Karims, the Healers

YOU CAN’T TAKE India out of this pair. “One, because we love the curry, and then, we are addicted to Bollywood movies and Indian music,” says Salim Abdool Karim, the Indian-origin South African epidemiologist who has made seminal contributions to HIV prevention and Covid treat­ment along with his wife, Quarraisha Abdool Karim.

Considered the world’s top AIDS researchers, the duo received the prestigious 2024 Lasker Bloomberg Public Service Award “for illuminating key drivers of heterosexual HIV transmission and introducing life-saving approaches to prevent and treat HIV”. The $250,000 award is often referred to as “America’s Nobel”.

Their work extends far beyond HIV and AIDS research, although the Durban-based couple is primarily known for the strides they made in this segment. More than anything else, their work lies in proving that antiretrovirals stop sexual transmission of HIV and genital herpes in women. The couple’s expertise in the field proved crucial in developing protocols for the treatment of Covid-19 when the killer virus forced the world into a months-long lockdown, starting in early 2020.

The Karims, both of whom are 64 years old, are the first generation in their families to get a university education. Salim and Quarraisha are third and fourth-generation diasporic Indians, respectively, the former from Gujarat. Quarraisha has no clue where she is from. She merely knows that her great-grandfather went to South Africa as an indentured labourer from somewhere in the South; nothing else is known about her roots.

Quarraisha, who holds professorships in clinical epidemiology at Columbia University, Nelson R Mandela School of Medicine, and the University of KwaZulu-Natal, besides being associated with the Centre for the AIDS Programme of Research in South Africa (CAPRISA), shares that she was born in Tongaat in KwaZulu-Natal, some 40 km north of Durban. Tongaat is home to the oldest Indian community in South Africa where labourers were brought in from India to work in sugarcane plantations and coal mines.

For his part, Salim has a clearer understanding of his roots in India. His grandfather travelled to South Africa on a ship as a young man in the 1930s. “He settled down here in Durban. He was running a shop for somebody. He got married and had three daughters and four sons. And then somewhere along the way, my granny and my three aunts returned to India, specifically to Baroda (now Vadodara), which is where they were originally from.” The grandfather and his four sons, including Salim’s father, stayed back. Strange as it may sound, the sons never saw their sisters or their mother ever again. “It amazes me,” notes Salim, who currently holds multiple posi­tions in South Africa and the US. He is pro vice-chancellor (Research) at the University of KwaZulu-Natal, a professor of public health at Columbia University; and director of the Centre for the AIDS Programme of Research in South Africa.

Part of the issue earlier was that HIV was a death sentence. You had HIV; you were going to die. Today, we can treat you, so it has become less of a threat. But it is still spreading. We still had about 650,000 deaths last year from HIV-related causes, says Salim Abdool Karim, South African epidemiologist

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Salim’s academic accomplishments are so vast that he reminds one of Dr BR Ambedkar who held numerous degrees. The Royal Society, London, describes Salim as an inventor of patents used in HIV vaccine candidates and antibody-based passive immunisa­tion strategies. His TB-HIV treatment studies have shaped inter­national guidelines on the clinical management of co-infected patients, it adds. Salim also chairs the UNAIDS Scientific Expert Panel, the World Health Organisation’s (WHO) HIV Strategic Ad­visory Committee, and serves on the WHO TB-HIV Task Force. “He is a member of the US National Academy of Medicine, American Academy of Microbiology, African Academy of Science, Acad­emy of Science of South Africa, and the Royal Society of South Africa. Among his many awards, he is the recipient of The World Academy of Sciences Prize in Medical Science and the African Union’s ‘Kwame Nkrumah Scientific Award’, the most prestigious scientific award in Africa,” the Society’s website adds.

Quarraisha, according to the UNAIDS website, is the associ­ate scientific director of the Centre for the AIDS Programme of Research in South Africa, and her main research interests are in un­derstanding the evolving HIV epidemic in South Africa, including the factors influencing the acquisition of HIV by adolescent girls, and sustainable strategies to introduce anti-retroviral therapy in resource-constrained settings. She is also a visiting scientist at the Massachusetts General Hospital and a visiting lecturer at Harvard University. Quite interestingly, she was the principal investigator in what is considered “the landmark CAPRISA 004 tenofovir gel trial” of 2010 – which concluded that tenofovir gel, applied before and after sex, reduced HIV incidence by 39 per cent. As a result, accord­ing to CAPRISA, in South Africa alone, tenofovir gel could avert 1.3 million new HIV infections and over 800,000 deaths.

Their scientific breakthroughs in fighting AIDS and HIV infections were not attained by a sudden flight. The power couple of today lived and studied under the dreaded apartheid rule in South Africa, which became a democracy as late as 1994 when Nelson Mandela was elected its first president. As Salim remembers, in parks and in toilets, he went to facilities marked for non-whites. Similarly, after high school, he went to study medicine at the Uni­versity of Natal, which was then the only medical school they had in the region for black students. “We considered ourselves black then,” says Salim, and Quarraisha endorses his words. Both became anti-apartheid activists while in university. Quarraisha, who finished school in 1976, joined Durban University to study biochemistry and microbiology.

Their studious nature was an outcome of their aspirations to do well in life, and the values instilled in them by their parents who wanted them to be properly educated. At both their homes, their parents spoke to them in English, giving emphasis to learning, even if their own English wasn’t as fluent. As luck would have it, not only did the Karims do well in their studies, they also did their PhDs from Columbia University in New York.

