Needed: African-American organs Modifying risky behaviors to prevent HIV Lessons from Alu Man the Can Koplan named head of CDC

Stephen Thomas (left), Jennie Perryman, and Dean James Curran are co-chairs of the new commission, which will address a critical shortage of organ donations from African Americans in Georgia.

f the approximately 900 candidates waiting for transplants in Georgia, some 60% are African Americans. Yet, as the number of African Americans needing transplants has grown, the percentage of organ donors am ong this group has decreased. There is a higher percentage of blacks on the United Network for Organ Sharing waiting list than there are cadaveric donations from blacks. Yet, organs from African-American donors generally make a better match in compatibility for blacks needing trans plants than do organs from whites, contributing to the problem. The crisis created by the shortage of donors highlights a problem fueled by religious beliefs, mistrust of the medical research establishment, and misunderstanding about the benefits of transplantation, according to Stephen Thomas, principal investigat or of a new project funded by the Carlos and Marguerite Mason Trust. "The Georgia Leadership Commission on Organ Donation Among African Americans is designed to increase organ, tissue, blood, and marrow transplantation among African Americans in Georgia," says Thomas, an associate professor at the school and director of the Institute for Minority Health Research. The three-year project is a collaboration of the Rollins School of Public Health, Emory's Center for Transplantation, and community partners that include the American Red Cross, Clark Atlanta University, LifeLink of Georgia, the Mental Health Associati on of Metropolitan Atlanta, and the Association of Black Cardiologists. To accomplish its goal, the commission staff are conducting a national assessment of strategies designed to increase donations from African Americans. The commission - composed of opinion leaders from the African-American community, donor families, tra nsplant recipients, and organ procurement agencies - will conduct a national assessment of the best practice strategies to learn more about what works to overcome barriers to transplantation in the black community. This committee will also serve as the pr imary forum for public deliberation, making recommendations on how to disseminate the project's findings throughout Georgia. In addition to inquiries about behavioral strategies, the committee will seek answers to complicated scientific questions, such as 1) why a higher percentage of African Americans compared to whites are in need of transplants, and 2) why African-America n donors make better matches for African Americans who require a transplant. Other objectives of the project include establishment of a visiting lecture series designed to stimulate critical thinking about the social context in which blacks make decisions about organ donation. The commission will conduct hearings throughout Geo rgia to gather testimony from health care providers, opinion leaders, and patients to help determine the issues and challenges to African-American organ donation. Finally, the project will produce a training and dissemination module for transplant center coordinators, organ procurement outreach workers, and civic organizations to ensure that the lessons learned reach the citizens of Georgia. The commission also hopes to increase organ donation for both live and cadaveric black donors, including donations of blood, according to co-investigator Jennie Perryman, director of the Emory Center for Transplantation. "The decreased availability of blood from African-American donors often extends the time blacks spend on the waiting list for transplants," Perryman says. However, "the donor shortage problem in Georgia is a problem with a solution," says Thomas. "The Georgia Leadership Commission represents a significant step in increasing donations through the careful evaluation of existing programs and dissemination o f promising strategies." For the first time in Georgia, the project will apply a public health approach to this national crisis.

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Colleen DiIorio is the principal investigator of the Emory component of an NIMH Multisite AIDS Prevention Trial that showed researchers can have a significant impact on modifying sexual behaviors in populations at high risk for contractin g HIV.

