Fellowship Site: Lima, Peru
In Peru, the HIV/AIDS epidemic revolves around core groups of men
who have sex with men (MSM) and female sex workers (FSW). The HIV-1
seroprevalence in Lima is approximately 20% in MSM and between
1 and 5% in FSW. This contrasts with rates in the general population
of 0.5% among pregnant women. The dynamics of the HIV epidemic
in Peru highlight the importance of targeting core groups who are
often marginalized and not readily accessible using standard public
health measures with interventions to promote HIV testing and prevent
transmission. Prostitution in Peru, although not legal, is permitted,
and requires periodic STD examination at a Public Health Clinic.
Both FSW and MSM are eligible to receive health care at these clinics.
With the arrival of the Global Fund in Peru, all HIV-infected people
are eligible to receive HAART therapy without charge.
University of Washington collaborative research efforts in Peru
target FSW and MSM populations and design and conduct interventions
aimed at preventing and treating HIV and STD infections in core
groups as well as in the general population. Current collaborative
projects are being conducted with Peruvian Universities (Universidad
Peruana Cayetano Heredia/UPCH and Universidad Nacional Mayor de
San Marcos/UNMSM), as well as with non-governmental organizations
in Lima (INMENSA) and Iquitos
(www.selvaamazonica.org)
and include:
HIV Vaccine Trials Unit (HVTU): established in
2000 as a site in collaboration with UW HVTN Director, Dr. Julie
McElrath. The goal is to develop a safe HIV vaccine and conduct
Phase I, II, and III trials.
HIV Prevention Trials Unit (HPTU): This site was
established in Lima in collaboration with UW HPTN Director, Dr.
Connie Celum. Over 1,500 MSM in Peru participate in HIV prevention
trials, including Phase I-II microbicide trials and a randomized
trial of acyclovir suppressive therapy of HSV in at risk men.
International Adult AIDS Clinical Trials Group (AACTU):
Lima, as well as five cities outside Lima (Iquitos, Arequipa, Sullana,
Pucallpa, and Ica) have been developed into sites for international
clinical trials sites for UW ACTU studies. These trials assess the
safety and efficacy of treatment regimens in HIV-1 infected people
living in Peru.
In addition to collaborative studies of HIV, potential NIH-funded
clinical research projects at the UW Peru site are available in
the areas of meningitis (CNS
Infections) HTLV-I, HTLV-II and HPV infections, in adult or
pediatric populations.
Prior Scholar activities:
2004-2005: Dr. Evelyn Hsieh, our first Scholar, participated in
a multi-city randomized STD prevention trial, developed skills in
STD diagnosis and learned digital colposcopy at the public health
clinic "Alberto Barton del Callao." She also designed and implemented
a prospective cross-sectional study of Peruvian and Ecuadorian FSW
to determine STD knowledge and prevalence in registered and non-registered
FSW working in brothels, hostels and bars in Lima. She is presently
a resident in pediatrics at Yale.
2005-2006: Dr. Felicia Chow preformed clinical work at the Instituto
Nacional de Ciencias Neurológicas (http://www.icn.minsa.gob.pe)-
the reference center for neurologic disease in Peru, and designed
a study to assess diagnostic testing for vasculitis of the central
nervous system associated with neurocysticercosis. Felicia plans
to return to Peru this year to continue her project. She is presently
a resident in Neurology at the Partners Program in Boston.
2005-2006: Dr. Carolina Mejia examined factors associated with
migration of female sex workers between different Peruvian cities.
She is completing her PhD thesis at the University of Washington.
2006-2007: Christina Kahn conducted a retrospective analysis at
the Instituto Nacional de Enfermedades Neoplásicas (http://www.inen.sld.pe)
of survival following surgery for cervical cancer and also designed
an evaluation to determine the prevalence of violence against FSW.
She plans to pursue a residency in General Surgery after completion
of medical school.
2006-2007: Christina Rager worked with obstetricians at the Instituto
Nacional Materno Perinatal (http://www.iemp.gob.pe/contenido.htm)
to examine beliefs and practices regarding cesarean section for
HIV-infected women. She plans to pursue a career in either OB/GYN
or neurosurgery after completion of medical school.
