Global Health Chronicles

Dr. James Curran (Part II)

David J. Sencer CDC Museum, Global Health Chronicles
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0:43 - International Cases/ Haitian refugees

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Partial Transcript: In 1983, that's about two years after the first cases were reported to CDC, there were a number of meetings in Europe in the spring and later in the fall, where European participants presented their cases of this new syndrome...Can you describe your thinking about these early cases in Europe as you were hearing them?

Segment Synopsis: Dr. Curran relates these early European cases as cases coming from Central African countries to their colonizing nations for treatment. After the 1983 meetings, cases found amongst Haitian migrants were eerily similar to those of Central Africa, which led the theory of heterosexual transmission. Curran illuminates the controversy of identifying an entire nationality as a risk group and notes that at that time, most of the cases being reported from Florida were among the Haitian population.

Keywords: 100,000; accurate surveillance; African migrants; attribute; autocratic dictoral rule; case definition; compatible; conditions; early indication; economic and social disaster; epidemic in Africa; epidemic of AIDS; equal incidence rate; first pattern; gay men; gender; Haiti to Florida; Haitian migrants; Haitian refugees; Haitians; heterosexual men; heterosexual spread; heterosexual transmission; heterosexual transmission epidemic; higher rate; identify Haitians group; injecting drug users; J. Duvalier; major cities; male-female ratio; men with AIDS; migrants; migration; mode of transmission; Montreal; new epidemic; new occurrence; New York City; New York [City]; no real proof; not occurring; P. Farmer; political refugees; political turmoil; Port-au-Prince; previous Haitian immigrants; refugee migration; sexual partners; sexual transmission; similar; Toronto; women; wrong

Subjects: Africa; AIDS [acquired immunodeficiency syndrome]; Belgium; Cameroon; CDC [Centers for Disease Control and Prevention]; Central Africa; Europe; Florida; France; Haiti; Kaposi's sarcoma; STD [sexually transmitted disease]; United States; Zaire

7:24 - AIDS in Zaire/Projet SIDA

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Partial Transcript: Now, 18 of the cases came from Zaire and nine from so-called Congo Brazzaville, so Central Africa. Did CDC have staff working in Zaire at the time? What were we learning about this burgeoning epidemic in Central Africa?

Segment Synopsis: Dr. Curran shares CDC's history with Zaire during the first Ebola epidemic in 1976 and how from that, a strong relationship with the ministry of health formed. A team from CDC, NIH, and the Institute of Tropical Medicine Antwerp went to Zaire to do an initial survey and found high incidence of opportunistic infections. Although different from the diseases that were affecting the United States, there were strong similarities of immunosuppression and the physical characteristics of wasting syndrome. Finding a loophole in the budget allowed for Curran's team to form Projet SIDA.

Keywords: 1976; before; budget; chief lab technician; childhood diseases; couldn't be done; cytomegalovirus; developing countries; didn't have; disseminated toxoplasmosis; dying; eclipsing; epidemiology of the disease; establish; extensive tuberculosis; hallmark diagnosis; infectious diseases; initial survey; international budget; investigation; J. McCormick; Kinshasa; land-wise; largest country; leading cause of death; looked the same; M. Banga; main hospital; mining of minerals; ministry of health; not seen; open lung biopsy; original Ebola virus epidemic; P. Piot; population-wise; project in Kinshasa; research; retinitis; S. Mitchell; similarity in the faces; T. Quinn; vowed almost immediately; wards; wasting disease; young men; young women

Subjects: Belgian Republic of Congo; Belgium; CDC; Central Africa; Democratic Republic of Congo; Ebola River; Kaposi's sarcoma; Mama Yemo Hospital; NIH [National Institutes of Health]; northern Zaire; Pneumocystis carinii pneumonia; United States; Zaire

12:43 - Dr. Jonathan Mann

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Partial Transcript: To head up this Projet SIDA, you ended up recruiting [Dr.] Jonathan Mann...What was he like?

