Tracing the Routes of HIV, Combating its Spread in Children

…It is one of the five leading causes of death in the world.

…Some 36 million people are infected worldwide.

…There are an estimated 40,000 new infections in the United States each year.

The statistics, of course, refer to the AIDS epidemic, a household word for Acquired Immunodeficiency Syndrome that was synonymous with isolation, pain and death when it was first discovered. In the early 1980's, it was an unknown agent that was attacking seemingly unrelated segments of the population – gay men, intravenous drug users, young children, and persons with hemophilia.

Long before Hollywood celebrities raised awareness of AIDS by donning red ribbons, a handful of EIS public health heroes combated prejudice, public apathy, government budget cuts, and bureaucratic red tape, to trace the early cases of AIDS. In the process, they identified the key risk factors, pinpointed the virus's transmission paths and raised awareness about how to safeguard against becoming infected.

One such EIS officer was Martha Rogers, a young pediatrician intrigued by the opportunity to work "with diseases of unknown origin." A 1976 graduate of the Medical College of Georgia, Rogers was assigned to CDC's viral disease program in July 1981, and became a key member of the CDC task force focused on the first cases of AIDS.

"CDC assembled many people with different types of expertise. The viral disease program was called to do a laboratory scan. I coordinated this effort, as various health departments sent us laboratory specimens. We were not clear on the cause of the disease, and were hoping to gain some clues through extensive laboratory testing," recalled Rogers.

Rogers was joined by EIS officers Harold Jaffe and Mary Guinan from CDC's sexually transmitted disease program, Harry Haverkos from the parasitic diseases program, Polly Thomas, an EIS officer assigned to the New York City Health Department, and David Auerbach, a Los Angeles-based EIS officer, to develop a case definition and to begin conducting national surveillance. Based on a case-control study completed in early 1982, "Analysis of the interview data clearly pointed to sexual activity as a key transmission path for acquiring HIV," recalled Rogers.

However, because the disease had initially struck only the gay population, many people in the general public considered the disease a "curiosity" and not something that affected them. That soon changed when EIS investigators detected the disease in children and in blood transfusion recipients beginning in 1982.

One of her more unusual and heartfelt investigations involved a mother who had acquired AIDS from her infant, who had contracted AIDS from a blood transfusion. The baby suffered from gastrointestinal problems, which exposed the mother to the child's secretions while caring for him. The toddler later died. The mother continues to live with AIDS with help from medication and has stayed in touch with Rogers over the years.

"I really admire this mother and others like her who were willing to talk to EIS officers and share with us their personal and often painful stories. They were willing to do this for the greater good, because often it was too late to help them or their children. They really contributed to the knowledge that HIV can be spread through exposure to blood and body fluids. This knowledge allowed us to come up with guidelines for universal precautions, now in widespread use in the medical and dental care system to prevent the spread of HIV," said Rogers.

For example, universal precautions include the proper disposal of anything contaminated with blood or body fluids, and the routine use of gloves in dentist offices, practices that didn't exist before HIV, according to Rogers.

After completing her EIS stint, Rogers continued at CDC for her preventive medicine residency and then joined the AIDS effort full time, focusing the rest of her career on eliminating pediatric cases of HIV. She helped set up the first surveillance system to track HIV in children. She studied the dynamics of transmission among populations of mothers and infants in the United States and in Africa. These data helped scientists formulate some of the first intervention strategies. For example, a now famous NIH-funded clinical trial, AIDS Clinical Trial 076, found that if a mother takes antiretroviral medication before and during childbirth, and her child is given antiretrovirals after birth, the child will have a better chance of avoiding HIV during birth.

Cases of pediatric AIDS in the United States have been drastically reduced, thanks to this preventive approach. While AIDS continues to ravage populations in Africa, advances in treatment have prolonged life for many in the United States. "People survive but at a price," Rogers said. "Antiretroviral medication can cause debilitating side effects, such as fatigue, anemia, nausea, and others, and viral resistance to the drugs can develop, making the drugs less effective. The challenges we face now are in developing new, more effective treatments and, even more importantly, on preventing infection in the first place – particularly among young people."

Rogers, a working mom with two teenagers of her own, believes reaching adolescents and keeping them from engaging in unsafe behaviors are the key to curbing the spread of HIV in the future.

"It's during their adolescent years that kids begin experimenting with adult behavior. If you can keep them out of trouble by educating them on the dangers of high-risk behaviors and the importance of safe behaviors, you have a good chance of keeping them healthy."

A senior scientist with CDC's HIV prevention program, Rogers has spent the past year working as a visiting scientist with the Task Force for Child Survival and Development, an organization affiliated with Emory University and dedicated to improving health and human development around the world. Rogers finds her current role at the Task Force an appropriate place given her longstanding interest in children's health issues.

"My work now really focuses on keeping kids from getting into trouble from a health standpoint," she said. "During my work in HIV, I saw a lot of people who had gone down a very bad path in life – a path of abusing drugs and being highly sexually active. If you wait until people have already adopted that kind of lifestyle, it's very difficult for them to change their behavior. Our goal should be to teach children and young people to adopt healthy lifestyles."

Of her more than 20 years spent on the HIV/AIDS epidemic, Rogers expresses a sense of satisfaction with her role in helping stem the spread of HIV among children, and in the hands-on education she received from some of the best epidemiologists at CDC. Her mentors were Jim Curran, who headed the AIDS effort at CDC in the 1980s, and EIS alumnus Harold Jaffe. Jaffe currently directs CDC's HIV, STD and TB laboratories, where he is focusing on developing more accurate, rapid tests that can detect all the new types of HIV as well as supporting CDC's work on HIV vaccines.

"They were very supportive, wonderful mentors who were very caring of me," said Rogers. "The EIS is very much a hands-on program. Mentors were how you learned. We were taught on the job – it's about seeing and learning as you're doing."

She concluded: "Most EIS officers go out on an epidemic, watch it unfold and they leave within a few weeks or months. My epidemic has taken place for more than two decades, and I am continuing to see it through. It has been enormously challenging and rewarding for me."