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Residency program at Brigham draws in students


Tackling AIDS in Lesotho
Howard Hiatt Physician
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Three years ago, Jim Kim was approached by the then new head... two years, two... over two-and-a-half years ago, Jim was approached by the then new head of the World Health Organization, JW Lee, and asked whether he would come to Geneva to set up an AIDS program. The World Health Organization had done very little in this realm, and Jim agreed to go, set up what he termed a 3x5 program, that is, a program in which 3 million people in... in impoverished communities, particularly in Africa, would be in treatment for AIDS by the end of 2005. That goal wasn't achieved. Jim never... Jim believed that it wouldn't be, but he felt that setting that goal that high would really lead people to take the effort seriously.

By the end of 2005 the number of people in treatment for AIDS in Africa had increased from a few thousand to over a million and it seems absolutely clear that that 3 million figure will be reached in a reasonable period of time. Well, reasonable is the wrong word. It can't be reached early enough, but we're on route to reaching it. The... the program at the Brigham, which I don't think I mentioned earlier, the program at the Brigham which is called the Division of Social Medicine and Health Inequalities is really the... the base for the physicians who are in the program, and these physicians come here for training, come here for some of their research activities and consulting others, and then go back into the various sites where we've been working.

I mentioned Rwanda. When Jim... before Jim left, Jim left the World Health Organization in the latter part of 2005 and rejoined the Division of Social Medicine and Health Inequalities and Partners of Health here in Boston, before he left the WHO, he had persuaded the king of Lesotho, a small country located within South Africa, to address the AIDS problem and the king agreed that he would test all of the pop... the entire population of Lesotho and offer treatment to those people who were found to be infected and in need of treatment - with HIV - and in need of treatment. Jim agreed that we would help, we, in the Division and in Partners in Health, would help in that effort and the Clinton Foundation had already agreed to provide the medications there.

Very early after his return, Jim suggested to Dr Jen Furin, another one of our remarkable young physicians, a woman who was trained as an anthropologist as well as a physician, to go to Lesotho to attempt to assess the situation there, determine what would be required in order to mount a nationwide program and, perhaps, if she were willing, to lead that program. Jen came back within a few weeks and reported that the country, with a population of 2.5 million, is one that consists of grandmothers and orphans, a country that she was told, in the absence of intervention, will cease to exist in 20 years.

We did agree, of course, to join the king, join the Clinton Foundation and Jen agreed to oversee our program there. She's there now full-time. There are others of our physicians who rotate through. We have an administrator who's gone out to work with her, and the Clinton Foundation is actively involved.

If, when that country has every patient with AIDS in need of treatment under treatment, the effect on the... the South Africa, on the nation of South Africa that surrounds it, could be of great importance. The people, the men in Lesotho all, virtually all, work in South Africa and then return at infrequent intervals to be with their families. The presence of a country within, within it offering treatment to the entire nation cannot but have very important effects around, around it and throughout all of Africa.

The Clinton Foundation has also agreed to go into Malawi, another country in South Africa, in... in the south of Africa, and we've agreed to, to join in that effort as well. So, our activities, using the Farmer and Kim approach, community health workers, nurses, doctors, that activity is underway and attracting a lot of attention on, on the part of, of our young colleagues but, and equally important, a lot of attention on the part of those people who can help support what's going on, because that support is urgently needed.

Born in 1925, American Howard Hiatt set up one of the first medical oncology research and training units in the US and has headed up some of America's most prestigious medical institutions. Hiatt attended Harvard College and received his MD from the Harvard Medical School in 1948. He was a member of the team at the Pasteur Institute, Paris, that first identified and described mRNA, and he was among the first to demonstrate mRNA in mammalian cells. From 1991 to 1997, he was Secretary of the American Academy of Arts and Sciences, where he began and directs the Academy's Initiatives For Children program. He is also committed to helping disadvantaged people access decent health care.

Listeners: Milton C. Weinstein

Milton C. Weinstein, Ph.D., is the Henry J. Kaiser Professor of Health Policy and Management at the Harvard School of Public Health and Professor of Medicine at the Harvard Medical School. At the Harvard School of Public Health he is Academic Director of the Program in Health Decision Science, and Director of the Program on Economic Evaluation of Medical Technology . He is best known for his research on cost-effectiveness of medical practices and for developing methods of economic evaluation and decision analysis in health care. He is a co-developer of the CEPAC (Cost-Effectiveness of Preventing AIDS Complications) computer simulation model, and has conducted studies on prevention and treatment of HIV infections. He is the co-developer of the Coronary Heart Disease Policy Model, which has been used to evaluate the cost-effectiveness of cardiovascular prevention and treatment. He is an author of four books: Decision Making in Health and Medicine: Integrating Evidence and Values; Cost-Effectiveness in Health and Medicine,the report of the Panel of Cost Effectiveness in Health and Medicine; Clinical Decision Analysis; and Hypertension: A Policy Perspective.He has also published more than 200 papers in peer-reviewed medical, public health, and economics journals. He is an elected member of the Institute of Medicine of the National Academy of Sciences, and a recipient of the Award for Career Achievement from the Society for Medical Decision Making. Dr. Weinstein received his A.B. and A.M. in Applied Mathematics (1970), his M.P.P. (1972), and his Ph.D. in Public Policy (1973) from Harvard University.

Tags: Lesotho, South Africa, Africa, World Health Organization, Division of Social Medicine and Health Inequalities, Clinton Foundation, Malawi, Jim Yung Kim, Jen Furin

Duration: 7 minutes, 19 seconds

Date story recorded: September 2006

Date story went live: 24 January 2008