How the BHP Came to Be

Max Essex, Deeda Blair and Maurice Tempelsman

By Martha Henry

Maybe it all started with Deeda Blair, an early (and constant) supporter of the Harvard AIDS Institute. She introduced Max Essex, Chair of HAI, to Maurice Tempelsman in the 1980s.

Because of his business and personal interests in Africa, Mr. Tempelsman’s knowledge and contacts were essential in helping establish HAI’s research and prevention collaborations in Senegal. Studies with a cohort of commercial sex workers yielded the identification of HIV-2 and evidence that it was less virulent than HIV-1. Senegal has been cited by the World Health Organization as a major success story, having the lowest rate of HIV/AIDS in sub-Saharan Africa. The program continues to this day, under Dr.Phyllis Kanki, making it the longest prospective study of HIV in Africa.

Fast forward to June 1996. Maurice Tempelsman, now Chair of the HAI’s International Advisory Council, was hosting a dinner at Washington’s celebrated Cosmos Club. The dinner was in honor of President Ketumile Masire of Botswana. Knowing of the growing AIDS crisis in Botswana, Mr. Tempelsman invited Max Essex to the dinner and introduced him to President Masire. The two spoke briefly. The President asked Dr. Essex if he could meet with him the next morning. Essex, who had a class to teach at Harvard the next day, said no, but that he could meet later that evening.

When the meal was over and the formal goodbyes said, President Masire and Dr. Essex went back to the President’s hotel suite. The President knocked on the door of his Personal Physician, who was also a Consultant Physician, heading one of the Medical Units at Princess Marina Hospital in Gaborone. As Essex remembers, Dr. Joseph Makhema had already retired for the night when he was roused by the President’s knock. Still wearing his bathrobe, Dr. Makhema joined the two men for a discussion about the growing AIDS crisis. At the end of the conversation, it was decided that Essex would travel to Botswana as soon as his schedule allowed.

Max Essex and Ria Madison photo by Richard Feldman
Max Essex and Ria Madison photo by Richard Feldman

A few weeks later, in the summer of 1996, Max Essex landed in Botswana for the first time. He was met by Ria Madison, who worked for Maurice Tempelsman as Personnel Officer at Lazare Kaplan Botswana, a diamond polishing operation that employed several hundred people. Many of the employees were young women whose small hands enabled them to do the precise work of cutting and polishing diamonds. Later, young women as a group were found to have one of the highest incidences of HIV/AIDS in Botswana.

On that first trip, Essex made presentations about his research and met with government officials to discuss potential areas of collaboration. Blood samples from HIV-positive individuals were collected for Essex to bring back to Boston.

When the samples were analyzed back in the lab, researchers discovered that the virus in Botswana was different from the virus found in the U.S. and Western Europe. “As soon as we knew that the rates of HIV infection were high and that the virus was different, which we didn’t know until then,” said Essex, “we decided that it was important to set up a program and have a lab.”

After hours of discussions, planning and negotiations, the idea of a collaboration between HAI and the Republic of Botswana became a reality. In October of 1996, an official agreement was signed.

Dr. Ibou Thior, a researcher who had played an important role in HAI’s work in Senegal, was appointed as the first Project Director. Ria Madison formally became the Project Administrator, the first official employee of the Botswana-Harvard AIDS Institute Partnership for HIV Research and Education (BHP). Doctors, nurses, lab researchers and pharmacists soon joined the project.

Fast forward ten years to the present. Today the BHP employs 204 people, of whom 163 are Batswana. HAI was renamed in 2004 and is now the Harvard School of Public Health AIDS Initiative. Dr. Joseph Makhema, who was present at that first meeting between President Masire and Dr. Essex, is the current Project Director of the BHP. One of his long-term goals is to see more African senior scientists employed by the BHP.

Botswana elected a new president in 1998, His Excellency Festus Mogae, who continues his government’s tradition of strong leadership and support in the fight against AIDS. President Masire is now chair of the National BHP Advisory Committee.

As President Mogae said at the time of the BHP’s 10th anniversary, “Through close collaboration with the BHP clinicians, the first public ARV therapy clinic was piloted in 2001. This pilot provided many valuable lessons and later grew into Masa, the first public and nationwide ARV therapy program in the region. It is encouraging to know that as a result of this program, many people who were on their deathbeds are back on their feet and are productively engaged and providing for themselves and their families.”