In 1988 Dominique Ricard noticed, while working in clinics for commercial sex workers in Ziguinchor, Southern Senegal,that a high number of women who were HIV-2 infected came from a rural area in N-W Guinea Bissau. Together with Andrew Wilkins and Hilton Whittle, he set up demographic surveillance in Caió, the main village of this area, to study the epidemiology of HIV-2.
The Manjago village population of Caio, which currently numbers around 10,000, is dispersed in several settlements among the cashew and palm forest. Rice growing, palm oil, palm wine and cashew nut production are the main economic activities. Many men and women travel to work elsewhere in Guinea-Bissau, West Africa or further afield.
For over twenty years, unique community-based epidemiological and immunological studies of HIV-1, HIV-2 and HTLV-1 have been conducted in Caió on a shoestring budget. An old shop was converted into a laboratory, the shop keeper’s house was upgraded to offices and living quarters, and under the guidance of Hilton Whittle and Tim Vincent, the Site Head, and Peter Aaby, Director of the Projecto de Saude de Bandim, Bissau, the site has thrived.
Current staff consists of the site head, a clinician, a data entry clerk, 5 fieldworkers, a driver, a laboratory technician, a mechanic and 7 part time domestic/maintenance staff. The laboratory has been upgraded to allow cell culture and cell cryopreservation and flowcytometry.
Clinical staff were trained for the rolling out of Anti Retroviral Therapy (ART) which was introduced by the Ministry of Health, and through the efforts of the field site has been available in Caió since April 2007. Community health education using the Stepping Stones method has been led by Tim Vincent. Social studies relating to sex work and risk factors for the spread of HIV (Buckner 1999 & 2004; Constantine 2007) have also been part of the research efforts.
Building on this remarkable base, a number of laboratory and epidemiological studies have been concluded in recent years, including a further survey for HIV and HTLV-1 infection in the village; detailed survival analyses of HIV-1, HIV-2 and HTLV-1 infected subjects; examining possible interactions of HIV and HTLV-1; studies of HIV-2 specific CD8 T lymphocyte phenotype, function and viral escape mutants and the role of neutralizing antibodies in HIV-2 infection.
Community participation thus far has been very good and all projects are submitted to the Guinea-Bissau Ethics Authority for approval prior to the commencement of any research work.
