Emory University Woodruff Health Sciences Public Health



	When the International AIDS Trust (IAT) moved to the Rollins School of Public Health (RSPH) this past summer, IAT President SandraThurman found herself back home. An Atlanta native, she's living once more in the Morningside house she kept all the years she was based in Washington, D.C., serving as AIDS czar under President Clinton and then as head of IAT, a not-for-profit organization that helps galvanize leadership, mobilize resources, and promote effective interventions in the global battle against AIDS.

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	In some ways, Thurman says, it feels as if the International AIDS Trust has come home too. Although IAT was never officially connected to the RSPH before, Thurman has worked on the front lines of the AIDS battle from the earliest days of the epidemic with many researchers and physicians now associated with the RSPH and Emory. "I've felt close to Rollins for a long time. I've known Jim Curran from the early days of the epidemic, when he was head of the CDC's AIDS program. There's not another dean of a major U.S. school of public health with his expertise in HIV and AIDS. AIDS is extremely complex because of all the underlying co-factors that exacerbate this disease. And Jim ‘got it' way before anyone else seemed to," she says. "In fact, we have many people here at Rollins who were part of the history of learning to deal with AIDS and have so much to share with people around the world. I see the International AIDS Trust and Rollins as a great match."

	Ties to AID Atlanta
	How did this Mercer University graduate who, in her words, once assumed she'd do some social work, get married, and have kids, wind up in mid-life as one of the world's leading experts on AIDS issues, traveling around the world working with leaders like Clinton, British Prime Minister Tony Blair, President Yoweri Museveni of Uganda, and former President Nelson Mandela of South Africa? And how did she gain the expertise, knowledge, and passion to help change U.S. policy to encompass HIV as a global problem? Thurman's involvement with AIDS evolved from events she confronted in her personal life. Her father was diagnosed with cancer in the early l980s. "I became involved with hospice when we learned his illness was terminal, and we made the decision to keep him at home, where he died in l981," she recalls. Her dad had worked in the garment industry, and her mother, a lawyer, was active in the arts. So Thurman grew up knowing people who worked in fashion, theater, and the arts, many of whom were gay. About the same time her father died of cancer, several of her gay friends were stricken with a mysterious illness associated with swollen lymph glands, Kaposi's sarcoma, and a rare lung infection diagnosed as Pneumocystis carinii pneumonia. They were some of the first people in Atlanta with the disease that would eventually be called AIDS. "Both the fashion and art communities were hit very hard early on," says Thurman. It was a time when victims were too often ignored, shunned, and even abandoned. Thurman volunteered to do respite care and, using the skills she'd acquired during her father's illness, taught people how to tend the sick and homebound. In the mid-l980s, Thurman became a volunteer at AID Atlanta, a community-based nonprofit organization providing health and support services to people living with HIV/AIDS. By l988, her drive and commitment had landed her a full-time position there as director of policy and development; less than a year later she was named executive director. Long involved with fund raising for other nonprofit health organizations, her fund-raising and management savvy soon turned then-faltering AID Atlanta into a viable organization. In fact, under her leadership, AID Atlanta tripled in size, becoming a multimillion dollar, direct-service agency with 90 staff members and more than 1,000 volunteers. Did Thurman know at that point AIDS would become her life's work? "Absolutely not," she answers. "I really thought, as most of us did, that the epidemic would be over in a few years, that science would find an answer. I never dreamed I would still be doing this work 20 years later."