Salim won a postdoctoral fellowship at Columbia University in 1987 and four months later, he and Quarraisha got married. Which meant both became students at Columbia University in 1988. That was the time when the AIDS epidemic was wreaking havoc in the US. As qualified epidemiologists, they returned to South Africa a few years later with the thought: what can we do to stop these mind­less deaths of young people?

Around 1989, the couple developed a protocol to quantify and understand the AIDS/HIV scourge. “It was a population-based study which enrolled about 5,000 to 6,000 people. And when we analysed the data, we found the overall prevalence of HIV was less than 1 per cent. In this survey, what we noted was that young women of 15 to 24 years had very high rates of HIV infection,” explains Quarraisha.

The Karims were also at the centre stage when Covid-19 struck the world. The couple came out with findings on how Omicron, the new Covid virus, affected HIV and TB patients

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Their finding was that while the prevalence of HIV was low in teenage boys, it was high in teenage girls –this was because the girls were getting it from older men who controlled access to any kind of safe sex, especially condoms. The couple focused on this phenomenon of “age-disparate sex” and started looking at ways to empower young women through awareness campaigns.

Much later, the breakthrough happened, thanks to the tenofovir gel trial of 2010. The jewel in the crown of the Karims’ achievements was the work they did for CAPRISA, which has done groundbreaking research in AIDS, HIV, TB, Covid 19 and several STDs.

In the early years of their public health crusade, they had to fight tooth and nail the AIDS denialism of the second president of South Africa, Thabo Mbeki, who succeeded Nelson Mandela in the post. Salim, who was tasked with AIDS research in the country, openly challenged the leadership of the time, including Mbeki and his minister of health Tshabalala-Msimang. “I was in the newspapers all the time, attacking the president and the min­ister. To me, it was always a sign of how strong our democracy was then. I never once feared for my life. I always knew that we would debate and challenge each other… The African National Congress (ANC, which led the liberation movement) had an unusual way of working. They tolerated a high level of dissent within the organisation,” Salim says, adding that finally he won and secured funds for the AIDS programme.

The rest is, of course, history as their hard work paid off. Ameri­can physician and public health administrator Margaret Ann Hamburg noted in her speech at the Lasker Awards commending the couple, “Their groundbreaking work in the fight against HIV includes a major advance against a leading cause of death among HIV patients—co-infections with TB. They led a trial that showed that combining anti-retroviral treatments with TB treatments greatly improves survival. This has now become a standard of care globally. In Africa, it’s credited with averting more than one hundred thousand deaths a year.”

The Karims’, who have two daughters and a son, were also at the centrestage when Covid-19 struck the world. It was also the period when Salim was on TV discussions across the world, including in India. The couple came out with findings on how Omicron, the new Covid virus, affected HIV and TB patients. Hamburg rightly said, “Their interest in Covid-19 variants provided the first evidence of the dangers posed by the Omicron variant.”

Meanwhile, the duo is upbeat about the prospects of a new twice-a-year injection called Lenacapavir for HIV/AIDS prevention. According to reports, a clinical trial for this formulation was carried out in Uganda and South Africa. Over 2,000 patients received the Lenacapavir injections and not a single patient contracted HIV during the trial. Salim was quoted in the media saying, “In my 40 years of doing AIDS research, I have never seen a result like this.”

The couple’s range of research on AIDS/HIV and other communicable diseases is astounding, to say the least. They fig­ured out very early on that the virus that had spread in the gay community in South Africa was the same virus that was being seen in the US and Europe. In the rest of Africa, however, the virus that was found was a strain common among the general population– in fact, it was also found in India and China. In their long years of research, the couple also established protocols for patients with HIV and TB whom they argued should be provided integrated treatment.

Now, CAPRISA, where the globally recognised couple did most of their research, comprises more than 300 staff. Among them are 57 PhDs and 38 medical doctors, most of whom are specialists. CAPRISA was formally established in 2002 under the NIH-funded Comprehensive International Program of Research on AIDS (CIP­RA) by five partner institutions: the University of KwaZulu-Natal, the University of Cape Town, the University of Western Cape, the National Institute for Communicable Diseases, and Columbia University.

During the interview with Open, Quarraisha keeps referring to Salim as Slim—his nickname from his school days. A topper in school and slightly big in size, Salim was jokingly called Slim by friends.

Widely travelled across the world and in India, the Karims often visit the country of their ancestors to attend seminars and conferences and have friends in various cities. The couple is well-networked across public-health agencies worldwide thanks to their cutting-edge research.

Fighting HIV/AIDS and using takeaways from their research to fight newer communicable diseases, like Covid-19 and others, are part of an ongoing project for the couple and their team. Although there is not as much media focus on their primary area of research as there used to be, HIV or AIDS is still a public health challenge. “Part of the issue earlier was that HIV was a death sentence. You had HIV; you were going to die. Today, we can treat you, so it has become less of a threat. But it is still spreading. I mean, we still had about 650,000 deaths last year from HIV-related causes. We had 1.3 million new infections,” says Salim.

If HIV is less fatal now than it was a few decades ago, the world has the Karims to thank for that. Their rigorous decades-long research and their people-first approach have raised the bar for the next generation of public-health scientists.

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