Segment Synopsis: Dr. Curran delves into the attributes of the late Dr. Jonathan Mann calling him a force of nature. Due to his proficiency in French and want to try new things, Mann jumped at Curran's offer to work in Zaire. Mann was pronounced project director, and by the end of his two years in Zaire he has published over twenty peer-reviewed articles.

Keywords: 110 percent of control; 80 percent of the budget; clinical person; EIS officer; experimental HIV tests; first two years; fluent in French; H. Francis; J. Conrad; J. Mann; J. McCormick; laboratory director; major language in Zaire; Paris; project director; published 22 or 23 peer-reviewed articles; R. Colebunders; state epidemiologist; two years

Subjects: EIS [Epidemic Intelligence Service]; Harvard College; HIV [human immunodeficiency virus]; Institute of Tropical Medicine [Antwerp] at Belgium; National Institutes of Health; New Mexico; Projet SIDA

18:07 - Relationships

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Partial Transcript: How did it go with regard to the Zairois, the Congolese Ministry and hospital leadership? What was the relationship with Projet SIDA and the country?

Segment Synopsis: Dr. Curran reveals that the initial relationship with the Zairois was very welcoming and accepting even though Zaire was ruled by an autocratic dictator, Mobutu. Curran reassures that the Ministry of Health was easy to work with and they recruited outstanding native Zairois doctors for Projet SIDA. Dr. Curran continues on to describe the early findings that came out of Zaire, such as the link between household contacts and the relation to HIV and malaria.

Keywords: A. Greenberg; AIDS in Africa; arthropod-borne transmission; Atlanta; B. Kapita; beginning; blood transfusions for malaria; cardiologist; chief of medicine; childhood malaria; close; closely associated; cohort studies; concerns; country fell apart; crumble; developing world; difficult country; EIS officer; English; evidence; first international conference; household contacts; J. Mann; key representative; keynote speech; lack; M. Banga; Malaria Branch; men to women; native; not sexual and not birth contacts; Paris; physicians; project; R. Ryder; receiving blood transfusions; recruit; relationship between HIV and malaria; sexual contact; sexual transmission from women to men; showed no evidence; studies; talent; terrific; terrific information; top notch; tryanny; two or three hundred people; W. Heyward; Zairois; Zairois doctor

Subjects: HIV; Mama Yemo Hospital

22:36 - Budget/Funding

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Partial Transcript: In terms of CDC's support of this international work or the HHS [Health and Human Services] support of this international work, was that an issue at that time? Were you using domestic funds?

Segment Synopsis: When the AIDS epidemic was just beginning, Ronald Reagan was President and had instituted a hiring freeze. Dr. Curran reveals that in order to get the program in Kinshasa set up, he explained to public health leadership that epidemiological monies could be utilized better in Zaire as "more could be learned there for the same amount of money." By maneuvering his way through the bureaucratic process, Curran was able to implement an unofficial international program.

Keywords: couldn't; detail EIS officers; epidemiologic investigation money; epidemiologic investigations; funding freeze; hard-to-fill positions; hire people; hiring freeze; learned there; more; R. Reagan; same amount of money; short; spent in Zaire; statisticians; surveillance initially; unfortunate; W. Foege

Subjects: CDC; Reagan administration; Zaire

24:15 - Second African Site

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Partial Transcript: Moving to a second international site, and that was Projet RETRO-CI, which was a site in Côte d'Ivoire...Can you tell us a little bit about that and what led to the idea of actually having a second site in Africa?

Segment Synopsis: Dr. Curran shares that Projet RETRO-CI was created out of the concern that the recently discovered HIV-2 virus could cause a completely different epidemic. During the 1976 Ebola outbreak in Zaire, Dr. Kevin DeCock found a high prevalence of a viable virus to HIV in the blood supply. Ten years later in the same village, the prevalence rate was almost the same. Dr. Curran believed DeCock the best candidate to lead the Côte d'Ivoire project due to his experience and affinity for working in Africa. The findings from studying HIV-2 showed that it was more stable and less virulent than HIV-1.

