The Race to Save LIVES

As infection rates continue to climb, Black researchers and health educators are in desperate race to stem the AIDS Ores toll on Black communities

As an HIV/AIDS educator and community services administrator at Charles R. Drew University of Medicine and Science in Los Angeles, Cynthia Davis has seen the toll of the epidemic up close and longer than most. She has been coordinating HIV/AIDS prevention efforts as part of her work at Drew since 1983.

"I've hired people who had AIDS and they later died," she says. "I've seen a lot of AIDS workers burn out."

In the 1980s, when little was understood about how socioeconomic conditions and social behavior gave rise to the spread of HIV/AIDS in Black communities, it fell to academic researchers, such as UCLA's Dr. Vickie Mays and Columbia University's Drs. Mindy and Robert Fullilove, to document the demographics of its transmission.

Similarly, physicians, scientists and community educators, such as Davis, at the nation's four Black-led medical schools also took on significant and pioneering roles to push for prevention education, basic science research and clinical care for AIDS patients in the poorest and most vulnerable of Black communities.

The '90s have been marked by the emergence of a dramatic racial disparity in the demographics of the HIV/AIDS population. As new cases of HIV infection have begun falling among Whites, they are exploding among Blacks. Some 57 percent of all new HIV cases involve Blacks, according to the U.S. Centers for Disease Control and Prevention in Atlanta. African Americans account for just 12 percent of the national population. That staggering racial disparity has prompted Black leaders to demand targeted assistance to the Black population.

"The AIDS crisis in the Black community is real and severe," wrote U.S. Rep. Maxine Waters, D-Calif., earlier this year. "[U.S. Health and Human Services Secretary Dr. Donna] Shalala must take ... action to make sure that treatment, prevention and research programs follow the disease."

Nearly 20 years into the HIV/AIDS epidemic, an even larger intervention is now springing forth from African American researchers and medical professionals in the academy. This time, the intervention -- largely supported by increasing government assistance -- is expected to have its broadest base ever. In particular, historically Black institutions, charged with educating undergraduates, are expected to expand their community outreach activities and partnerships with community-based organizations.

At the end of last month, for example, U.S. Surgeon General David Satcher used the resources of his office and those of the nation's four historically Black medical schools and Tuskegee University to convene a national teleconference on the subject. The objective of the event was to educate and enlist hundreds of Black community organizations and the HBCU community in the fight against the HIV/AIDS epidemic.

"This teleconference [was] a watershed event," says Drew's Davis, adding that it has mobilized more Black organizations and HBCUs around a single HIV/AIDS event than any previous activity.

With federal officials having begun to lead high-profile efforts to encourage HIV/AIDS prevention and funding intervention and research, Blacks in academia are hopeful that more of their colleagues and students will join in the fight against the HIV/AIDS epidemic. Veterans of HIV/AIDS academic initiatives point to well-established models of community education, social behavioral studies, clinical trials work and scientific research as the foundation for even larger HIV/AIDS initiatives by Black scholars and Black institutions.

For example, Jackson State University in Mississippi is receiving $5 million from the Centers for Disease Control and Prevention over a five-year period to prevent the spread of HIV/AIDS among Blacks in the South. The award is part of the $156 million appropriation in targeted HIV/AIDS funding that was secured by the Congressional Black Caucus last year.

"We need everybody involved," says Dr. Dawn Smith, a researcher and administrator at the Centers for Disease Control and Prevention.

A Research Agenda Emerges

Behavioral research in the late 1980s by scholars proved instrumental in mapping out disease transmission patterns among African Americans and ultimately led policy makers to allocate resources to combat the HIV/AIDS epidemic in the Black community.

Much of that early research came from scholars whose interest in AIDS sprang from direct appeals by grassroots community organizers, such as Rev. Carl Bean in Los Angeles. Those implored to join the fight usually were Black researchers based at resource-rich, predominantly White institutions. At the time, the research agenda developing around the HIV/AIDS epidemic in the Black community also attracted researchers who had already studied Black communities.

"Early in the epidemic, the emphasis was on looking at gay White men," says Mays, of the U.S. medical and social research establishment. "Statistics collected on the HIV/AIDS epidemic were not broken down by ethnic groups."

