Para Las Mujeres - Carmen Zorrilla
In 1974 Dr. Carmen Zorrilla told her boyfriend she wanted to go to medical school. He escorted her to a college counselor, who told her women really shouldn't study medicine. "So I applied," laughs Zorrilla. "And I got in. And then my boyfriend left me."

Now, as a doctor of obstetrics and gynecology at the University of Puerto Rico, Zorrilla runs one of the first-ever prenatal HIV screening clinics in the world, the Centro de Estudios Materno Infantiles (CEMI, or Maternal Studies Research Center). The clinic opened in 1986, when one of Zorrilla's colleagues found HIV in 1.6 percent of blood samples taken from pregnant women he was studying for other purposes. That set off alarms. "He told me this in the hallway," says Zorrilla. "I said, 'What?' I had no other choice. We started a universal prenatal screening clinic."

In addition to prenatal testing, Zorrilla found herself counseling women about HIV and quickly realized that they needed more. Little information circulated about the disease at that time, and women were left without much follow-up care after delivery. "I would sneak them into my gynecology clinic, and I ended up having a women's clinic—by chance, by my sense of responsibility," she explains. That clinic is now expanding into a full women's health research center that also addresses such issues as adolescence, menopause, and breast cancer.

Zorrilla is one of the most sought-after HIV investigators in new drug trials for women, a role she considers critical as a physician. "We are prescribing these drugs to women, but we don't know what their effects are," she says. "If we know that viral loads are different in women and men, how will this affect choosing a viral load threshold when a woman is pregnant? And what will the risk for drug resistance be if we're starting medication for people earlier than they might normally start [because of pregnancy]?"

For some researchers, these are just questions to be answered. For Zorrilla, they are real issues that affect the daily lives of her patients. She remains a deeply community-oriented physician intent on educating her patients to take charge. Last fall she brought a group of them all the way from Puerto Rico to Los Angeles to attend the National Conference on Women and HIV/AIDS. She also brought her 12-year-old daughter. "I want to expose her not only to my work but also to the women that I work for and to the issues," she says.

Zorrilla recalls her own sheltered, Catholic upbringing and the world that opened up to her at her first AIDS conference. "I didn't see a condom until I was in medical school. I was so ignorant." So while it may shock her daughter just as it shocked Zorilla, "It's not fate—it's a conspiracy of the universe to make you do what you're supposed to do!"

-Stanya Kahn

Yvonne Bryson
Professor of Pediatrics, UCLA, and Director of Los Angeles Pediatric AIDS Consortium, Los Angeles, CA

Current Project: Various studies of mother-infant transmission and prevention and treatment of pediatric HIV infection.

Her Take: "We've really made incredible advances. I am optimistic about our ability to prevent perinatal transmission and create a new generation of children born without HIV."

Lisa Frenkel
Associate Professor of Pediatrics and Laboratory Medicine, University of Washington, Seattle, WA

Current Project: Working to understand the evolution of resistant virus in people with undetectable viral loads and pregnant women.

Her Take: "The need for near total adherence is difficult for most people. Hopefully the half-life of drugs or the way they are administered can be modified, because modifying people's behavior may be even more difficult."

Lynne Mofenson
National Institutes of Health, Bethesda, MD

Current Project: Pediatric and perinatal HIV clinical trials

Her Take: "To me, care of both mother and child are intertwined [and] is best facilitated by involving the woman in health care decisions."

Cool Operator - Brigitte Autran
Meet Brigitte. But be careful. If you've never been starstruck by a scientist, it could be a bit of a surprise. At 45, this razor-sharp Parisian researcher could have walked straight off the set of a James Bond film, all grace and impeccable grooming. But style without substance doesn't cut it in the world of HIV, and it's her research that makes Dr. Autran so divine. As a leader in the field of immune reconstitution, she's answered crucial questions about how, with some outside help from potent antiretroviral therapies, even people with longstanding HIV infection can regain their ability to fight off some diseases.

