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Curran: It is pretty humbling when you think about it.
Harden: I am thinking of the term that David Henderson used. It was “lightning rod,” in the sense that you and Bob Gallo and Tony Fauci were very public figures who spoke about AIDS, frequently on the television. Did this have any impact on your personal life?
Curran: At first, I was the most visible. Then Gallo became the focus of attention. And then Fauci became the central spokesperson and stayed there. My visibility was dimming by that time.
Harden: You never had any friends who refused to have dinner with you because you worked with AIDS?
Curran: I have had a lot of personal experiences, but my wife has never worried about it. I had staff that died of AIDS, and I also had staff that, before the virus was discovered, got needle sticks during the investigations. They were really panicked, and their spouses were panicked.
Actually, I had fairly severe sinusitis when the epidemic first started, and I had a brutal travel schedule and did not take care of myself. I was coughing all the time. I would get up to speak and I would have a sinus headache. I would show these X-rays of people with Pneumocystis. And I would be coughing and coughing. I would go from meeting to meeting around the country coughing. I knew it was sinusitis, but I think sometimes people thought that I might have had Pneumocystis.
No, I did not feel personally threatened. An ironic thing was that my phone number had been listed in the directory all those years. I never had an unlisted phone number. I never had people come to my house and break my windows or anything like that. In fact, I received a couple of awards from the gay community, in 1982 and 1983, when they were really upset with the government.
During the time of the women's issues case definition, Tony Fauci and I, but especially me, were the enemies of ACT UP. I got 20,000 postcards, with my picture with a target on it. A lot of them came to my house. I went to conferences and got spit on a few times, and there were protesters at some of the public appearances.
Harden: Did the CDC have pickets?
Curran: Yes, we had pickets, people in our offices. I used to hang the postcard target up in my office. I had an award from the Atlanta Business and Professional Guild, which was a euphemism for the Atlanta gay business community. They gave me that award in 1982, and then my staff, when I moved from one job to another, gave me a blowup of this target with my picture on it. I put that underneath that award in my office.
I did that to show that the award and the target post card came from essentially the same community, and I was the same person. But it really was not personal. I was getting the award for what the CDC did early in the epidemic. And I was getting blamed for what the Reagan Administration would not do, that is, provide Social Security benefits to people with AIDS. The gay community wanted the case definition of AIDS changed so that the Social Security Administration would be forced to provide those benefits. It had nothing to do with surveillance. Of course, people in the gay community, even in ACT UP, did not distinguish my surveillance responsibilities from the Reagan Administration's policy decisions. They just decided that I was the person they saw dealing with AIDS, so I was the target. My son got the postcards in the mailbox, and he was an adolescent and did not like this, so he wrote “F–- You“ on a couple of them in the back, just to see if he could get me upset. Sometimes my wife would get them from the mailbox and would say, “This is really getting out of hand.”
Harden: It is hard if people spit on you.
Hannaway: Yes, I would be pretty upset.
Curran: At a meeting that Tony Fauci and I went to in Washington, a Women and AIDS Conference, I was the designated target. I got up and gave what I thought was a very heartwarming, pleasant, informative speech. And, of course, they were all screaming and yelling.
Curran: Then I had a big public affairs bodyguard, a huge guy. A few women followed me out. They were not big women, but they were angry, and the cameras were all around. They were spitting at my face. The idea was that I was supposed to react in some way so it would look like I was hitting them or doing something. But the real problem was I could not go to the meeting. They kept me in a Washington hotel room for my own safety.
In Amsterdam, I had ACT UP Europe angry at me for the same reason, and that was because of the case definition of AIDS. The case definition was really related to Social Security benefits.
Harden: Yes, I wanted you to continue on about that.
Curran: It had nothing to do with anything in developing countries, but the activists claimed that our case definition was killing women in Africa due to poor surveillance, which, of course, made no sense. I gave several talks, and after I gave one talk, when they were all standing and screaming at me, I agreed to meet with them afterwards in the ACT UP conference room. Now, the interesting thing was that the CDC did not have a conference room at the meeting, but ACT UP had this beautiful conference room. They had become “corporatized“ activists. Some of them did not speak English. Maybe it is a new form of activism, but fundamentally it was not personal.
Harden: Tony Fauci was telling us that Larry Kramer insulted Tony's wife at some point, and Fauci said, “He has spent the last 10 years trying to make up for that insult.” Kramer said that it was not personal either but it was what he had to do as an ACT UP person.
Curran: Remember Ellen Cooper, who is now at OAR? At the time I am speaking about, she was at the FDA. She was in charge of approving drugs at the FDA. The activists were very hard on her, and she decided to leave government. Well, the activists relented and claimed that Ellen was the best person they had ever worked with. Not being in Washington, I experienced less personal activism here in Atlanta. I am sure that if I had been in Washington or New York, I would have been more likely to have people actually picketing my house. But I was always there for them to talk to. I did not go away. I would go to meetings and talk with them.
Harden: Did we do the right thing by not employing some of the traditional public health contact tracing and not publicizing the names of people who were infected? There is one recent case that is very upsetting–the case of the man in New York who was going around infecting high school girls.
Curran: There is a misconception about what constitutes traditional public health methods. First of all, we have the STD Control Division. There are 25 or 28 STDs. The only STDs that ever had any public support for contact tracing in the United States were gonorrhea and syphilis. Most recently, there has been some funding for chlamydia control. These are all bacterial infections that could either be prevented or treated easily with one shot of antibiotics or one pill, or sometimes a slightly longer regimen and, hence, identification of contacts offered some direct benefit.
