Acts of grace

Bill Snyder
Published: July, 2006

James Hildreth, M.D., Ph.D., wants to empower women to protect themselves from AIDS.
Meharry Medical College
In 2006 James Hildreth, M.D., Ph.D., met with Zambian officials to discuss ways to partner in the first clinical trials of a “chemical condom” that could protect women from HIV infection.

“If you’re a woman in a third-world country, and you cannot negotiate the use of a condom by your male partner… you’re always at risk,” says Hildreth, founding director of the Meharry Medical College’s Comprehensive Center for Health Disparities Research in HIV.

A microbicide-containing vaginal cream could “empower women to protect themselves,” he says.

Hildreth started investigating HIV as a young faculty member at Johns Hopkins University in the late 1980s, but his determination to solve problems that disproportionately affect poor people and minorities was forged 20 years earlier, in segregated small-town Arkansas.

When he was 11, he lost his father to cancer. “Because we were poor and because we were black, my father received little care,” he says. “It made me a very angry young man.”

Months later, his hero, the Rev. Martin Luther King Jr., was cut down by an assassin’s bullet. “My despair gave way to rage. I turned completely inward and didn’t speak to anybody.”

Fortunately his “praying, patient and insightful” mother Lucy helped him to channel his anger in ways that nourished rather than destroyed him.

“Dr. King faced unimaginable hatred and enmity… and yet he never responded in kind,” Hildreth told Vanderbilt medical and nursing students during a lecture in 2006 honoring the civil rights leader. “My mother helped me understand there was no reason to hate ... If I was to be true to Dr. King, I had to have the same grace he had.”

Hildreth went on to Harvard, won a Rhodes scholarship to Oxford where he earned a Ph.D. in immunology, and received his medical degree from Johns Hopkins.

At first he wanted to become a transplant surgeon, but soon turned his attention to HIV after witnessing the disproportional impact of AIDS on “the poor, the disadvantaged and people of color.”

Applying his expertise in cellular immunology, he and his first graduate student, Rimas Orentas, reported in 1989 that HIV essentially “hijacked” proteins on the surface of certain white blood cells in order to attach to and infect the cells. The points of attachment are called lipid “rafts” because they are full of cholesterol.

Hildreth and his colleagues wondered what would happen if they disrupted these viral “lifeboats.” By 2001, they had an answer: when cholesterol was “sucked out” of the membrane by a lipid-attracting chemical called beta-cyclodextrin (BCD), HIV was no longer able to infect its target cell.

Within three years, Hildreth and his colleagues had developed a BCD-based cream that, in animal studies, blocks HIV infection.

About that time, he received an offer to direct a new AIDS research center at Nashville’s historically black medical college. He declined twice. His wife Phyllis urged him to reconsider.

“As I thought about it… to do (my work) at this place, which has been battling health disparities since its inception, became more and more appealing,” Hildreth recalls. “It would be a tremendously powerful thing if even a partial solution to the AIDS problem could have its birth here at Meharry… I felt compelled to come.”

In concluding his lecture to the Vanderbilt students, Hildreth returned to the grace that illuminated King’s life.

“This is your world to take and do with as you please,” he said. “But… I beg you not to become what Shakespeare calls the indifferent children of the world, who would stand and watch as the world falls into chaos… The bottom line is there is a lot of work for us with grace to do.”

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