Vibrant Gray
A Courageous Champion of the Fight Against AIDS Early On, Researcher Glenda Gray, MD, Intensely Pursues An HIV Vaccine
by Dann Dulin

Photos by JP Crouch

“Don’t let me die!” pleaded a twenty-four year old patient who was living with AIDS as he clutched Dr. Glenda Gray’s arm. It was the mid-eighties in the ICU unit of Soweto’s Chris Hani Baragwanath Hospital in South Africa.

The patient had pneumocystis pneumonia (PCP) and Gray, a young doctor, was intubating him (placing a tube in his trachea) when she confronted the horror in her patient’s eyes. She promised that by ventilating him he would have the best chance of survival, assuring him that she’d take care of him. But his condition worsened…and he died.

This was the doctor’s first patient to die of AIDS-related causes and the fateful memory is deeply embedded. Dr. Gray learned about the epidemic in medical school. After receiving her license in pediatrics, she soon was treating young women with HIV, their babies, and children in the wards. She joined South African Health Workers Congress (SAHWCO), an organization for progressive health workers, and led the AIDS desk. They organized communities around the issue of HIV and AIDS, using this as a tool working toward a non-racial South Africa and a desegregated health care system.

Dr. Gray, fifty-six, is President of the South African Medical Research Council and has received the “Hero of Medicine” award by the International Association of Physicians in AIDS Care (IAPAC) for her work in the field of HIV treatment in children and adults. In 2013, Glenda was awarded the Order of Mapungubwe, South Africa’s highest honor, for her life-saving research in mother-to-child transmission of HIV and AIDS that has changed the lives of people in South Africa—and abroad.

In 2017 she was listed among Time magazine’s 100 most influential people in the world.

Glenda has three children, a daughter, twenty-four, another daughter, twenty, and a fourteen-year-old son. In 2002, she received the Nelson Mandela Health and Human Rights Award. Her kids were so proud that they took the award to school and subsequently the school asked her to head the AIDS committee. Along with a fellow doctor (Lerato Mohapi), who was also working in HIV treatment, they held a meeting in the school’s science lab, with five parents attending.

As the meeting began, a Mercedes-Benz unexpectedly pulled up. A young driver hopped out, opened the back door, and out stepped an elegant Nelson Mandela. The meeting was hushed as Mandela talked about the epidemic. There was an air of disbelief. After Mandela left, Glenda and Lerato screamed and soared with excitement, realizing that he cared!

Dr. Gray was impacted by multi-level encounters of the epidemic. She witnessed many patient deaths, watched as her staff and friends succumbed to AIDS, and when the drugs finally arrived, Dr. Gray observed friends struggle with the new meds. The whole time was shrouded in stigma—the societal shame that led people to keep their positive status a secret. Glenda was outraged and angry.

Certainly, one cannot glance at Dr. Gray without noticing her eerie resemblance to another humanitarian—Hillary Clinton [A&U, April 2005]. The comparison pleases Glenda. She has not met Mrs. Clinton, but she did meet up with Bill Clinton one time when he was in Soweto, visiting the PMTCT (prevention of mother to child transmission) program.

Though this physician has a busy schedule, she manages to take time to celebrate life—spending time with her children, lazing on a sun-drenched porch on weekends, cultivating her garden while smelling the fragrant roses, taking quiet strolls, and doing laps in the pool. The dynamic doctor and professor also enjoys dancing, sipping wine, and listening to loud music.

Dann Dulin: I heard you speak once, stating, “HIV is the epidemic of our time.” Can you elaborate?
Glenda Gray, MD: HIV has consumed the energy of the world in both the twentieth and twenty-first century. It exposed both our medical deficiencies and global social inequalities. It formulated careers and institutions. The weapons created to fight HIV have been novel: Global Fund, UNAIDS, TAC, NACOSA and SANAC.

