HIV: 15 years of leadership

Leadership has been pivotal in the battle against HIV, noted James W. Curran, dean of the Rollins School of Public Health, in an Oct. 2 lecture titled "HIV in Perspective: The First 15 Years." "Never before with an epidemic has so much leadership evolved from the people with it," said Curran, who cited David Jowers, for whom the lecture was named, as one of those people.

Assigned to investigate the outbreak of a new disease affecting four young gay men in Los Angeles in 1981, Curran recalled, "We were used to dealing with problems like that very quickly and then they would go away." But AIDS didn't go away and his assignment lasted 15 years until he left the U.S. Centers for Disease Control and Prevention (CDC) to become dean of the School of Public Health last November. Curran said he was amazed to learn how much the Emory community was involved with AIDS. He noted that the major focus of 98 Emory professors, assistants and associate professors is AIDS research and treatment, and many others, including students through Volunteer Emory, work in projects such as Open Hand, AID Atlanta and Jerusalem House.

Curran divides HIV into three five-year time periods: the period of discovery, the period of growth and the current era. From 1981 to 1986, he said, mind-boggling discoveries were made that included the mode of transmission, the virus, the risk groups, AIDS in Africa, heterosexual transmission, the antibody, AZT as a treatment and a way to protect the nation's blood supply.

Noting that French investigators discovered HIV and that its role in AIDS was confirmed by CDC investigators, Curran showed a slide of HIV budding from the top of a CD4 lymphocyte cell. "This slide, which has now been distributed to hundreds of thousands of people throughout the world," said Curran, "was taken on an electron microscope at Emory because at that time the CDC didn't have adequate electron micrographic equipment."

"Along with these discoveries came one of the saddest and most poignant memories for me," said Curran. That was when the CDC tested blood samples dating back to 1978 from nearly 7,000 participants in a hepatitis B study and found that 70 percent of them were already infected with HIV. Next they discovered that those with antibodies remained infected, instead of shedding the virus, and there was a correlation between how long they had been infected and the condition of their immune systems and whether or not they became ill and died. "Until then, we thought we were on the front end of the epidemic and could still do something about it, but after that we knew that it was already too late for hundreds of thousands of people," said Curran.

From 1987 to1991 there was an enormous growth of funding and investigations and the World Health Organization's AIDS program was established. "Many people thought that a vaccine was just around the corner," said Curran. But it was also during this time that scientists at the CDC predicted that the 1,600 cases of 1986 would mushroom to 270,000 cases by 1991 because of the long incubation period. Another downside was a growing fear by the public, culminating in irrational concern and discriminatory situations such as Ryan White, the youngster with AIDS, who was kicked out of school.

Referring to the years from 1992 on as "the long haul," Curran said that 1,200 new cases of AIDS are reported each week and AIDS has become the leading cause of death among those ages 25-44 in the United States. The number of new cases, however, seems to be leveling off in the United States, European countries and Australia, but not in the rest of the world. It is estimated that there will be 30 million to 40 million cases of AIDS worldwide by the year 2000. The United States now has reported 570,000 cases.

Successes during this period include a 45 percent decline in the transmission of HIV from infected pregnant women in the United States, who, along with their newborns, are treated with AZT. "For me, this is very gratifying," said Curran. He added that one of the first hospitals to offer routine voluntary HIV testing to pregnant women was Grady Memorial.

But there are still many barriers to HIV prevention and treatment. Curran noted denial, reinforced by the disease's long incubation period, the scarcity of preventive education, the lack of adequate health and social services and discrimination. Comparing discrimination to weeds in a garden that constantly need routing out, he urged people to put aside their prejudices and fears in order to provide much needed care and social services.

The future will depend on leadership and commitment, he said. "We must seek common ground, provide leadership and move on to fight the epidemic, in memory of David (Jowers) and others who have died."

--Bob Keaton

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