Not a Bond Girl but perhaps a female Bond, Autran is nearly unflappable. So it's not surprising that long before she made headlines with news about the return of the immune system, she had her eye on it—was even expecting it—based on groundbreaking advances in bone marrow transplantation in 1985. "At the time we had no idea that this [immune rebound] would be the case also for HIV-infected individuals," she says. "But I had always been thinking if one day we had strong antiretroviral drugs, we should observe the same phenomenon. So I was waiting for that. It only came in 1996."

Once better meds were in place, the world didn't have long to wait to hear from Autran: Her lab provided the first evidence that T-cells actually regenerate once HIV infection is controlled. "We discovered that naive T-cells could come back at the end of 1996, only three months before the Washington meeting [a major AIDS conference]," she recalls. Autran had not originally been invited to speak. "I submitted the work as an abstract and was selected for an oral presentation. I was so shocked to be right. People believed me and they understood that it was the beginning of something very new."

Having launched a thousand hopes with her lab work, Autran is looking forward to a time soon when all doctors will be able to use simple, standard tests to measure immune system function. And even though she stopped seeing patients several years ago, she remains committed to bridging the gap between research and the real world of people living with HIV. Trained as an infectious disease clinician in Paris hospitals, she saw the first French patients suffering from AIDS back in 1981. After four years in infectious diseases, she switched gears, taking on a whole new area of expertise—and a bastion of male scientists—to become an immune researcher. "I think I have had two jobs," she says. "I learned a lot before becoming a doctor, and I had to learn again before becoming a researcher."

Autran and her husband, a manager in industry, have two children, now 20 and 22. And how do they feel about having such a celebrity in the family? If she wants to take a moment to bask in her accomplishments, she certainly doesn't show it. "Oh," she says. "They want me to be home more."

Catch that, 007?

- Emily Bass

Susan Allen
Associate Professor of Epidemiology, University of Alabama at Birmingham, AL

Current Project: Developing and testing prevention strategies for heterosexual HIV transmission in Africa.

Her Take: "Vaccines, vaccines, vaccines. Barring a miracle, treatment in developing countries will remain out of reach for cost reasons."

Phyllis Kanki
Associate Professor of Pathobiology, Harvard School of Public Health, Boston, MA

Current Project: Transmission studies of HIV-2 in Senegal; recently found that HIV-2 seems to prevent infection with HIV-1.

Her Take: "Our study suggests that maybe this related virus can tell us how we can make a vaccine that will create immunity against HIV-1."

Bette Korber
Co-principal Investigator with Carla Kuiken at Los Alamos Laboratory Theoretical Biology and Biophysics Group, Los Alamos, NV

Current Project: Maintains a sequence and immunology database that summarizes global HIV variation and evolution.

Her Take: "I lost a friend to AIDS in 1990. My work essentially began as my own version of a quilt square, something I could do to honor and remember him. The magnitude of this global pandemic is compelling [and] serves to keep me motivated and focused on HIV."

Julie Overbaugh
Chair of the National Institutes of Health Molecular HIV Study Section, Fred Hutchinson Cancer Research Center; Bethesda, MD

Original Thinker - Beatrice Hahn
Timing is everything. Just ask Dr. Beatrice Hahn. When Hahn announced to the world last year that HIV (officially called HIV-1) originally spread from endangered chimps in West Central Africa, she became famous overnight. So did Marilyn and two other Pan troglodytes troglodytes chimpanzees who harbored remarkably similar viruses to HIV-1. Here was concrete proof that HIV-1 evolved from ancient simian viruses that had somehow jumped the species barrier. The discovery confirmed a leading theory about HIV's origins—from monkeys to man—and Hahn, 45, couldn't be happier with the publicity that's followed. "People want to know [and] understand what happened in order to prevent future transmissions," she says. Her own work holds implications for prevention and vaccine studies.

Born in Germany, Hahn got an early start in medicine by accompanying her father, Heinz, a doctor, on visits to patients in rural Bavaria. As a teenager, she liked figuring out why people got sick. "I liked to draw blood," she says, laughing. "He let me do that." She also spent her summers analyzing blood and urine samples in her father's lab until she left for medical school in Munich, and started down a career path to cardiology.