2007-2008: Melanie Gipp, Sural Shah and Marie Wang will be involved
in clinical activities and research involving meningitis, tuberculosis,
and HPV in children and adults.
Future Scholars may choose to work in clinical research involving
HIV, other retroviruses, STD, or infections of the nervous system;
U.S. and Peruvian mentors will work with each Scholar to develop
a research and training plan tailored to her or his research goals.
Such a plan will likely entail performing clinical work in Lima
and possibly other Peruvian cities, developing a clinical research
protocol and human subjects application, and writing manuscripts.
A mentoring team comprised of Peruvian and U.S. physicians with
established clinical research will mentor each Scholar. Each Scholar
will be expected to participate in an NIH-sponsored course in Lima
regarding responsible conduct of research and good clinical practice.
Our hope is that each Scholar will return to Peru following completion
of the Scholarship to continue research initiated during the Scholarship
year.
Potential clinical sites in Peru include public health clinics
serving FSW, MSM, and people at high risk for STD, as well as hospitals
specializing in different areas of health care.
The NIH-funded clinical research includes the following projects:
- HIV Prevention Trials Unit
- HIV Vaccine Trials Unit
- AACTG Lima Unit (Adult AIDS Clinical Trials Group)
- HPV
and HTLV in Female Sex Workers
- Central
Nervous System Infections in Peru
- Neurologic
and Immunologic Manifestations of HTLV-I Infection in Peru
- Peru
ICOHRTA Network for AIDS/TB Research Training
Possible additional research: Blood Banking
We have NIH funding to create a blood bank screening program
for HTLV infection.
Once IRB approval is received of our HTLV blood bank screening
protocol, we hope to involve additional Scholars in studies
of HIV/HTLV co-infection and the neurologic manifestations of
HTLV, HIV/HTLV co-infection and co-infection with other "tropical"
infections.
Housing Availability:
Most Scholars choose to live in Miraflores - a safe and
interesting section of Lima. The UW Peru program can assist
with locating furnished apartments. The approximate cost for
room and board is $650/month. Transportation in a taxi cab costs
about $2-3 dollars; faculty in Lima will arrange for secure
taxis to and from the work site.
Immunizations Needed for this Site:
See the U.S.
Centers for Disease Control Web site and The
Yellow Book: Health Information for International Travel.
The NIH/FICRS program mandates that all Scholars see a physician
prior to their assignment abroad.
Safety and Danger Issues:
See the U.S.
State Department Web site for information.
Language Requirements Other than English:
Yes. Knowledge of Spanish is necessary. Language lessons can
be arranged.
What is it like to live in Peru?
Peru
is a country of contrasts: strolling through the center of Lima,
evidence of the Spanish conquest remains engrained in balconies
and entryways of buildings and churches, while in the district
of Miraflores, luxurious highrises stud the cliffs overlooking
the Pacific Ocean; walking along the Avenida Larco, the
cosmopolitan atmosphere is permeated with a mixture of the lively
South American culture and tropical trees and flowers. Juxtaposed
against the antiquity of central Lima, and modernity of Miraflores,
are the pueblos jovenes sprawling over the surrounding
hills; homes of thatch and corrugated metal, many without electricity
or running water, contain the workforce of this city of over
8 million people.
The people of Peru are a mixture of indigenous cultures, and
descendents of Spanish, Japanese, and African ancestors. Meals
usually include seafood, poultry, pork or beef, served with
rice, potatoes, or beans. The food is not spicy, but can be
adjusted to a tongue-searing heat by the addition of a scoop
or two from the bowl of aji available at all restaurants.
The weather varies between a comfortable temperature during
the winter months (June-October), when a light jacket is usually
required, to a humid, scorching heat during the summer months.
Medical care in Lima varies according to ability to pay; free
medical care is available to Peruvians who have seguro social,
but the majority of people rely upon the medical care provided
at government-subsidized public health clinics, which charge
nominal fees for services and prescriptions. Modern diagnostic
tools, such as magnetic resonance imaging, are available at
private medical clinics, and some hospitals, but the cost of
such tools often limits access to wealthy clientele or patients
able to raise money through community fund-raising events, such
as a pollada, where the patient's family roasts and sells
dozens or hundreds of chickens at neighborhood gatherings.
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