Keywords: 1976; almost the same; appealing site; blood samples stored; blood supply; blood test; collaborators; colleague; discovered; Ebola outbreak; EIS officer; epidemic; epidemic pathogen; guarantee; HIV-1 overwhelmed; HIV-2 stayed; J. Mann; K. DeCock; learn much more; less prone to epidemics; less transmissible; less virulent; London; M. Banga; major commitment; malaria; mid '85; number two; other countries; pathologist; political instability; potential instability; preceded; predominatedly CDC; prevalence; project in Zaire; R. Ryder; reason number one; regime; resources; S. Lucas; screen blood donations; screen out HIV-1; seminal studies; similar; stable; studies; survey; sustainable plan; the ministry; totally different virus; tuberculosis expert; viable virus; village in Zaire; virus

Subjects: Belgium; CDC; Côte d'Ivoire; France; HIV-1; HIV-2; Institut Pasteur; Kenya; north and western Africa; Senegal; United States; World Health Organization Global Program on AIDS

30:13 - Cultural Differences

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Partial Transcript: Can you tell us a little bit about the sexual mores in Côte d'Ivoire—how that might have compared to those in Zaire?

Segment Synopsis: Dr. Curran describes Abidjan as an international hub, a multi-national hot spot where non-CDC staff were from 10 or 15 different African countries. Whereas in Kinshasa, about 200 native Zairois compiled the non-CDC staff. Curran explains that Abidjan's popularity amongst African migrant workers and tourists caused the prevalence rate to more than double the prevalence rate of Kinshasa in a matter of years. Dr. Curran attributes the positive collaborative process to the previous CDC projects on the African continent.

Keywords: 10 or 15 different countries; 10 or 15 expatriates; 200 Africans; Abidjan; affect; Africans; deal with problems; destination; double Kinshasa’s prevalence; eradication of smallpox; expressways; faster; great collaboration; great success; Guinea worm; half a dozen; immunization programs; international destination; Kinshasa; low prevalence; migrated; migrating populations; Paris of West Africa; population; reputation; spread; staff in Kinshasa; tourism; tourist town; urban areas; virus; willing partners; working in Africa

Subjects: Africa; Cameroon; CDC; Côte d’Ivoire; Ghana; Nigeria; PEPFAR [U.S. President’s Emergency Plan for AIDS Relief]; Zaire

33:47 - Thailand program

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Partial Transcript: Moving along, in 1990 CDC formalized an existing relationship with the government of Thailand to form the CDC/Thai HIV collaboration...Why Thailand?

Segment Synopsis: Dr. Curran explains an explosion of HIV, the multiple United States institutions already in Thailand, and a strong higher educational system made it an easy choice to set up an AIDS program. Curran goes further to share that the proximity to the Golden Triangle meant a higher prevalence of injecting drug users. The open sexual culture of Thailand also played a major role in the heterosexual epidemic. But with the governments support for AIDS prevention and education, the frequently visited Thai brothels implemented 100% condom-use policy.

Keywords: African sites; AIDS education; AIDS epidemic; B. Weniger; beggars; blood supply; cabinet minister for AIDS; capacity clinically; capacity medically; commercial sex workers; common brothel use; concern; condom distribution; condom use; conducting studies; different; drug use; drug users; epidemics; explosion of HIV; family planning; famous minister; global AIDS epidemic; good reputation; head of Thailand; heterosexual epidemic; heterosexual populations; higher education system; HIV prevalence; increasing incidence; injecting drug users; jailed; king of family planning; learn; long history; long-time collaboration; M. Viravaidya; Mechai; mid-range income country; military; military recruits; nickname; only country; open communications; open sexuality; population control; princes; reduced the incidence; released them; serosurveys; successful; testing; tropical diseases; TV shots; vaccine trials; volunteered; widespread brothels

Subjects: AIDS; Burma; CDC; Field Epidemiology Training Program; Golden Triangle; ministry of health [Thailand]; National Institutes of Health; NIH of Thailand; Szechwan China; Thailand; U.S. Army; Vietnam; Walter Reed [Walter Reed National Military Medical Center]

39:05 - Mother-to-Child Transmission

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Partial Transcript: So much important work was done in Thailand, [such as] prevention of mother-to-child transmission and others. Can you reflect on what you think some of the highlights were?

