Faculty from the Rollins School of Public Health (RSPH) traveled to South Africa with Emory President Bill Chace last spring to build new partnerships and strengthen international ties at Emory.

Emory is poised to help South Africa overcome one of the highest rates of HIV infection in the world, says RSPH Dean James Curran. He is also director of the Emory/Atlanta Center for AIDS Research, which supports HIV-related research across many disciplines.

"Vaccine development, prevention science, and testing anti-retroviral drugs are probably the best ways that Emory can help," he says.

According to surveillance in South Africa, about 30% of pregnant women there are HIV positive. Based on that figure, 4.7 million people are estimated to be infected.

Ronald Braithwaite, professor of behavioral sciences and health education, was also part of the delegation. He remained in South Africa for two months to work on an NIH-funded, HIV-prevention study among South African prison inmates. He is collaborating on the project with Priscilla Reddy, director of health promotion at the Medical Research Council in South Africa and RSPH visiting professor.

The three-year, $1 million study will examine the health status and concerns of inmates soon to be released from four prisons. It will also evaluate the effectiveness of HIV education programs conducted both by other inmates and by prison administrators.

"It's pretty well established that as soon as inmates are released one of the first things they want to do is have sex, and they often go back to alcohol or drugs," says Braithwaite. "While they are inmates, they really are a captive population, so we have a unique opportunity to provide them with information about HIV prevention and substance abuse. If we can get them information while they're incarcerated, then it may dissuade them from engaging in risky sexual behavior when they're released."

Braithwaite says the United States can learn from South Africa as well. Prisons there offer inmates easy access to condoms. Only two US prison systems--Mississippi and Vermon--now do so.

Keith Klugman, RSPH professor of international health, also has work ongoing in South Africa. Klugman, who joined the RSPH faculty last year, continues to serve on the faculty of the University of Witwatersrand in South Africa and directs the Pneumococcal Disease Research Unit of the South African Medical Research Council. He is now working on a study of pneumococcal vaccine among 40,000 children in Soweto, many of whom are HIV positive.

Twenty years after scrawling "Hot Stuff" across a CDC report about five mysterious cases of pneumocystis carinii pneumonia in Los Angeles, RSPH Dean Jim Curran is still where the action is in the fight against AIDS.

Researchers at the Emory/Atlanta Center for AIDS Research (CFAR), where Curran is principal investigator and director, recently developed what has been hailed as the "most promising AIDS vaccine yet." According to results published in the March 2001 issue of Science, the vaccine prevented AIDS in monkeys infected with a highly virulent hybrid of simian and human immunodeficiency viruses (SHIV).

The vaccine stimulated a strong immune response that allowed infected monkeys to maintain a low level of infection while remaining healthy. Lead author Harriet Robinson, faculty member of the Emory Vaccine Research Center and CFAR, says infections were controlled even among groups receiving a low-dose vaccine.

This simple, three-step vaccine regimen offered better protection than any other HIV vaccine candidate to date, placing it among the most promising candidates moving toward clinical trials in humans, which will begin next year.

The vaccine was given in three steps—two DNA priming vaccines followed by a modified pox virus booster. The vaccine's greatest strengths are its abilities to elicit expression of multiple proteins and to provide memory immune responses several months after inoculation. Many other AIDS vaccine candidates induced immune responses to only one or two proteins expressed by HIV. Robinson's vaccine causes expression of three, potentially increasing the body's ability to recognize and react to the virus.

In the two-year study, Robinson and her research team vaccinated 24 monkeys and compared them with a control group. Seven months after the vaccine regimen was complete, the monkeys were infected with SHIV. As expected, all became infected. Response in vaccinated animals, however, was dramatic.

The researchers found that after vaccination, the immune system generated large numbers of T-cells specific to SHIV and immune system memory cells. The establishment of these memory cells is vital to the success of any vaccine, because these cells recognize a pathogen long after vaccination.

After infection, the non-vaccinated monkeys rapidly developed high levels of virus and progressed to AIDS. By contrast, the vaccinated animals maintained low levels of virus and remained healthy. At 12 weeks after infection, the lymph nodes of the vaccinated animals were intact and responding to the infection, while those of the infected control animals had been functionally destroyed by the virus. By 28 weeks, all four nonvaccinated monkeys developed opportunistic infections associated with AIDS. All 24 vaccinated monkeys remained healthy.

