In the early days of the AIDS epidemic, back in the 1980s, the virus was seen as a threat mainly to gay men.
South African husband and wife researchers Salim and Quarraisha Abdool-Karim changed that narrative with their ground-breaking research. They discovered that in South Africa, young women had a high rate of HIV. And then they did something about it.
The couple met at university over a temperature-controlled ultracentrifuge and fell in love. It was a whirlwind romance: A week later Salim was headed to Columbia University in New York. They persisted with a long-distance relationship and just months later were married, with Quarraisha going on to join Salim at Columbia.
Last week, after decades of partnership, in and out of the lab, the epidemiologists received the prestigious Lasker Prize — often referred to as “America’s Nobel” — for their life-saving HIV research.
The power couple won the prize in the public service category “for illuminating key drivers of heterosexual HIV transmission; introducing life-saving approaches to prevent and treat HIV; and statesmanship in public health policy and advocacy,” the Lasker Foundation said in a statement. The honor comes with a $250,000 award.
Growing up as South African Indians under the brutal apartheid system of white-minority rule, the Abdool-Karims faced discrimination and segregation and had limited educational opportunities. Despite this, Salim and Quarraisha — who were both active in the anti-apartheid movement — went on to become two of the foremost scientists of their generation.
One of their major findings came in the early days of the HIV pandemic, in the 1980s, when the disease was seen in the U.S. and Western countries as predominantly affecting gay men. The Abdool-Karims found that in their home country it was predominantly women in their teens getting infected by older men.
The couple set out to find a way for these women to protect themselves — a challenging task. After almost two decades of research, the Abdool-Karims had their breakthrough: their trials of a drug called Tenofovir showed that when used as a vaginal gel, it could help prevent HIV transmission to women.
South Africa has one of the world’s highest number of people living with HIV — an estimated 8 million — but almost 80% of them are now on anti-retroviral drugs (ARVs). New infections have dropped significantly from a peak of around half a million in 2000 to 150,000 last year. The Abdool-Karim's work has contributed in no small part to these successes, according to the Lasker Foundation.
NPR spoke to the Abdool-Karims hours before they attended the prize ceremony in New York on Friday. The interview has been edited for length and clarity.
What barriers did you face entering the sciences in apartheid South Africa?
Salim: Growing up in apartheid South Africa with hindsight is somewhat of a surreal experience.
We lived in an area where only Indian people lived. When we went to the post office, we entered by the door that said non-whites. When we went to the parks, we sat on a bench that said non-whites.
Living in that kind of situation, the message you get over and over and over is that you're not good enough and you are inferior because you are not white. And having grown up in that kind of environment [it] was almost a challenge for us to say, actually, we are good enough.
And eventually, I went to medical school at the University of Natal, which at that stage was the only medical school for Black students. And became an anti-apartheid activist and joined the struggle for freedom. And having graduated as a young doctor, I decided to specialize in virology.
Quarraisha: And maybe I'll add a little bit because I was growing up on the north coast, north of Durban. And it's in the middle of the sugarcane plantations. My great-grandparents came as part of the Indians from India brought to South Africa in 1860 to work on the sugarcane plantations or the coal mines.
But [my family] really valued education. When I finished high school in 1976, I knew I wanted to be a scientist. So I went to the University of Durban and did my BSc [bachelor of science] degree. And during that time, [as I was] studying biochemistry and microbiology, there was an emerging understanding of immunology.
You both studied in the States, then returned to South Africa in the early days of HIV/AIDS. What differences did you see between the two countries?
Salim: What became very clear to us in New York is that HIV is going to be a big problem in Africa. When we came back to South Africa at the end of 1988, we decided that we will pursue research in HIV. And that pretty much defined the rest of our 35 years of research together.
And that’s when you made a startling discovery about HIV.
Salim: Our study that we did back in 1989-1990 produced data that took us quite by surprise. When we looked at the information from this large community survey, we found that in teenage boys, the prevalence of HIV was quite low. But if you looked at teenage girls, they had very high rates of infection [6 to 8% of women between ages 15 and 24 compared to 2% or less of males the same age. However, the rate among men in the 1990 study rises as they get into their mid-to-late 20s.]
