She was shocked when she found out that United States President Donald Trump’s administration was cutting the Sex Worker Outreach Program’s (SWOP) $1.6 million USD in funding through the U.S. President’s Emergency Plan for AIDS Relief.

SWOP, which UM has helped operate since 2008, provides HIV treatment to Adhiambo and thousands of other people in Nairobi, Kenya.

“Without ARVs, some of us will definitely die. We are really, really in need because we don’t want to lose our fellow sex workers,” said Adhiambo, who was in Winnipeg for meetings at the end of September with three other SWOP peer leaders, and the physician in charge of the program, Dr. Joshua Kimani.

[From left to right] Joyce Adhiambo, Emily Kimemia, Dr. Joshua Kimani, Dr. Keith Fowke and Veronica Were attended meetings at the Fort Garry Hotel while in Winnipeg.

Dr. Keith Fowke, professor and department head of medical microbiology and infectious diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, said UM and the Rady Faculty are providing financial support to put a temporary plan in place to keep the program running after the loss of aid on Sept. 29.

Fowke said the emergency funding will allow them to keep five of 10 clinics open with a reduced staff. One clinic will stay open for 12 months, and four clinics will remain open for three months while the SWOP team works to secure funding to reopen all the clinics.

“We’re hitting on every front we can – from philanthropy to research grants and clinical trials to manufacturers and other donations. So, it’s going to take a number of different approaches to keep the program running,” Fowke said.

Kimani said the SWOP clinics serve about 50,000 patients, who include sex workers, gay-bisexual men who have sex with men and transgender individuals. He said that while the clinics that remain open will focus on the 5,000 patients on ARVs, SWOP’s HIV prevention work will suffer.

“You don’t close the tap by just doing treatment. You close the tap by prevention and treatment. Prevention is important, and it’s more expensive,” Kimani said.

Emily Kimemia presents to members of the UM department of medical microbiology and infectious diseases about the role of the community advisory board in research activities. She is the chair of the board.

Emily Kimemia, a SWOP peer educator and peer leader, said her work bridges the gap between the community and the clinics by providing education and HIV prevention services.

“Because of the poverty level, the clinics mean a lot to them since they get everything for free, like condoms, treatment and ARVs. We all know that once you take care of one community member, you’ve taken care of a lot of families, because she has a lot of clients,” Kimemia said while in Winnipeg.

Kimemia and Adhiambo said they’re concerned for patients who will now have to seek medical care at other health-care facilities in Nairobi because of the stigma and discrimination they face.

“SWOP has changed people’s lives,” Adhiambo said. “The program has created a safe space for all of us because sex workers are a marginalized community, and when we go to the program, we feel safe, and we feel secure. It is a home for some of us.”

Dr. Peter Nickerson, vice-provost (health sciences) and dean of Rady Faculty of Health Sciences, (left) meets with (from left to right) Joyce Adhiambo, Dr. Joshua Kimani and Veronica Were.

Not only will the program cuts impact the care patients receive, Fowke said it will be devastating to UM’s research projects. UM is a partner with the Partners for Health and Development in Africa, a Nairobi-based non-governmental organization, and they enroll patients from the SWOP clinics in research studies.

“It’s a real symbiotic relationship where the community can benefit from having good clinical care in an area that would otherwise be underserved. And as researchers, we have access to research participants who tell us what their priorities are, and then we can follow up and design research programs,” Fowke said.

Without access to research participants, it will be more challenging to attract funding for future projects, Fowke added.

“It’s always dark before dawn,” Kimani said. “So maybe this is the darkest point, but the sun will come out still, and hopefully things will get better.”

The majority of clinical services and drugs supplied in these clinics is funded by the United States Agency for International Development (USAID) President’s Emergency Plan for AIDS Relief (PEPFAR) program and the Global Fund.

“The recent announcement by the US government that this funding is paused, massive work stoppages, and that the USAID program is at risk of being dismantled, sent a major wave of stress and fear amongst these communities in Kenya…it was palpable,” said Dr. Peter Nickerson, vice-provost and dean (health sciences) and dean, Max Rady College of Medicine, who visited the UM partner clinics in Nairobi last week along with UM President Dr. Michael Benarroch, Chancellor Anne Mahon and medical microbiology and infectious disease head Dr. Keith Fowke.

“Individuals who have had their HIV counts reduced to undetectable levels for 20 plus years allowing them to feel well, are now at risk. We know that missing one’s medications will lead to a resurgence of the HIV virus as well as new drug resistance. While immediately impacting these communities, it also has global implications as we have learned from the COVID pandemic – drug resistance will spread across the world.”

Because the aforementioned vulnerable communities are deemed illegal in Kenya, they are stigmatized by the public health system and at risk of extortion by the police or incarceration by the legal system, Nickerson noted.

“We take great pride in the success of these community clinics. Over the last 45 years the UM has played a key role in building both clinical and research capacity that is now led by Kenyans,” said Nickerson. “The goal is to advance care in both the prevention and treatment of HIV AIDS and other sexually transmitted infections.”

A major part of the success of these clinics is the investment in peer educators, including paralegals, who provide critical information and support to members of their communities, he added.

“The clinics provide an environment without judgement where individuals can come for peer support and counselling, in addition to receiving appropriate medical care. Without access to life-saving medications, millions of people living with HIV will be at risk.”

Nickerson called on researchers and physicians to both advocate for the US administration to reverse its foreign aid decisions and ask the Canadian government to step into the breach to prevent this humanitarian tragedy from occurring across the developing countries of the world.

“I was reminded and affirm that health is a human right and we who live in abundance have a duty to care for our fellow human beings,” he said.

Dr. Keith Fowke and Dr. Mario Pinto with patient cohort at Nairobi research clinic.

Today, UM research in Kenya includes two major inter-related Rady Faculty of Health Sciences programs led by Keith Fowke, Department Head of Medical Microbiology and Infectious Diseases and James Blanchard, Executive Director of the Institute for Global Public Health. Responding to a need for public health advocacy from UM research partners in Kenya, Global Public Health programs expanded to Kenya in 2008 as an extension of successful projects originally started in India.

