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Two Sides of the AIDS Coin

In working on the international AIDS crisis, two alums—an administrator in Washington, DC, and a health educator in
Africa—learn the same lesson: money can impact health.

E. Anne Peterson, MD, 94MPH, first experienced Africa as a fourth-year medical student working at a mission hospital in Kenya. “In places like this, once people are sick enough to go to the hospital, it’s usually too late,” she says. “I realized early on that preventing illness out in the villages was the only way.”

During the past 20 years, that crucial lesson in public health has guided Peterson’s illustrious career. Still in its early stages, that career has led from six years in Kenya as a health educator touting the importance of washing hands with soap and teaching HIV prevention skills to working with the leadership of the Virginia state health department during the anthrax attacks. In 2001, President George Bush appointed her assistant administrator for the Bureau of Global Health of the US Agency for International Development (USAID).

In that role, she helps millions of people around the world live healthier lives and is the only Bush appointee with extensive international health experience. She manages a budget of $2 billion in more than 70 countries, helps guide international health policy for the President’s administration, and reports her agency’s progress to Congress.

Peterson says that improving the health of entire nations is a difficult balancing act. “I have one foot in both doors,” she says. “Health is very political and controversial, and in a role like mine, you have to speak two languages. I have to translate the science for the politicians and the politics for the public health workers. Some would say these two roles are incompatible, but to get anything done, public health professionals must package public health issues so that politicians understand the real issues. We have to have our evidence lined up.”

Peterson encourages politicians and policy makers to base health policies on solid scientific evidence of what works. She also has incorporated economic analysis of health interventions and their impact, so politicians will see that sustainable public health projects reduce poverty and encourage economic development.

“I have worked to make public health functional and relevant by integrating epidemiology with behavioral analysis, health education, and culturally appropriate prevention programs,” she says. “Our goals at USAID are to provide technical assistance in the field, research to help countries make good funding choices, and global leadership on the gamut of public health issues.”

Peterson’s enthusiasm for her job can hardly be contained. “This is by far the hardest job I’ve ever had, but in this kind of position you really are able to see and measure your successes. That is very rewarding.”

One of her biggest challenges concerns the international AIDS crisis and the many political issues surrounding it.

“We know what to do with AIDS prevention,” she says. “We just need the dollars. We’ve been underfunded for the amount of need. The resources have just not been big enough to turn around national-level numbers for the most part.”

The other side


Rebecca Vander Meulen takes a sample from a latrine for analysis in Mozambique, where she helps provide seminars on preventing and living with HIV.

 

Rebecca Vander Meulen, 03MPH, has lived in a remote province of Mozambique for just seven months, and already, she has learned the power of money—or lack of it—to impact health.

She works with a small Mozambican organization that provides seminars on preventing and living with HIV. “Our biggest challenges are organizational––delegating responsibilities, managing finances, and setting priorities,” she says. “I'm seeing how management fundamentally links donor aid and health. I've seen that just a little money, well managed, can contribute to lots of improved health, and that a lot of money, poorly managed, can do nothing for health.”

For Mozambicans, the daily challenges of living in poverty overshadow the comparably distant danger from mounting threats like AIDS. “The better I get to know my Mozambican friends, the more amazed I am at their daily persistence in the face of deep poverty,” she says. “I am amazed by the complicated world in which they live, in which on-the-job preoccupations revolve around spreadsheet formatting and organizational issues and their at-home preoccupations are repairing leaky straw roofs and finding money for coal to heat bath water.”

One in six people in the country is said to be infected with HIV, and the problem is growing. The province where Vander Meulen works, Niassa, has one of the country’s lowest prevalence rates, about 1 in 15, because of its particular isolation. “While this is great news,” she says, “in terms of prevention, it can be a challenge. People have trouble believing that HIV actually exists because it’s asymptomatic for so long. Compared with much of southern Africa, relatively few people have actually died of AIDS here. And many of those who have died while infected with HIV have actually died of the same things that have always killed people—malaria, tuberculosis, and diarrhea.”

In fact, some of the most difficult struggles of many HIV-positive Mozambicans are related to poverty, not HIV. As the disease progresses, the financial situations of the patients’ families usually goes from bad to desperate, she says.

The moral and financial dilemmas of turning around the AIDS epidemic on a large scale are enormous and must be confronted with care, says Peterson, especially with regard to providing antiretroviral (ARV) drug treatment to developing countries.

“It is unacceptable that we have a disconnect between what we do and expect for ourselves in our own country and what we expect to be done in other countries,” she says. “We need to provide ARV treatment to everyone, but we need to do it carefully. It can work in Africa. Data has shown Africans have better compliance with complicated drug regimens than Americans. But we have to be careful not to divert money and resources from prevention and other clinical care for those with AIDS. Because the key to the AIDS epidemic continues to be preventing new infections.”

Prevention programs must be proven effective and manageable on a large scale for politicians to decide to fund them, Peterson says. “Some very basic public health measures have taken a long time to implement on a large scale. Simple things like clean water storage and vitamin A supplementation were only proven in small isolated pieces. The research on any public health issue cannot be considered complete until it is shown to work on a national scale.”

The big picture
But the close-up shot is important too, says Vander Meulen. Without it, politicians will forget that public health is about people more than numbers. She is learning this lesson in much the same way as Peterson—“on the ground” amidst the grinding poverty of Africa, serving witness to the complicated interplay of humanity and disease.

Both women say their experiences at the Rollins School of Public Health (RSPH) were invaluable. “Funding from the Gangarosa award allowed me to conduct my thesis research here in Mozambique between my first and second years in the MPH program,” says Vander Meulen. “For an international health student, there’s nothing better than first-hand experience. My summer in Mozambique shaped how I read articles and listened to lectures during my second year at RSPH. It also brought me back here to live and work after graduation.”

Peterson, who was awarded the RSPH Distinguished Alumni Achievement Award in 2003, agrees. “RSPH has an incredible richness of people and resources because of their close relationship to the CDC,” she says. “As a student I worked on a study on soap use and its effect on diarrhea in refugee camps. It showed a 23% decrease in diarrhea when soap was used consistently. I later published it and several years later at USAID, a health officer told me they still consider that study a classic. The lasting effects and the importance of the work I had the opportunity to do as a student at Emory were amazing. These opportunities show students how they really can make the world a healthier place.”

By Valerie Gregg, a freelance writer in Atlanta and a former editor of this magazine.


Spring 2004 Issue | Dean's Message | News Briefs | The Straight Story
Disease Detective | Instamatic Informatics | Veteran Epidemiologist | The Human Strain
Expelling the Fiery Serpent | Corps Class | Class Notes | Rollins School of Public Health

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