Transmission & Surveillance

Transmission & Surveillance

In the United States and elsewhere, people tend to get tested later because they're worried about the stigma associated with HIV.

The earlier people get tested for HIV, the greater the chance they won’t spread the disease. That’s the driving idea behind James Koopman’s work of the past 24 years. Koopman, a professor of epidemiology at SPH, is developing new methods for a science of infectious transmissions, and HIV/AIDS is a key focus of his research. Using data from a Montreal surveillance system set up by the province of Quebec to genetically sequence HIV isolates, Koopman and his research team are identifying the patterns of HIV transmission during early stages of the infection, with the hope that their findings can lead to new means of slowing the AIDS epidemic.

Because the creators of the Montreal surveillance system have gone to great lengths to respect the human rights of HIV-infected people in high-risk groups such as gay males and drug users, members of these vulnerable minorities are much more willing to be tested early. That’s “a boon for our investigation,” Koopman says, noting that early-stage HIV samples are invaluable because they better reflect the chains of transmission.

The Montreal data has shed important new light on temporal and spatial patterns of transmission and allowed Koopman and his team to begin to understand a number of factors, including the degree to which small outbreaks of AIDS are related to primary infections, the extent of transmission in the early stages of the disease, and the various types of transmission chains that contribute to the spread of AIDS.

Epidemiologic Work Is Always Involved in Human Rights

It was 1973, and James Koopman had just signed up to be an epidemiologist in southern Chile when General Augusto Pinochet and a military junta overthrew the country’s demo- cratically elected president, Salvador Allende, and installed a brutal dictatorship that ultimately lasted 17 years. Koopman cancelled his work plans and stayed home, but he read daily press accounts of what was happening in Chile. Like others, he was appalled by the many reports of kidnappings and murders. Particularly sobering was the revelation that the isolated region in southern Chile where he’d hoped to work had become a dumping ground for political prisoners. “You could take people, and there was no expectation they’d ever find their way back.”

In 1978, several Chilean physicians who’d been documenting instances of torture in the country were arrested and jailed, and the American Academy for Advancement of Sciences, together with the American Public Health Association, launched a mission to pressure the Pinochet government for their release. Koopman and two others made up the mission. Using contacts Koopman had established on earlier visits to the country, and backed by the political force of AAAS and APHA, the three were able to get into key governmental offices and press for the physicians’ release. Koopman says he learned a valuable human-rights lesson, that “international prestige can exert a tremendous force to help protect people.”

He and his colleagues also got in touch with members of the opposition and with members of the Chilean Supreme Court, and they met with the jailed doctors in prison. A couple of months after the mission’s departure, the physicians were freed. Because their story had garnered widespread press attention, the doctors’ findings—which documented atrocious forms of torture—were more widely publicized than they might otherwise have been, Koopman believes.

Koopman has since done epidemiologic surveillance work in Colombia, where he investigated environmental justice issues, and in Uruguay, where he countered government allegations that an epidemic of bacterial meningitis had broken out. “Epidemiologic work is always involved in human rights,” he says today. “Epidemiology is a science of the people, for the people, and by the people, and that’s the way I’ve practiced it.”