US-UK Collab: Biological and Human Dimensions of Primate Retroviral Transmission

Lead Research Organisation: University of Bristol
Department Name: School of Arts

Abstract

One of the great enduring mysteries in human health concerns the origin of AIDS. HIV-1, the retrovirus that causes pandemic AIDS, entered the human population from wild primates many decades ago, probably near the turn of the 20th century. How did this happen? Specifically, what social factors created the conditions that allowed a primate-borne virus to be transmitted to people, ultimately spreading around the world to become one of the deadliest infections in human history?

We will attempt to provide answers to these questions by studying present-day interactions between people and wild primates in a "hot spot" of human-primate conflict and contact in western Uganda. We will focus on communities of people who live in close proximity to red colobus monkeys, an ideal study species for this research. Decades of research on these primates has revealed that they interact regularly with local people in a variety of contexts, including antagonistic interactions leading to the killing of primates and/or human injury, and that such interactions increase rates of disease transmission between the species. Our study will build on this exceptional base of information to understand how human social factors underpin "risky" human-primate interactions. Our study will begin with a series of surveys to understand how people perceive and experience the risks of disease transmission from primates. Because risky human-wildlife contact is tied to social resources (e.g. power, access, social situation, economic status), we will reconstruct social networks in order to identify individuals who hold critical knowledge about human-primate contact and the risk it might entail. We will then target these individuals in order to probe their attitudes and knowledge with respect to human-primate contact. We will complement this interview-based approach with "activity-space mapping," which will reveal the physical locations of human-primate contact. To gain insights into perceptions and cultural norms, we will use "participatory video," in which people are instructed in the use of video cameras and asked to record events from their own lives, to share stories, and to voice opinions on topics related to primates or disease transmission.

At the same time that we study the human dimensions of disease transmission from primates, our colleagues based in the United States will study the primates themselves, in an effort to understand how retroviruses are maintained within primate populations with complex structure and demography. Our overall collaborative effort will yield a holistic picture of the root biological and social factors that drive the transmission of primate retroviruses. This effort will substantially improve our understanding of the biological and social conditions under which new and similar diseases might emerge, which will benefit public health on a global scale.

Integral to our efforts will be the training of international scholars. We will train a unique team of British, Ugandan, and North American scholars in core methods from the social and natural sciences, and we will send our British scholars to Uganda and North America to participate in fieldwork and laboratory work, respectively. The international, cross-cultural exchange represented by our training efforts will enhance the quality of life, health, and creative output of British citizens now and into the future.

Planned Impact

Most broadly, this research will benefit the public at large, since the research is focused on understanding, predicting, and preventing new zoonotic diseases from entering the human population. Pandemic diseases such as AIDS are phenomenally costly to treat after they emerge; preventing such diseases therefore carries enormous economic and societal benefits.

International health policy makers will benefit directly from our research. In Uganda, we will partner with Conservation Through Public Health (CTPH; www.ctph.org), a Ugandan non-governmental organisation focused on preventing zoonotic disease through public health education, to relay our findings to local communities in Uganda (see attached letter of support from Dr. Kalema-Zikosuka). Members of our team hold appointments in a variety of institutions across a breadth of disciplines, from university posts in anthropology and veterinary medicine to positions in the Centers for Disease Control and Prevention in the USA, who are major players in the global public health community. We will make full use of the unique positions of our team members to relay our findings to key decision makers in academia and government. Our analyses of social drivers of disease transmission will help direct the application of novel preventive medical technologies towards the most vulnerable parties.

In the past, members of our team have given public lectures, been featured in nature films (e.g. by BBC, Scorer Films, Omni Films, and National Geographic), and participated in other similar venues to educate the public about ecology, health, and social science. The research will enhance the information that we can present in these formats and will allow us to expand these activities within the UK and internationally, thus benefiting public sector and third sector stakeholders.

The final product of our effort will be a new and holistic picture of the biological and social forces that cause wildlife diseases to enter the human population and to spread. This information will be critical for predicting and preventing new infections and targeting education and intervention programmes in the future. For this reason, the research has great potential to impact on health and well-being of society. Currently, over 1.1 million Ugandan Citizens have been diagnosed with AIDS, and over 60,000 have died (Ugandan Ministry of Health, 2009). The average cost of treatment for an infected individual is $18,000 per year. Preventing future epidemics of this sort would therefore reap enormous benefits for both individuals and Ugandan society and , as well as for other nations around the world.

The benefits of our research will realistically be realized on a timescale of decades. This is because implementing international public health policy is a slow process. We note, however, that AIDS emerged over three decades ago, and still no effective vaccine is available. Long-term preventive medicine through global public health policy appears, therefore, to hold as much promise as more technological solutions.