“Our programs in Kenya are a unique example of how laboratory-based researchers interested in molecules and cells are collaborating with researchers studying issues of stigmatization and together they make meaningful impacts for marginalized people,” said Keith Fowke.

As researchers began working with marginalized patient cohorts, increased need for community-based supports emerged, informing new programs developed by UM researchers Dr. Souradet Shaw Canada Research Chair (CRC) in Program Sciences & Global Public Health, Dr. Marissa Becker, Dr. Lisa Lazarus, Dr. Lisa Avery, Dr. Joshua Kimani, Dr. Larry Gelmon, Dr. Lyle McKinnon, Dr. Julie Lajoie, Dr. Leigh McClarty, Dr. Jason Kindrachuk CRC in Molecular Pathogenesis of Emerging and Re-Emerging Viruses and Dr. Rob Lorway, CRC in Global Intervention Politics and Social Transformation,. 

“When I first came to Kenya in 2009 there was a group of young men who were starting to attend clinics established for female sex workers, many of whom identified as gay and bisexual, which is criminalized in Kenya,” said Rob Lorway. “Some were young students, and some were older or married, but what was important is that they had a high HIV prevalence. They came to us because we provided safe spaces from Kenya’s public healthcare system that can be, at times, quite judgmental.”

A legacy of evidence-based support & patient directed research

Four decades ago in the early 1980s, after eradicating an outbreak of the sexually transmitted infection Chancroid in Manitoba, Dr. Allan Ronald was recruited to lead a similar program with the Department of Medical Microbiology at the University of Nairobi, Kenya. Dr. Francis Plummer, then an infectious disease fellow on Ronald’s team studying with a group of sex-workers, would gain global renown for the discovery of a link between the spread of sexually transmitted diseases and the emerging HIV/AIDS epidemic.

Among the patient cohort exposed to HIV/AIDS, Plummer and his team identified a group of women with a natural immunity to HIV-1, the virus that leads to AIDS. Over the following 17 years UM researchers, including Fowke, studied the immune system of these women leading to new approaches to HIV prevention. The women participating in the study had contributed to saving and improving the lives of tens of millions of people living with HIV around the world but continued to live a criminalized lifestyle at the fringes of society.

Dr Elizabeth Ngugi, a local public health nurse working with Plummer in managing the patient cohort in the 1980s and ‘90s, recognized the adversity these women and others like them endured each day. Through advocacy, a new patient-directed research model was developed to foreground the needs and voices of patients as fully recognized research partners, rather than research subjects.

Keith Fowke, who was a graduate student at UM labs in Kenya at that time, recalls of Dr. Ngugi, “she was a very direct and clear-thinking woman. Beginning in 1984, Dr. Ngugi developed a peer educator model to train sex workers and support them as informed and educated leaders within the community. Dr. Ngugi’s influence has been global and has resulted in a deep 40-year relationship with this community which has now evolved into the Sex Worker Outreach Program (SWOP) which has been adopted as a best-practice model by the World Health Organization, UN AIDS and countless others.”

Dr. Julie Lajoie (second from left), Dr. Mario Pinto, Joyce Adhiambo (pictured in SWOP t-shirt) and Dr. Keith Fowke pictured here.

Now in 2024, UM infectious disease research in Nairobi encompasses 10 SWOP clinics providing HIV prevention and care services to more than 30,000 female sex workers, about 9000 men who have sex with men and close to 1500 transgender individuals. Supported by Joshua Kimani and Larry Gelman who follows in the legacy left by Dr. Ngugi, some patient partners are now respected community organizers like Joyce Odhiambo with SWOP Ambassadors, who presented to EU Parliament in Brussels in 2018.

Current clinical programs funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) deliver HIV care and prevention services. However, due to the criminal status of sex work and homosexuality in Kenya, the mere presence of HIV medications or even condoms could provoke harassment or police response.

Members of the patient cohort meet at a Nairobi health clinic.

“In Kenya 4% of the general population is infected with HIV, and in sex workers it’s about 28%,” said Fowke. “Despite these high risks, many women in our cohort choose not to take anti-HIV drugs to prevent infection because of the stigma resulting from their association with being used to treat HIV infection. We are working on providing new approaches to HIV prevention that would be acceptable to these women, including the anti-inflammatory drug, aspirin, which may prevent the immune cell HIV infects from entering the vaginal mucosal environment thereby preventing infection.”

Community empowerment through global public health research

Members of the male patient cohort meet with Dr. Keith Fowke and Dr. Mario Pinto.

“We’re talking about marginalized and stigmatized people, whose lives and livelihoods are criminalized,” said Lorway. “Within the first year of our program 12% of men who have sex with men who originally tested negative for HIV were testing positive. So, despite clinicians doing everything they could at the time – providing risk reduction counseling, supplying condoms and lubricant – HIV infection was growing among these men in our cohort.”

Tourism in Kenya has influenced hotspots where gay and bisexual men can congregate and celebrate themselves. By mapping these hotspots, the Global Public Health team have provided local clinicians and community organizations the ability to establish program catchments and generate their own accurate community health data to inform program coverage targets that guide the funding priorities of donors and the Government of Kenya. Furthermore, by providing training to community leaders so that they can cultivate their own research agenda, now community leaders are coming to Lorway and the team for support with their own investigations.

These expanding partnerships have paved the way for organizations like SWOP Ambassadors, who provides legal aid training and support to sex workers and engages with police to ensure that the right to access healthcare services is respected. The internationally-funded community based organization, HOYMAS (Health Options for Young Men on HIV, AIDS, and Sexually transmitted infections) has now established a clinic in Nairobi which guarantees non-discriminatory care and runs anti-stigma campaigns focused on sexual health and human rights advocacy.

