Bringing Momentum to the Fight Against AIDS

Dr. Jim Yong Kim takes a global approach to treatment, testing and prevention

A physician-anthropologist and the first Chief of the Division of Social Medicine and Health Inequalities (DSMHI) at Brigham and Women’s Hospital, Dr. Jim Yong Kim is an expert in tuberculosis and has conducted extensive research on strategies for treating strains of TB resistant to standard drugs. He has received a number of professional awards during his career, including the MacArthur “Genius” Fellowship in 2003, and was elected to the Institute of Medicine in 2004. As a student at Harvard Medical School in the 1980s, Dr. Kim joined with friend and classmate Dr. Paul Farmer, now DSMHI’s Associate Chief, to found Partners In Health (PIH), a charity that seeks to bring the best of modern medicine to some of the most impoverished places in the world. Their work has helped prove that it is possible to successfully treat complex diseases such as HIV and TB in poor nations—a notion that was long disputed by many health policymakers.

Kim recently spent a three-year leave of absence at the World Health Organization, first as advisor to the Director-General, then as Director of HIV/AIDS. Drawing upon his knowledge and experience treating complex diseases in resource-poor nations, in 2003 he led the launch of the “3x5” initiative, which sought to bring HIV/AIDS treatment to 3 million people around the world. Thanks in large part to this initiative, over 50 countries have more than doubled the number of people receiving therapy.

Kim returned to the DSMHI and his position as Chief in December of 2005. Here, he talks about his recent experiences and plans for the future.

What was the most important lesson you learned at WHO?

The most important lesson I learned was that multilateralism, the notion of all nations working together, is incredibly important. Having a multinational health organization like WHO is critical, and we need to continue to make it ever more effective and ever more attuned to what’s going on in the world.

Why did you think an initiative like 3x5 was needed?

At the time of 3x5’s inception, there was really no clear target for HIV treatment that changed the way the world responded to the epidemic next week, next month, next year. Treatment goals can be very concrete, and we felt that naming a really concrete, difficult and compelling target would get things moving, which it did. Now, the challenge is to bring that same momentum to prevention.

Looking back, how did your experience with PIH affect the way in which you approached your work at WHO?

The goal of providing the best of health services to everyone is, to me, eternal. Having a clear sense of that mission was important to me, and I tried to carry it with me during my time at WHO.

You recently became involved with the government of Lesotho in an ambitious initiative to offer HIV testing to every citizen in the country. Tell us about the situation in Lesotho, where one third of the population is HIV-positive, and why you think the universal testing initiative there is so important.

Lesotho is one of about half a dozen countries that are at risk for dying of AIDS. The whole population of the country could literally become extinct. Something dramatic has to be done. The people of Lesotho have shown that they can scale up HIV treatment: they’ve gone from a few hundred patients on treatment to more than 8,000 in the course of one year. Now the question for them is, what’s next?

One of the things that they can do is to offer an HIV test to every single person in the country who wants one. But that means you have to scale up treatment and prevention services at the same time, because if someone discovers he’s HIV negative, he has to have the prevention services to continue to be negative. And if someone is HIV positive, he has to have access to treatment. So treatment and prevention must both be available right away after testing.

But testing is key. Testing is the thing that links treatment and prevention. By establishing when you’re going to offer testing and counseling, you’re also establishing when prevention and treatment have to be in place. I think that many countries are going to have to look at really radically different approaches that will move much more quickly and that tie treatment to prevention. This is the first nationwide attempt to do that.

How have your experiences at WHO influenced your vision for the future of the DSMHI?

Working at WHO has given me a much more global view of the mission of the DSMHI. Rather than thinking about the Division only in terms of its role at the hospital or in the United States, I think about its part in the overall effort to improve the healthcare of people in poor countries.

I think it can play a critical role in this effort. First of all, it can help to re-define the role of teaching hospitals in global health. Teaching hospitals have a huge role to play because now, global health has moved from implementing simple public health interventions to implementing real clinical interventions. The best hospitals and the best clinicians in the world should be involved.

I would also like to see DSMHI train the next generation of clinicians who will be outstanding clinicians and good researchers, and who will also be extremely good at making sure that funding for global health is used wisely and effectively. We need this new cadre of clinicians, to provide the kind of assistance that countries need right now. These clinicians will also play a critical role in developing functioning protocols of interventions for poor people.

Finally, I see the Division playing a crucial role in educating the public and raising awareness. The need in developing countries is very compelling, and the DSMHI has the power to inform people about what they can do—and what we can do as a nation—to help transform the state of healthcare around the world.