A chance meeting in Munich with Robert Gallo [the codiscoverer of HIV], convinced Hahn to take a chance on coming to the United States to study retroviruses. But there was one hitch to working in Gallo's lab. "He told me, 'Sure [you can come], if you come with your own money,' " Hahn recalls. "It took almost two years, but she got a fellowship, and on May Day 1982, arrived at the National Cancer Institute in Bethesda, Maryland.

A year later, AIDS appeared, although back then it was better known as GRID—Gay-Related Immune Deficiency. When Mikulas Popovic in Gallo's lab cultured and isolated the offending virus, Hahn and coworkers dropped everything to clone it. It was an exciting time, says Hahn. "It was a tremendous opportunity that I was allowed to work on [HIV]," she says. "Things popped up left and right. We pooled together and things just clicked."

A few years later, Hahn moved to Alabama with her lab partner and future husband, George M. Shaw, another leader in the HIV field. Their collaboration continues today. The couple have two "beautiful girls," Katharina, 9, and Christiana, 3.

Hahn comes across as intelligent, intimidating, and a bit in-your-face. As a scientist, she's not afraid to take on the difficult and, at times, controversial and politically charged questions of how, when, and why HIV evolved. "Certain people are afraid of me," she admits, laughing. But despite her success, she denies that she's a mover and shaker. "I'm not interested in politics. I'm passionately interested in science and my family." Nor is she content to sit back and rest on her laurels. "There's still a lot of things I want to find out about monkey virus evolution, so we will have our hands full there. I really want to analyze all the viruses that are out there, whether they jump to humans or not."

While she remains focused on basic science, she also hasn't lost sight of the social impact of the HIV epidemic. "I'm not the saint that starts her career by saying, 'All these poor people, I have to help them,' "she says. "But in all the things that I do, at the end of the day, it would be nice to do something that makes a difference for people suffering from this dreadful disease."

-Vicki Burkitt

Katherine Jones
Professor of Regulatory Biology, Salk Institute, La Jolla, CA

Current Project: Studying how tat, a key HIV gene, affects virus replication.

Her Take: "Currently there are no good drugs on the market directed against tat. I see a lot of hope in this area for the future. [In the meantime] get informed, be proactive and be aggressive about health care."

Flossie Wong-Staal
Professor of Medicine and Biology, University of California, San Diego, CA

Current Project: Focusing on HIV and gene therapy development—trying to find a preventive vaccine and a cure.

Her Take: "Vaccine development is a question of trial and error and we can't afford to wait until one thing fails to try another."

Global Diplomat - Geeta Rao Gupta
"Because of AIDS, for the first time communities are recognizing that gender inequity is fatal and that we need to do something about it. Where discussions would have been impossible 10 years ago, people are thinking, 'My daughter should know more. We need to protect her.' It's tragic but it's a step forward."

Meet Geeta Rao Gupta—a feminist policy analyst and leader on global women's health issues. A social psychologist and president of the International Center for Research on Women in Washington D.C., she comes armed with hard data and even harsher words for political leaders and scientists who she believes have failed to respond to the HIV crisis in women. As she watches the disease target the world's poor, she sees an epidemic that is killing women who lack any means to protect themselves. Her message is simple and urgent: Help these women. Give them something more than condoms.

A 43-year-old field-worker-turned-globetrotter, Rao Gupta is compassionate and politically savvy, her rhetoric softened slightly by a mild British accent and a warm, frank manner. Born in India, she studied and taught women's health before moving to the United States from Mumbai with her husband and their newborn child in 1985. At ICRW, she's continued to research the economic issues that affect women's health care in developing nations.

Back in 1985, she says she was a stranger to HIV and AIDS. It wasn't until 1989 that she was alerted to the impending epidemic in Africa, which was mysteriously affecting women in monogamous relationships. Already well placed to study women's sexuality and economic status, she took to the HIV puzzle naturally. At ICRW, she oversees a number of research programs dealing with women and AIDS in the developing world.

As she points out, a growing body of research clearly shows that women desperately want an alternative to condoms, something that can be used without a partner's knowledge. Women cannot always negotiate condom use, especially those in long-term relationships. And throughout the world, cultural, social, and religious factors often leave women in subordinate positions when it comes to decision making. Although the female condom exists, it's relatively expensive and not widely available. Women also want something that not only prevents HIV transmission but allows for pregnancy. Given this picture, microbicides—a new class of prevention creams, jellies, and suppositories used in the vagina to block HIV transmission—would fit the bill, she says.