Mays, who is a clinical psychologist, recounts that in the 1980s activists and grassroots community leaders began seeking emergency assistance to get care and counseling for Black AIDS patients. Having specialized in women's health issues as a psychologist, Mays began focusing heavily on HIV/AIDS as a research interest after having the dramatic experience of providing emergency counseling to a suicidal Blackwoman suffering from AIDS.

"When I became involved in HIV/AIDS, I had a pretty full agenda," she says.

Early on, Mays gained a national perspective on the impact HIV/AIDS was having on Black communities through research work that allowed her to travel around the nation. In 1987, she founded a research center known as Black Community AIDS Research and Education Project and later published groundbreaking studies documenting how HIV/AIDS was spreading among gay and bisexual Black men.

"There was a feeling among those working in AIDS that if we worked hard enough, we could defeat the epidemic. What happened was that we realized the AIDS epidemic was here to stay," Mays says.

Columbia University's Fullilove says he and his wife, Mindy, found themselves in the late 1980s drawn into early HIV/AIDS behavioral research by accident. Although officials at the University of California-San Francisco medical school had decided to start on HIV/AIDS research center, the insistence by community groups that Mindy Fullilove, then a UCSF researcher, participate in the initiative proved to be a turning point in her and her husband's academic careers. Mindy Fullilove joined the project and was soon followed by her husband, then an administrator at the University of California-Berkeley.

"What began as a part-time effort eventually became a full-time commitment," Robert Fullilove says about his contribution to the UCSF project. "I write about HIV/AIDS with the purpose of putting in a social and cultural perspective."

In 1990, the Fulliloves published a study predicting that the sexual activity stemming from the crack cocaine trade would become a major factor in fueling the spread of HIV/AIDS within the Black community.

"This [was] one we hit out of the ballpark," Robert Fullilove says, explaining that their reputation as researchers grew substantially because of the accuracy of their prediction. "All our worst fears were realized."

Smith, of the Centers for Disease Control, says work by researchers such as Mays and the Fulliloves has proven an essential component of the effort to persuade federal research agencies to pay serious attention to the impact of HIV/AIDS on the Black population. She cites African American scholars Dr. John Peterson and Dr. Mark Smith as other examples of influential researchers.

"[These researchers] did valuable work," the CDC's Smith says.

Black Med Schools and HIV Infrastructure

In contrast to the social scientists, Dr. Deborah Lyn pursues science research to unlock the mysteries of HIV, which is the virus that causes AIDS. Lyn, a native of Jamaica, is part of a team of six scientists based at the Morehouse School of Medicine who do HIV/AIDS science research.

Trained as a molecular biologist, Lyn initially pursued cancer research, but she began exploring HIV/AIDS science not long after joining the faculty at the Morehouse in 1994. Since arriving at Morehouse, Lyn's research has grown to include investigating why people who are HIV-positive and those who have AIDS are predisposed to developing certain kinds of cancer. Grants from the National Institutes of Health support much of Lyn's research.

"I'm interested in questions of how the virus works," she says.

Since the 1980s, Morehouse has dedicated itself to becoming a leading medical school of faculty and staff pursuing HIV/AIDS science research, clinical trials, behavioral studies and prevention work.

The 24-year old medical school boasts a cadre of 15 faculty members who have specialties in HIV/AIDS -- which is considered a large number for a medical school of Morehouse's modest size. The school enrolls 196 students, which includes masters' and PhD. candidates. Morehouse has a full-time teaching staff of 177.

Lyn says that although her research may seem far afield from her colleagues who pursue clinical or prevention research, it is beneficial for her to work among them because she can learn about the latest advances in HIV/AIDS research.

"We're trying to develop an AIDS group," Lyn says of efforts being led by Morehouse's Dr. Craig Bond to bring all the researchers, physicians and administrators together under a more formal structure.

Other science researchers at Morehouse say they were drawn to the medical school because of its community of researchers and advanced laboratory facilities. Upon completing a post-doctorate fellowship at the prestigious National Institutes of Health in Bethesda, Md., Dr. Michael Powell joined the Morehouse faculty.

Powell, who is White, says Morehouse represented a good fit for him largely on the strength of the science faculty.

"They had a group of AIDS researchers already there. That group of people impressed me and I thought it would be a good place to [go]," says Powell, a biochemist.

Powell adds that Morehouse is equipped with laboratory equipment that allows researchers to handle the HIV virus, a rare resource among medical schools.