“The shifting scope of Global Public Health research in Kenya is a strong sign of transformational success,” said Mario Pinto, Vice-President (Research and International). “The work of these dedicated researchers and clinicians to advance health as a human right has empowered these underserved communities, not just in self-advocacy, but as entrepreneurs and leaders in their field on the international stage. We know that when people of sexual minorities live free of harassment and stigmatization, they are more likely to access life-saving medical care and be their authentic selves.”

CFI-Funded laboratory provides much-needed sex worker outreach programs

Dr. Keith Fowke and Dr. Mario Pinto pictured with Dr. Julius Oyugi, Director of the University of Nairobi Institute for Tropical and Infectious Diseases

In Kenya, UM has partnered with the University of Nairobi to build a Canada Foundation for Innovation funded lab on their campus and has now developed 10 different SWOP clinics across the city as part of ongoing sex worker outreach programs. “When we first started this program, there wasn’t much medical research infrastructure in Kenya, now I’m supervising Kenyan PhD students doing cutting edge research projects without having to leave their country and we are able to hire all staff locally through with grants available to African institutions,” said Keith Fowke.

Decades of results in overcoming epidemics and securing international funding from partners including Bill & Melinda Gates Foundation and the Global Fund to Fight AIDS has helped to foster good relationships with government. health officials have signaled a willingness to collaborate on efforts to prevent an emerging epidemic of anal cancer among men who have sex with other men resulting from the sexually transmitted infection HPV.

“We have begun addressing an epidemic of cervical cancer resulting from HPV among female sex workers, but a different approach is needed to provide care for men who have sex with men,” said Lorway. “Hate speech almost constantly enters the political theatre during times of economic disruption like the COVID-19 pandemic, so it’s often about quiet negotiations with health official — which can be frustrating because of the urgent need for care. Working with our local partners we’ve established new provisions for anal health care for men who have sex with men. Although working in such a prohibitive political climate can be challenging, these partnerships provide the room we need to discretely develop programs without provoking a negative public reaction.”

Research impacts at home in Manitoba

Joyce Adhiambo (left) and Victoria Were (right)

“There is a presumption that access to care and sex worker support programs are less advanced in the global south. However, in Canada, by criminalizing the clients, we push sex works even further underground,” said Lorway. “Criminalizing sex work makes it extremely difficult to deliver health services. In this case we have something to learn from our work in Kenya about how to provide services to those who are hardest to reach.”

Leading the way in sex work advocacy in Manitoba is the Sex Workers of Winnipeg Action Coalition (SWWAC)  who are partnering with UM infectious disease expert Julie Lajoie, to facilitate an ongoing information exchange between the sex worker communities in Nairobi and Winnipeg. Two community leaders came to Winnipeg in 2022 to discuss their role as grant co-applicants and to share strategies on getting organized in the face of criminalization and public stigma.

“In Canada, we have a parallel issue of Missing and Murdered Indigenous Women, and tragically, there are commonalities in the experiences of marginalized people on both sides of the ocean,” said Keith Fowke. “In Manitoba we’re at least a decade behind African programs in HIV prevention approaches. There are more new cases of HIV in Manitoba this year than in epidemic of the 1980s and ‘90s, and it’s mainly among women in indigenous communities.  We need to adapt global best-practices to prevent infections in Manitoba.”

The Winnipeg-based community resource center Sunshine House is leading the way in Manitoba by offering HIV and sexually transmitted disease testing services and have held a Science + Supper, often featuring presentations from UM Faculty members.

“Programs like those offered at Sunshine House, SWWAC and SWOP Ambassadors are foundational,” said Lorway. “Something we as researchers can always work toward is the de-monopolization of science, to put the power to make change into the hands of those who most urgently need it.”

The funding for 10 UM research projects was awarded through the CIHR’s Project Grant Program, which is designed to support ideas with the greatest potential to advance health research, health-related fundamental or applied knowledge, health systems, health care or health outcomes.   

“Congratulations to the individuals from the Rady Faculty that secured funding for their important research,” said Dr. Mario Pinto, UM vice-president (research and international). “I’m thrilled to see that three of the teams were ranked No. 1 by their respective peer review committees. This demonstrates the leading-edge health research being conducted at UM.”

Dr. Peter Nickerson, dean of the Rady Faculty of Health Sciences, said the projects also reflect the diversity of health research taking place at UM.

“The studies are led by scientists from many different fields – from community health sciences to oral biology to pharmacology and therapeutics. This funding will help our researchers carry out their projects which will inevitably have an impact on the health of Manitobans, Canadians and people around the world,” Nickerson said.  

One of the UM grant recipients is Dr. Soheila Karimi, professor of physiology and pathophysiology, Max Rady College of Medicine, and founding director of the Manitoba Multiple Sclerosis Research Centre. She and her team received $1,143,675 over five years to study what could one day be a new treatment for progressive multiple sclerosis (MS).

“MS happens when the body’s immune system attacks and damages myelin, a protective layer around nerve fibers of the brain and spinal cord. My research group has identified that Neuregulin-1, which is an important protein for proper function of the brain and spinal cord, is depleted in MS lesions. We have strong evidence that Neuregulin-1 holds promise as a potential treatment to promote myelin repair in progressive MS when repair fails, resulting in increased neurological impairments,” said Karimi, who is also a researcher with the Children’s Hospital Research Institute of Manitoba (CHRIM).

Karimi’s project will evaluate Neuregulin-1 as a future treatment to prevent the progression of MS and support tissue repair. A new treatment is much needed, Karimi said, because Canada is home to the world’s highest prevalence of MS and current medications are minimally effective for the progressive phase of the disease.

“We are really hoping that this research will set the groundwork for conclusive findings which would justify going to clinical trials, especially for progressive MS, because there is a critical treatment gap,” Karimi said.

Learn about the other UM projects funded through the latest round of CIHR’s Project Grant Program. More information about the research teams and the work they’ll be doing is available here.

