Fighting The War On AIDS

Boxes are still piled up outside of Martin Fishbein's new office. They should be -- the new head of Health Communication at the Public Policy Center is still finishing up his move from the Center for Disease Control in Atlanta, where he worked on large-scale AIDS prevention programs. Fishbein is a social psychologist at the Annenberg School for Communication, one of three schools at the University heavily involved in the fight against AIDS. The University is truly taking an interdisciplinary approach in its efforts to battle to the AIDS epidemic, sponsoring research studies which attack the disease at different stages. In 1996, approximately 56,730 people were diagnosed with AIDS in the United States, according to the CDC. While this figure represents a 6 percent drop off in new cases since last year, it is not an accurate reflection of the spread of the epidemic throughout the world. For example, since 1984, 400,000 Ugandans have died of AIDS-related diseases. Much of the research in the field of AIDS prevention has met with minimal success. Since the dawn of the epidemic, there have been more than 800 clinical trials for AIDS vaccines throughout the world. None has come to fruition. Yet the fight goes on. Fifty physicians arguing for the right to test a potentially lethal AIDS vaccine on themselves pleaded their case to the National Institute of Health last week. At Penn, AIDS research may be less dramatic, but the effort is as widespread. Indeed, the fight against AIDS is quite possibly the best example to date of the unified concept of "one University." The Sociological Front Fishbein's AIDS Community Demonstration project at the CDC studied the effect of developing and distributing AIDS awareness materials to urban communities, including Seattle, New York and Denver. That project targeted intravenous drug users, female partners of users, youth living on the street, commercial sex workers and men who have sex with other men but do not identify themselves as gay. Fishbein plans on launching a similar program in West Philadelphia. But first, he must gather information about the beliefs and behaviors of the community. "AIDS is a problem here," he said. "Once I get settled, I'll start doing my homework." Fishbein's projects are based on his theory of "reason action," which states that people's attitudes and social norms determine their beliefs. If Fishbein can change those beliefs, then he can change risky behaviors that lead to the transmission of HIV, the virus that causes AIDS. "Dealing with how to change the behavior of the community is appealing to me," Fishbein said. "It's a challenge." Education Professor Lorretta Jemmott also takes up that challenge, several blocks away. Jemmott is the director of the Center for Urban Health Research in the Nursing School and the principle investigator of a project designed to promote AIDS awareness. The Mothers and Sons Health Promotion Program is a $3.9 million project designed to teach single African-American mothers about HIV and help them talk with their teenage sons about AIDS-related issues. The goal of the project is to lower the entire family's risk of contracting HIV by learning about the disease. "We're empowering women to be able to talk to their sons," Jemmott said. "All they've got to do is show up on a Saturday." The program reaches 42 separate housing developments across Philadelphia, educating 630 women and their sons. Throughout the project, two mothers from each development come to the Nursing School for an intensive 10-day training session. These women then become "educators" for their developments and return to teach more mothers about AIDS and other sexually transmitted diseases at four weekly sessions. "It helps me get along better with my son," said Darcel Cobbs, a program educator at the Martin Luther King Housing Plaza. Talking about AIDS has become easier since the program, she added. Jemmott is currently expanding the three-year-old study to include grandmothers raising their grandsons. "You're never too old to learn," she said. The Patient Care Front On the same floor of the Nursing Education Building, Nursing Professor Linda Aiken is working to improve hospital care for AIDS patients, a study that could eventually prolong lives and increase patient survivability. Aiken surveyed AIDS patients in 20 hospitals around the country, comparing patients' satisfaction with the kind of care they receive. She found that patients in dedicated AIDS wards were more satisfied with their care than patients scattered throughout a hospital. Aiken also discovered that, on average, patients in these AIDS wards lived longer than patients without such specialized care. "If anything was going to be different in these specialized units, it was going to be nursing," she said. "[The units] are organized around a professional nursing model." These models place a greater emphasis on interdisciplinary care and patient interaction. They are also less impersonal. "Professional nurses know how to treat these kinds of things," Aiken said. "This is what nursing is: taking care of people who have all of these physical and emotional problems." During the study, Aiken also found that so-called "magnet hospitals" had the lowest overall mortality rate of AIDS patients, despite their lacking dedicated wards and specialized AIDS physicians. Indeed, magnet hospitals are like any other hospitals, except in their administrative organization. They give more control over patient care to the doctors and nurses, while the administrative offices make fewer of such decisions. The traditional hierarchy seen in most hospitals is reversed, according to Aiken. The findings from this study recently prompted Aiken to launch another research project designed to find out exactly what makes these magnet hospitals better at treating AIDS patients. The Biochemical Front A few buildings over, in Stellar-Chance Laboratories, Pathology Professor David Weiner recently discovered which HIV protein prevents cells from turning on the human immune system, a finding which could eventually lead to a drug to combat the onset of AIDS. The results, which appear in the October issue of Nature Medicine, show that the HIV protein called Vpr disrupts normal cell function in three ways: · Inhibiting the production of chemicals used by the immune system to start and control responses to infection. · Preventing the cell's death, so it can be used as a factory to produce more copies of HIV. · Killing "healthy" immune system cells near the infected cell. Weiner has also found that RU-486, the controversial drug which induces abortion, blocked Vpr from disrupting the immune system. He stressed, however, that this research was conducted within a test tube. RU-486 has not yet proven to be an effective way to stop HIV in human beings. In the past, Weiner was heralded for vaccinating chimpanzees against the virus that causes AIDS. But the practical implications of such a discovery were limited, considering the vast differences in simian and human physiology. Pathology Professor Robert Doms is also fighting AIDS on the biochemical level, but from a different front. He is looking for a way to block HIV's entrance into a cell. "If you can work out that mechanism, that might give you some ideas for treatment," he said. Doms found that HIV needs a molecule on cells' surfaces called CCR5 to penetrate the cell and cause an infection. "Approximately 1 percent of Caucasians simply don't have CCR5," Doms said. These individuals are therefore highly resistant to many forms of viral infection, including HIV. "If you look the world over, there are only three people in the world who don't have CCR5 who have AIDS," Doms said. A viable strategy for blocking AIDS would be binding a "decoy" to CCR5, thereby preventing HIV from finding a way inside the cell. "The fact that CCR5 appears to be dispensable to human health makes it a wonderful target for antivirals," he said. Much like those investigators before him, however, Doms has yet to find clinical evidence of a molecule which prevents an HIV infection. Skepticism About Success Jefferson University Medicine Professor Omar Bagasra thinks such evidence is a long time coming. "I think we may be jumping to conclusions because we're so desperate to find a vaccine or a cure," Bagasra said. "Ten years ago, when we found AZT [a medication which prolongs the lives of some AIDS patients], there were press releases all over the world claiming that we had the cure for HIV," he said. Bagasra said all aspects of AIDS research are important, considering that no single front is on the verge of a breakthrough. But still they continue to fight.