Speaker shares expertise on HIV/AIDS issues in Africa

Brian Wells Pence, a research scholar on HIV/AIDS at Duke University, traveled to Moshi, Tanzania, Africa, last year to work with local care providers.

"They're really doing amazing work and we're honored to be able to partner with them," he told members and guests at an Oakland branch, American Association of University Women, meeting Monday, April 23, at the Oakland YWCA in Clawson. "It was really empowering for them, it was really exciting for us."
Pence and his wife, Caroline, a social worker, traveled to the African country last summer as part of his work at Duke. Pence is the grandson of Mary Pence of Ferndale and an expert in epidemiology, including mental illness, substance abuse and psychiatric conditions that relate to HIV/AIDS treatment.

"It is very interesting," Mary Pence said of her grandson's work, noting he's a graduate of the University of North Carolina with a Ph.D. and of Yale University. "I think you'll be glad you came."

Brian Wells Pence showed a map of the part of southeastern Africa he and his wife visited with their young son. Pence showed a photo of a full University of Michigan football stadium, noting Michigan's population is less than 1 percent HIV-positive, a little lower than the national average in the U.S.

In Tanzania, it's 6.5 percent, about 20 times as prevalent. "These are all individuals who are likely to die in the relatively near future," Pence said.

He described how the virus replicates upon infection, with an initial test coming back negative. The virus attacks cells at the core part of the immune system.

"This equilibrium period can go for quite a while" during which a person could unknowingly pass on the virus. Eventually, an ill person dies "not from AIDS but from one of these infections their body can no longer fight off."

Pence discussed highly active antiretroviral therapy in widespread use in the U.S. Effectiveness of drugs is reduced if not taken exactly as prescribed, he said, and drug use has been made easier for patients in recent years, boosting adherence.

"Many people are doing very well on these medications." Getting the drugs to infected people in sub-Saharan Africa is much tougher, he noted, citing such factors as poor transportation networks and cost.

Some experts have questioned if poor people in Africa can take medicine on schedule. Pence showed a photo of a man from Uganda who was HIV-positive -- and missed only one pill in 89 days.

"I certainly could not accomplish this," Pence said. "As it turns out, he used his radio." The man, who had no wristwatch or formal education, judged by the sun when radio broadcasts would be aired.

A recent study found resource-poor countries tend to have better adherence, Pence said. The facts that patients are in cities and often selected for commitment and ability to get to a clinic are factors, he added, but the key issue in Africa is getting drugs delivered.

Pence and his colleagues from Duke worked on research training with people from a local nonprofit and hospital in Tanzania. "Health care is really a challenge there due to lack of resources," he said.

His April 23 presentation generated a number of questions, with Pence noting the Bush administration has funded HIV/AIDS work overseas more than previous administrations. He questioned the focus on abstinence programs as compared to those that encourage such preventative measures as condom use during sexual intercourse.

The AAUW members and guests found the presentation interesting. "There's so many layers" of the issue, said member Carol Missett of Farmington Hills.

Missett doesn't feel the government in the U.S. has addressed the issue honestly, with hospital care not readily available. "A lot of social structure problems, and the superstition," she said of Africa. She also questions our government's restrictions on prevention teaching.