Today I will share with you part of a conversation I had recently with Professor Oveta Fuller of the University of Michigan. Dr. Fuller is both a scientist and a person of faith. She has brought both of these parts of her life to bear on AIDS work in Africa. We have a lot to learn from her. Dr. Fuller is virologist who is a member of our university's microbiology and immunology department. Among her research interests, she has studied influenza, and herpes simplex virus, which has similarities to HIV. Ovita Fuller is also a minister in the African Methodist Episcopal Church. As the AIDS epidemic grew, and as the situation got worse in Africa, Dr. Fuller took time away from her work at the university, and went to Africa to search for ways to make a contribution. This led to her work with ministers and church people. The approach is to help these community members to become more knowledgeable about HIV and AIDS so the, that they can provide leadership in their communities in the fight against the epidemic. This particular approach is called the trusted messenger intervention. Doctor Fuller also received a Fulbright Grant to help her evaluate the trusted messenger approach. I began the conversation with Dr. Fuller by asking her for a few memories, snapshots of Africa that stand out for her. Dr. Fuller tells two stories. It is no accident that both of the stories involve children who are AIDS orphans, children who have lost parents to the epidemic. Before I show you excerpts of my conversation with Dr. Fuller I'll make a few comments about AIDS orphans. Since AIDS primarily attacks people who are sexually active many of the people who die are parents. In sub Saharan Africa alone, there are 10 or 11 million AIDS orphans. Doctor Fuller's two stories describe AIDS orphans who are being cared for by relatives, so they still have some intact family structure. But there are many other children who do not. Some are being cared for in orphanages or in other settings where they have nutrition, education, social services. Yet many others are alone, destitute, vulnerable. Some of them are subject to unspeakable exploitation and suffering. Some of them are HIV-positive, and only a small percentage of HIV-positive children in poor countries are receiving anti-retroviral drugs. Much of what Dr. Fuller tells us is optimistic and I think she is by nature a positive person. But in the background are these AIDS orphans whom we must remember and advocate for. I'd like to start, Dr. Fuller, by asking you to think back, to your several trips to Africa and are there any snapshots that stand out in your mind that you can share with us that might capture some of the reality that you've been learning about? >> Well, I, I think about my trips to Africa and there are so many amazing experiences,. We started going there in 2004, to Botswana is the first place. And then I've been to Zambia several times. I think, if I could give you a snapshot, one of them would be at the end of the workshops that we do on HIV with clergy in the community is to see people really understand and, and how that changes the perspective on what they did not understand before. I'll, I'll give you an example. One of the first trips I went to was through South Africa, through Johannesburg. And there was a woman, who was one of the, at the hotel who was one of the, assistants, at the hotel who had an HIV ribbon. This was in 2006 and that was when people didn't really talk about HIV a lot even though, in South Africa some one out of six people were HIV positive and people, there were, there were more funerals than, than, than one could manage. But people still didn't really talk about it, so she had on the red HIV ribbon, and, one day when I was at the desk for something and I ask her about it, and I said, I'd like to talk to you more about it. I'm here to work with, clergy on HIV, education. So we ended up having lunch and she told me that, she's really delighted to learn more and that she had a sister who had passed of HIV. And her husband, the sister's husband also had died of HIV and that she was now caring for her 11 year old nephew. And that she was, he was very healthy, she was very happy that he was doing very well. She was sure to make sure he had the right foods and that he made all of his medical appointments. And but she never understood when they went to the doctor's office that she, she knew that they always give them two numbers, but she didn't know what the numbers were. She knew one of them should be high, and one of them should be low. But she just didn't understand. And she just thought she wished she could understand a little bit more, because she worked really hard to take care of her nephew. So I told her yes those to numbers one is the CD4 immune cell level which you want to keep high because that's what fights off other foreign items in the body. And then the other is the virus load, which once you're infected, the virus is always there but the antiviral drugs actually reduce the ability of it to replicate. So you want the viral load to be low and the CD4 level to be high, and she looked at me and she was so excited. Oh, I never knew that. That makes so much sense. Oh, I'm so glad. Now I can, now I'll know how we're doing. because she was putting forth all this effort but, and getting the doctors' reports or the community healthcare person's reports, but didn't really understand if it meant that her nephew was doing really well or if he was, you know, he was on the edge of needing a change in his drugs. So that's one example. Another one that is very vivid in my mind is when we go to visit the grannies. There are a lot of grandparents who have lost children, because obviously HIV, AIDS affects people in the prime of their life, so there are lots of grandmothers who care for their children and their grandchildren and their great grandchildren. There's one picture that we actually have a photograph. One of my students happened to be taking photographs and it's of