Dr. Tracie Afifi, professor of community health sciences, Max Rady College of Medicine; Canada Research Chair in childhood adversity and resilience; researcher, CHRIM

Grant: $100,000 (one year)

Afifi will focus on updating and expanding her 10-year-old study related to child maltreatment across Canada. The team will update national and provincial prevalence of child abuse statistics and aim to understand the experiences of child abuse among those with different gender and sexual identities and how this impacts mental health and substance use outcome across age groups.

Dr. Heather Armstrong, assistant professor of internal medicine, Max Rady College of Medicine; Canada Research Chair in integrative bioscience; researcher, CHRIM

Grant: $814,725 (five years)

Armstrong’s team will study the reasons why some dietary fibres are not well tolerated in patients with inflammatory bowel diseases (IBD). She hopes these findings support development of personalized dietary fibre guidelines for IBD patients, based on the individual’s gut and microbiome health to ensure only safe fibres are consumed, therefore promoting improved microbe and gut health.

Dr. Prashen Chelikani, professor of oral biology, Dr. Gerald Niznick College of Dentistry

Grant: $1,319,625 (five years)

Chelikani and the team will work to understand why some dental fungi are associated with tooth decay in preschool children and the local environmental factors that might influence them. This research on the dental mycobiome associated with severe tooth decay will assist with the development of new tooth decay prevention strategies for young Indigenous children.   

Dr. Keith Fowke, department head and professor of medical microbiology and infectious diseases, Max Rady College of Medicine

Grant: $956,250 (five years)

Fowke will partner with organizations and community members in Nairobi, Kenya, to better understand the immune system among women who clear human papilloma virus (HPV) infection. The project aims to identify the immune cells that are important in the natural clearance of HPV with the goal of identifying these HPV clearance associated immune factors that are important for a therapeutic HPV vaccine to mimic.

Dr. Nathan Nickel, associate professor of community health sciences, Max Rady College of Medicine; director and senior research scientist, Manitoba Centre for Health Policy; researcher, CHRIM

Grant: $577,574 (three years)

In partnership with the Manitoba Métis Federation, Nickel and his team’s study will shed light on whether a Manitoba Health campaign that promoted the importance of childhood vaccinations improved childhood vaccination among Métis families. The study’s findings will support the development of strategies aimed at keeping childhood vaccination rates high in Manitoba as well as nation-specific strategies for Red River Métis citizens.

Dr. Christopher Pascoe, assistant professor of physiology and pathophysiology, Max Rady College of Medicine; researcher, CHRIM

Grant: $784,125 (five years)

Pascoe seeks to better understand why exposure to diabetes during pregnancy makes airways twitchier in asthma. The team will learn whether reducing blood glucose levels during pregnancy is an effective way to prevent changes from occurring and this information may allow them the ability to stop asthma in children exposed to diabetes from developing before it’s a problem that requires treatment.

Dr. Joel Pearson, assistant professor of pharmacology and therapeutics, Max Rady College of Medicine; researcher, Paul Albrechtsen Research Institute, CancerCare Manitoba

Grant: $983,025 (five years)

Pearson will lead a study aimed at understanding the underlying causes of small cell lung cancer (SCLC) and how non-small cell lung cancer can change to SCLC. This research will help them identify new and improved treatments for SCLC so patients living with this cancer will have longer lives and better outcomes.

Dr. Souradet Shaw, assistant professor of community health sciences, Max Rady College of Medicine; Canada Research Chair in program science and global public health

Grant: $883,576 (four years)

Shaw’s study seeks to develop a deeper understanding of trends, determinants and responses to sexually transmitted and bloodborne infections (STBBI) in Manitoba over a 30-year period. Collaborations between community, public health and academics will be at the forefront of this project, with the goal of co-learning and co-designing interventions to ensure no one is left behind while addressing current and future STBBI outbreaks.

Dr. Roberta Woodgate, distinguished professor of nursing, College of Nursing; Canada Research Chair in child and family engagement in health research and healthcare; researcher, CHRIM

Grant: $768,824 (four years)

Woodgate will lead a study to gather evidence to inform the co-design of policies and research priorities meant to enhance the health and well-being of young people who care for family members or other loved ones. Young carers will co-design the policy recommendations and research priorities by gathering evidence grounded in their experiences and providing them with a leadership role in the process.

“Our researchers have demonstrated excellence by securing federal support for a diverse range of innovative health studies,” said UM Vice-President (Research and International) Dr. Mario Pinto.

“Many of our UM experts will be collaborating with community members to help our research have impact and provide solutions for society.”

Dr. Peter Nickerson, dean of the Rady Faculty of Health Sciences, also noted the involvement of community partners in many of the funded projects. “This is important because community members have valuable expertise to contribute,” he said.

Dr. Jonathan McGavock, professor of pediatrics and child health at the Max Rady College of Medicine in the Rady Faculty of Health Sciences, was a double recipient, landing two of the 10 grants to UM in the Spring 2023 round of funding.

McGavock, who is also a researcher with the Children’s Hospital Research Institute of Manitoba (CHRIM), has a key research interest in youth diabetes, with a particular focus on encouraging physical activity. The professor, who holds a PhD in exercise science, published a study last year demonstrating the cardiovascular health benefits associated with living near a multi-use activity trail.

He and his team have now received a grant of $1,453,500 to lead a five-year study of how Canadian cities can best implement urban trails that are fair for all citizens and generate the greatest possible cardiovascular health benefits. Seven cities, including Winnipeg, Brandon and Selkirk, are partners in the study.

“Our team will be working closely with city planners, and with organizations in all seven cities that support the use of trails, to create an optimal ‘recipe’ for trail creation that can inform the next wave of urban trails in Canadian cities,” McGavock said.  

The second grant to McGavock’s team is for $734,400 over four years. It will fund a randomized trial of a program for adolescents living with obesity. The program will support teens’ social, emotional and psychological needs as well as lifestyle changes, such as better sleep, daily activity and healthier eating.

