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The Long Journey Deciphering an Epidemic

Tuesday, February 19, 2013
Yaakov Sullivan

Born to a family of physicians in Egypt, Dr. Wafaa El- Sadr, at Columbia’s Mailman School of Public Health and College of Physicians and Surgeons, came to understand at an early age that whatever career path she chose, it would have to have meaning and be of benefit to others.  After receiving her medical degree in her home country, she arrived to the United States to continue her work in infectious diseases.  Little did she know at the time what awaited her.

It is not often that doctors at the start of their careers find themselves in the midst of deciphering an epidemic. Yet that is exactly where Dr. Wafaa El -Sadr found herself in 1982.  The trajectory of the HIV virus, from then till now, is well documented, but back in the early 80s it was very much a mystery waiting to be solved.  Within a short time, a pattern evolved.  Doctors began seeing a rapid increase in the number of gay men who came in for treatment of very serious and startling symptoms.

These patients were not responding to existing forms of treatment.  Soon what Dr. El- Sadr had initially seen attacking a mostly male gay population began to move into other populations.  After her arrival to Harlem Hospital in 1988, Dr. El- Sadr began to see similar symptoms affecting drug users, women with transmission to their babies.  By this time, the medical community knew that AIDS was caused by a virus and that its spread would be the epidemic of their generation, one that would be around for a long time.

The first thing that needed to be confronted was the stigma associated with the disease, as well as the pervasive misconceptions about its transmission. Unlike the earlier population of largely gay men, who had a well organized and tenacious support and advocacy  system behind them, the affected  population in Harlem often found themselves alone, isolated  and poor, many unemployed without any kind of insurance. There were few to advocate for them. Those who came in for treatment were often highly suspicious of those offering any kind of assistance, recalling the legacy of abuse by researchers decades earlier.

Continuing  her work in Harlem, Dr. El- Sadr  came to recognize early on the need for developing a family/ community-focused approach;  that when dealing with HIV/AIDS and its partner, TB, an encompassing program was needed that would treat not only the patient but respond to family needs as well.   Her approach emphasized a holistic and multidisciplinary engagement in forming teams of health care providers who offered a wide range of services to the patients; including social support, substance use treatment, nutritional counseling as well as help with housing and financial needs.  The staff in the clinic where she worked became a sort of surrogate family establishing a welcoming environment for the patients which in turn, acted as an incentive in getting them more self involved and motivated  to complete their treatment. For example, infected mothers with children would often bring their babies into the pediatric HIV clinic but forget their own health care.  In response, Dr. El- Sadr and her colleagues set up the clinic so mother and child could be treated at the same time.

With the success of this union of treatment and prevention program in Harlem, while the disease was spreading globally, Dr. El- Sadr recognized the growing global need for confronting the HIV epidemic as it rapidly spread.  She went on to establish a network of similar programs across 14 sub-Saharan African countries.  They supported the establishment of the MTCT Plus Initiative (Mother to Child Transmissions), in Africa and Asia, building on the same family-focus approach. This Initiative was one of the first efforts that demonstrated that HIV care and treatment programs could be successfully established in some of the neediest countries around the world.  Building on this success, she established ICAP, a large center at the Columbia Mailman School of Public Health whose mission is to enhance the health of families and communities around the world.  With support from the US government, ICAP has enabled more than one million people living with HIV to access care and more than 800,000 have received life-saving treatment.  Dr. El-Sadr currently directs ICAP, with more than 1000 employees working in 20 countries around the globe.  As a visionary involved in changing the world, Dr. El- Sadr was awarded a 2008 MacArthur Genius Award.

“To Columbia I owe a deep debt of gratitude," said Dr. El-Sadr.  "It has given me the guidance, support and intellectual faith to embark on the long journey that has brought us here.”

After more than two decades on the frontline of combating this epidemic, Dr. El- Sadr continues to scale up her fruitful work which has saved or prolonging the lives of countless individuals around the globe who today no longer face a death sentence.  It has been a collaborative effort between ICAP and governmental and non-governmental agencies and academic organizations around the world, along with providers, patients, and communities.  She deeply believes that the lessons learned from the HIV response can and must inform efforts to confront other health threats. One thing is certain, whatever global health challenges present themselves in the future, the seminal work of Dr. El-Sadr and her team will serve as a model in both prevention and treatment.

Wafaa El-Sadr delivers her address titled "The HIV/AIDS Epidemic: Global Tragedy, Lasting Triumphs"

President Lee C. Bollinger and Provost John H. Coatsworth host the University Lecture
given by
Wafaa El-Sadr, MD, MPH, MPA
Director of ICAP and Director of the Global Health Initiative at Columbia University's Mailman School of Public Health
Professor of Epidemiology and Medicine at Columbia University's Mailman School of Public Health and College of Physicians and Surgeons

"The HIV/AIDS Epidemic: Global Tragedy, Lasting Triumphs"
More than sixty million individuals have been infected with HIV, and twenty-five million have died since the epidemic first emerged. Today, more than thirty-three million people around the globe are living with HIV-three quarters of them live in sub-Saharan Africa and more than a million reside in the United States. Having been thrust in the midst of an emerging epidemic thirty years ago, Wafaa El-Sadr, epidemiologist, physician, and global health leader, will reflect on the trajectory of the epidemic and its tragic impact on individuals and communities over three decades. She will share the remarkable scientific discoveries that have transformed HIV/AIDS from a death sentence to a chronic, manageable condition and reveal some of the profound transformative effects of the epidemic on individuals, families, communities, and health systems.