me talking with the community health workers who were trained by our clergy from one of the churches that we had worked with and there's a lady, a older lady sitting on rocks in the courtyard of her home and she's holding a young child. Child's maybe about two years old, so, the, the, the community health worker is translating for us, and she's explaining to me, in English, and talking to the grandmother that this is her great granddaughter, her, her daughter who is the woman inside the home is recovering from a bout with AIDS and is now getting better, because she's on antivirals but that the child is her great-granddaughter that she's holding. And, and what, what's amazing in the picture is that the woman and the child are sitting on a pile of gravel, like, you know, the gravel we see that you put on roads. But beside the gravel is this big boulder, and what happens is those granite boulders are very common in Zambia. The grandmother has people who bring the boulders into her courtyard and she actually takes a handpick which she sits and breaks up the boulder into these small gravel. And then the gravel are sold for public transport work, in Zambia, as the income for the family. So her daughter is unable to work because she, she has AIDS. Many of her, her great grand, her grandchildren are no longer living, like the mother of this child that she's, that she's holding. So to me, it's, it's, it's just a vivid picture of how the whole community is affected. And how you do what you need to do in order to make an income, or to engage with community resources. One of the things that I, I get very excited about is when I see the community health workers who typically may be members of the church who now, when the clergy, the minister, the pastor understands HIV, he or she begins to engage with programs that were already in the community, but that they weren't taking advantage of. So in this case, the pastor that came to our 2006 workshops, went back to his congregation and said, okay, let's get some volunteers to be trained by the US AID program or some other program so that you can help take care of people because you can't get it by taking care of people. And so now they have this team of about eight community health workers that take care of about 50 some AIDS patients in, or persons with AIDS, in their community. And it's just awesome. >> It's so interesting that two of your stories, both of your stories involve oh, orphans which as you say is because we're, we've lost the middle generation. >> That's right. >> Or many people in the middle generation. You've mentioned the church congregations, and you've mentioned the church members. Let's step back and give our students a more complete view of, of your work and, why it's so natural for you to make reference to that. You are a, both a virologist and a person of faith who has served as pastor in several churches and you have combined your expertise as a virologist with your commitments as a person of faith. And you've brought that to the world of HIV and AIDS in Africa, as well as in our own country here in the States. Why don't we begin by talking about the core idea of your work in Africa, the trusted messenger interventions. >> You know me well, eh? [LAUGH] >> I'm proud to know you well. >> [LAUGH] So I think, my journey has been very unusual. I'm, I'm a virologist by training. I'm, I'm a microbiologist. I've studied herpes simplex and influenza in laboratories for years and really loved doing that work. Viruses as you've heard me say before are fascinating. They're so small and, and yet they do, they can con-, take control over, of a, of a cell in a person. >> I'm glad you said that because most of us think of viruses as something that make you sick. And as a, as a scientist you think of viruses as something to study and, and learn about. >> I think they're fascinating, absolutely. How they do what they do. To take advantage of a cell to reproduce. Everything has to reproduce and how viruses do that are just, it's just fascinating. So yes, I would have been quite happy continuing to study viruses in the lab and understand a little bit more about how they work. But I, I also because herpes simplex is similar to HIV in some of its structure and that both viruses once you get them, they're always there, we always used HIV as sort of a model for what might be happening with, with herpes simplex. That's how I kept up with the literature. And I knew that HIV was just wreaking havoc on communities and particularly in in Africa which was this epicenter particularly sub-Saharan Africa. So I didn't really understand when I under, when I knew that I, I needed to do the training in ministry. I, I, that wasn't my goal, I wasn't looking to do that. But sometimes you just have to do what you have to do and later I, I guess it, it became clear to me those two things really did come together in that as a scientist who knew the viruses and knew how they work, and knew how antiviral works, and knows how the immune system work, works. But now as a minister, and I'm, I'm in the African Methodist Episcopal church, for which there is a, at the time that I started, there were four years of training required, and a rigorous structural program. At that time if you had an additional degree, you didn't have to do formal seminary. Now you do. You have to do, you have to have an M-Div degree to get the highest ordination. But at that time the combination allowed me to engage with the clergy and the bishops. We had twenty bishops around the globe. So what this does is it opens up an avenue to go anywhere, to work with clergy under the bishop that happens to be the one who plans the education, the continued education of clergy. So, so it allowed me to work in South Africa, and Zambia. As a matter of fact their first real workshops were at the invitation the bishop from Zambia, who wanted his clergy to understand HIV because they were dealing with both funerals as well as vulnerable children and needed to