“Very few treatments aimed at supporting a healthy lifestyle for adolescents with obesity incorporate skills to help regulate emotions and support positive mental health and quality of life,” McGavock said. 

“We want to determine if it’s feasible to deliver a treatment for teens living with obesity that includes emotional skills training.”

Here’s a look at the other CIHR-funded UM projects. More information on the studies and research teams is available here.

Dr. Jeremy Chopek, assistant professor, physiology and pathophysiology, Max Rady College of Medicine

Grant: $975,376 (five years)

Chopek’s study seeks to better understand how electrical spinal stimulation can not only improve motor function in people with spinal cord injury, but also improve the body’s autonomic functions, such as regulating heart rate and blood pressure. The long-term goal is to increase exercise capacity, reduce obesity and improve overall health in people living with spinal cord injury.

Dr. Sanjiv Dhingra, professor, physiology and pathophysiology, Max Rady College of Medicine; principal investigator, Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre

Grant: $1,027,780 (five years)

Dhingra will focus on mesenchymal stem cells (a type of multipotent cells that can differentiate into a variety of cell types) derived from bone marrow. Aiming to understand why, in treating heart disease, transplanted stem cells are rejected by the recipient, Dhingra’s team will experiment with modifying the cells to improve their survival in the heart.

Dr. Keith Fowke, professor, medical microbiology and infectious diseases, Max Rady College of Medicine

Grant: $100,000 (one year)

Partnering with community members in Nairobi, Kenya, Fowke’s team will study immune cells from Kenyan women who naturally clear the human papilloma virus (HPV) in the presence or absence of HIV co-infection. Because HPV causes cervical cancer, understanding how the immune system clears it naturally is an important step toward developing a vaccine to clear HPV infection.

Dr. Lauren Kelly, associate professor, pharmacology and therapeutics, Max Rady College of Medicine; researcher, CHRIM

Grant: $749,700 (three years)

Kelly will lead a randomized clinical trial of cannabidiol (CBD) alone versus CBD in combination with tetrahydrocannabinol (THC) as a treatment to reduce seizures in children and adults with drug-resistant epilepsy. Patient-centred organizations have partnered with researchers in guiding the trial, which will involve 90 participants across eight sites.

Dr. Lorrie Kirshenbaum, professor, physiology and pathophysiology, Max Rady College of Medicine; Canada Research Chair in molecular cardiology; director, Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre

Grant: $757,350 (five years)

Doxorubicin is an effective chemotherapy drug with the side effect of inducing heart failure in some cancer survivors. Kirshenbaum’s study will examine the apparent link between cancer patients’ disrupted body clocks, autophagy (the body’s process of “recycling” damaged cell parts to maintain cell quality), and the harmful effects of doxorubicin on the heart.

Dr. Deepak Louis, assistant professor, pediatrics and child health, Max Rady College of Medicine; researcher, CHRIM

Grant: $481,951 (four years, three months)

Louis will lead a three-province study of how the birth of a preterm baby affects siblings in the family. Parents of a preterm infant often experience stress, isolation, financial difficulties and mental health effects. Louis’s team will be the first to examine siblings’ risk for developing behavioural, socio-emotional, mental and physical health problems in childhood and adolescence.

Dr. Kristin Reynolds, associate professor, psychology, Faculty of Arts

Grant: $351,901 (four years)

Reynolds’ team will partner with community organizations in Manitoba, Saskatchewan, Ontario and British Columbia to implement and evaluate the CONNECT Program, a group telehealth mental health program for older adults. Working with the organizations, the researchers will assess the program’s effects on participants’ loneliness, social connection and mental health.

Dr. Roberta Woodgate, distinguished professor, College of Nursing; Canada Research Chair in child and family engagement in health research and healthcare; researcher, CHRIM

Grant: $100,000 (one year)

Woodgate’s mixed-methods study will focus on vaccine uptake within families. Her team aims to understand Manitoba childrearing families’ perspectives and decisions about vaccinating their family members against COVID-19 and influenza, with the goal of providing recommendations to promote vaccine uptake.

Induction into the CAHS as a Fellow is considered one of the highest honours within Canada’s academic community. CAHS Fellows, who serve as unpaid volunteers, are nominated by their institutions and peers and selected in a competitive process based on their internationally recognized leadership, academic performance, scientific creativity and willingness to serve.

“These are two outstanding clinician-scientists who run innovative research programs that have made indelible impacts on the lives of so many around the world, and they have given so much of themselves to their research programs and training of the next generation,” says Dr. Digvir Jayas, vice-president (research and international) and Distinguished Professor at UM. “The University of Manitoba is very proud of them and congratulates them on this most deserved recognition.”

UM now has 31 Fellows in the CAHS.

About the inductees:

Keith Fowke

Dr. Keith Fowke

Professor and Head in the Department of Medical Microbiology and Infectious Diseases at the University of Manitoba.

His research focuses on biomedical HIV prevention and is based on cohort studies in Kenya. Dr. Fowke’s studies of individuals who are intensely exposed to HIV, yet remain uninfected, have been paradigm shifting and have led him to develop the “Immune Quiescence (IQ) hypothesis”. Today, Dr. Fowke’s team is currently testing a novel HIV prevention strategy using the safe, affordable and globally available anti-inflammatory drug, aspirin.

He demonstrates national leadership by chairing CIHR’s HIV advisory committee and as President of the Canadian Association for HIV Research, and he is also a founding member of the Prairie Infectious Immunology Network who has twice he appeared before the Parliamentary Standing Committee on Health. Internationally, he helped established the HIV-Exposed Seronegative field and his important research is recognized for its innovation.

Dr. Fowke has published 120 peer reviewed papers that have been cited 6786 times, with the top publication being cited 568times, and 19 publications having >100 citations each.

Ruth Ann Marrie, an Associate Professor of Medicine & Community Health Sciences in the U of M’s College of Medicine, is the Principal Investigator leading the multidisciplinary research team.