This epidemic has affected me personally, as has been the case for almost all of my colleagues. HIV pulled me into medical research from a clinician/pediatrician, revolving around young women and their children. It has in some ways enriched me and in some ways embattled my life.

How so, Glenda?
My patients who were children, who died, are imprinted in my memory. There are the babies, an eight-year-old boy, and then his mom; a two-year-old daughter of a fellow activist, and patient of mine; an infant girl, of a young eighteen-year-old; a teenager and treatment activists.

What was going through your mind?
I kept thinking that this should not be happening. All the memorial services and funerals I attended. [She pauses.] Sheer horror.

Tell me one of your personal experiences with HIV.
My housekeeper was diagnosed HIV-positive. We started her on treatment. We then had to test her young son, who fortunately was negative. I watched as she went into acute renal failure due to tenofovir, as the doctors were telling me to call a priest and prepare for her death. I brought her home from the hospital and I was convinced that I was not going to let this [death] happen. I sent my family away, while her son and I constructed a mini ICU at home, and with proper fluid management and care, brought her back to life.

Thank heaven! Share one of your professional losses.
The head of the ICU was a brilliant man, who was a talented thoracic surgeon. I could not understand why he was not operating. One night on call, he disclosed he was HIV-positive. He got TB a year later and died of HIV. This was in 1988, long before ARVs were available as treatment.

More and more patients came into our hospital who were HIV-infected. The wards were gruesome, filled with sick and dying people, and they were all young.

In layperson’s lingo, what are you currently working on scientifically?
My research is focusing on HIV vaccines. We are testing two HIV vaccine approaches. We are trying to find an HIV vaccine that can protect against HIV. This has been the focus of my research since mid-2000s. HIV vaccine research is a team science. Clinicians have to work with laboratory scientists, with social scientists, and with community members. It truly is team science, as all components are necessary to forge ahead.

In December 2017, you launched an HIV vaccine trial. What are the particulars of the study?
We enrolled over 2,000 participants—young men and women in South Africa in thirteen sites, rural and urban, across the country.

What is the study called?
The HVTN 702 study or Uhambo, meaning “journey.” It is evaluating a vaccine strategy that primes the immune system with a viral vector containing HIV synthetic antigens and boosts the immune system with this viral vector and a 2 component synthetic HIV protein compound, genetically engineered from the envelope of HIV. This regimen hopefully will cause the human immune system to develop antibodies that will protect against HIV acquisition, when exposed to HIV during sex.

How long before the world receives an HIV vaccine?
We hope to have answered substantial questions from our trials that will either show that our vaccine approach has worked, or [she takes a beat] shows us the way. We will be able to answer this by 2020/21.

What happens if the vaccine shows promise?
Then the real hard work starts! How do you scale up manufacturing? What is the engineering process to take our approach to scale, so we can deliver this? How do we roll this out? What are the regulatory and licensing issues that require answering before the vaccine can be licensed. Who pays? Who scales it up?
There are Global Access Committees that work on answering these issues, so that we have our ducks in a row, should we be successful. Team science!

Whom do you consider a hero in the AIDS pandemic?
There are many heroes. There are the children who struggled with their illness, who went to school with a secret, less they get thrown out. There are those who got thrown out of their homes, beaten to death like Gugu Dlamini (1962–1998) for being open about their status. There are treatment advocates who helped drive the price down, the mothers who fought alongside TAC [Treatment Action Campaign] for PMTCT, the nurses, the doctors, the families, those who fought AIDS denialism. The true heroes are the people who faced this adversity, stood up and were prepared to be counted. And mostly they were just citizens….

What do you believe is your greatest accomplishment, Dr. Gray?
I think I am a work in progress. Being part of a team that finds an HIV vaccine will be my greatest scientific accomplishment.

What drives you? What makes you continue in the storm of adversity?
I am a doctor. It’s my job. It’s my duty. This is the epidemic I was born into as a young doctor and I have a duty to help end it.

Dann Dulin is a Senior Editor of A&U.