Professor Ann Williams and Dr. Roger Detels began collaborating on AIDS research and treatment in China 15 years ago — around the same time that World AIDS Day, marked every year on Dec. 1, was established to unite people around the globe in the fight against HIV.
Ann Williams, associate dean for research at the UCLA School of Nursing, has traveled the world for nearly 30 years caring for people with HIV/AIDS and conducting research to improve treatment outcomes. Over that same period, Dr. Roger Detels, professor of epidemiology at the UCLA Fielding School of Public Health, has taken a similar route, conducting AIDS research and training epidemiologists.

Fifteen years ago, their paths intersected in China, when Detels was looking to include nursing as part of a training program in HIV research for Chinese health care professionals. Professor Williams signed on, and they have been collaborating ever since as part of an international effort to limit the spread of HIV-AIDS and improve the care of those already infected.

Recently, each received HIV research training grants from the Fogarty International Center at the National Institutes of Health to help scientists and clinicians in developing countries build much-needed research infrastructure.

The AIDS infection rate in China is estimated at about .05 percent of the population, a relatively small number compared to hotspots like Africa. But in 2009, AIDS became the leading cause of death from infectious disease in China.

A big part of the problem, Williams and Detel agree, is that 20-30 percent of those with AIDS don’t know it, having never been tested. And of those who have been tested and identified as HIV-positive, only 20 percent have been treated to the extent where they can no longer spread the infection to others.

Understanding the Chinese culture is critical to the success of their work, the researchers agree. In that country, Williams said, “just the stigma of getting tested is a huge barrier; the mere fact that you are getting tested raises the suspicion that you are doing something wrong. The key to working in China is the discipline of listening —  having ‘big ears and a small mouth.’”

Another challenge is getting those with AIDS to comply with treatment.

“Adherence to a medication regimen … is very hard,” said Williams, who is studying this problem. “China is not a private society, so if someone is going to be taking a pill everyday, it would get noticed. We work with a lot of men who are having relationships with other men, yet are married to women and don’t want the women or their families to find out. So they just don’t take the medication. And that puts more people at risk.”

Williams has conducted some of the earliest studies of AIDS among drug users. She has tested interventions to decrease HIV transmission, improved gynecologic care of women living with HIV and increased patient adherence to antiretroviral medication in the United States, China, Vietnam, Thailand and Poland.

An AIDS awareness poster in China.
Under Williams’ NIH grant, nurses and psychologists in China will get advanced training on the mental health aspects of HIV at the Xiangya School of Nursing in Changsha, Hunan Province.

“China is way behind the western world in treating mental illness,” Williams said. “Services are virtually nonexistent … In our work in Changsha, we see a huge prevalence of mental health issues when someone is diagnosed with HIV; 60 percent of those individuals report depression. We know that physicians and nurses have a low awareness and are poorly trained in mental health.

“Our goal is to increase the number of nurse-scientists in China who are prepared to conduct interdisciplinary studies of interventions addressing the many mental health conditions associated with HIV,” Williams said. “Ultimately, research conducted by our trainees will benefit patients not only in China but in the developed and developing worlds.”

Detels began his work in AIDS in 1981 when he conducted the first study of AIDS in young homosexual men in Los Angeles. In 1983, he formed the Multicenter AIDS Cohort Study with three other centers across the country — a study that’s still going strong. Currently, he runs the UCLA/Fogarty AIDS International Training and Research Program, in which health professionals from China, Southeast Asia and India earn advanced degrees in epidemiology at UCLA.

So successful has the program been, Detels said, that “the heads of almost all the HIV/AIDS programs in China and Southeast Asia have been UCLA graduates.” Among them is Dr. Zunyou-Wu, director of the National Center for AIDS/STD Control and Prevention at the Chinese Center for Disease Control and Prevention, as well as an adjunct professor of epidemiology at UCLA.

Detels’ work in HIV/AIDS has been an uphill climb. Many years ago, he was working in Southern Yunnan province, where up to 50 percent of young men became drug users and consequently at high risk for HIV infection.

One of Detels’ graduate students asked the villagers about the problem. “For the next two hours, they blamed the central government,” Detels said, “until a grandmother in the group piped up, ‘These are our kids. We have to do something.’” At that moment, Detels and his graduate student knew their plan to reduce drug use would work. They helped the villagers develop an intervention program which used plays, loudspeakers and strategies such as youth centers and volunteer work programs to give young men a sense of their value. The number of new drug users fell by two-thirds within a year.

Since then, the Chinese have designed and implemented an ambitious program to address the epidemic by establishing methadone clinics, needle/syringe exchange programs and a comprehensive treatment program. Currently, the Chinese are working with support groups for gay men as well as non-governmental organizations. Both Detels and Williams are assessing the effectiveness of all these efforts.

The need for highly trained researchers in China and Southeast Asia continues. So Detels is using his recent NIH grant to provide Ph.D. training to Chinese students in a program in which UCLA is partnering with the Chinese Center for Disease Control and Prevention.
“China needs more well-trained research personnel to analyze the large data sets of information possible in China that can help them create and lead effective intervention programs.”

Learn more about Williams’ work in this story and at her website. For more about Detels’ work, see this previous UCLA Today story and his website.