Segment Synopsis: Dr. Curran describes the highly controversial yet breakthrough study of the AIDS 076 Trial in which HIV-infected mothers were taking AZT as to not pass the disease to their children. Curran describes the study as highly controversial since it used a placebo control to see what simplified regimen would work for developing nations.

Keywords: AIDS 076 Trial; anxiety; AZT [azidothymidine]; breakthrough study at the time; Canadians; controversial study; D. Satcher; developing country; Director of CDC; Director of NIH; don’t deliver in hospitals; during labor; evoked commentary; highly active antiretroviral therapy; last stage of pregnancy; M. Angell; newborns; placebo control; pregnant women; reduce perinatal transmission; scrutiny; simplified regimen

Subjects: Agence Nationale de Recherches sur le SIDA [ANRS]; France; INSERM [the Institut National de la santé et de la recherché medicale]; New England Journal of Medicine; Thai government

41:21 - International Activity

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Partial Transcript: Somewhere around the early '90s, you actually created an international activity in your AIDS division. What led you to that, and was there support for that in the agency?

Segment Synopsis: Dr. Curran explains that domestic studies and international studies require different institutional support, such as visa concerns. Curran states that by creating an international activity, CDC staff were able to get more involved in different areas they normally would not have been involved in.

Keywords: anxious; assigned; Atlanta office; bumps; conducting studies; controversial; currency valuation and exchanges; development; different expertise; different parts of CDC; different type; domestic studies; focus; good; higher-ups at CDC; involved; our own staff; our views; protocol; required; short-term consultations; staff of others; support; support these studies; times; visas

43:20 - Collaborative relationships

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Partial Transcript: Any thoughts about CDC's collaboration with WHO during some of the early years?

Segment Synopsis: Dr. Curran reveals that CDC and WHO have been working together since CDC was known as Malaria Control in War Areas. Curran attributes the continuance of a good relationship to Dr. Walt Dowdle's connections at WHO and how Dr. Jon Mann was able to grow the Global Program on AIDS into WHO's largest program in their history.

Keywords: CDC’s beginning; Director General of WHO; F. Assaad; H. Mahler; J. Mann; largest program; malaria control; recruited; W. Dowdle; WHO’s history

Subjects: CDC; Global Program on AIDS; WHO

44:18 - International Legacy/Closing thoughts

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Partial Transcript: Someone said that CDC's AIDS work and its international AIDS work changed the face of CDC. Can you comment overall on that and on CDC's international work on AIDS in particular?

Segment Synopsis: Dr. Curran shares his belief that AIDS changed global health as a whole, which effectively will change any public health institution such as CDC. Curran relays that CDC has always been active in international work beginning with malaria control and continues with programs like PEPFAR, which has made a commitment to indefinitely diagnose and treat those around the world. Curran concludes the interview by sharing to not underestimate the presence AIDS has in ones life.

Keywords: AIDS epidemic; budget; CDC employees; CDC’s work; Center for Global Health; central; changed; changed each of us; changed the world; concern; developed world; developing world; diagnosing and treating; engaged; field workers; first recognized; global health; global work; global world; immunization efforts; indefinitely; interest; international epidemic problems; involve; knowledgeable; L. Zyla; largely not domestic; late 1940’s; lifeblood; malaria control efforts; migrated; millions of people; new disease; scientist; see the world; smaller and smaller; smallpox eradication; staff; stronger international influence; T. Frieden; then; thousands of scientists; U.S. citizen counterparts; workers; world; worldwide advocacy

Subjects: AIDS program; CDC; HIV; malaria; PEPFAR; smallpox; southern United States; TB [tuberculosis]; United States