At Charles R. Drew University, administrators and faculty members are developing an infrastructure to allow them to pursue all facets of HIV/AIDS research. This includes the capacity to conduct clinical trial research, which typically involves the study of HIV/AIDS patients and their responses to drug treatment, basic science research, prevention research and social behavior studies.

"If you look at basic science research, we have not had that here, and there's been limited clinical trials work," says Dr. Eric Bing, a Charles R. Drew faculty member who conducts a number of HIV/AIDS and substance abuse research projects and institutes.

"I think Drew has the necessary research infrastructure to [facilitate] good social behavior research," he adds.

Bing notes that the Los Angeles-based school was recently awarded a $7.5 million grant from the National Institutes of Health to enable it to build more science facilities for health science research.

Since 1985, Morehouse and Drew, as well as the Howard University College of Medicine and Meharry Medical School, have had help building their health science research infrastructures through participation in the Research Centers in Minority Institutions Program.

The mission of this federally supported initiative is to expand the capacity for research in the health sciences by assisting through grant support of minority-serving institutions that offer doctorates in the health professions and or the health sciences.

The Role for Undergraduate Progams

While Black medical schools have taken the lead in pursuing research and developing community intervention programs, it is believed that the undergraduate HBCUs also have an important role to play in the fight against the HIV/AIDS epidemic.

A number of HBCUs have instituted AIDS education programs for the benefit of their students. The National Association for Equal Opportunity in Higher Education, or NAFEO, and the American Red Cross have co-sponsored summer training institutes to teach undergraduates how to conduct HIV/AIDS peer-to-peer counseling and education. Campuses that have hosted the training institutes include Hampton University, Bethune-Cookman College, Tuskegee University and Shaw University.

NAFEO has conducted workshops that have helped schools develop Hi-V/AIDS community outreach partnerships with community-based organizations.

Recently, the NAMES Project Foundation, which is the founder and sponsor of the AIDS Memorial Quilt, launched a national quilt tour and prevention campaign on the campuses of historically Black colleges and universities for the 1999-2000 academic year. Coretta Scott King delivered the keynote address for the program's kickoff ceremony held in October at the Atlanta University complex in Atlanta. The tour sets up on-site testing, HIV prevention education, counseling, treatment information and referral services for students and others.

"The numbers speak for themselves -- AIDS is decimating the African American community," says Andrea Shorter, deputy director of the AIDS Memorial Quilt. "The goal of this new initiative is to heighten the level of AIDS awareness and bring potentially life-saving information and resources to students and other African American youth in communities surrounding our target campuses."

In addition to prevention and community outreach, these undergraduate-focused historically Black institutions have put forth efforts to place their faculty members into partnership arrangements with the HIV/AIDS behavioral and biomedical research projects that are being conducted by other higher education institutions and federal agencies.

Through assistance from the Research Centers in Minority Institutions initiative, Tuskegee University officials established the Center for Computational Epidemiology in 1992.

The center, headed by Dr. Tsegaye Habtemariam, has utilized computer modeling to study HIV/AIDS epidemiology in Black communities and HIV/AIDS biochemistry at the cellular level.

Habtemariam describes the science behind computational epidemiology as a blend of a mathematics, statistics, and computer-based modeling to predict course of an epidemic.

"We saw that the big research universities weren't looking at [HIV/AIDS] epidemiology in Black communities. We decided to pursue it because it was important that it become a research priority," Habtemariam says.

With federal help, Tuskegee also launched the National Center for Bioethics in Research and Health Care in January 1999. The center, which supports HIV/AIDS research initiatives, was pursued in the aftermath of President Clinton's apology for the U.S. Public Health Service's infamous syphilis study conducted at Tuskegee, in Macon County, Ala.

Given the impact that African American researchers and institutions have already had in the fight against the HIV/AIDS epidemic, government health officials see HBCUs as a critical set of institutions. The CDC's Smith says that HBCUs have a strong base of social scientists who have experience studying social conditions in Black communities.

"Their knowledge on how to do research [in the Black community] would greatly benefit the AIDS field. It might be useful to have more people involved who have done large-scale surveys in the Black community,"

[ILLUSTRATION OMITTED]

COPYRIGHT 1999 Cox, Matthews & Associates
COPYRIGHT 2004 Gale Group