Dominican Republic flag imageDr. Reza Nassiri, a Michigan State University researcher, tells a story about a car painter from a suburb of Santo Domingo to explain why poor places far away from East Lansing need help in the life-or-death struggle against HIV and AIDS.

Nassiri, named director of MSU’s Institute of International Health near the beginning of the year, noticed this particular patient leaning up against the wall in a make-shift clinic set up in a local church about four years ago.

“He had unusual skin manifestations,” he recalls. “There was number of legions on his arms, legs and face, all over his body.”

Nassiri asked the medical students with him — all helping that day in the make-shift clinic — to interview the man in his mid-40s, who wondered aloud whether his regular exposure to paint might have caused the ugly reaction. Nassiri knew that wasn’t it.

“I told the student from my experience in Africa, the patient has Kaposi sarcoma,” he says, citing a very rare kind of cancer that is usually only found in patients with full-blown AIDS. “He thought that it was a reaction to paint, but later on he admitted he had multiple partners,” he adds. Nassiri then points out a key geographic difference: “A Kaposi sarcoma almost never happens in the United States.”

That’s because the standard of HIV/AIDS care in rich nations is much higher than in the developing world. And that’s precisely what Nassiri and his fellow MSU researchers are aiming to redress at the Santo Domingo clinic, where they hope to develop a new, better model for poor countries.

According to an MSU press release sent out a few days before Christmas, the new MSU-Santo Domingo partnership seeks to develop a HIV plan that can help beyond this one country famous for beautiful beaches and merengue music. From the release:

Expanding Michigan State University’s global health outreach, a team of researchers is working in the Dominican Republic to establish a model for HIV/AIDS care that can be exported to other resource-limited countries.

The partnership already includes a range of participants — including medical students — all seeking to bring the full-range of diagnostic methods, treatment, and public health education to the Santo Domingo clinic and the people it serves. Again, from the release:

Others involved in the partnership from MSU include Walid Khalife, director of the Molecular Diagnostic Laboratory at Lansing’s Sparrow Hospital, and Linda Williams, a clinical nurse investigator in the College of Osteopathic Medicine. A team of four physicians from the HIV/AIDS clinic in Santo Domingo – led by director Ellen Koenig – are working closely with MSU physicians, and some have come to East Lansing for training.

Nassiri notes the jaw-dropping factoid that HIV/AIDS has become the leading cause of death among teenagers and adults between 15 and 49 years of age in the Dominican Republic.

Thus far, funding for the partnership has come from MSU’s College of Osteopathic Medicine, but Nassiri is also seeking additional funding from the National Institutes of Health. He says his grant request for $100,000 will be submitted in February, and he adds, “These grants are very competitive.”

Nassiri’s MSU colleague, Peter Gulick, an associate professor of internal medicine at MSU, is also seeking a donation of HIV diagnostic kits from the Rochester Hills-based pharmaceutical firm Abbott Labs for use in the country.

But Nassiri doesn’t mince words about the need for additional funding to achieve his ambitious goals.

“We are looking for big money,” he says, “something in the order of perhaps half a million dollars not only to buy the equipment that is necessary for genotype or phenotype analysis, but for laboratory monitoring for patients. We need to hire techs, to train them. Part of the money will also be used to purchase medications that are more effective, and part of the money will be used to educate the general public.”

It’s that last time that Nassiri sees as most important.

“Dealing in that region, I happen to believe that our number one priority really should be education,” he says. “The best medication is education.”

Nassiri explains that there’s “a huge difference” between the kind of care an HIV patient receives in the United States, versus a developing country like the Dominican Republic.

“Someone in East Lansing has proper antiretroviral medications, according to the guidelines,” he says, “But over there they do not have all the kinds of antiretroviral medications.”

Beyond the medications, there are stark inequalities regarding the ability of local medical providers to effectively treat “opportunistic infections” that stem from HIV infection, as well as a lack of ongoing genetic analysis to test antiretroviral resistance in HIV patients that he says is routine in the United States.

“That’s why we’re there,” he says. “The Dominican Republic has a national program for HIV care, but that’s not enough. Our intention is to seek funds from foundations or philanthropists to bring a better standard of care in the region.”

Early next year, the MSU medical delegation will be headed back to Santo Domingo, and the university’s molecular diagnostic laboratory will also host a Dominican physician training in HIV diagnostics.