The Accelerating Excellence In Translational Science (AXIS)Charles Drew University of Medicine and Science

HIV International Programs
From left - Dr. Ekow Sey, Cora Ortile, Wilfredo Lopez, Jason McCuller, Dr. Charles Hilliard, Dr. Lejeune Lockett and Azeb Teshome.

Many people are aware of Charles R. Drew University's mission to reduce health disparities in minority and underserved populations. What may be less well known to the public is CDU's pursuit of this mission in regions outside of California and the United States. The university's International Health Programs have a long history of reducing global health inequities. Some of the most successful and innovative of these programs are U.S. Department of Defense and PEPFAR (the President's Emergency Plan for AIDS Relief)-funded programs that partner with the military of host countries Rwanda, Angola, Belize, and Jamaica to tackle the problems of HIV/AIDS. Through these programs, CDU is helping to address multiple issues in HIV/AIDS prevention and treatment, not just in the military, but in the population at large. Dr. Hilliard and Dr. Sey are Co-Program Directors on these International Programs and are supported by Dr. Lockett, the Operations Manager. Dr. Gus Gill provides overall oversight of the programs.

Dr. Charles L. Hilliard is the Program Director and Principal Investigator of the project in Rwanda, which has been operating since 2006. CDU works in partnership with Drew Cares International and the Rwandan Defense Forces with this project. Dr. Hilliard explains, “We work at two different military hospitals, six brigade clinics and operate a mobile clinic. About 80 percent of the clients that are served are civilians. Even though the program is designed to address the HIV epidemic among soldiers, we are constantly working with civilians as well.” The extensive Rwanda program has multiple components, including providing human resource and infrastructure development (like improved laboratories) in these hospitals and clinics.

A Mobile Medical Clinic also meets the needs of soldiers serving in remote areas. Dr. Hilliard notes that in addition to supplying diagnosis and treatment, the program provides psychosocial assessment, treatment and support. “Because there aren't enough trained social workers and mental health providers, we have also done a lot of training of lay counselors . . . so the soldiers are feeling supported and are getting referred for additional services when they need it.” Additional important parts of the program include educational activities, the integration of tuberculosis screening and treatment, and services to prevent mother-to-child transmission. Another significant initiative works to provide voluntary male circumcision (which has been demonstrated to reduce the risk of HIV transmission).

CDU is pursuing similar initiatives in Angola, Belize, and Jamaica. Dr. Ekow Kwa Sey is the Program Director and Principal Investigator in these countries. CDU's collaboration with the Angolan Armed Forces began in 2002. Dr. Sey explains that CDU's strategy of using this military-based approach to initiating HIV prevention in regions that are fraught with turmoil and unpredictability gives the program stability. “One thing that is a constant in these regions is the military. Thus our initiative centers on a disciplined, well-organized, well-respected and permanent institution.” Dr. Sey notes that in this model, “the military are initially the target of change but as the program progresses they become the agents of change, and take the HIV prevention message out to the community.”

The program in Angola includes multiple components. Through the HIV Peer Activist program, CDU has helped train military personnel to promote HIV prevention, set up testing, and supply condoms. The Angolan program has also helped develop voluntary counseling and testing sites throughout the country. Partly due to the program efforts, new military recruits receive HIV prevention education as a routine component of their orientation. Improved training of military health care workers has been another project goal. Additionally, the project has conducted significant research to help understand the behavioral risk factors that influence HIV infection in the Angola military. Overall these efforts have helped normalize and destigmatize HIV.

In 2009 CDU began its project with the Jamaica Defense Force, following a similar model. Here the program has also included the establishment of a Health Education Center from which trained peer educators routinely disseminate HIV/STI education messages. Additionally, the program has conducted an in-depth behavioral and serologic survey which is being used to develop HIV prevention initiatives tailored specifically to the needs of the Jamaican Defense Force. This has included innovative computer-based HIV pre and post-test counseling and STI education developed by CDU to supplement in-person counseling.
CDU has also played a role in the Belize Military HIV Prevention Program since 2010 by working with the military to promote voluntary counseling and testing among military personnel, their families, and their community. As part of the program CDU has also assisted the BDF to implement structural changes, such as the development and enforcement of a non-discriminatory HIV workplace policy. Similar to Angola and Jamaica, CDU has supported a Peer Advocates program in the Belize Defense Force that has improved prevention and treatment of HIV/AIDS within the military. Additionally, CDU has promoted voluntary counseling and testing by supporting VCT clinics in underserved parts of the country.

CDU is wrapping up its efforts in Jamaica and Belize and is, focusing its resources on continued efforts in Rwanda and Angola. These projects will continue to help provide improved treatment, infrastructure, planning, staffing, and education. The programs will also continue to seek newer and more effective research-based strategies to decrease HIV transmission. Formulating effective prevention strategies is particularly important since they provide the most cost effective way of addressing HIV/AIDS in these developing regions. Through these and other programs, CDU continues to fulfill its mission to positively impact the health of underserved populations, abroad as well as at home.