Response to HIV crisis can serve as model for other global health problems

The response to the HIV/AIDS epidemic can serve as a model for other global health concerns, whether they be communicable diseases like tuberculosis, chronic diseases like hypertension or personal habits like smoking, said Thomas Quinn, M.D., National Institutes of Health distinguished investigator and founding director of the Johns Hopkins Center for Global Health. 

He spoke Tuesday as part of MUSC Global and Public Health Week. Kathleen Ellis, executive director of the MUSC Center for Global Health, said the week is a learning opportunity for students. 

“Each year, we host leading experts in the global health field, such as Dr. Quinn, to highlight the tremendous advancements that have been made and to spur discussion about the continued need for innovation, passion and science to achieve health equity around the globe,” she said.  “It’s important for our students and trainees - the future leaders in global health - to learn from the challenges and response to the HIV pandemic in order to be more prepared for the role they will play in transforming health care for underserved and vulnerable populations.”

 

Quinn has gotten an up-close view of the course of the HIV/AIDS epidemic throughout his career. He was a young doctor who had just finished his training in infectious disease when the first reports of AIDS began to emerge. It first showed up among gay men, then within a year was observed in Haitians, hemophiliacs, people who had gotten blood transfusions, infants and women who had sex with bisexual men. 

“Just think about the panic that is going through the United States at this time,” he told the audience of mostly young people, including high school students from Ashley Hall, who have only known a world where antiretroviral drugs mean a newly diagnosed 20-year-old can expect to live almost to age 80. When HIV/AIDS first emerged, life expectancy was one to two years. 

“We had no idea what virus or bacterium was causing this disease,” he said. 

At the time, the Centers for Disease Control and Prevention classified being Haitian as a risk factor for AIDS. Quinn took exception to that decision.

“I said you cannot list a nationality, an ethnicity, as a risk group for an infectious disease,” he said. 

Quinn traveled to Haiti to begin researching the disease. The audience chuckled as the silver-haired professor shared a photo of his much younger self from that time.

“Believe it or not, that’s me. I know it’s hard to believe that – I don’t have any gray hair there – but I’m more like you all. This is your opportunity. As things come up, and you get intrigued by particular diseases, seize that opportunity and go pursue it,” he said. 

From Haiti, his group traced the disease back to Kinshasa, Zaire, a country in central Africa now known as the Democratic Republic of Congo. There, he was shocked to find what had been considered a “homosexual” disease in the general population. 

Two years later, in November 1986, he published a paper in Science warning that prevention and control of HIV should be an immediate priority for all African countries. The paper was trying to influence leaders in the Southern Hemisphere, but no one listened, he said. 

“There’s one thing wrong with this paper and maybe why people didn’t listen. Do you see an African co-author?” he asked, pointing at the first page of the study displayed on the auditorium’s screen. “They’re not there. We’re all Americans. I’ve learned a lesson, and I’m passing that on to you. We had studies working with the Africans – they needed to be up there.”

“When you’re working overseas, you’ll have partners, and you need to recognize the role that they play in helping you put those studies together."

 

Dr. Thomas Quinn

He urged the students and young doctors in the audience to learn from his mistake, one he said he never repeated. 

“When you’re working overseas, you’ll have partners, and you need to recognize the role that they play in helping you put those studies together,” he said. 

Quinn said the year 2000 was a turning point for fighting HIV/AIDS in the developing world. That year, the International AIDS Conference was held in Durban, South Africa.  It would be the first time it was held in an African nation – despite the fact that 70 percent of infected people at the time lived in Africa. Nelson Mandela, who until 1999 had been the president of South Africa, and then-President Bill Clinton both spoke at the conference. Quinn said the conference sparked a flurry of activity from the international community, including bringing the issue of HIV/AIDS to the United Nations Security Council, the first health concern to be discussed by that body. 

In 2003, President George W. Bush announced the President’s Emergency Plan for AIDS Relief, or PEPFAR, during his State of the Union address. As of September 2018, funding from PEPFAR has put 13.3 million people on antiretroviral therapy, prevented 2.2 million perinatal HIV infections and has achieved a 25 to 40 percent decline in new HIV cases in young women and adolescent girls, Quinn said. 

And yet, he added, there are an estimated 10 million people with HIV who aren’t receiving treatment; perhaps because they don’t know they have the disease. There are 1.8 million new infections each year, he said. 

“Our country is one of the problem sites,” he said. New infections in the U.S. have continued at the same rate for the past decade, rather than decreasing, he said. He was excited to hear President Donald Trump announce a new HIV/AIDS initiative during his State of the Union address, though Quinn expressed skepticism about the mechanics, because Trump’s proposed budget also includes cuts to Medicaid. “How are you going to do it without Medicaid? It’s the poor people, the disadvantaged people, that get HIV predominantly,” he said. 

Quinn said the world should come together in the same way to fight other diseases, using the infrastructure that was built up to address HIV. Tobacco use is a major killer around the world, accounting for 6.4 million deaths each year, and is a tangible risk factor that health professionals can educate people about. 

“For a nonsmoker, and living in a country where smoking has become more rare, it’s a bit surprising that it’s still so bad. Half a billion people in the world are still smoking,” he said.  

Clinics that were built to treat HIV patients could also do glucose monitoring for people with diabetes, he said. It’s easy enough to take a blood pressure reading, and from there treat hypertension, he said. 

“Strengthening the health systems to go after these chronic diseases is really key, and it has to be integrated with HIV. And that is global health – a fully integrated health system that’s multi-system involvement in making a difference,” he said.