While some see HIV in a rear-view mirror—given the effectiveness of today’s treatments—Wafaa El-Sadr, MD, MPH, MPA, FIDSA, professor of epidemiology and medicine, director of ICAP and director of the Global Health Initiative at Columbia University, sees unfinished business.
The self-described “stubborn optimist” has been applying the hard-won lessons of HIV to broader community threats, including tuberculosis and malaria, as well as non-communicable diseases such as hypertension, diabetes, and cancer.
Dr. El-Sadr’s focus is the well-being of the whole person, an approach that stems from her days as a physician at Harlem Hospital Center in New York, where she began caring for HIV-infected individuals as the virus surfaced in the early 1980s. It was at Harlem Hospital where she and her colleagues extended their
gaze from sole focus on the patients themselves to the whole family – from individual mothers, to mothers and babies, and to partners and siblings.
“Whether you have HIV yourself or your family member has it, you are affected profoundly,” Dr. El-Sadr noted. “We began thinking of HIV – rather than as an individual with a viral infection – as a condition that affects whole families.”
“It was such a difficult time,” she recalled about the time before the antiretroviral AZT was developed. “I saw children lose their mothers, and so many women who lost their kids. I saw men who lost their beloved partners, gay men who had been together for years, who profoundly loved each other.”
This family approach that Dr. El-Sadr established in Harlem informed the work of ICAP at Columbia University, the global health center that she founded in 2003 at the Mailman School of Public Health to bring HIV prevention, care, and treatment to poor regions of the world severely affected by HIV such as sub-Saharan Africa.
“There was a huge disparity. Those living in wealthy countries could access life-saving medicines for the treatment of HIV and live healthy and long lives with HIV,” Dr. El-Sadr said. “The same time, in Africa there were millions of people living with HIV who had absolutely no chance of getting
these medicines. To me that was just simply unacceptable.”
But getting treatment to those who desperately needed it, was not easy. Dr. El-Sadr’s “stubborn optimism” served her well. “There were people who felt very strongly that bringing treatment to Africa, rather than focusing on prevention, would be misguided because there was no infrastructure, because they believed local healthcare workers wouldn’t know enough to treat such a complicated disease, because there were no labs, few clinics and that people with HIV themselves would not seek treatment for fear of stigma.”
“We were determined to prove all of these naysayers wrong,” she said. And they did.
Today more than 2.4 million people in 30 countries around the world have accessed HIV care through ICAP support.
Dr. El-Sadr’s commitment to focusing on the whole person, not just the illness, has roots in her early days in medicine when she decided to become an infectious diseases specialist.
She was born in Egypt, where both her parents were physicians. “I had the sense that medicine would give me an opportunity to do something that was meaningful,” she said. “Clearly this was one way to impact people’s lives.”
She earned her medical degree in 1974 from Cairo University, where half her fellow students were women. In contrast, at that time in the US, approximately 10 percent of medical school graduates were women, according to the American Association of Medical Colleges. As a woman, Dr. El-Sadr did not feel disadvantaged in medical school. “I think it was harder for the pioneering women who were in medicine in those years in the US,” she said.
Dr. El-Sadr gravitated toward infectious diseases in part because she says she had fantastic mentors when she did her clinical training in New York and Cleveland. She was drawn to the mix of hard and soft skills needed to be successful in the profession.
“Infectious diseases is about problem solving,” she said. “It involves pulling different pieces of a puzzle from the patient, from the lab, and from whatever other information available from the family and putting all those pieces together. You’re trying to elicit all the clues that can help make a diagnosis and craft a way forward.”
She was just finishing up her training in the early 1980s when HIV emerged, bringing with it a momentous transformation for the ID profession. “It seemed that the world overnight became divided into two groups of people: people, including physicians, who ran away from HIV and those who came to the forefront to take care of people living with HIV; and many ID physicians rose to the occasion,” she said.
“For many of these early patients, we were sometimes the only support they had, the only people they could confide in,” she added. “It was this connection with desperate and stigmatized people that made me a better human being and a better physician. Just having the opportunity to take care of people with HIV has been an enormous privilege.”
It was a privilege that came with challenges, certainly. Raising a daughter while serving on the front lines of HIV treatment and prevention – a field that was changing daily – required continual assessment and adjustment of personal and professional priorities.
“I think the concept of life balance is elusive,” she said. “It’s a matter of trying to think of what are the most important things and keeping those front and center.”
Dr. El-Sadr’s daughter Olivia grew up on those front lines, attending HIV/AIDS conferences with her mother from an early age. In this way, Dr. El-Sadr managed to include some concept of balance by exposing Olivia to her love of theatre and the beautiful art that she collected during her travels. “While my daughter may not have appreciated being dragged around with her mother to conferences at an early age, she now appreciates the learning and remembers this as an amazing experience,” Dr. El-Sadr said.
On the global health front, Dr. El-Sadr sees much work that remains to be done. “Even with the massive scale-up of treatment it’s estimated that only about half the people living with HIV are being treated; and there are almost two million people who acquired HIV in the past year,” she said. “We’ve made a lot of progress but there’s so much work that remains still to be done.”
Whether the focus is on HIV or tuberculosis, the latter still a major infectious disease killer, “we need attention on discovering new treatments and new prevention tools including vaccines, while at the same time getting what we know works to those who need it.”
In terms of advice for young women entering medicine today, Dr. El-Sadr encourages them to be open to all opportunities as they come their way. “One’s career can take very interesting and rewarding twists and turns,” she said.
“I tell them to be willing to take the unexpected paths, just be open to opportunities and you will be pleasantly surprised and wonderfully rewarded.”