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Last fall, the MacArthur Foundation announced its annual "Genie Awards". One particular name is distinguished: Gregg Gonsalves, 55, assistant professor in microbial diseases at the Yale School of Public Health.
In the 1980s, Dr. Gonsalves was an influential member of the AIDS advocacy group Act Up; he then founded or supported a number of national and international AIDS organizations.
The foundation cited his contributions to "training a new generation of researchers who, like him, work in the areas of public health and human rights, scientific research and activism to correct disparities in global public health.
We spoke recently for two hours in New York, then again by phone. Our conversations have been edited and condensed for more space and clarity.
The people of MacArthur say that you have combined activism and quantitative research. How exactly?
Well, I'm an epidemiologist. It is my job. However, my work involves a fusion of disciplines – biology, policy analysis statistics, and activism. One of the things I do at Yale is the co-director of the Partnership for Justice for Global Health, where we study public health issues.
What we do here, which is a little unusual, is that we sometimes borrow social science techniques and combine them with advocacy and political organization. Epidemiologists usually work on disease data.
How does this approach work on the ground?
A few years ago, I was working with a community group in Khayelitsha, a big city outside Cape Town, South Africa.
The women present reported a huge problem of sexual assault. At night, to relieve themselves, the women left their homes and traveled long distances to the communal toilet. En route, their risk of sexual assault was high.
By creating a simple mathematical model, we showed Cape Town leaders why installing more toilets made economic sense. In our model, we showed that less time spent outside meant less risk for women.
We put an economic value on the cost of more toilets and compare it to the cost of aggression. Besides the implications for human rights, we showed how more toilets would be a money saver.
How did it go?
Unfortunately, Cape Town has not made the right choice. But we gave them the facts.
Where did you try this approach?
With H.I.V.-AIDS. Research shows that between 14% and 15% of people living with HIV in the United States do not know they are infected. Finding them is a problem of needle in the haystack.
There are now very effective quantitative tools for locating needles in haystacks. Oil companies engaged in oil exploration activities and rescuers looking for slaughtered aircraft use them. Although the problems are not analogous, you can reuse their algorithms to locate H.I.V. virus clusters. undiagnosed. case.
This is important because H.I.V. remains a problem among gay men in the United States and among opioid users who share needles.
Why did you become an epidemiologist?
Frankly, because of H.I.V.-AIDS. I was a gay college dropout in the 1980s. That's when H.I.V. was hit for the first time in the United States. The government did not seem to care. It was called "homosexual illness", which allowed the general public to ignore it more easily.
A man I was in love with was positive for H.I.V. I needed information about what we were facing. There was not much. I therefore began to attend the meetings of the organization of activists Act Up and later co-found the action group for treatment, which advocated research and development. new drugs.
In both cases, members – most of us, not professionals – read articles in virology and immunology. At the same time, we learned about the functioning of N.I.H. and the F.D.A. On the activist side, we went to Washington and asked for concrete action.
Our work has a lot to do with the introduction of protease inhibitor drugs in 1995. They have turned AIDS into a manageable disease for those with access to health care.
Are there lessons in your experience for today?
As in the case of H.I.V.-AIDS, the current opioid epidemic has repercussions for a marginalized group of society, namely drug users sharing needles.
The balance sheet was devastating. In 2017, the National Institute for Combating Drug Abuse registered 47,600 deaths due to simple overdoses. These people had friends and relatives who loved them. They must make their voices heard and get policy changes.
Ironically, this epidemic has a H.I.V. component. When people inject drugs and share needles, as opioids often do, the chances of hepatitis C transmission and hepatitis I. are high.
What policy changes would slow down the mortality rate?
We know what to do about opioids. Dayton, Ohio, had one of the worst overdose rates in the country. They cut it in half. How? They did this by providing naloxone to first responders, which reduced the number of overdose deaths. They have done so by setting up a clean needle distribution program, so that drug users stop sharing their needles. They have expanded access to methadone to treat addiction.
By contrast, Scott County, in southern Indiana, is a place where state authorities have not acted decisively. In 2008, public health officials began to spot the first signs of opioid abuse. In 2015, they had 215 cases of H.I.V. in Scott County.
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My colleague Forrest Crawford and I wondered if that could have been avoided. C.D.C. had data showing when individuals in Scott County were infected and who their contacts were. From that, we created a computer simulation essentially to trace the epidemic and see what it could have been.
Our model shows that if they had just tested H.I.V. in 2011 and 2013, you could have blunted or perhaps even avoided the epidemic.
Has the state not finally put in place a needle exchange program?
Yes. In the spring of 2015. But it was too little, too late. A large number of infections have already occurred – about 150 infections diagnosed. To end a potential epidemic, governments need to respond quickly and dynamically.
With epidemics, the goal should not be to resume the last battle, but to learn from it. C.D.C. says that there are 220 counties currently at risk of H.I.V. outbreaks. They must not become Scott County.
He was recently reported in London a man cured of AIDS by a stem cell transplant. Is it important?
We can prevent H.I.V. with everything we have now – we just do not do it. A guy healed in London is interesting scientifically. But the real lessons are about everything we just talked about.
You received your doctorate only two years ago. How was it to go to the university at age 44?
I liked that. I had abandoned Tufts in the 1980s. With all that was happening, Russian literature did not interest me.
When I enrolled at Yale in 2008, I wanted to learn skills to be more effective. I had been working as an AIDS organizer for almost 30 years and came to realize that activism alone was not enough. I wanted to marry activism to science.
With this kind of motivation, I finished my bachelor's and doctorate in nine years. The references would allow me to be more effective in a battle that consumed my adult life.
When I think about it, AIDS could have killed me. That killed a lot of friends. Instead, it has given me a calling and made me what I am.
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