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Illumination magazine.
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HERBAL INSPECTION: Bill Folk contemplates Sutherlandia at South Africa's Kirstenbosch National Botanical Garden.

As rain clouds engulf the summit of Table Mountain above him, Bill Folk makes a beeline through the lush Kirstenbosch National Botanical Garden towards a small, nondescript shrub marked Sutherlandia frutescens. Its plain green foliage pales in comparison to the garden's exotic proteas and other flowering plants, but the gangly legume boasts a stunning botanical résumé.

"Sutherlandia could make its way into medical history," says Folk, a professor of biochemistry and senior associate dean for research at the University of Missouri-Columbia School of Medicine. Folk has for years been making the 9,000-mile trek between MU and South Africa to lay the groundwork for the research that could make that history.

"The plant already has a remarkable story, and it has now become the focal point of our international collaboration to scientifically study African traditional medicines used for HIV infection and AIDS," he says.

At the botanical garden, a marker boasts that Sutherlandia "is an old remedy for cancer and is now also used as an immune booster for AIDS patients." That simple claim, accepted in many South African communities, poses a complex challenge for Folk and collaborators who are trying to separate fact from legend. Do the dried leaves of Sutherlandia, sipped as an herbal tea or taken as pills, have an impact on people whose immune systems are being compromised by infection with HIV?

That question and related issues took Folk from his laboratory at the University of Missouri-Columbia's medical school on a working visit this summer to South Africa, where the human immunodeficiency virus, HIV, infects an estimated 5.5 million people, more than any other nation.

ORPHANS: A grandmother and children in Hlabisa, KwaZulu-Natal.

Every day nearly 1,000 South Africans die from AIDS-related diseases and a similar number are newly infected. The epidemic, which now affects nearly 20 percent of the adult population, shows few signs of slowing down, despite a recent ramp-up in the government's prevention and treatment programs.

As part of this vigorous, if tardy, intervention campaign, practitioners of modern medicine have brought some of their most potent weapons to bear on HIV, spearheaded by antiretroviral, or ARV, drugs. At the same time, many traditional healers -- who are consulted by a startlingly high number of South Africans -- have been dispensing Sutherlandia as a tonic to slow the wasting associated with the disease. Even though the herb is used by thousands, there has been little clinical research on the safety and effectiveness of Sutherlandia, or, for that matter, on other traditional remedies.

That is about to change. The first scientific clinical trial of Sutherlandia is scheduled to start this fall at Edendale Hospital in the province of KwaZulu-Natal, the epicenter of the nation's HIV/AIDS epidemic. "This is a groundbreaking clinical trial," says Folk, who, along with South African researcher Quinton Johnson, leads the International Center for Indigenous Phytotherapy Studies, or TICIPS, which is responsible for supporting the Sutherlandia trial.

Getting to this stage in the research has been surprisingly difficult. In a nation where every approach to dealing with the HIV epidemic seems to be mired in controversy -- South Africa's president at one point questioned the link between HIV and AIDS, and the health minister has stubbornly advocated nutritional remedies for HIV infection -- merely gaining approval for Sutherlandia trials from the government's Medicines Control Council and other regulatory boards took two years.

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Published by the Office of Research.

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