THE DISCOVERY of
protease inhibitors, commonly known as antiretroviral drug
cocktails, in 1995, much has changed for the nearly 850,000
Americans living with HIV/AIDS. A diagnosis no longer brings
the spectre of rapid wasting, debilitation, and death.
complacency can be disastrous when combatting an infectious
disease as cunning and persistent as AIDS. Prevention efforts
remain as important as medical treatments, say Emory researchers
who are joining forces to fight the epidemic on all fronts.
a misperception that inhibitors are a cure: If I pop these
pills, Ill have the disease under control. . . . I wont
have to wear condoms anymore, says Lawrence Bryant
(above), a senior research coordinator for the behavioral science
core of Emorys
Center for AIDS Research (CFAR). The younger generation
hasnt experienced AIDS the way the older generation haslosing
close friends every other day, seeing the disease manifest itself
in its entirety. Theres not the same urgency to be safe
as there was in the 80s.
one of nineteen National Institutes of Health CFAR centers in
the country, Emory has scientists from the fields of public
health, medicine, statistics, virology, pharmacology, and immunology
working to develop potential vaccines, prevention strategies,
public health initiatives, and community-based programs, as
well as providing comprehensive patient care.
August, the Emory/Atlanta CFAR grant for $7.5 million was renewed
for five years, and the University is supporting the center
with an additional $1.8 million. Since being designated a CFAR
in 1998, AIDS research funds to Emory have doubled, now totalling
more than $45 million in grants.
level of commitment and funding must be maintained, says Rollins
School of Public Health Dean James W. Curran, CFARs director
and principal investigator whose expertise in AIDS extends back
twenty years to the first recognized cases at the Centers for
Disease Control and Prevention. Speaking at the Fourteenth International
AIDS conference in Barcelona this summer, which was attended
by more than twenty Emory scientists and clinicians, Curran
called for an HIV revolution.
hope for an effective vaccine to prevent HIV infection and I
hope for curative therapy. I hope both [will be] readily accessible
to the whole world, Curran said. But we must place
a higher priority on HIV prevention. . . . My greatest fear
is that our efforts will merely stay the same as now, and that
the revolution will be won by HIV rather than by us.
the statistics remain staggering, both in lives lost and projections
of future deaths: AIDS has killed twenty-two million peoplea
half-million of those American. It is now the fourth leading
cause of death in the world. An estimated forty million people
worldwide are living with HIV, with an additional eight thousand
new infections a day. More than 800,000 babies worldwide were
born with the AIDS virus last year, and many more are orphaned
or lose a parent to the disease.
researchers at Emorys Vaccine Research Center are working
toward developing an effective HIV/AIDS vaccine. These include
Mark Feinberg, director of the Hope Clinic in Decatur, where
vaccines are given to volunteers; Rafi Ahmed and John D. Altman,
internationally known for work in immunology; and Harriet Robinson,
whose lab has developed a DNA-based AIDS vaccine that, after
showing promise in primates, is moving into human trials.
the School of Public Health has been building a strong core
of behavioral scientists active in prevention. We went
from having a few stars in HIV/AIDS to one of the largest concentrations
in the country just in the last five years, says Kimberly
Sessions, assistant administrative director of CFAR. If
you want to see whats happening in cutting-edge AIDS research,
you look at whats happening at Emory.
prevention researchers Ralph J. DiClemente, Charles Howard Candler
professor of behavioral sciences and health education, and Associate
Professor of Behavioral Science and Health Education Gina Wingood
are trying to find effective ways to reduce HIV-risk behavior
in adolescents, especially African-American females. Our
programs include an emphasis on ethnic pride, self-image, and
self-awareness, as well as sexual health, Wingood says.
Professor of Behavioral Science and Health Education David Holtgrave,
who joined the Rollins team last year from the CDC, has
found through his research that the higher a states social
capitalthe level of trust, reciprocity, and cooperation
among community membersthe lower the rates of sexually
transmitted diseases, including HIV/AIDS. North and South Dakota
were first and second in social capital among the states ranked;
Georgia was third from the bottom, above Mississippi and Nevada.
increased levels of social capital, Holtgrave says, it
seems that risk behaviors go down and access to health services
addition to intensive research, Emory provides direct care to
about six thousand people with HIV. Patients with HIV/AIDS are
seen at five sites in Atlanta by CFAR clinical science faculty:
the Ponce de Leon Center of Grady Health Systems, Grady Memorial
Hospital, the Veterans Affairs Medical Center, Crawford Long
Hospital, and Emory University Hospital.
midtowns Ponce Center, one of the largest and most comprehensive
HIV outpatient treatment facilities in the country, Emory doctors
and clinicians work with psychologists and other social scientists
to ensure that their more than four thousand patients take their
anti-retroviral medications exactly as prescribed.
doses are worse than not taking anything, because they allow
the virus to mutate and become resistant, says Jeffrey
L. Lennox, associate professor of medicine and CFAR director
for clinical research. If we dont address patients
social needs, they wont be able to adhere to the regimens.
1993, the spacious, five-floor center in midtown Atlanta has
housed Grady Health Cares infectious disease clinic; a
full-service pharmacy; dental, eye, and mental health clinics;
nutritionists; child care; pediatrics; and social service agencies
like Project Open Hand, Living Room, Atlanta Legal Aid, and
the Department of Family and Children Services.
Ponce Center also has a research unit, and enlists patient volunteers
for research studies on enhancing treatment and care for HIV/AIDS
patients. Lennox recalls a debilitated man who agreed to a regimen
of experimental medications who is now a muscular brick mason
working full time. At first, there can be some distrust
over research, Lennox says. But once they are involved
and see the benefits, patients often enroll in several studies.M.J.L.