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In the beginning:
An eyewitness expert recalls the early days of AIDS

In the beginning:
An eyewitness expert recalls the early days of AIDS


During the 1980s, Jim Curran, MD, MPH, was one of the most vital scientific minds driving the U.S. government's fight against the awakening AIDS epidemic. As an epidemiologist at the federal Centers for Disease Control and Prevention, Curran was present during the first cases of the condition that would become known as AIDS--a syndrome that would change the world. Curran became chairman of the Kaposi's Sarcoma Opportunistic Infection Task Force in 1981, and eventually the director of the CDC's Division of AIDS. Today, he is the dean of the School of Public Health at Emory University in Atlanta and the director of the university's Center for AIDS Research. To mark the 25th anniversary of the first identified AIDS cases, Dr. Curran spoke with Benjamin Ryan.

Talk about when, in 1981, you first heard about the cases of Kaposi's sarcoma and pneumocystis pneumonia that indicated the beginning of the AIDS epidemic.

When the first cases of pneumocystis pneumonia were reported to CDC, I was asked to chair a task force. And one of the first tasks was to go to New York City and visit a doctor and his patient, who had Kaposi's sarcoma. The patient, as it turned out, was within a year or two of my age--a young man from a suburb of Detroit who went to Catholic prep school, as I did. We laughed about our childhood; we laughed about our high school experiences, our similarities in backgrounds. What turned out, as I got to know him more and saw him during several more visits to New York City and watched his disease progress and [watched] him die, was that the virus was the real thing that separated us. He died in 12 months.

In the beginning of the epidemic, what did you foresee for this mysterious collection of diseases?

We knew that there were more people infected than were seriously ill. And we were constantly touting how cases were doubling and this was only the tip of the iceberg. But even we greatly underestimated the extent of the problem.

In the early 1980s, you struggled to begin the fight against AIDS with a paucity of funds. What are your recollections about the politics of that era and how they kept such a tight rein on public health spending?

When the Reagan administration took office in 1981, there was a ramping-up of the defense budget and cutbacks in the domestic budget. And those cutbacks affected the CDC and the National Institutes of Health. We were fortunate to have a flexible work force in terms of epidemic intelligence service officers, and physicians, and some science staff, but were severely constrained in the areas of ancillary staff, and travel, and, in particular, our ability to provide assistance in health departments and universities to help with this. We were constantly asking for more money.

What were some of your greatest needs that went unmet?

There was a concern about having enough staff at the CDC. There were inadequate numbers of support staff, particularly statisticians. The CDC had a hiring freeze and some reduction of force; that tends to make it more difficult to get scarce resources donated or directed toward a problem.

You were accustomed to researching gay men and their sexual behavior because of your work with hepatitis B in the 1970s. Most others at the CDC were probably not ones to give much thought to gay sex acts. Did you have trouble persuading people to join the fight against AIDS?

One of the things the CDC is known for is rapid responses to epidemic challenges. And there was a lot of enthusiasm in a lot of the young people in getting involved with this. The problem we had was in identifying and developing laboratory expertise and identifying support staff. The [lack of] laboratory expertise was due in part to the scarcity [of virologists] and perhaps the fear of dealing with the unknown. I think it was self-selection...They didn't sign on.

You advised San Francisco officials during the effort to close down the city's bathhouses in the 1980s. Today, much of the unrestrained sexual behavior that once took place in such venues is now facilitated by the Internet. How do public health workers target the unsafe sex that goes on between men who meet online?

Now, the problem is mostly related to the fact that AIDS doesn't have the amount of publicity or urgency for young people today as it did then. And of course there are universal interests in sex. We certainly can't shut down the Internet. So I think the issue is more one of getting the community concerned enough in order to have enough information out there.

You have said that HIV prevention works "if its hands aren't tied." How are the hands of U.S. prevention efforts currently tied?

Where it's easiest to see is in the area of drug abuse. Our country has a true disdain for drug abusers. Our major tactic to deal with drug abuse often is to imprison people. We've not yet provided strong support for needle and syringe exchange programs and, more importantly, for drug treatment programs for people at risk for HIV. And we know these things work.

What are you currently researching about HIV/AIDS?

At Emory, we have a center for AIDS research that develops and tests HIV therapies and vaccines.

Harper's magazine recently published an article by AIDS dissident writer Celia Farber that espoused a myriad of controversial views that HIV/AIDS is hoax. How did you react to the story's publication?

I was really disturbed that the magazine published such and article. It was just so filled with inaccuracies and hopeless speculation. It was really embarrassing for Harper's that such an article should come out.

How do these skeptical theories still thrive despite seemingly overwhelming evidence to the contrary?

It isn't surprising to me that a small segment of people can be in great denial and be skeptical about science in general. But what's surprising to me is that they should get so much press. There are people who think the world is flat.

There is a pervasive anti-science, anti-condom, anti-harm reduction attitude in the Bush administration and among influential political conservatives. How can public health experts counter attitudes that are antithetical to effective HIV prevention?

I think it's important for scientists and for public health officials to speak up for what works and what doesn't.

What will AIDS look like in another 25 years?

I hope we'll have an effective and safe vaccine. I hope we'll have curative therapies. Those things are both really needed. If we don't have those, we'll be dependent upon continued public education, information and prevention strategies. And I hope we're not still debating abstinence vs. condoms, and needle and syringe exchange, or things like that. And I hope we have much more open discussions in community-based prevention efforts with strong leadership around the world. The first 70 million infections will far more than double in the next 25 years--to 150 million or more--unless we can be much more effective with prevention.

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