he largest, controlled HIV behavior intervention study ever conducted in the United States has just concluded, showing that people at highest risk for contracting HIV and AIDS will significantly modify their risky sexual behaviors in response to behavioral interventions. The findings, published in the June 19 issue of Science, apply to people in underserved, lower socioeconomic groups. The National Institute of Mental Health Multisite HIV Prevention Trial enrolled primarily 3,706 African-American and Hispanic men and women in 37 inner-city STD and public primary health care clinics in seven sites around the nation. Emory University, the only site in the Southeast, enrolled 619 people from 1994 to 1996. Other study sites included Columbia, Rutgers, Johns Hopkins, Medical College of Wisconsin, and the University of California at both the Los Angeles and Irvine campuses. According to Colleen DiIorio, professor of behavioral sciences and health education at the school and principal investigator of Emory's contribution to the study, participants attended seven intervention sessions during a three-week period. Small group s of eight to 10 people met with male and female facilitators. They learned about the behavioral risk factors associated with HIV through activities that explored myths and realities of the disease, through role-playing that encouraged partners to use con doms or abstain from sex, and through demonstrations of correct condom use. By contrast, participants in a control group received a one-hour AIDS education session that included a videotape and question-and-answer session. The effectiveness of the interventions was measured using self-reported data in interviews at three, six, and 12 months after the intervention. Investigators also reviewed participants' medical charts for STD infections and conducted tests to detect ch lamydia and gonorrhea. The self-reported data included the number of unprotected sex acts, condom use, and sexual abstinence. During the 12-month follow-up period, gonorrhea incidence among men in the study group was half that of men in the control group. Study group individuals also reported fewer unprotected sex acts, had higher levels of condom use, were more likely to use condoms consistently, and reported significantly fewer STD symptoms. Those participants who attended the most sessions had the greatest change in behavior. "Although condom use was a major topic in the interventions," says DiIorio, "we also talked about not having sex, reducing the number of partners, or having sex only within a monogamous, committed relationship with a disease-free partner. Many people in o ur intervention groups reported limiting or eliminating sex during the period following the intervention and increasing condom use." To be eligible for the study of high-risk persons, participants had to have engaged in unprotected sex within the previous 90 days of enrollment and had at least one of the following during that time period: sex with a new partner or more than one sexu al partner, a sexually transmitted disease, sex with a partner known to have other sexual partners, sex with an injection drug user, or sex with a person infected with HIV. Seventy-four percent of the participants were African American, and 25% were Hispa nic. DiIorio believes the study demonstrates the people at the highest risk for HIV can be taught and encouraged to change their high-risk behaviors. "To control the AIDS epidemic right now, we have to encourage people to adopt safe behaviors," she says. Th e next step in this study is to test the results over a longer period as well as to take the intervention to the community through STD clinics, county health departments, and other related organizations.

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In her lecture, Audrey Gotsch emphasized that better environmental citizens tomorrow start with comprehensive health education today. She is shown here with Robert DeHaan.

t the Virginia S. DeHaan Lecture on Health Promotion and Education in May, speaker Audrey R. Gotsch, president-elect of the American Public Health Association, brought along a few friends to help deliver her talk. Her primary assistant was a computerized figure with a cylinder-shaped body and blue arms and legs that resembled straws. During the presentation, Alu Man the Can visited Nettie Newspaper, Mr. G - that's G for Garbage - and Benjamin J. Bottle III in a video that is part of an environmental health curriculum that Gotsch helped design. But behind the cartoon characters is a serious agenda. Gotsch, professor, department chair, and institute director at the Robert Wood Johnson Medical School, has been involved in the design, implementation, and replication of the environmental and occu pational health information program since 1984. The program includes an environmental health sciences curriculum to provide critical thinking skills for youth from kindergarten to 12th grade. "This is my vision," Gotsch told the audience. "Critical thinking skills for youth today will have an impact on environmental problems of tomorrow." Although parents support environmental education, often money is unavailable for such efforts. Even when funding is present, there is only so much time in the school day. Educators must find a way to incorporate environmental issues into other core cou rses such as math, science, and reading. The environmental health sciences curriculum Gotsch helped design has received the Secretary's Award for Outstanding Community Health Promotion, and one component, ToxRAP, which teaches children about toxicology, risk assessment, and pollution, won the 1997 National Environmental Education Achievement Award. The curriculum's success lies in its approach through illustrated stories, problem-based learning, games, case studies, and graphing, says Gotsch. By the end of this year, the curriculum will have reached 66,000 students.

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his summer, Jeffrey Koplan was named director of the Centers for Disease Control and Prevention (CDC). Previously the president of the Prudential Center for Health Care Research, which conducts health servic es and outcomes research, Koplan has had a 22-year career in public health, including service as an adjunct faculty member at the school. Beginning as an Epidemic Intelligence Service officer at CDC, he has served in a variety of roles there: as Assistant Surgeon General, assistant director of Public Health Practice, medical director of the Caribbean Center for Epidemiology, and the firs t director of CDC's National Center for Chronic Disease Prevention and Health Promotion. During his six-year leadership of the center, Koplan made chronic disease prevention and control a national public health policy, establishing a national women's breast and cervical cancer detection program that now reaches every state. He also was ins trumental in focusing attention on the global impact of the health hazards of tobacco. Koplan's "experience, leadership skills, and perspective suit him well for leading one of the world's most important public health organizations," says Dean James Curran. "As adjunct professor of epidemiology, he has provided advice to many of us at th e school, taught in our classes, and provided mentoring and jobs to our graduate students." His wife, psychiatrist Carole Koplan also serves on the adjunct faculty, teaching mental health.