Health Issues in the Black Community, Second Edition, Jossey-Bass, 2001, By Ronald L. Braithwaite and Sandra E. Taylor

Infant mortality, cancer, addiction, heart disease, asthma, diabetes, AIDS, and homicide—African Americans suffer from all these ailments at disproportionate rates. A sweeping new book edited by RSPH faculty member Ronald Braithwaite examines health disparities and suggests multidisciplinary solutions. Emphasizing the need for innovative health care policies that are culturally sensitive, Health Issues in the Black Community offers chapters written by eminent scholars. Health status, social challenges, chronic diseases, lifestyle behaviors, and ethical and political issues are also covered.

A foreward written by Jesse Jackson Sr. issues an urgent call to action: “These problems and challenges are immense and require the vision of giants, the creativity of geniuses, the energy of genies.... Leave no American behind. Keep hope alive!”

Girls exposed to the chemical polybrominated biphenyl (PBB) in utero and as infants experience puberty at younger ages, according to a study conducted in part by researchers at the Rollins School of Public Health (RSPH).

A fire retardant containing PBBs was accidentally mixed with animal feed on Michigan farms in 1973. Milk production from the cattle plummeted, and many calves were born dead or with hoof deformities. By the time chemical contaminants were identified as the source of the problem, at least 4,000 people had been exposed through contaminated meat and dairy products. PBB accumulates in fatty tissue in the body and is stored for years.

Many of the daughters of women exposed to PBBs have experienced early menstruation and pubic hair development, according to the study in the November 2000 issue of Epidemiology. Michele Marcus—a faculty member in the RSPH departments of epidemiology and environmental and occupational health—was the principal investigator.

The daughters of the most highly exposed women began menstruation, on average, before their 12th birthdays. Early puberty can be difficult socially and psychologically and could affect breast cancer risk and cause endocrine problems later in life. Puberty at 11 is within the normal range and is not medically considered early. But the most highly exposed girls began menstruating a full year earlier on average than other girls in the study. "This study supports the hypothesis that events associated with puberty may be affected by pre- and postnatal exposure to PBBs," says Marcus.

For the study, researchers contacted female offspring, 5 to 24 years of age, born to mothers listed as exposed to PBB in the Michigan PBB registry. Those with earliest menstruation were daughters of mothers with the highest estimated serum levels of PBBs during pregnancy who had also nursed their infant daughters, giving them both prenatal and breast milk exposures. The most highly exposed girls started their periods about a year early, at 11.6 years compared with 12.7 years for less-exposed girls.

This is the second study to associate early puberty with exposure to a specific chemical. The first study, published in Environmental Health Perspectives, associated precocious puberty in young girls in Puerto Rico with plasticizer chemicals.

Annette Frauman, an advocate for public health nurses everywhere, received the Charles R. Hatcher Jr., MD Award for Excellence in Public Health last June.

Frauman, associate professor in the Nell Hodgson Woodruff School of Nursing, has worked hard to bring continuing education to public health nurses in rural Georgia. She also helped establish a graduate program in public health nursing leadership at Emory last year. She began her nursing career as a public health nurse in rural South Carolina.

“I grew up in rural Georgia, and I'm keenly aware of how few educational opportunities there are for nurses and women in rural areas,” she says. “I've felt the isolation that rural public health nurses feel as they go about their duties.”

Frauman has worked in pediatric nephrology for many years and is now conducting a study to help children with end-stage renal disease become more independent.

Chronicling a betrayal of trust The images were devastating: A Kenyan family—rail thin and dying together of AIDS; hundreds of young Russians shooting IV drugs in a park on a gray winter day; a village populated solely by AIDS orphans on the banks of Africa's Lake Victoria. Journalist Laurie Garrett flashed these slides across a big screen last spring as she delivered—in typical high-impact fashion—the Virginia S. DeHaan Lecture on Health Promotion and Education. Garrett, a science and medical reporter for Newsday and a Pulitzer Prize–winning author, urged public health workers to stay true to their population-based roots.

"Medicalizing public health problems can be disastrous...," she said. "AIDS became a 'medicalized' problem—first with the advent of AZT and in 1996 with HAART drugs. This shifted the epidemic in this country from one viewed as a collective disaster to one seen as an individual treatment paradigm."

Meanwhile, the AIDS epidemic has spread unchecked in sub-Saharan Africa, where there is little or no access to treatments. In the South African state of Kwazulu Natal, 45% of the adult population is estimated to be HIV positive, Garrett said. At the University of Nairobi in Kenya, a recent study showed that 30 percent of students there are HIV positive. "If this were the case in America, wouldn't we have declared it an international catastrophe?" she asked.

