Fellowship Site: 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 adolescents and in the general population. Currently funded projects also
include clinical epidemiology and manifestations of retroviral (HTLV-1 and 2)
infection, tropical infections of the central nervous system, cerebrovascular
disease and operational research regarding HIV and TB infections. 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 (Selva Amazónica)
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, and operational research in HIV
and TB infections (ICOHRTA-AIDS/TB).
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 - 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 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 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 and 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. Research projects are
expected to involve human subjects and will also involve laboratory results -
but Scholars are not expected nor encouraged to work in a laboratory. Projects
may also involve analyzing existing databases from studies conducted in Peru. Housing
Availability:
Upon arrival in Peru, each U.S. Scholar is met at the airport
and brought to a hostel in the middle class neighborhood of Miraflores in Lima.
In the past, U.S. scholars have found furnished apartments over the first 1-2
weeks by word-of-mouth, CraigslistPeru, the newspaper or expatriate community
websites (www.livinginperu.com,
www.expatperu.com). Some
Scholars have leased apartments vacated by prior Scholars, others have chosen
to share an apartment with Scholars from the UW or Hopkins programs. Unfortunately,
two Scholars encountered difficulty with unscrupulous landlords. We now contract
with a real estate agent to assist with finding and leasing apartments. Apartment
rentals in Lima range from $500-800/month. Travel to clinical or research sites
in Lima is typically 20-45 minutes; most Scholars use the local buses ("combis"),
which cost less than US$1; taxis are also available and typically cost $3-5/trip.
Purchase of automobiles is discouraged. Travel within Peru is easily arranged
via travel agents or the web (www.lan.com). Health
Issues and Immunizations Needed for this Site:
See the Centers
for Disease Control and Prevention Web site and The
Yellow Book: Health Information for International Travel. The FICRS
program mandates that all Scholars see a physician prior to their assignment abroad.
The site will require a formal letter from your physician stating that you have
received the necessary immunizations prior to the start of your fellowship. Safety
and Danger Issues:
Upon arrival, all Scholars undergo a safety briefing
at the U.S. Embassy to receive information regarding travel and security within
Peru. Each Scholar will also register with the Embassy and provide contact information
in case of emergency. The State Department recently launched a website specifically
for students traveling abroad; this website also provides multiple different sources
of online advice for travel and safety (http://studentsabroad.state.gov).
See the U.S.
State Department Web site for information. Language Requirements
Other than English:
Our program requires a working knowledge of Spanish
(conversational level). Although all of the on-site research mentors are bilingual,
most of the clinical mentors and nearly all patients speak only Spanish. A conversational
level of Spanish will allow the Scholar to focus on learning clinical research
skills rather than language acquisition. Although we expect each selected applicant
to have at least a conversational level of Spanish, we also encourage additional
tutoring, language classes or conversation partners once in Lima to further refine
language skills. Exception may be made for applicants with a strong skill in other
languages, such as Portuguese or French. 
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 high rise condominiums 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. | 