A major goal of our research will be to train scholars in research and professional skills related to social science and its applications to the health-related disciplines. The British, North American, and African scholars whom we train will be uniquely poised to apply their new skills to employment sectors ranging from academia to commercial industry to public service.
 
Description We undertook social, demographic and health surveys among 400 households living in a rural region of Western Uganda around Kibale National Park. By combining quantitative and qualitative survey methods, we have identified the main factors which are responsible for putting people in contact with wildlife around a national part in Uganda (published in EcoHealth, and unpublished PhD thesis). In particular, we have identified a previously unrecognised gendered dimension to human-primate contact and disease transmission, with women being an important vector for transmission. We have employed and developed novel techniques for exploring social networks, including disease transmission networks (published in PLOSONE).The data we have collected has been cleaned and prepared for future analyses (and will be made freely available to others). One of the many benefits of our data is we have very detailed information on the type and number of infections, and the behavioural responses to them; this data has been recoded to facilitate further analyses on the social drivers of child health and care-seeking e.g. the social network of adults, and the number of individuals that caregivers can call upon for help.
Exploitation Route We are still working on producing several research publications and impact outcomes. We have disseminated our research findings to academic audiences at international conferences and to local stakeholders in Uganda (including the local community). We have engaged with schools interested in learning about the kinds of anthropological methods and approaches which can be used address contemporary world issues e.g. emerging pandemics. Further we have taken part in qualitative methodological training events for Ugandan, US and UK PGR and staff involved in the project. Two of the students linked to this project have already secured follow-on funding for postdoctoral research on related projects.
Sectors Communities and Social Services/Policy

Healthcare

Other

URL http://www.vetmed.wisc.edu/KibaleEcoHealth/research.html
 
Description We published a core paper on human-primate ecological overlap, contact, and disease transmission risk [1]. This effort was led by US team member Dr. Sarah Paige at University of Wisconsin-Madison under the supervision of PI Tony Goldberg. Dr. Paige now works for the USAID Emerging Pandemic Threats program and is actualizing many of the methods used in this project. These methods are important in that they reveal entry points for educational and policy intervention and support ongoing efforts to improve the effectiveness of public health services in this and similar rural Ugandan communities. Our analyses of clinical disease in our human study population has also revealed useful methods which could be used to improve health surveillance systems. Together with intellectual collaborator Dr. Simon Frost at University of Cambridge, led by Ph.D. student James Lester, we have developed, deployed and published a novel system for syndromic surveillance based on cell phone reporting [2]. To our knowledge, this publication is the first implementation of participant-driven electronic syndromic surveillance in a resource-limited setting. Our intent is to validate such methods to be used beyond academia in early detection of zoonotic disease outbreaks. Furthermore, work by University of Bristol Ph.D. student Christiaan Oostdijk has helped to create a culturally-relevant index of social capital and have applied it to two communities in our study. Our results show that men and women vary considerably in social capital, access to health-care and movements into and out of the study area. We continue to investigate whether this variation is predictive of infectious disease risk, including contact with non-human primates and infection with non-human primate zoonoses. This effort is complemented by related research by our group on the zoonotic transmission of other pathogens, and socio-economic solutions to problems of health care access, zoonoses, and conservation. The knowledge of gender inequality in health-care is important for public health delivery in the region, and Dr Oostdijk has recently returned to the study community to disseminate the findings directly to local leaders and health care professionals, the people who are in a position to bring about improvements in access to health-care for all. 1. Paige, S.B., Bleecker, J., Mayer, J., and Goldberg, T., 2017. Spatial overlap between people and non-human primates in a fragmented landscape. Ecohealth, 14: 88-99. 2. Lester, J., Paige, S., Chapman, C.A., Gibson, M., Holland Jones, J., Switzer, W.M., Ting, N., Goldberg, T.L., and Frost, S.D., 2016. Assessing commitment and reporting fidelity to a text message-based participatory surveillance in rural Western Uganda. PLoS One, 11: e0155971.
First Year Of Impact 2017
Sector Digital/Communication/Information Technologies (including Software),Healthcare,Other
Impact Types Societal

Policy & public services

 
Description School workshop (Bristol) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Geographic Reach Regional
Primary Audience Schools
Results and Impact 25 pupils to attend participatory workshop on Human Dimensions to Infectious disease transmission, which sparked questions and discussion afterwards about applied anthropology

A school has asked for the PI to come and talk to students about research
Year(s) Of Engagement Activity 2014,2016
URL http://www.bristol.ac.uk/fssl/festival/programme/2014/event5-3.html