Dr. Ruth Ann Marrie

Professor of Medicine and Community Health Sciences at the University of Manitoba, and Director of the Multiple Sclerosis (MS) Clinic at Health Sciences Centre Winnipeg, and holds The Waugh Family Chair in Multiple Sclerosis.

Dr. Marrie is known internationally for her innovative work regarding the effect of comorbidity on people with multiple sclerosis (MS), a largely unexplored area in the field of MS before she began her work. In 2010, she published the first report suggesting that vascular comorbidities such as diabetes and hypertension adversely affect disability progression in MS. Subsequently, she showed that comorbidity adversely affects relapse rates, treatment, mortality, and quality of life in people with MS. These findings have influenced research, clinical care and treatment guidelines and international quality standards for care.

She serves as Chair of the Medical Advisory Committee for the MS Society of Canada, and the International Advisory Committee on Clinical Trials in MS. She is the Vice Chair-Elect of the Scientific Steering Committee for the International Progressive MS Alliance. She received the Canadian Society for Clinical Investigation’s Distinguished Scientist Award in 2018.

She has a sustained record of research excellence as exemplified by her ability to obtain research funding from local, national and international organizations. She has authored or co-authored more than 325 peer-reviewed scholarly publications and 30 editorials and has given lectures throughout North America and Europe.

The students have formed local and international collaborations and worked on COVID-related research, outreach and knowledge translation.

“It’s been exceptional,” said Dr. Keith Fowke, professor and head of medical microbiology and infectious diseases. “The students have really stepped up. They’ve said ‘OK, here’s a global pandemic and I’m a microbiology-infectious disease student – how can I help?’”

Many of the students have been in the lab working on COVID-related projects.

Research projects include one study that tested suitable swabs for COVID-19 to determine if alternatives are available if there’s a shortage. Another study focused on developing a sequencing infrastructure that would enable a national genomic surveillance system for SARS-CoV-2.

“The graduate students saw the need and filled the need for COVID-related projects,” Fowke said. “Graduate students drive research at the University of Manitoba, there’s no question about that. They’re the main mechanism, the main energy and the main sets of hands behind most of the research that occurs at the university.”

Graduate students are also working on COVID-related projects outside of the lab.

Students in the International Infectious Disease and Global Health Training Program, which Fowke directs, were invited to help write articles for a COVID-19 special issue journal. They collaborated on the project with Ramaiah University in Bangalore, India.

Medical students and graduate students collaborated to create the Manitoba COVID-19 Weekly Report. They produced eight newsletters, which addressed clinical questions based on current evidence, and reached about 9,000 health professionals around the world.

Several students have used social media, news outlets and public talks to educate their peers, high school students and communities about COVID-19.

“I really think it brings into focus how important being a researcher in this field is,” said Jasmine Frost, a PhD student. “You have a responsibility to help people understand what’s happening and to help promote accurate information and debunk some of the myths that were circulating, especially at the beginning of the pandemic.”

Students also volunteered to screen people for COVID-19 symptoms at the entrances to the Health Sciences Centre.

“From the students to the professors, we’re all trying to use our knowledge of infectious disease and our research to empower communities around the world,” said Toby Le, a PhD student. “I think the reason why we’re doing COVID projects, and why we’re so driven, is there’s a natural affinity in our department to take what we know about infectious disease and try to use it to empower people that are facing it.”

Visit the department of medical microbiology and infectious diseases’ website for more details about the students’ COVID-related research and for a list of the students involved in the community projects.

In January, the milestone was celebrated at an international research conference in Nairobi, Kenya.

The partnership between the two institutions has been recognized as a best-practice example of North-South research collaboration. It is regarded as a model global health initiative and has received millions of dollars in funding from the Canadian Institutes of Health Research and the Bill and Melinda Gates Foundation.

The partners’ landmark discoveries include that HIV can be transmitted from mother to child through breastfeeding; that STIs such as gonorrhea and chlamydia increase susceptibility to HIV infection; and that some individuals have natural immunity to HIV.

“The collaboration has made a huge impact,” said Keith Fowke [B.Sc.(Hons.)/88, PhD/95], head of medical microbiology and infectious diseases in the Max Rady College of Medicine.

“U of M has been a global leader in making cutting-edge contributions to understanding HIV and other sexually transmitted infections, thanks to this partnership.”

At the conference, Dr. Ruth Nduati, professor of pediatrics at the University of Nairobi, spoke of the opportunities that the partnership has given to Kenyan scientists.

“This collaboration has been a gift to the young people of Kenya,” she said. “It has given them the possibility to dream that their work can be part of transforming the world.”

The collaboration began in 1980, after two doctors from opposite sides of the world met at a conference. Dr. Herbert Nzanze, head of medical microbiology at the University of Nairobi, convinced Allan Ronald [MD/61, B.Sc.(Med)/61, DSc./11], a UM research pioneer in infectious diseases, to come to Kenya to help combat sexually transmitted chancroid infections in men.

A small lab was opened in Nairobi, and Manitobans started travelling back and forth to operate it. Ronald brought in one of his star students, Frank Plummer [MD/76], and engineered links with infectious disease specialists at other institutions, including the University of Ghent in Belgium and the University of Washington in Seattle.

Seeking to track down the source of the chancroid infections, the group opened a clinic in the shantytown of Majengo to assess female sex workers. They soon brought chancroid under control. But in 1985, they were shocked to discover that a high percentage of the sex workers had HIV/AIDS. They changed their focus to the growing epidemic.

More students came to join them, not just from Manitoba but from Belgium and Seattle. Kenyan medical students started going to Winnipeg and Seattle to further their training.

In the late 1980s, Plummer led a team – including Fowke, then a graduate student – in discovering that some Kenyan women sex workers who had been exposed to HIV infection were naturally immune to it. This breakthrough provided vital new information for HIV vaccine and drug development.

In 2007, a team led by UM professor Dr. Stephen Moses demonstrated that circumcision reduces men’s risk of HIV infection by as much as 60 per cent. This insight led to expanded circumcision programs throughout eastern and southern Africa.

