Growing Up and Branching Out

Although the new University-wide AIDS Institute is still in its infancy, scholars here have already taken steps to organize a diverse array of Harvard resources into a cohesive research effort designed to study different aspects of AIDS-related issues.

Just this past week, the Institute's policy board, which is responsible for long-range planning and is headed by President Bok, appointed the program's first administrative executive director, and the four-month old organization also received a major grant to sponsor a conference series on the future of AIDS health care.

New Executive

The arrival of the new executive director, Alan Fein, should help accelerate communication and planning among different Harvard faculties, as well as efficiently coordinate AIDS research activities, according to Institute Director Dr. Myron E. Essex, a member of the policy board and chairman of the Department of Cancer Biology at the School of Public Health (SPH).

The executive director will make University AIDS research efforts more effective by organizing research newsletters, seminars and conferences at Harvard, officials said.

"[His hiring] will get our act together a little faster than it would have otherwise," says Essex. The executive director's duties will also include fundraising for various research projects and educational programs, he says. Money needed for research, new buildings and other facilities will total several million dollars, and officials expect the funds to come from government grants and private sources, according to Essex.

Fein, who has no background in the health sciences, comes to Harvard from the University of Chicago, where he served as director of that university's financial planning and budget departments for three years.

This new position is the third administrative post Fein, who has an M.B.A from Stanford, has held at Harvard. He served as publisher of Harvard Magazine and director of the Arnold Arboretum from 1980 to 1985.

"AIDS is the most important problem in our lifetime," Fein says. "The opportunity to get involved in the ground level of an organization that will be dealing with all aspects of the disease is just overwhelming."

Fein, who is due to arrive in October, was chosen from a field of more than 100 candidates from across the country, Essex says.

Big Bucks

Although Fein has not yet assumed his post, the Institute has already received a major grant to fund a series of AIDS conferences starting this winter and lasting 18 months.

The conference series, funded by a $450,000 Macy Foundation gift, is called, "Meeting the Need for Health Care Personnel: Managing the HIV Epidemic in the 1990s." The conference program is part of a long-term goal of the Institute to promote education about AIDS and to develop more effective health care policies for the disease.

"Seventy-thousand people have had AIDS," says Dr. Howard Hiatt, director of the Center for Policy and Education, one of five branches of the AIDS Institute. "Even now there aren't enough workers or enough hospital beds." Hiatt says that one of the concerns of the policy center will be figuring out how to construct feasible home care programs for AIDS patients.

"Traditionally, medical care hasn't paid for [home care treatment], so those services haven't been available. The question is how could and should those services be integrated into what people can expect, regardless of where they live," says Dr. Harvey J. Makadon, the Policy Center's associate director and program director for the newly funded conference series.

"There is a whole range of problems that have been with us in spite of AIDS," Hiatt says. "Insurance, confidentiality, sex education, drug abuse--all of those problems have been with us. AIDS has put them into sharper focus."

Makadon says the conference series will also study the problem of treating intravenous drug users and will investigate ways to extend special medical care programs beyond the gay community.

The Institute has also received funding from the Fogarty Institute of the National Institute of Health to support a fellowship fund which will bring AIDS researchers to Harvard from Africa and East Asia. This grant supports efforts by the new AIDS organization to relieve the dearth of health care workers qualified to treat AIDS patients, Hiatt says.

In addition, the Institute will co-sponsor a Boston conference with the American Society on Law and Medicine on the topic of health care professionals and AIDS. The conference is being scheduled as a tribute to World Day on AIDS, which the World Health Organization of the United Nations has set for Dec. 1.

Current Research

Although efforts for integration between various Harvard schools are nowhere near completion, researchers in different faculties have been studying a variety of AIDS-related topics, which will later be collected under the Institute's organizational umbrella.

Clincal research at the Medical School, for example, is focused on the testing of new drugs in AIDS patients and in patients who are infected with the HIV virus--which causes the disease--but do not yet display the symptoms of AIDS, according to Dr. Martin Hirsch, who is co-director of the Center for Clinical Care, another branch of the Institute.

"We're working on drugs that affect the growth of the virus," Hirsch says. Over the summer, Med School researchers discovered that a natural protein, which they can synthesize chemically, inhibits growth of HIV in laboratory cultures by preventing the virus from attaching to cells. The drug, called CD-4, is now being tested in people for the first time.

Clinicians are also continuing to study the chemical AZT, which has been successful in prolonging the lives of AIDS patients.

Although the University this month introduced a program to market the research of Med School professors, members of the AIDS Institute Policy Board say that this will not have much effect on AIDS research or the new Institute.

"I don't think [that plan] would have any effect because the Institute is a group of free standing, non-profit individuals," says Dr. Jerome Groopman, who co-directs the Center for Clinical Care with Hirsch.

"Any inter-faculty endeavor is complicated, but I sense that because of this public health problem, people are putting aside their personal ambitions," said Elkan R. Blout, dean for academic affairs at SPH.

In addition to the many medical projects going on, professors at the Kennedy School of Government and the Law School are dealing with the complex social and legal aspects of the disease.

Lecturer in Public Policy Mark Kleiman, who is the Insitute's liaison at the K-School, says this year he will continue to study methods of reducing transmission of the fatal disease.

Kleiman says he is focusing on pre-marital testing for HIV, reduction of heroin use and improving prison policies toward incarcerated drug addicts and AIDS victims as methods of reducing spread of the disease.

"People have simply done analyses wrong as to whether intervention [testing] is likely to be [helpful]," Kleiman says. He adds that in the past, studies have simply reported whether people have tested positive for AIDS symptoms. There is no reason to assume that those who have will practice safe sex procedures, Kleiman says, and policies must be designed to convince them to do so.

Problems like these will also concern scholars at the Law School, according to Professor of Law Lance M. Liebman, who is coordinating AIDS research there. "There will be lots of legal issues in the area of treatment and finance," Liebman says, adding that these issues will become more dominant as medical research continues.

The Beginnings

The Institute was conceived more than one year ago by SPH Dean Dr. Harvey V. Fineberg '67, who says it will create an organized forum to bring together specialists on all aspects of the disease and establish a think tank for experimentation and policy making.

"AIDS is almost all-encompassing in the health field and hits on so many dimensions in society," Fineberg says. "I think a university like Harvard really has a responsibility to respond--we've got a capacity to bring together experts from all the related fields."

The Institute is divided into five branches which deal with policy and education, clinical care, disease epidemiology, the monitoring the internal health of victims and the study of new biological approaches to AIDS.

"The [Institute] will try to bring together the people in different parts of the University whose skills are in the areas that we must call upon to address these difficulties," Hiatt says.