SINCE THE DISCOVERY of protease inhibitors, commonly known as antiretroviral “drug cocktails,” in 1995, much has changed for the nearly 850,000 Americans living with HIV/AIDS. A diagnosis no longer brings the spectre of rapid wasting, debilitation, and death.

But complacency can be disastrous when combatting an infectious disease as cunning and persistent as AIDS. Prevention efforts remain as important as medical treatments, say Emory researchers who are joining forces to fight the epidemic on all fronts.

“There’s a misperception that inhibitors are a cure: ‘If I pop these pills, I’ll have the disease under control. . . . I won’t have to wear condoms anymore,’ ” says Lawrence Bryant (above), a senior research coordinator for the behavioral science core of Emory’s Center for AIDS Research (CFAR). “The younger generation hasn’t experienced AIDS the way the older generation has–losing close friends every other day, seeing the disease manifest itself in its entirety. There’s not the same urgency to be safe as there was in the ’80s.”

As one of nineteen National Institutes of Health CFAR centers in the country, Emory has scientists from the fields of public health, medicine, statistics, virology, pharmacology, and immunology working to develop potential vaccines, prevention strategies, public health initiatives, and community-based programs, as well as providing comprehensive patient care.

In August, the Emory/Atlanta CFAR grant for $7.5 million was renewed for five years, and the University is supporting the center with an additional $1.8 million. Since being designated a CFAR in 1998, AIDS research funds to Emory have doubled, now totalling more than $45 million in grants.

This level of commitment and funding must be maintained, says Rollins School of Public Health Dean James W. Curran, CFAR’s director and principal investigator whose expertise in AIDS extends back twenty years to the first recognized cases at the Centers for Disease Control and Prevention. Speaking at the Fourteenth International AIDS conference in Barcelona this summer, which was attended by more than twenty Emory scientists and clinicians, Curran called for an “HIV revolution.”

“I hope for an effective vaccine to prevent HIV infection and I hope for curative therapy. I hope both [will be] readily accessible to the whole world,” Curran said. “But we must place a higher priority on HIV prevention. . . . My greatest fear is that our efforts will merely stay the same as now, and that the revolution will be won by HIV rather than by us.”

Internationally, the statistics remain staggering, both in lives lost and projections of future deaths: AIDS has killed twenty-two million people–a half-million of those American. It is now the fourth leading cause of death in the world. An estimated forty million people worldwide are living with HIV, with an additional eight thousand new infections a day. More than 800,000 babies worldwide were born with the AIDS virus last year, and many more are orphaned or lose a parent to the disease.

CFAR researchers at Emory’s Vaccine Research Center are working toward developing an effective HIV/AIDS vaccine. These include Mark Feinberg, director of the Hope Clinic in Decatur, where vaccines are given to volunteers; Rafi Ahmed and John D. Altman, internationally known for work in immunology; and Harriet Robinson, whose lab has developed a DNA-based AIDS vaccine that, after showing promise in primates, is moving into human trials.

Meanwhile, the School of Public Health has been building a strong core of behavioral scientists active in prevention. “We went from having a few stars in HIV/AIDS to one of the largest concentrations in the country just in the last five years,” says Kimberly Sessions, assistant administrative director of CFAR. “If you want to see what’s happening in cutting-edge AIDS research, you look at what’s happening at Emory.”

AIDS prevention researchers Ralph J. DiClemente, Charles Howard Candler professor of behavioral sciences and health education, and Associate Professor of Behavioral Science and Health Education Gina Wingood are trying to find effective ways to reduce HIV-risk behavior in adolescents, especially African-American females. “Our programs include an emphasis on ethnic pride, self-image, and self-awareness, as well as sexual health,” Wingood says.

And Professor of Behavioral Science and Health Education David Holtgrave, who joined the Rollins’ team last year from the CDC, has found through his research that the higher a state’s “social capital”–the level of trust, reciprocity, and cooperation among community members–the lower the rates of sexually transmitted diseases, including HIV/AIDS. North and South Dakota were first and second in social capital among the states ranked; Georgia was third from the bottom, above Mississippi and Nevada.

“With increased levels of social capital,” Holtgrave says, “it seems that risk behaviors go down and access to health services goes up.”

In addition to intensive research, Emory provides direct care to about six thousand people with HIV. Patients with HIV/AIDS are seen at five sites in Atlanta by CFAR clinical science faculty: the Ponce de Leon Center of Grady Health Systems, Grady Memorial Hospital, the Veterans Affairs Medical Center, Crawford Long Hospital, and Emory University Hospital.

At midtown’s Ponce Center, one of the largest and most comprehensive HIV outpatient treatment facilities in the country, Emory doctors and clinicians work with psychologists and other social scientists to ensure that their more than four thousand patients take their anti-retroviral medications exactly as prescribed.

“Skipped doses are worse than not taking anything, because they allow the virus to mutate and become resistant,” says Jeffrey L. Lennox, associate professor of medicine and CFAR director for clinical research. “If we don’t address patients’ social needs, they won’t be able to adhere to the regimens.”

Since 1993, the spacious, five-floor center in midtown Atlanta has housed Grady Health Care’s infectious disease clinic; a full-service pharmacy; dental, eye, and mental health clinics; nutritionists; child care; pediatrics; and social service agencies like Project Open Hand, Living Room, Atlanta Legal Aid, and the Department of Family and Children Services.

The Ponce Center also has a research unit, and enlists patient volunteers for research studies on enhancing treatment and care for HIV/AIDS patients. Lennox recalls a debilitated man who agreed to a regimen of experimental medications who is now a muscular brick mason working full time. “At first, there can be some distrust over research,” Lennox says. “But once they are involved and see the benefits, patients often enroll in several studies.”–M.J.L.