Investing social capital  pg. 4

Number one, it is possible to conduct high-standard research with high ethical values in developing countries.

With limited resources you can obtain excellent results—if you have a well-conceived plan.

And the third thing which we have done is that if you can rapidly implement the results of the research, (it) will have national impact.

Dr. Holtgrave?

The 100-percent condom use program that was put in place in Thailand I think suggested a very interesting and effective kind of policy. Programs for injection drug users early in the epidemic seemed to make a major difference in Australia.

The idea of couples counseling (for HIV prevention) has been an important one now throughout the epidemic. That work was really pioneered in Africa.

And so I believe there are many lessons to be learned from around the world about what kinds of policies are most effective.

Dr. Holtgrave, I understand that your department at Johns Hopkins is exploring how multi-level interventions work together to improve health. Why is this approach important?

The new Department of Health, Behavior and Society will look at a number of different disease areas, from HIV to cancer to cardiovascular disease to diabetes.

When we consider any one of those specific disease areas, we don’t think about what’s the one magic bullet to change health behavior in that particular area… but rather, we try to understand how to intervene at all or at least a multiple of those levels.

What are those levels? Well, you might intervene with one individual at a time, with a couple, a family, with the community, with the whole society or a whole nation, and you might even go beyond that and say you want to change policies, laws or even the environment in that nation.

In HIV prevention, our department is interested in individual counseling, group and community-level interventions, services that address entire social networks, and structural interventions such as using housing for homeless persons as a kind of HIV prevention intervention. Further, we are interested in addressing multiple levels at once.

Dr. Pape, how important to the research has been the contributions of your colleagues at Cornell and Vanderbilt?

They’ve been invaluable. There is no way that we could have done what has been done, and there is no way the epidemic could be somewhat controlled in Haiti without that kind of support.

With Vanderbilt, what has been very important is the contribution of Peter Wright, M.D., who heads pediatric infectious diseases at Vanderbilt, in getting (GHESKIO) into (testing) HIV vaccines.

Vanderbilt and Cornell have been instrumental to initiate ACTG (AIDS Clinical Trial Group) studies. Those were very, very important studies for us to initiate and scale-up HAART in Haiti, as our staff learned from the vigorous research training and applied the experience acquired to patient care. We could not have enrolled 100 new patients per month, and that’s the rate we’ve been scaling up HAART. We have now over 3,000 patients on HAART.

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