An Ounce of Prevention


AS A PROFESSOR AT THE UNIVERSITY OF MANITOBA AND THE PROGRAM MANAGER FOR HIV PREVENTION PROGRAMS IN INDIA, DR. STEPHEN MOSES DEFIES THE CONVENTIONAL IMAGE A RESEARCHER. YOU’LL FIND HIM DEEP IN THE FIELD, WORKING HAND-IN-HAND WITH THOSE HE’S HELPING.


and interact with their peers… just seeing that kind of transformation.” An ounce of prevention is worth a pound


Many researchers never leave the confines of their office, but Dr. Stephen Moses—a professor and researcher at the University of Manitoba specializing in public health—has been working closely with the communities and individuals he’s been serving in both Africa and India for nearly three decades. A native of Toronto, Dr. Moses studied medicine at the University of Toronto, and later completed a master’s degree in public health at Johns Hopkins University. For the past four years, he has been based in Bangalore, India, in the southern Indian state of Karnataka, managing HIV preven- tion programs for high-risk groups there. Many of the people they are targeting in their prevention programs—female sex work- ers and men who have sex with men—are socially marginalized, poor and many are illiterate. But Dr. Moses says that through the programs and better education about HIV and how it’s transmitted, he has seen firsthand how people there are developing a sense of empowerment over their own health and wellbeing. And, he says, that’s the most rewarding part of the job. “What’s most gratifying about the work


we do,” says Dr. Moses, “is seeing how women and men, who start off with very little in the way of resources, skills and knowledge can over a period of time become transformed and become very eloquent and masterful in the way they conduct themselves


of cure. It’s an old saying—but it’s the phil- osophy that’s guided most of Dr. Moses’ career. Many of the programs he’s worked on—both in India and in Kenya where he was based for ten years working with the International Development Research Centre (IDRC) and later the University of Manitoba—also provide treatment and care for those already infected with HIV/AIDS. However, Dr. Moses main focus has always been on prevention. “The burden of treatment,” he explains, “is becoming greater and greater over time as more people develop more advanced stages of HIV infection and require more drugs. So that burden will continue to increase, unless you start preventing those infections from occurring. It’s like water in the bathtub, if you don’t pull out the plug, the water will continue to rise. Unless you stop the inflow, you’ll never be able to keep up with the burden of treatment.”


in western Kenya. This trial, along with other trials in Uganda and South Africa, proved that male circumcision can reduce the rate of HIV infection by a whopping 60 percent. “The results were so striking and so consistent that virtually everyone is convinced now that male circumcision is effective in reducing acquisition of HIV among men. At a population level, that can have a major effect on HIV transmission in general,” he says. And governments are taking notice of


the results. Just over the past three years, Dr. Moses says, there have been more than 200,000 male circumcisions performed in Nyanza Province that would not have been done had those results not come out. (Nyanza Province is home to the Luo ethnic group, which is the main group in Kenya that does not practice male circumcision traditionally.) South Africa, Botswana and Zambia, among other countries in eastern and southern Africa, have all adopted similar programs and have targets for expanding their male circumcision services—all in an


“It’s like water in the bathtub, if you don’t pull out the plug, the water will continue to rise. Unless you stop the inflow, you’ll never be able to keep up with the new infections.”


True to his philosophy, Dr. Moses’


research has had a direct and significant impact on HIV prevention around the world. Starting back in the late 1980s, data kept popping up that indicated that areas in Africa where male circumcision was prac- ticed traditionally had lower rates of HIV infection. A large amount of clinical data also supported that observation. However at that time, Dr. Moses explains, there was reluctance in the international community to promote male circumcision as means of HIV prevention in the absence of data from clinical trials. His team at the University of Manitoba did just that. Starting in 2002, with col- leagues from the University of Nairobi and the University of Illinois at Chicago, they performed a randomized clinical trial in Kisumu city, the capital of Nyanza Province


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effort to curb rates of new infections. “It’s not being promoted as a magic bullet, as something that will stop the epidemic on its own, but as rather as something that will help reduce people’s risk. But it has to be done in conjunction with other safe sex practices.” For Dr. Moses, working in public health has always been about practicing medicine at a broader level, trying to improve lives on a wider scale—a goal that he no doubt has accomplished in nearly 30 years in the field. “It’s important for me to feel that I’m making a contribution to improving the lives and improving the well-being of large num- bers of people,” explains Dr. Moses. “I just find that a rewarding experience….That’s why, I think, anyone gets involved in preven- tion and public health.”


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