understand what they were doing better. So my first real workshops in Southern Africa were at the invitation of Bbshop Kawimbe who was a newly elected bishop. He's Zambian. And he wanted his clergy to understand HIV, not just to hear that it's sexually transmitted, that it's a virus, that, you shouldn't touch blood, but to really understand it. So those two things have actually overlapped quite nicely into what you mentioned, the trusted messenger intervention. And that's where we take biomedical science that you would give, that we give, that I give to medical students or dental students or graduate students, and what you do in your class, to clergy in their environment. They're called together by their presiding bishop or their elder or someone who has the authority to say I need you to be here. They show up and once they get there, we're there and we present the science and they're fascinated. >> You give the clergy people infor, basic biological information about HIV and probably medical information too, about AIDS. How do they take that information and turn it into action in the community? >> You know, what you mentioned is a, is a big issue with educational interventions period. One can give information but it, it can also be like, water running off a duck's back, right. What you really want is for people to take it, and use it, and apply it, for what they need it to be. So, there's a couple things we do at Trusted Messenger what we call the TMI intervention. Is one, we are always invited to come in. And two, when we get there we, we always have a focus group of people who help us understand the issues, the priorities, the context if you will, of the disease in their community and what they think about it, what they see as the issues. So it's not like I'm dropping in with the answer. I'm dropping in with a piece of the puzzle and in a partnership with the members of the community and with the, the clergy leaders, the presiding elders, or bishops or whoever it is that invited us, who the official hosts are, we try to give them what we know from a science point of view, but then ask them in the two days to put it into the context of the issues in their community and the solutions they already have that need to be activated. So, so what we do is we think of it as a catalyst. You know, in chemistry you already have the various reagents. You just want something that's going to be the spot that gets those reagents working together. So we think of bringing this biomedical information as a catalyst that actually activates the clergy to understand things in a way that they didn't before so that now they can do their job more effectively. They have influence, they have contact, they have resources in the community. For example there are there are organizations that do free HIV testing. And they complain, even Hawk here in Ann Arbor, they say that the churches rarely invite them to come to do the testing at church events. So what we do is to say to the clergy, here's an organization that does testing at no cost to you. All they want is an invitation. They will come, they will set up, they will bring everything that's needed, and all you have to do is provide the people. And we even recommend that the pastor and the officers are the first in line, to demonstrate that routine HIV testing is good healthcare is, is a smart thing to do. It's, it's not risky. It's not because you've been unfaithful to your spouse. It's because you care about your health and you want to set a model that everybody should do this. So essentially, we are not, asking them about sexual issues. We're asking them to be good leaders. And good leaders will take what is available, learn what they need to know, and then encourage their people to be healthy. We do obviously go into conversations about, sexuality, we talk about, this is not a moral disease. HIV is a virus, like flu, like the common cold. As a matter of fact, it's weaker than either of those viruses. We talk about the fact that you can avoid HIV by avoiding the four fluids. There are only four fluids that allow it to be transmitted. You knew that, right? >> Yes. >> But people don't know that. So why is that? So explain that HIV has a very, thin fragile membrane around it and that has to remain hydrated and that things like salt in tears or enzymes in saliva, all those things destroy that membrane or the proteins in it, so the virus has to be in blood, sal, blood, semen, vaginal fluid or breast milk in order to survive. And once they hear that they go, so you mean I can't get it by taking care of someone? I'm like no, as long as you don't come in contact with their blood, or use universal precautions. So once the clergy get this, they see the tremendous need. They already are taking care of vulnerable children in their communities. Many of them already have schools where the church building itself is used as a worship sanctuary on Sunday but it's a school during the week. So they are already doing things they just are not taking advantage of all the things around them, because there's this mor, moral issue or stigma that it's associated with it. And so when they get the science, the stigma just begins to fall. >> What have you learned about helping people deal with their issues of stigma? Of course you've said that the main way is to, by giving them information. Tell us more. >> I guess it's not just information. People have information coming out of their ears. You know, you see posters everywhere, you see pamphlets everywhere. What we try to do is give them understanding. That is, not that you know that, you don't only know that HIV is sexually transmitted, you now know that it is transmitted by contact with semen and breast milk and vaginal fluids, because those are the few solutions that it can survive in. It's not through the air. So yes, it is a result of sexual contact. But it's not a punishment for sexual contact which is a big belief that's been out there. Which I think is changing in general.