Basing this conclusion on her own research, Rao Gupta believes that women's gaining more economic power, combined with such technological advances as microbicides, could help stem the rising tide of HIV throughout the world. To further this goal, she's joined the Alliance for Microbicide Development, a Maryland-based group that's pushing drug companies and governments to back promising microbicide trials. When asked what's holding up microbicide development, she says unwaveringly, "I believe it's the political value of women's needs. A microbicidal compound is more likely to be used more widely [than a condom], [but] I don't believe the private sector or the government believes there is a demand for it."

Given these obstacles, how does she keep going? "I feel very motivated that there's an agenda that seems so obvious, and it hasn't been met," she says, thoughtfully. "I feel motivated by the data. If research shows you that women economically contribute, but that women don't have easy access to resources, why aren't we doing something about it? Why is society so reluctant to give women equal status?"

Fighting words, indeed.

- Cindra Feuer

Eileen Hansen
Public Policy Director at the AIDS Legal Referral Panel, San Francisco, CA

Current Project: Fighting discriminatory HIV and AIDS policies such as names reporting and the mandatory testing of pregnant women and newborns.

Her Take: "I saw AIDS as a nexus of racism, classism, gender discrimination, and homophobia. If we dealt with those things as a society, we would be dealing with AIDS completely differently."

Cynthia Chandler
Attorney, Founder and Director, Women's Positive Legal Action Network, Oakland, CA

Current Project: Legal advocacy and community education around the needs of HIV positive women prisoners.

Her Take: "Women prisoners, particularly those with HIV and hepatitis, are routinely denied access to the most basic medical education and treatment, including emergency care. In 1999 at least 13 women died at the Central California Women's Facility, three of liver failure within one month. We must put a stop to the torture of women prisoners."

California Dreamer - Judith Currier
What would happen if the leading lights of HIV clinical care one day set aside their latest draft of federal treatment guidelines and pulled up stools for a quick game of "Who would play you in a major motion picture?"One thing is certain: If that fantasy ever becomes real, it will be Dr. Judith Currier's cue to leave the room. Even though she's considered a star by her peers and one of the epidemic's true Renaissance women, the 43-year-old clinician from the Univeristy of California at Los Angeles' CARE Center doesn't crave celebrity.

During a recent interview, she brushes her hair behind her ears and crosses her arms around herself before posing the first question: "What do you want to know?" Well, for starters, how did she get launched on her career path? "I don't know, I don't know," she laments, half-joking. "Don't get me started like that."

Luckily, her work speaks for itself. As vice-chair of the Complications of HIV Disease Research Agenda Committee at the AIDS Clinical Trials Group, or ACTG, and as a tireless physician in her UCLA practice, Currier has taken on a host of the most important questions in HIV clinical research. These include how to treat opportunistic infections and when to stop, and how to tease out important differences in HIV disease between men and women. In 1996 she was the first to report on gender-based dosing differences for the drug ddI-precedent-setting data that haven't been reproduced in other drugs.

Born in Minnesota, Currier is the second of five children who "learned at an early age about how, dealing in a group, to get things done." Of course, that means knowing when to step aside and when to step up to a challenge. "You don't have to wait for somebody to ask you to do something. You can see a problem, see an issue, figure out a way to do it yourself," she says. "It's probably the same for women across the board. For women with HIV, to get involved, to take the initiative, can really make a difference. You just have to realize the opportunities that are out there."

That's what she's doing. HIV, says Currier, is "a field that's rapidly changing, and I think it's exciting to be able to move into different areas as it changes." Over the years, she went back to school to snag a master's degree in epidemiology and has become particularly adept at the diplomatic and analytical dance required to get clinical studies up and running. That goes for drug-company sponsored trials, many of which stand to answer pressing questions about HIV in women (see "Standing Trial"). Now she's looking at the relatively new frontier of vaccine studies. "I think it's really important that we bring some of the things we've learned from HIV therapeutic trials into vaccine trials as they begin to expand, and also that we recognize and make an effort to get women involved in these studies."