The Manitoba-Nairobi partnership also developed HIV prevention and control strategies that included opening free clinics‚ educating sex workers and distributing condoms. Many of the strategies have successfully been implemented by other countries.

Today, the University of Nairobi STD/HIV/SRH Collaborative Research Group includes several other universities in addition to Manitoba, Ghent and Washington, including the University of Toronto, McMaster University and the University of California.

To mark the 40th anniversary, attendees at the conference included then UM President and Vice-Chancellor Dr. David Barnard and University of Nairobi Vice-Chancellor Dr. Stephen Kiama.

Reflecting on 40 years, co-founder Ronald, now distinguished professor emeritus in medical microbiology and infectious diseases, emphasized the links between science, public policy and clinical practice, and the priority of getting research results implemented so they can save lives.

“Global health needs to be further defined as a shared responsibility between scientific and academic leaders, governments and implementation processes that are demonstrated to the public, and to funders, as able to reduce disease burden,” he said.

Kenyan professionals have been vital to the collaboration’s research and clinical success. A number of Kenyan students who went abroad to study at universities affiliated with the collaboration eventually assumed health-system and research leadership roles in their home country.

Omu Anzala [PhD/97], currently director of the Kenyan AIDS Vaccine Initiative, earned his PhD at UM. Dr. Joshua Kimani, who became chief clinician for the collaboration, recalled a visit to Winnipeg that influenced his career path.

Back in 1987, Kimani was a third-year medical student when a Canadian – Dr. Frank Plummer – came to lecture his class on sexually transmitted diseases. “HIV had just come,” Kimani remembered. “People didn’t really understand it.”

Kimani and another student were so intrigued by Plummer’s talk that they volunteered at the Majengo clinic. That experience influenced them to specialize in infectious diseases. In 1989, they received funding from UM to spend three months in Winnipeg.

They did rounds at local hospitals and were awestruck to meet senior figures like Ronald, Dr. Robert Brunham and Dr. Joanne Embree, who were well-known members of the collaboration with their names on numerous research papers.

“By the time we came back home,” Kimani said, “we had seen a different world and been opened up to the opportunities in public health.”

Fowke, who has made more than 40 trips to Kenya in his career, said it was moving and inspiring to mark the 40th anniversary in Nairobi with an international network of colleagues and friends.

“With five generations of UM and UN researchers represented at the meeting, I felt tremendous pride in the vision of the founders, immense hope for the future – seeing the excellence of our students – and honoured to be part of this collaboration,” he said.

“UM researchers and students have improved the health of Kenyans and people around the world, and we should all take a moment to celebrate that accomplishment.” 

LARRY KROTZ and RADYUM STAFF

Remembering Dr. Frank Plummer

The celebration of the 40-year University of Manitoba-University of Nairobi partnership gave way to sorrow on Feb. 4, 2020 with the sudden passing in Nairobi of esteemed scientist Frank Plummer [MD/76], a leading figure in the collaboration.

The day before his passing in Nairobi, Dr. Frank Plummer was reunited with Hawa, a research participant who was found to have natural immunity to HIV nearly 30 years ago.

The world-renowned infectious disease expert was 67 years old. Just days before suffering a fatal heart attack, he had spoken at the 40th-anniversary conference and enjoyed reuniting with many of the Kenyan women whose natural immunity to HIV his team had discovered in the late 1980s.

“Frank Plummer’s contributions to public health on a global scale were immense. Today we lost a giant,” said Brian Postl [MD/76], dean of the Rady Faculty of Health Sciences and a medical school classmate of Plummer. “Frank distinguished himself as a true leader and visionary.”

The Winnipeg-born Plummer, who joined the UM faculty in 1984, spent 17 years in Nairobi leading the collaboration. His work not only produced vital knowledge about the HIV epidemic in Africa, but led to prevention and control strategies that influenced worldwide health policy on sexually transmitted infections, saving tens of thousands of lives.

In Canada, Plummer’s leadership roles included serving as scientific director general of the National Microbiology Laboratory in Winnipeg and director general of the Centre for Infectious Disease Prevention and Control in Ottawa.

He led the Canadian laboratory response to the SARS outbreak in 2003 and the H1N1 influenza outbreak in 2009. At the time of his passing, he was distinguished professor emeritus of medical microbiology and infectious diseases at UM and was working to develop an HIV vaccine.

“The work of Dr. Frank Plummer has had a tremendous impact on global public health, and he was a prime example of dedication and passion in one’s profession,” said Dr. David Barnard.

Plummer’s many prestigious honours included the Order of Canada, the McLaughlin Medal of the Royal Society of Canada, the Prix Galien Research Award, the Canada Gairdner Wightman Award and the Flavelle Medal of the Royal Society of Canada.

“He was an outstanding, world-class researcher who was a dear colleague, mentor and friend to many of us lucky enough to work with him, and beside him,” said Keith Fowke [B.Sc.(Hons.)/88, PhD/95], head of medical microbiology and infectious diseases. “He will be dearly missed by all of us in the academic and scientific community.”

Dr. Christine Zhang, manager of the Flow Cytometry Core Facility at the Rady Faculty of Health Sciences, was one of six scientists and administrators recently recognized by the Canadian Network of Scientific Platforms (CNSP).

Flow cytometry is a laser-based tool for rapid detection and characterization of cells and other microbial particles based on their light scatter and fluoresence properties, routinely used in basic research for disease immunity profiling and clinical diagnosis of conditions like blood leukemia. Zhang’s facility has five state-of-the-art flow cytometry machines available for researchers. It is the only facility of its kind in Manitoba.

“This means quite a lot because it’s an acknowledgement of the work I do as well as the guidance and support of my two directors, Dr. Keith Fowke and Dr. Aaron Marshall and the Max Rady College of Medicine,” Zhang said. “This award lets people across Canada know that we have very strong research and a good supporting team.”

