Congress Avenue project gains the backing of city officials

Plans for a new research and teaching complex on Congress Avenue took several large steps forward over the winter, bringing the planning process for the proposed 440,000-square-foot structure closer to completion.

New Haven’s Board of Aldermen approved the plans on March 15, leaving a final review by the City Plan Commission in May. The Yale Corporation, which is reviewing the project in stages, endorsed the design development phase last fall. In early April, the Corporation authorized funding for construction documents for the building.

“This building is about more than bricks and mortar,” Dean David A. Kessler, M.D., said at a press conference with city officials and community leaders in February. “It’s about people and ideas and the creation of a favorable environment for making medical breakthroughs. By having a clear focus on disease, I think we will see real advances that impact both individuals and the health of the public. Our goal is to advance the scientific basis of the practice of medicine.”

Demolition of two buildings on Congress Avenue will begin in August, and construction of the new facility is to begin as early as October, with substantial completion in June of 2002. The school still must squeeze $4 million from construction costs to meet the $160 million project budget, develop a parking plan and relocate offices from the buildings slated for demolition. Bruce Carmichael, who manages the myriad details of the process as executive director of major projects, admits it’s not a simple task. “This is a three-dimensional checkers game in the dark on a rocking boat,” he observed. “But we will find a way to make it work.”

The new building will be about three times the size of the Boyer Center for Molecular Medicine, which opened in 1991 on a site diagonally across Congress Avenue. Much of the new space will be devoted to wet-bench laboratories and the school’s Magnetic Resonance Center. The new building will also include histology and anatomy laboratories for medical education, meeting rooms, and a 140-seat auditorium and expanded laboratory support.

Laboratories will have a standard design, with no customized fittings, in order to maintain flexibility. “As research groups grow, as program needs change, we expect a great deal of assignment and reassignment. We want a generic quality that can accommodate that,” Carmichael said.

A “toxic mismatch” in Havana

A student’s research on Cuban HIV policy shows the potential for higher rates of infection.

For years Cuba had the distinction of being the only country in the world to quarantine people who tested positive for HIV. One of a handful of remaining communist nations, Cuba took pride in comparing the success of its approach with the failures of capitalist nations to contain the disease. But all that is changing, reports Helena Hansen, an M.D./Ph.D. candidate at Yale who spent six weeks in Cuba in 1997, interviewing physicians, public health professionals and people with or at risk for HIV infection.

She found a growing recognition among health care professionals that a new strategy is needed as tourism becomes the leading industry and Cubans flock to the cities to become entrepreneurs in a new, dollar-based economy. “There are many social changes taking place because the economy has changed so much,” Hansen said in January during a talk that was part of the Humanities in Medicine series.

Change in health strategy faces formidable obstacles in Cuba, where universal health care has been a cornerstone of social policy since the 1959 revolution that brought Fidel Castro to power, Hansen said. Cuba eradicated polio, diphtheria and other diseases endemic to other Latin American nations. The island has twice the number of doctors per capita as the United States and significantly lower infant mortality rates than its Caribbean neighbors. Even after Cuba lost its principal financial patron with the breakup of the Soviet Union, the government continued to invest in health care and promote a small biomedical industry. Although fuel, food, housing and consumer goods remain scarce, the government points to health care as a benefit of the revolution.

Cuba’s centralized, authoritarian approach to public health allowed it to report one of the lowest incidences of HIV in the hemisphere. In 1997, Cuba had 1,609 cases of HIV and 600 cases of AIDS in a population of 11 million—compared to more than 21,000 cases of AIDS in Puerto Rico, which has a third the population. Cuba banned foreign blood products and monitored its population for diseases that indicated the presence of HIV. Surveillance was so precise that health officials could say with certainty that AIDS came to Cuba in 1985, carried by a bisexual theater worker who had traveled to New York and several soldiers returning from Africa.

“The decision to quarantine HIV-infected citizens reflected a classic approach to public health that Cuba had exercised with success,” Hansen said. But, by 1996, despite the containment strategy, HIV infection was increasing. Popular tourist spots in Havana and elsewhere in Cuba, Hansen said, are witnessing a phenomenon unseen since the days of dictator Fulgencio Batista—the emergence of street hustlers called jineteros. Today’s sex workers come from diverse backgrounds and can be college students, doctors or lawyers who occasionally turn to prostitution to obtain U.S. dollars and access to scarce consumer goods, Hansen said.

In response to pressure from international human rights organizations, Cuban health officials have relaxed their quarantine. People with HIV are advised, rather than required, to spend six months in a sanatorium to learn, among other things, safe sex and behavior modification, but the country has not yet embarked on a comprehensive AIDS education program. Monitoring of HIV-positive people and the tracing of their sexual contacts remain the mainstays of current policy. Scarcity of condoms and a culture of aversion to condoms limit their use. The simple possession of a condom, Hansen said, can label a woman as a prostitute plying the tourist trade. And the illegality of prostitution and strong stigma of homosexuality drive underground two groups at risk for infection. Although the government supports one official AIDS prevention group run by HIV-positive Cubans, it is illegal for other groups to organize without official sanction. Nevertheless, Hansen said, gay men report that recent government promotion of tourism has created a more liberal atmosphere that allows gay clubs and hotels to operate.

“A toxic mismatch may be occurring in Cuba,” she said, referring to the high social and geographical mobility of Cubans in the face of inadequate HIV prevention programs. She notes that when it comes to AIDS, revolutionary ideas and a centralized medical bureaucracy may be at odds with the realities of a changing society.

AIDS Researcher David Ho reports on “hidden HIV” and potential new avenues of attack.

In 1996, when Time magazine named David Ho, M.D., as its man of the year, people with AIDS were enjoying the first glimmers of hope for long-term survival, thanks to the combination therapies he and others helped develop. They were living longer, and the new treatments kept many with HIV from developing full-blown AIDS.

Three years later, however, that optimism has waned as the limitations of those therapies have become apparent. Although mortality due to AIDS has decreased five-fold over the last several years, the new treatments don’t work for everyone. Strains of HIV are now resistant to the medications. And survival means a life ruled by rigorous adherence to an unforgiving schedule of foul-tasting pills.

Ho, director of the Aaron Diamond AIDS Research Center in New York City, described the next steps in the battle against AIDS at the first T.S. Lin Memorial Lecture, sponsored by the Department of Pharmacology. In his talk, Advances and Obstacles in HIV Therapy, Ho said that studies have found that although some patients have apparently undetectable levels of HIV, pools of the virus remain, lodged in immune cells called memory Cd4 lymphocytes. “The level of replication of the virus, we think, is exceedingly low,” Ho said. “One has to come up with a strategy that would facilitate the decay of the reservoir.” His approach, still under study, is to activate the immune system’s resting Cd4 cells to keep the pool of virus in check. “We think it would be very difficult to drive this pool to zero,” he said. “We could drive it sufficiently low that we could ask the immune system to clean it up and keep it under control.”

The lecture series honors Lin, a pharmacology research scientist who died in 1992 and collaborated with William H. Prusoff, Ph.D., professor emeritus of pharmacology, to develop the anti-retroviral compound d4T as a treatment for AIDS. Marketed as Zerit, d4T has helped to prolong many thousands of AIDS patients’ lives. Ho was introduced by Yung-Chi Cheng, Ph.D., the Henry Bronson Professor of Pharmacology and Medicine, who helped develop 3TC, another AIDS treatment.