr Andrew Robinson, the man co-ordinating the Durban vaccine trials, McCosh has been very involved in preparing for the vaccine trial.
Even so, her decision was not easy or automatic. “When I first came to work for the vaccine unit a year ago, I thought anyone putting themselves forward would get AIDS and I wondered who would do such a thing.”
Once she understood that the vaccine volunteers would not become HIV-infected, McCosh started to think about taking the step into the unknown.
“I thought a lot about the people who volunteered to test the smallpox and polio vaccines. Where would we have been if they hadn’t volunteered?”
Nkosi heard about the vaccine trial while listening to the radio. “I became interested and so I decided to come to the Medical Research Council to find out. They explained everything to me. I went home and thought about it and I decided to be a volunteer.”
The first phase of the trial, being run by the international HIV Vaccine Trials Network, will take a year to complete.
Robinson says there is “no chance” of any of the volunteers becoming HIV-infected from the vaccine. However, this phase of the trial will test its safety and the immune system responses it causes and it is possible that some volunteers will react negatively to the vaccine.
Neither McCosh, Nkosi nor any of the 22 other volunteers in Durban and Johannesburg are getting any money for their efforts. Each person only gets a transport allowance to enable them attend their physical check-ups.
The volunteers have been through a rigorous selection process and are willingly donating their time to the 12-month study during which time they will be injected three times with the vaccine and have numerous physical examinations.
“A lot of people think we are going to get AIDS,” says McCosh. “At first, my eldest son was a bit concerned but once he understood that there was no danger of me getting HIV, he stopped worrying. My husband is quite relaxed about it and supports my decision.”
Nkosi, who is the seventh of eight children and comes from in Piet Retief in Mpumalanga, says his family thought he was joking at first when he told them he had volunteered. His two-year-old daughter is far too young to understand what has happened but “one day she will understand what I have done”, he says.
Most of Nkosi’s friends are too afraid to go for an HIV test, let alone volunteer, he adds.
All volunteers have to be HIV negative and at low risk of HIV infection. Nkosi says that he has had three HIV tests since late July, when he decided to volunteer.
“I am very proud to be HIV negative and I’m going to make sure that I stay that way,” says Nkosi. “I had a girlfriend, but she was not good. So I have decided not to get involved with anyone until I meet the girl I want to marry.”
All volunteers had to fill in a detailed nine-page informed consent form and get 100% in a test on the vaccine in order to convince researchers that they understood exactly what was going to happen to them.
Neither Nkosi nor McCosh are comfortable in the limelight. Nkosi returns to his studies as soon as his 30-minute observation period is over, while McCosh goes outside to smoke a cigarette.
They are both ordinary South Africans doing something extraordinary simply because they feel someone has to do it if the next generation has a chance.
How the vaccine aims to work:
Dr Carolyn Williamson of the University of Cape Town, who has worked on developing the vaccine, explains:
“Alphavax has manipulated the Venezuelan encephalitis virus (VEE) to make it act as a delivery system for a portion of HIV genetic material.
“The VEE replicon containing parts of the HIV genetic material (which makes selected HIV proteins) is not infectious and cannot spread from cell to cell. Therefore it is a dead-end process making it very safe.
“When the vaccine enters the body, the genetic material is delivered to the lymphoid tissue, where it enters the cells and makes copies of itself which results in the production of large amounts of HIV protein.
“The body identifies these proteins as foreign and makes a strong immune response against them.
“This is a ‘dummy run’ for a real HIV invasion of the body, and teaches the body how to respond so that when a live HIV virus comes along it is primed to defend itself.’
E-mail Kerry Cullinan