Scientists must work to understand why the disease has spread so rapidly in some areas and not in others, she said. "West Africa is successfully holding its HIV rates down, while in the east and south the epidemics keep growing in truly mind-boggling proportions. Families, villages, clans, and cultures are being decimated."

Public health approaches are the best way to battle AIDS in places like Russia as well, said Garrett. The Russian Ministry of Health estimates that by the year 2015, 14 million people there will be HIV positive—roughly 10% of the population. Garrett said HIV is spread there predominantly by "disillusioned and alienated teens with no hope—drug addicts. A recent University of Moscow study found that 100% of students admitted to injecting narcotics at least once."

Other social factors like overcrowded prisons, drug use, sexual behavior, and unsanitary hospitals and clinics also contribute.

Garrett's books, The Coming Plague and Betrayal of Trust, discuss some of the most pressing public health issues of the day.

Environmental health in action More than 25 students and faculty members planted a tree in the rain last spring to celebrate the formation of a new student environmental health group. Called the Rollins Environmental Health Action Committee, the group aims to promote a “sustainable and just existence,” says organizer and MPH student Thomas Mampilly.

The group plans to advocate for a countywide recycling program in DeKalb County, raise awareness about sweatshops in developing countries, and work against environmental racism with the Southern Organizing Committee for Economic and Social Justice.

Teens with less parental monitoring are more likely to engage in risky sex, fighting, and frequent substance abuse, concluded a recent study at the Rollins School of Public Health.

Published in Pediatrics last June, the study underscores the value of family ties in raising healthy, well-adjusted adolescents, says Ralph DiClemente, lead author and Charles Howard Candler professor of behavioral sciences and health education.

"Because today's working families are more nuclear and less extended, there is less supervision inside and outside of the household, creating a window of opportunity for adolescents to become involved in risky activities," he says.

The study focused on black female adolescents living in low-income neighborhoods. DiClemente studied the teenagers' perceptions of their parents' knowledge about where they spend time outside of school and home and whom they are with.

Teens whose parents provided less monitoring were twice as likely to have multiple sex partners and a history of arrest, 40% more likely to have abused alcohol, and almost three times more likely to smoke marijuana frequently.

DiClemente says what children think their parents know about their activities and friends is crucial. The findings also show that few children perceive fathers to be parental monitors. Rather, most adolescents said their mother was the heavy.

DiClemente suggests that parents learn how to balance a teen's desire for autonomy with their own parental obligation to protect their children from harm. "Parents can do this by instilling their own values in the child and providing constant monitoring of their children's activities and friends to reinforce their values," he says. "The goal, of course, is that eventually children will regulate their own behavior."

Many boys who find a hidden gun will handle it, point it at each other, and even try to pull the trigger, according to an Emory study published in Pediatrics last June. The results proved true even among boys trained in gun safety and whose parents trusted their judgment. “ Adults who keep guns in their homes have a responsibility to keep them locked and inaccessible to children,” says Arthur Kellermann, study co-investigator and director of the Emory Center for Injury Control at the Rollins School of Public Health. “While it’s fine to teach your child safe behavior around guns, that won’t be enough to keep them safe when they're unsupervised.”

The study included 64 boys aged 8 to 12, whose parents had completed a survey on firearm ownership, storage practices, and perceptions about their children's behavior around guns. The boys were divided into 29 groups of two or three and observed for 15 minutes through a one-way mirror in a room with toys scattered about. Two water pistols and a real .380-caliber semiautomatic handgun were hidden in drawers. Instead of bullets, the real gun contained a radio transmitter that activated a light whenever the trigger was pulled hard enough to shoot. None of the boys knew whether the gun was loaded, and only a few left the room to tell an adult.

About 76% of the boys discovered the handgun; 48% of the boys handled the gun; and 25% of the boys pulled the trigger. Afterward, nearly half of the 48 boys who found the gun said they weren’t sure if it was real. Also, more than 90% of the boys who handled the gun or pulled the trigger reported that they had previously received gun safety instruction. More than half of the parents of the boys who handled the gun had previously reported that their children had no interest in guns.

The study results affirm the position of the American Academy of Pediatrics that “the most effective measure to prevent firearms-related injuries to children and adolescents is the absence of guns from homes and communities.” It also supports the need for parents with guns in the home to keep their firearms secured away from all children, locked and unloaded.