Contact tracing has never been actively done traditionally with hepatitis, with herpes, cytomegalovirus infection, amebiasis, trichomoniasis, or most others. But it is the gonorrhea-syphilis mentality in venereal disease that people remember. They are thinking back to the Thomas Parran era and how they treated syphilis then. They think that syphilis is the venereal disease. How we treat syphilis ought to be how we treat everything; and that is the standard by which everything is set. Nowadays people do not even do contact tracing for syphilis uniformly. In fact, STD prevention and treatment has long been neglected.
So when people say, “Why don't we treat AIDS like other STDs," from my 10 years in STDs, I would say, “What do you mean, ignore them?" That is the way we treat other STDs. We ignore them.
Harden: That is interesting.
Curran: The question is, “What are the most effective means to treat and prevent HIV infection?" Obviously, prevention involves human behavior for the three major modes of transmission: sexual transmission, drug abuse-related transmission, and perinatal transmission. The first step is to promote safe and informed behavior before people become infected. Identify infected people as soon as possible. Make sure they know they should not transmit to others. What you have to do is get them to recognize that they are infectious for the rest of their lives. They have theoretically been infectious for as long as they have been infected. They could have had partners way, way back, they could have current steady partners, and they could potentially have future partners. So to stop the spread of the disease, you need to obtain their cooperation for the future. You have to get them tested. I do not think many people who are infected willingly and knowingly transmit to others. The trick is to find them early enough.
There are always going to be a few exceptions from which people will try to make the rule, like that man in New York who seemingly knowingly infected others. But if you think about it, who was going to find that man anyway? The system may not identify him until others are infected. He may not know he was infected. Even if he did know he was infected, and somebody counseled him not transmit to others, it may not have stopped him. Most individuals behave responsibly, however.
Harden: The analogy with Typhoid Mary, however, leaps to mind. Just put her in jail. Some people have suggested that we jail people infected with AIDS who knowingly transmit the virus. But we just do not do that.
Curran: I have reviewed the new book, Typhoid Mary, by Judith Leavitt.
Harden: Yes, we know the author very well.
Curran: Even Typhoid Mary was singled out as a carrier. There were thousands of carriers of typhoid, and she was the one who was imprisoned. Now there were some reasons. She went back to work as a cook against orders and started transmitting typhoid again. But she was also a single woman who was tough, somewhat large in size, and easily selected out. An example was made of her, then they just forgot about her when she was imprisoned for many years.
Once again, though, typhoid was transmitted in a different way. I think that if you found a person like the man in New York who was knowingly transmitting AIDS that the authorities certainly would stop him from doing what he was doing. But one of the questions is, “What do we do with prostitutes and drug users?" If we are really serious about transmission, why do we not have a serious attempt to deal with substance abuse in the United States ? Certainly, we cannot imprison all the infected addicts for life. Why don't we provide a greater emphasis on treatment? We cannot even use the words “needle exchange“ at a national level because of the political fallout. In the United States, the roots of the heterosexual epidemic are in drug users. How about all the women who are infected, for example, through drug abuse and needle sharing? How do we think they get the money to get their drugs? And how do we as a society deal with that?
In general, what we do is we lock up drug users. The last decade has shown that we have doubled the size of our prison population, and we have actually decreased the size of our drug treatment population. But that does not make sense. If people are really serious about stopping the transmission of AIDS, we must take a more epidemiologically targeted approach to HIV prevention. We must go to where the transmitters are. We need drug treatment programs in jails because a lot of people infected with AIDS are in jails. There are more of them in jails than there are in treatment now, and there are an awful lot of them on the street. So we ought to be figuring out how to deal with them, rather than being only focused on the disease in middle-class gay men. I think we need to have programs that encourage people to be tested and counseled. There may be some rare times when you have to use force, but when you start off with that premise, you end up with a very uncooperative population. For example, the NIH MACS studies and the CDC cohort studies in San Francisco and other places show that people in those studies were usually tested. They were counseled over a period of time. Then they eventually became candidates for drug therapy, and they were followed. The NIH said, “None of these people are getting infected anymore.” I said, “Isn't that wonderful. That is really great.” And they said, “But they are different from everybody else, because they have adequate counseling and adequate medical care, and access to drugs and treatment, and you cannot say that everyone else is going to be like that and not transmit or not get infected anymore.” Well, why can't they be? Why do we have only some people who are tested, treated, and counseled?
Instead, what we have is rhetoric on one side saying that we need to throw people in jail; when, in fact, a third of the population still does not know they are infected. They die of Pneumocystis before they get any therapy at all. In this circumstance, it is no wonder that transmission continues.
Harden: That is very well put. Is there anything else that needs to be said about AIDS before we try to get you to talk a little about being a dean of a school of public health.
Curran: No, nothing else needs to be said about AIDS.
Harden: Could you comment on your new career? What is your perspective now, having moved from AIDS, which clearly dominated the last 20 years or so of your life, to being a dean?
Curran: We have a wonderful School of Public Health at Emory, and it is nice to move into a combination of jobs of educating and being responsible for the training of the next generation of extremely idealistic people. It is just remarkable what these young people are like. They really want to save the world. And it is wonderful to be able to get resources to send them overseas; we have 90 people overseas this summer.
Harden: I noticed all the things on your bulletin board as we came in.
Curran: Yes, and you ought to see the international health board, on the next floor down. We just graduated 287 people last week, so there are not a lot of students around now, but it is great to be able to contribute in this way. It is great to continue my relationships with the NIH and the CDC, and to stay involved in public health issues. It is fun for me to broaden my interests and to be in an academic environment because I get a chance to do lots of other things that are interdisciplinary and inter-school. And Emory is a fun place to be. It has always been good, and it is getting even better.
Harden: Harvard is the “Emory of the north,” is what we Emory alumni like to say.
Curran: Emory is a friendly place, and there is a lot of hot research going on here. So I enjoy it.
Harden: We certainly appreciate your giving us this interview. Thank you.
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