That's what we call star power.

- Emily Bass

Street Warrior - Wafaa El-Sadr
As chief of infectious diseases at Harlem Hospital Center in New York City, Wafaa El-Sadr has taken a front-row seat at the nation's HIV epidemic.

The hospital's ties to the community and its dedication to helping underserved populations attracted her there in 1988. If you're going to work in HIV, why not go to where it's the worst? "Where else?" she asks, laughing. "Clearly, it was the most important thing to do."

At almost six feet tall, the regal-looking, Egyptian-born El-Sadr conveys confidence and warmth, qualities that make her patients feel that they're in good hands. She trained in infectious diseases in the early 1980s at New York Veterans Administration Medical Center, when HIV was just hitting. For her, Harlem was the place to be. El-Sadr quickly gained a reputation as a caring physician—a specialist in treating women, children, and drug users—and as an innovative community researcher. Today she sits on several advisory boards that oversee federal HIV drug trials, and is a boardmember of the American Foundation for AIDS Research [amfAR].

"Women of color are my focus," she says. "I went to Harlem at the time when HIV was sort of switching gears and changing dramatically from primarily gay men to involving more injecting drug users. By definition, that brought along women." As she explains, caring for women of color can be complex because of "comorbidities"—other medical conditions—including high blood pressure, hypertension, diabetes, and asthma. "We also see a lot of hepatitis in subgroups, like injecting drug users."

Through her clinic, hundreds of drug users have gained access to HIV drug therapy. Her approach has been to integrate HIV care and drug treatment, using a harm reduction model to reduce risky behavior. The clinic provides a range of supportive services to patients, including peer support groups. "We've actually looked at patients in our methadone treatment program where we provide HIV care. We find that the proportion of patients who become undetectable [for virus] in that population is no different from any other clinical population in the country, " she says proudly. Her success lies in looking closely at individuals to identify specific barriers to treatment and adherence. "We work very closely with drug users to see where they're at in terms of what they want to do about substance use," she explains. "There are a variety of ways to help a person feel that they're ready to make the commitment to treatment."

El-Sadr is also credited with bringing community-based clinical trials to Harlem in 1989. "When we first started [clinical trials], there was a lot of mistrust about research and a lack of information," she says. "People just did not know what clinical trials were. Now there is more familiarity about trials, [and] about the importance of new treatment."

If El-Sadr had a single wish, what would it be? Her answer is quick: a clinic that would provide a mesh of services in one place—one-stop-shopping. "The providers would be there as a wonderful team to fill all their needs, " she says, dreaming aloud. Anyone out there listening?

- Cindra Feuer

Super Sleuth - Alexandra Levine
Ever since she was a little girl, Alexandra Levine wanted to be a doctor. Today she can't imagine being anything else—except maybe a detective. That seems an appropriate second choice for someone who's worked with HIV since the beginning of the epidemic, sleuthing out all the disease's mysteries.

Levine's childhood dream led her to medical school and a specialty in oncology and hematology, and on to a teaching position at the University of Southern California. It was there, while working on cancers of the blood system—lymphoma, leukemia, Hodgkins' disease—that she first encountered the mystery of HIV.

"In 1981 I saw a patient who had a lymphoma that was extremely unusual and right away, I thought it was bizarre," she recalls. "And within the next year I saw two more of those cases, all in gay men." She knew something was not right; this seemed to be a new illness.

Not long after that, GRID—Gay-Related Immune Deficiency, the first name for AIDS—was described. Because her specialty was hematology-oncology, she saw many patients with the puzzling new disease when they developed lymphoma or other cancers.

Before long, it was clear to Levine that HIV had many complexities beyond its medical aspects. "I started to learn about those areas that I didn't really know about in an academic sense," she says, including HIV education and prevention, "and I got involved in a wider and wider spectrum." She was particularly intrigued by the way HIV infection in women was being handled. "Women were going to be at risk just like everyone else," she says. And yet she saw little education of women and no research on them. "It was crazy that 10 years into the epidemic, NIH (the National Institutes of Health) had not sponsored any studies in women."