Zhang joined the University of Manitoba in 2012 after completing her Ph.D. in the University of Toronto, and was heavily involved in the initial establishment of facility. In that time the facility grew from offering support to the departments of immunology and the medical microbiology and infectious diseases to a wide range of clients, including the St. Boniface Hospital Albrechsten Research Centre and CancerCare Manitoba.

In 2013, Zhang established the first symposium dedicated to flow cytometry in Manitoba. The event attracts a wide range of disciplines in biomedical research, clinical laboratories, biotechnological companies and government laboratories.

“We had three successful symposiums that attracted over 100 people. We also brought in people from across Canada and the United States to show researchers in Manitoba the latest techniques,” she said, noting the next edition of the symposium may need to be held virtually due to the COVID-19 pandemic.

Dr. Jude Uzonna, associate dean of research, Max Rady College of Medicine, said Zhang’s expertise is an important part of the facility’s success.

“Even if you don’t have the training, she will walk you through and help you analyze your results,” he said. “This award shows that not only do we have an outstanding core platform, but we have someone who is very capable of managing it. You can have all the technologies you want, but you need the right individual to be able to deliver the services. If not, it would be like someone who has an iPhone 11 but can only use it to make phone calls.”

As an international hub for infectious disease research, MMID has been involved in many international breakthroughs. More recently, in the case of the Ebola outbreak in West Africa, it was researchers from the NML and MMID who developed the vaccine to treat the virus. However, the genesis of how MMID got onto the international stage for infectious disease research is often unrecognized.

MMID’s response to the outbreak of a sexually transmitted infection known as chancroid (caused by Haemophilus ducreyi) was the prominent impetus that forged international ties to the University of Nairobi (UoN) in Kenya. Amid Winnipeg’s local chancroid outbreak in the 70s, the
active department head, Dr. Allan Ronald, and his colleague, Dr. Gregory Hammond, sought to identify the causative agent by developing conducive growth media and subsequently assessed antibiotic susceptibility. Their efforts were rewarded in the capacity to treat and eradicate this local outbreak, ultimately becoming experts in the management of chancroid.

In 1979, while attending a meeting of the United Nations, Dr. Ronald learned of a large chancroid outbreak in Kenya. He met the then Head of the Department of Medical Microbiology at the University of Nairobi, Dr. Herbert Nsanze, who invited him to assist with the chancroid outbreak in Kenya. In 1980, they worked at a Nairobi City clinic called the ‘Casino clinic’ in downtown Nairobi to study chancroid which mainly catered to male clients. This was the first international collaboration for MMID and one that is still ongoing.

In 1984, Frank Plummer, a medical fellow of Dr. Ronald’s, joined the clinic to study gonorrhea caused by Neisseria gonorrhoeae. For his research project Frank started a cohort of female sex workers from Pumwani District in Nairobi. Working alongside (the late Prof) Elizabeth Ngugi, a nurse with the project, they used a community engagement (peer engagement) model in which the sex workers themselves came up with ways of communicating STI prevention approaches. This led to the birth of the Majengo clinic where the MMID team is still providing health care for the sex workers. Initial research at this clinic focused on N. gonorrhoeae and its sensitivity to antibiotics.

Since then, the number of studies that have been carried out by students at the U of M and the UoN, as well as faculty from both institutions, and other research facilities based at the UoN. 

The U of M/UoN collaboration has greatly contributed to Kenya’s fight against HIV; especially among high risk populations as well as undertaking research other areas of infectious diseases.

One of the first demonstrations and publication of heterosexual HIV transmission of HIV in women in Africa was from the Nairobi cohort. Dr. Joanne Embry and Dr. Frank Plummer described mother-to-child transmission of HIV through breast milk, and the team also showed higher risk of HIV infection in men with foreskin. To translate their research into the community, they utilized the peer engagement model; a model where select community members work as peer educators to explain and translate key research on HIV. This model has been adopted by clinics in India.

Dr. Keith Fowke’s laboratory focuses on immune responses in individuals who, though exposed to HIV frequently, appear to be resistant to infection with the virus, known as highly exposed seronegative (HESN). They are currently conducting studies focused on blocking inflammation
as a new approach to HIV prevention.

Dr. Blake Ball’s research focuses on immune responses and susceptibility to HIV and TB; Dr. Lawrence Gelmon’s research interest is in HIV/ AIDS, STIs in relation to epidemiology and health policies; Dr. Kelly MacDonald’s research combines basic science and clinical aspects of HIV vaccines. Drs. Ma Luo and Frank Plummer are also working on an HIV vaccine based on studies from the HESN Nairobi sex workers. Dr. Lyle McKinnon’s research combines epidemiology with basic science studies of transmission among cohorts of men who have sex with men (MSM), female sex workers (FSW), and adolescent girls and young women (AGYW) in several countries including Kenya. Dr. Elijah Songok, is tackling HIV protection by the identification of novel biomarkers in HIV-resistant sex workers of the long standing Pumwani cohort of Nairobi for HIV drug development in the future. His position as head of Graduate Studies at the U of Nairobi, has enabled him to bridge international research capacity between U of Nairobi and U of M trainees with the Kenya Medical Research Institute (KEMRI)- the Kenyan equivalent of Canada’s NML. Dr. Jason Kindrachuk, Canada Research Chair in Molecular Pathogenesis of Emerging and Re-emerging Viruses, whose research focus is emerging infectious diseases, also leads science outreach activities in Africa that focus on building capacity and expertise in emerging virus preparedness at the local level.

Five generations of Canadian and Kenyan researchers have now been training through this collaboration. Together, from a modest start, the collaboration between MMID and the U of Nairobi has resulted in several highly significant research findings and improved health to populations globally.

Toby Le, M.Sc student, MMID

Shifa Mohideen, M.Sc student, MMID

Florence Mutual, Ph.D. candidate, MMID

Ruth Mwatelah, Ph.D. candidate, MMID