It has been 35 years since the first case of HIV/AIDS was recorded in Connecticut, and since then, Yale has been at the forefront of scientific interventions to address the challenges posed by the epidemic.
Elaine O’Keefe, who currently serves as the executive director for Yale’s Center for Interdisciplinary Research on AIDS, was one of the first public health practitioners to work on the epidemic. She vividly recalls the grave circumstances brought upon certain New Haven residents by the advent of HIV/AIDS in the 1980s.
“New Haven was the epicenter of HIV in Connecticut at the time,” she said. “HIV was heavily impacting the gay community and devastating injection drug users.”
Then working as a staffer in the New Haven health department, O’Keefe implemented the first legal needle exchange program in the United States with the help of her colleagues — and critical assistance from Yale researchers.
“There were people at Yale even then who were very committed not only to helping us with our organizing effort, but also to evaluating the syringe exchange program and showing that it was effective,” O’Keefe said, speaking in an office decorated with photos of the original needle-exchange van that she and her colleagues had set up three decades ago. “Their work remains today as one of the most substantial contributions made in the field of HIV prevention and treatment.”
Since those relatively modest beginnings, the efforts of O’Keefe and HIV-focused activists and researchers have made Yale a powerhouse in multidisciplinary HIV research that crosses geographic boundaries.
Gerald Friedland, a senior research scientist and a Yale School of Public Health professor emeritus, has worked on addressing various aspects of HIV/AIDS since 1981. After being based in New York City, he arrived at Yale in 1991 with the intention of organizing an HIV/AIDS care and treatment program there. He has been in New Haven since.
“At that point of time, there was not a great deal of HIIV/AIDS work going on,” Friedland recalled. “Since then, we have grown on a very wide and advancing front.”
Work done by Friedland and his research group presented the first convincing evidence of a lack of transmission of HIV by close personal contact. Friedland has been involved in clinical trials of antiretroviral therapies that have significantly extended the life expectancy of individuals who are diagnosed as HIV positive. Friedland has also closely observed the increase in basic science research into the pathogenesis of the HIV disease here at Yale, crediting professor of Medicine Michael Kozal in particular for his work in researching the genetic determinants of HIV.
Beyond the production of basic scientific research and knowledge, much of the HIV/AIDS related research conducted at Yale is performed under the auspices of CIRA, where O’Keefe has served as executive director for eight of its 20 years in existence. The Center prioritizes the development of implementation research on the prevention and treatment of HIV/AIDS, and the integration of multiple disciplinary approaches.
“If research stays only in publications, and findings are only read by other scientists, we have failed,” O’Keefe said. “We have to get that knowledge adapted in a way that can be used in real life situations.”
Currently, there are 51 active projects affiliated with CIRA. They spread across at least ten countries including the United States, and are situated in five different continents.
One such international project is Friedland’s ongoing work in South Africa, where he works extensively on the integration of tuberculosis and HIV care, treatment and diagnosis in urban and rural settings.
According to Friedland, a structural disadvantage of medical practice is vertical “stacking” — the categorization of doctors by a single area of disease expertise.
“Each disease has its own sort of chimney,” Friedland said, adding that the need to integrate HIV and tuberculosis treatment was particularly pressing as tuberculosis has become the leading cause of death for people with HIV globally.
By employing an integrated approach to the treatment of the two diseases, Friedland and his fellow researchers uncovered the existence of what is now recognized as extensively drug resistant tuberculosis in rural South Africa.
O’Keefe noted that researchers at CIRA also acknowledge the essential importance of research in the social realm.
“You can come up with the best drugs and you can work on all these clinical aspects, but at the end of the day, [HIV/AIDS] is a disease of marginalization,” said Fabian Fernandez ’15, who completed a senior essay on networks of support for people living with HIV/AIDS in Havana, Cuba.
Fernandez said that as a queer man of color, he was aware of the prevalence of HIV in his community. He also said that he got involved in advocacy and research efforts by reaching out to professors and through student groups like Student Partners in Global Health, which was known as the Yale Ecuador HIV Clinic Initiative in his time as an undergraduate at Yale.
“Nothing at Yale is very easy, but with some effort I was able to connect with faculty studying HIV-related issues,” Fernandez said. “There’s a lot of activity going on in the field at Yale and it really is an exciting time to be working on HIV.”
Looking ahead, O’Keefe identified two pressing challenges for further HIV/AIDS-related research at Yale and beyond — ever-increasing competition for a limited pool of funding and what she characterized as an alarming lack of diversity among researchers themselves.” For many years, HIV research scientists have been predominantly white, and this is an epidemic disproportionately affecting black and Latino communities,” she said. “We need more representation from the communities that are most impacted.”
To address this disparity, CIRA hosts a research education institute for scholars from underrepresented backgrounds every summer.
Despite the significant strides made in research and practical work over the past three decades at Yale and elsewhere, researchers and practitioners interviewed widely acknowledged that the goal of ending the AIDS epidemic as a global threat remains daunting.
An event organized by the Yale Debate Association in Linsly-Chittenden Hall Monday evening centered on what Amy Justice MED ’88, a Yale-affiliated HIV/AIDS researcher, considers one of the most pressing unresolved challenges in achieving any such goal — addressing what the ending the epidemic even means.
Along with two Yale sophomores and Keymanthri Moodley, a bioethicist at South Africa’s Stellenbosch University, Justice participated in a debate on “Resolved: Prioritize finding a cure for HIV/AIDS over treatment and prevention.” Moodley argued for the motion, and Justice argued against.
“Treatment and prevention may not be enough, but treatment as prevention may be enough,” Justice said in response to Moodley’s argument for devoting funding from other areas of HIV research toward finding a cure.
Justice also told the news that an ill-advised emphasis on directing funding towards attempts at curing HIV rather than preventing and treating it that are hampering efforts to effectively address the epidemic.
“There is a political tension there that we need to do our best to resolve,” she said.