The Justice

Epidemiologist Brian Williams spoke at Brandeis on Feb. 11 in an address called "Fighting AIDS; Human Policy vs. Public Health." While on campus he also held several other lectures.

CORRECTION APPENDED SEE BOTTOM

Pointing to a map of England's Soho neighborhood in 1884, Brian Williams noted that the cases of cholera in the era's epidemic were clustered around the same water pump. John Snow originally made this observation and concluded that cholera, a bacterial infection of the small intestine, must have spread through the water. Despite this strong evidence, people were reluctant to accept his explanation and clung to their belief that cholera was transmitted through the air.

Many preventable deaths later, Snow removed the handle from the pump in Soho and the cholera epidemic quickly petered out. Williams, an epidemiologist at the World Health Organization, likened people's reactions to the 1884 cholera epidemic to reactions to today's HIV epidemic.

In a Feb. 11 address called "Fighting AIDS; Human Policy vs. Public Health," Williams spoke with unusual optimism about grave health issues, including the reasons behind the widespread reluctance among national governments and international organizations to implement public measures against the spread of HIV/AIDS and what can be done to change that attitude. Williams, a distinguished visiting practitioner, held several lectures and other events between Feb. 9 and 13 at Brandeis.

A reluctance to accept and implement logical remedies to disease is typical of most governments' reactions to epidemics, Williams said.

"All diseases can be managed. The problem is really one of political will. If all you have to do is the science, then the problem would be easy [to solve]," Williams said in an interview before the presentation.

Williams explained that much of governments' and international organizations' unwillingness to implement measures against the spread of HIV/AIDS comes from fears of infringing upon individual rights.

"Everybody is terrified of imposing anything on anybody else," he said in his address. As a result, HIV/AIDS is treated as a personal issue rather than a societal burden.

Williams argued in the address that the HIV/AIDS epidemic needs to be redefined as a "public health and infection disease emergency," even if it means that people must relinquish a few of their individual rights as a result.

"We need to balance the demands of public health with the imperatives of human rights. Only in this way will we begin to manage the epidemic of AIDS effectively," he said in the address.

Through large-scale testing of individuals in HIV/AIDS-infested areas once a year on average, Williams believes that ultimately, HIV will no longer be a global health threat.

"If we test people once a year on average we will cut transmission by 10 times and eliminate HIV," Williams said in his address. Since every HIV-positive person infects on average "only" seven other people, Williams explained that "if we can cut transmission by a factor of more than eight, we will eliminate the infection."

In addition to annual HIV testing in areas where HIV is most common, Williams proposed monitoring resistance to the treatment drugs and using second-line drugs when patients develop resistance to the medications. He also suggested focusing on preventing residual transmission, when HIV is transmitted through blood contact such as sharing needles or blood transfusions. These measures will only be successful with compliance of people living in AIDS-infested areas and may sometimes conflict with the need to protect individual rights.

During the question-and-answer period following Williams' talk, Prof. Maria Green (HELLER) offered an alternate take on the relationship between halting the spread of HIV and respecting individual rights. She said that HIV/AIDS treatment is actually part of exercising a right to public health.

"International human rights law actually includes a right to public health, which means that governments have a human rights obligation to take public health measures, including sometimes measures that limit personal freedoms," Green wrote in an e-mail to the Justice.

Still, she acknowledged the inherent difficulties of balancing public health and human rights.

"This is not at all to argue with Professor Williams' core point, which is that we need to find ways to navigate the tensions between effective public health protections on the one hand and the claims of individual autonomy on the other," she wrote.

Williams dismissed in his address several typical explanations for the lack of large-scale global measures against HIV/AIDS. He said that the absence of sufficient treatment is not a matter of money; until 2007, the United States contributed $35 billion to AIDS treatment, and is expected to increase this amount to $45 billion in the next five years. He also rejected a lack of political will as the sole cause for the unsubstantial response. Williams cited numerous international organizations, national organizations, philanthropists, acitvists and scientists that address the HIV/AIDS epidemic.

Williams also discussed the need for large-scale treatment measures to centralize political efforts to fight AIDS. "A major problem in the world of public health is that there are so many players. No one works together," he said in his address.

Williams believes one of the reasons behind the failure to turn HIV/AIDS into a public policy issue is the stigma attached to the disease. He explained that HIV/AIDS is often associated with gay men, Haitians, drug addicts, hemophiliacs, Africans, sex workers and migrant workers.

Williams quoted in his address "Shadow on the Continent," an article by by Kevin De Cock, the director of the World Health Organization's Department of HIV/AIDS. "Paradoxically, treating HIV/AIDS as being different from other infectious diseases probably enhances stigma rather that reduces it," De Cock said. "The emphasis … on anonymity [might] have been counterproductive. Anonymity is impossible to maintain as immune deficiency progresses."

In addition to the failure to treat HIV/AIDS as a public emergency, Williams explained that many organizations attempting to combat HIV/AIDS don't fully understand the factors that determine the spread of the epidemic. The weapons most typically employed to fight against the spread of HIV/AIDS are condoms, the treatment of curable sexually transmitted infections, behavior changes, vaccines and vaginal microbicides. Yet Williams explained that all of these measures have proven ineffective.

Instead, he argues, people should focus on drugs to prevent mother-to-child transmission, male circumcision and anti-retroviral therapy, which have all proven to be extremely successful in the treatment of AIDS.

This change in method came as a shock to Hannah Janoowalla '10, who educated drug users and sex workers on HIV prevention initiatives this summer in Mumbai, India. She said William's presentation "made me rethink my whole perspective [on HIV prevention.]"

"It's one of the best talks I've been to," she added. "I was expecting something very conventional, but everything he said was new. It was so informative and relevant to something I want to do for the rest of my life."

Correction: The article originally misspelled a student's last name. The student's name is Hannah Janoowalla, not Janoowall.

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