	The AIDS czar
	At the height of the epidemic, Thurman noted that many AID Atlanta social workers were suffering from burnout. "I would pull them off the front lines for a while to give them a little rest. Then I realized I was beginning to experience some of the same symptoms, so I knew I needed a break," she says. She discussed her concerns with the chairman of AID Atlanta's board, William Foege, co-founder and executive director of the Task Force for Child Survival and Development. Foege, now Emeritus Presidential Distinguished Professor of International Health at the RSPH, suggested a change. Thurman could work with him as Task Force director of advocacy programs. Although she continued to serve on the AID Atlanta board, she accepted the new position and, from l993 to l996, focused on health problems of children internationally, including immunization and the eradication of polio. "This was my first work in the global arena, and I couldn't have had a better mentor than Bill Foege," Thurman says. Her career would go down another serendipitous fork in the road when close friend and Democratic Party strategist James Carville asked her to serve as political director for Bill Clinton during the Georgia primary campaign. She accepted and wrote some of Clinton's first briefing papers on HIV and AIDS in l992. President Clinton was impressed and, after his election, Thurman went to work for him as director of Citizen Exchange Programs in the U.S. Information Agency. In l997, Clinton asked her to become director of National AIDS Policy—the country's AIDS "czar." "There were only two czars in the United States at that time, for AIDS and drugs, positions created to coordinate all the organizations working in a particular arena. I describe it as sort of like herding cats," she says. "I took the job with one caveat—we had to include global AIDS in the portfolio. They agreed, and we moved the Office of National AIDS Policy out of the Domestic Policy Council and put it under the President." Working with myriad government organizations, including the CDC, NIH, and the State and Justice departments, Thurman made sure the United States was placing AIDS in an international context. And she convinced President Clinton that AIDS was fast becoming a global crisis. The result was that Thurman was responsible for a change in U.S. policy. "One of the things I still find staggering is that before I arrived at the White House, U.S. government funding for global AIDS programs had been about $125 million a year under both the former Bush administration and the Clinton administration," she says. But once Thurman retooled the office to focus on global AIDS and got the attention of the President and senior staff, over a two-year period, funding for global AIDS programs tripled and the LIFE Initiative, the first global multisector approach to fighting HIV and AIDS, was created. "Finally, AIDS was becoming recognized as an economic issue, a justice issue, a gender issue, and a stability and security issue. And then we went out and got Congress to fund this new platform," she says. In l999, at President Clinton's request, Thurman accompanied a bipartisan group including members of Congress, their staff, and philanthropists to see firsthand the impact of AIDS on the African continent. "When we got home, we sent a report to Congress outlining what we saw, and it was not very hard at all to get them to go along with our recommendations," she comments.



	IAT is born
	After Clinton left office, the International AIDS Trust was created to privatize and continue many of the same programs developed under that administration's AIDS office. Clinton has remained involved, co-chairing the IAT board with Mandela. "IAT works with leaders in government, civil society, and faith-based institutions to develop innovative and sustainable approaches to dealing with the underlying co-factors that exacerbate the spread of HIV: poverty, gender inequity, access to education [particularly for girls], access to economic opportunity, and human rights," Thurman explains. "We garner and develop leadership at the very top levels all the way down to the grass roots. For example, we were funded by the Gates Foundation to create an organization of African First Ladies Against AIDS, which is very successful and active all over the continent." The focus of IAT has changed in the past couple of years, she adds, particularly in the developing world where the majority of those infected and affected are women and a large portion of health care is delivered by faith-based institutions. IAT is working to mobilize and equip women and religious leaders to deal with the AIDS epidemic, especially in the poorest parts of the world where the only infrastructure is often the religious institution. Thurman is exploring ways for the IAT and the RSPH to work together. "At Emory, we have the folks at Rollins who are highly experienced in working with AIDS, and we also have the Candler School of Theology and The Carter Center. Plus CARE and the CDC are located in Atlanta, which is quite a hub for public health. We are talking about ways to partner and use resources we have here and some we have overseas to put together programs that draw on the strengths of the history of IAT and the history of Rollins," Thurman says. In the early days of AID Atlanta, 20% of Thurman's staff was infected with HIV, and most have since died. Today, thanks to antiretroviral therapies, AIDS is no longer a near automatic death sentence, at least in the United States. The epidemic, however, is devastating millions of lives in other parts of the world. There is urgency in Thurman's voice when she relates the facts. "It is a nightmare on the African continent, with women and children being hit the hardest now. The second highest rate of infection is in the Caribbean, right at our own back door. The fastest-rising rates of infection are in the former Soviet Union and Eastern Europe. We have an epidemic that has swept the globe in large part while we were sort of twiddling our thumbs," she says. "And it is true we now have treatment, but the fact is the places where AIDS hits hardest are where people are living on a dollar, maybe two, a day. Drugs are still beyond the reach of the majority of people who need them."




	Hope amid despair
	Thurman will continue to travel in her work, most often to Africa and Asia. Every six weeks, she travels to Limuru, Kenya, where she's pursuing a master's degree in theology at Saint Paul's United Theological College. "My colleagues at Rollins have been very supportive of this," she notes. "I'll be working with women's groups and faith leaders while I'm there, too, to help them talk openly about AIDS to build an effective response." With 40 million people infected with HIV worldwide and 14,000 people becoming infected every day, how does Thurman keep up her hope and passion for fighting AIDS? "Whenever I feel down or like whining, I just think of Bernadette, a 72-year-old grandmother in Uganda who has lost 11 of her 12 kids to AIDS and is caring for 35 grandchildren, five of whom are infected. She received $50 through a micro-lending program and with a group of other grandmothers started a business, growing vegetables and raising chickens. She has her five infected grandchildren on meds, and most of her grandkids are in school. And she's not unusual. "When I go out into the communities and actually see the extraordinary work being done by ordinary people on the ground every day, people who have nothing, giving whatever they can to people who have less, it is so inspiring to me. I see hope every place I go in the midst of all this despair." Sherry Baker is a freelance writer in Atlanta.