That was a signal that these young women were not acquiring HIV from teenage boys; they were acquiring HIV from men who were about 10 years older. And so that started for us a whole research program to understand this age-disparate sex, and essentially laid the basis for research that we focused on, which is, how can we develop a technology that would empower women to protect themselves from HIV? Because, you know, condoms are under the control of men.
Describe what your breakthrough with Tenofovir gel was and how that research progressed since?
Salim: It took 18 years of research before we produced a successful outcome. And when we announced in 2010 that we had shown that this drug called Tenofovir, invented in the 1970s, protected women against HIV when used in a gel [applied vaginally before and after sex]. It provided new hope to the field of HIV at the time. The issue was that the gel was more expensive to make and didn't have the same level of protection as the tablets of Tenofovir. So it turned out that taking Tenofovir pills was as good and sometimes better than the gel and cheaper, and that's what led eventually in 2015 to the World Health Organization recommendation that Tenofovir-containing pre-exposure prophylaxis (PrEP) be offered to all individuals at high risk of infection.
Were there any challenges in getting these young women to take the pill?
Salim: Our problem became that young women were not overly keen to go and stand in a long queue at a clinic to collect tablets to take to prevent a disease they didn't have. And it became a real challenge for us because the uptake of Tenofovir PrEP was quite low. And even those who did start taking Tenofovir tablets for pre-exposure prophylaxis, after a while they just stopped taking it. And so we started a whole new research program to look at developing technologies that were long- acting.
South Africa’s second democratic president, Thabo Mbeki, engaged in AIDS-denialism while the country was in the middle of an epidemic. That must have been disappointing to see?
Salim: It came as a mortal blow in a way that when Mbeki took over from President Mandela, he dallied with these kinds of denialists and was influenced by their thinking and started espousing these falsehoods and this disinformation that HIV was not the cause of AIDS. And you know, we as scientists certainly couldn't just let that lie. We had to ensure that the public was aware of what the factual situation was. I was the head of AIDS research at the Medical Research Council at the time, and so I was often quoted in the media challenging the president and so were many others.
Quarraisha: It was a particularly painful time in that when we first started doing AIDS research in South Africa, we were dealing with a silent epidemic. And at the time Mbeki comes in, we're starting to see the face of AIDS, there were people dying all around us and in large numbers. And in 2000, when we hosted the International AIDS Conference, this is coinciding with the president, the democratically elected president, challenging this.
This year, you’ve been working on a new study with another drug, Lenacapovir, that’s shown impressive results.
Salim: That study showed that if you take the injectable of Lenacapovir [every six months], it was highly effective. In fact, there were no infections in women who took this injection. Young women could come in just once every six months, get an injection, and then they don't need to be concerned about the risk of HIV until they are due for their next injection six months later.
There is a heated debate over the presumed high cost of the injectable.
Salim: What we hope will be done is when it's licensed, it's not yet licensed, is that there will be a kind of access program that will enable poor countries to access lenacapovir at low cost.
What are you going to do with the prize money, and what’s next for you both?
Salim: The prize money will be used for research and/or training of students. We are now working on an annual long-acting prevention technology so that women will only need to have it once a year. (This could be in the form of a matchstick-size implant that has enough Tenofovir in it enough to release slowly over an entire year so that young girls don't need to think about prophylaxis.)
And to end on a lighter note: Salim, you’re widely known by your nickname, “Slim.” Where does it come from?
Salim: I acquired this nickname in high school when my Afrikaans teacher said to me “Jy dink jy is slim” — you think you are clever? — in response to some cheeky comment I must have made. Since my name was Salim, dropping the “a” made it a single syllable, I was the top student in class and I was quite rotund — so, for multiple reasons, her referring to me as “slim” just stuck.
Kate Bartlett is a freelance journalist based in Johannesburg, South Africa.
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