Book Talk with Jim Curran: HIV/AIDS then and now, the politics of pandemics, and hope for a better future
By Karina Antenucci
Before James W. Curran, MD, MPH, helmed Rollins for 27 years as dean, he led a vital task force at the Centers for Disease Control and Prevention (CDC) investigating what we now know as AIDS. The task force assignment was initially supposed to last 90 days in response to the first reported occurrence of the unknown disease in 1981, but continued for the next 15 years. This past May, the dean emeritus—who is also emeritus director of the Emory Center for AIDS Research—co-authored a book about the AIDS pandemic with his CDC colleagues Kevin De Cock, MD, and Harold W. Jaffe, MD.
Dispatches from the AIDS Pandemic is divided into three sections that cover the authors’ experiences during the beginning of the public health crisis to present day: “From Unexplained Illness to Expanding Epidemic,” “CDC and The Early International Response to AIDS,” and “The Modern AIDS Era.”
Here, Curran discusses the new book and the public health lessons we can all take away from it, the parallels he sees between AIDS and COVID, and his hopes for the future of HIV/AIDS research.
How did your prior experience at the CDC lead to running its early HIV/AIDS initiative?
When the first cases were reported to the CDC in June 1981, I was the chief of the research branch of the Division of STD Prevention. I was asked by Bill Foege, the CDC director at the time and Emory presidential distinguished professor emeritus of international health, to head a team to look into these infections and a rare cancer that had first appeared in gay men. The STD division was already engaged with the health of gay men and working with their physicians and providers regarding sexually transmitted hepatitis B, so it was natural to involve people who had been working with STDs and the gay community. It turned out that the distribution of AIDS was very similar to hepatitis B.
In what capacity did you work with your co-authors Dr. De Cock and Dr. Jaffe?
Harold and I worked on the task force together from the very beginning. Kevin came on a few years later from the CDC’s hemorrhagic fever group, which was doing a lot of work in Africa. We recruited him for a project in Cote d’Ivoire. He continued to be very engaged in the international aspects of AIDS and went on from the CDC to have a career including as director of the World Health Organization AIDS program and he headed the CDC division of AIDS. Harold stayed at the CDC after my departure and later became dean at the University of Oxford’s Department of Public Health and then returned to the CDC as an associate director of the agency.
What motivated you to work on this book now?
We had been involved in The Global Health Chronicles, an oral history project cataloguing the history of AIDS at the CDC. The perspective of the CDC is a special one. Of course, it’s not the only one by far, but the experiences were broad enough that they warranted telling. We all have written quite a bit and Kevin and Harold are prolific authors. They took the lead, and I was engaged in much of the discussions, editing, and some of the writing. We had a desire to do this while we still could.
What parallels have you seen between AIDS and COVID?
They’re both RNA viruses that have come from animals either directly or indirectly. HIV came from a chimpanzee and was transmitted to humans. COVID looks like it came from an animal species in China. Both were called global pandemics, which brings into play not only international politics but global politics. When an epidemic becomes important, everybody cares about it and it becomes very political. We’ve seen the interference and injection of politics into both pandemics.
How have the two pandemics differed?
COVID was the public health crisis of the century and disrupted societies throughout the world. We are still suffering from the impact of it in the U.S. It is transmitted through the respiratory system and there was a vaccine fairly quickly for COVID. The AIDS virus wasn’t even discovered for a few years after the epidemic had started. We were studying a fatal problem with an unknown cause. There was not any effective therapy for 15 years, so the diagnosis of HIV was a death sentence, and it remains so if people aren’t on adequate therapy. There is still no cure or vaccine—although Emory scientists and others are working on it.
Where have you seen improvements in public health since the early days of AIDS?
I think that the AIDS epidemic contributed to people understanding that the world is a small place, that what affects one country can affect other countries. It strengthened the role of the U.S. in dealing with global health issues. There were major scientific issues that were opened up by the study of HIV and AIDS, including in virology and immunology that spawned a lot of research. Some of the treatments for hepatitis, for example, have roots in some of the research that was done for HIV and AIDS.
What lessons can we take with us today from the book?
It’s a story of some of the ways the CDC and the thousands of people there who worked on AIDS have contributed to [improving] global health problems. For people who work in public health or global health, the book can give you a feeling for what it was like on the ground, what people dealt with and learned, and the contributions made by the public health community that the CDC worked with.
What is the state of the AIDS epidemic today?
The story’s unfinished. There are still 38 million people infected with HIV around the world. There’s good therapy now, but it requires a daily or monthly injectable treatment. It still requires lifelong therapy. It’s not like hepatitis C where you can eradicate it in an individual so that makes it very difficult to eliminate it as a global health problem. If you get COVID, you develop an antivirus response and, if you survive, it goes away. That’s one of the reasons the COVID vaccine works, at least partially. With HIV, there is no natural immune response that a vaccine can reproduce. It is an elusive virus. I hope we can find curative therapy for HIV and a safe and effective vaccine to eradicate the virus from the human population.
What role has Emory played in fighting HIV/AIDS?
Emory has made a lot of contributions. Its 25-year-old Center for AIDS Research is one of the most successful AIDS research centers in the world. Raymond Schinazi, PhD, DSc, at Emory School of Medicine, and Dennis C. Liotta, PhD, Samuel Candler Dobbs Professor of Chemistry at Emory College of Arts and Sciences, have developed two of the major drugs used to help control HIV infection, lamivudine and emtricitabine. These drugs have been groundbreaking. Emory provides medical care for between 7,000-8,000 people living with HIV in Atlanta. Our doctors and nurses are among the best and most prolific caregivers for people with AIDS in the country.