Sooner or later, Levine knew, someone would want to fund women's HIV research, so she got ready. Working with an advisory board of Los Angeles-area physicians and advocates, she planned a study of HIV-positive women, pinpointing the most likely—and necessary—areas of study. By the time NIH funds became available, Levine's group was ready and the Women's Interagency Health Study was born (see "Standing Trial"). Since then, she's worked on various WIHS studies, and as a member of the Presidential Advisory Council on HIV/AIDS, has pushed for increased research and treatment for women.

Looking back at her career, Levine isn't sure exactly what gave her the idea to go into medicine. "I didn't know any doctors; I'd never been exposed to any of that," she says. "I think of it as a little bit of divine guidance for which I will be forever grateful." Ditto for the rest of us.

- Geri Clark

Kathleen Mulligan
Assistant Professor of Medicine, University of California, San Francisco, CA

Current Project: Setting the gold standard for diagnosing and treating metabolic disorders.

Her Take: "I don't think that any of us can really properly appreciate the extent to which these [fat distribution] problems are affecting peoples' lives."

Pat Kloser
Medical Director, AIDS Services, University Hospital, Newark, NJ

Works on: Fighting the good fight, as doctor and ally, for underserved women in Newark, NJ and Ho Chi Minh City, Vietnam.

Her Take: "Ten years ago, a conference on women and HIV would have been a revolution. Although everything today isn't all pretty and wonderful and everyone isn't agreeing, I think that's growing pains."

Lisa Hirschhorn
Dimock Community Health Center, Roxbury, MA

Current Project: HIV clinical care and community-based clinical research.

Her Take: "We need to make sure that we don't lose sight of taking care of the whole patient because it's so easy to focus on the viral load and the CD4 T-cell count—to really be able to take the time to ask how her family is doing and what else is new."

Sharon Hillier
Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Women's Hospital, Pittsburgh, PA

Current Project: Microbicide research and development; mother of the Lactobacillus "vaginal vitamin."

Her Take: "We can make good, safe, microbicides publicly available if we choose to. We have everything we need to make it happen—except the will and the money."

Mary-Lou Clements-Mann (1947-1998)
Director, Division of Vaccine Sciences, School of Public Health, Johns Hopkins University

Mary-Lou Clements-Mann, along with her husband, AIDS researcher Jonathan Mann, died in the crash of SwissAir flight No. 111 off the coast of Nova Scotia on September 2, 1998. Clements-Mann, an epidemiologist, was a forerunner in the search for an effective HIV vaccine. She started her work with vaccines in 1975 when the World Health Organization placed her at the head of their campaign to eradicate smallpox in Uttar Pradesh, India. With Clements-Mann at the helm, the Indian state, whose population was nearly that of the United States, won the war against smallpox. At Johns Hopkins University, she was a professor of international health and an appointee in both medicine and molecular microbiology and immunology. She created and directed the Center for Immunization Research, a launching pad for efforts to develop and test vaccines against a number of bacteria and viruses, including influenza, hepatitis B, and HIV. She set the engines in motion for more rapid testing of possible AIDS vaccines, sending the message out to fellow researchers that there was no time to wait for the perfect vaccine.

Constance Bell Wofsy, MD (1943-1996)
Co-director, AIDS Program of San Francisco General Hospital

Constance Bell Wofsy died of breast cancer on June 3, 1996. She became a leader in the fight against AIDS from the earliest days of the epidemic, and a strong advocate for those living with the disease, especially women. As a researcher, she was a co-investigator of the innovative Women's Interagency Health Study (WIHS) and co-founded AWARE (Association for Women's AIDS Research and Education), a community-based organization that offered confidential testing and counseling to women at high risk for HIV. Wofsy was also one of the first AIDS experts to confront the rise of AIDS discrimination in the workplace. Her leadership in AIDS was well-known outside the United States as well. She brought scores of AIDS caregivers from around the world to San Francisco General Hospital for specialized training in HIV care through her APEX Training Program (AIDS Provider Education and Experience). She was a compassionate visionary.

Genoveffa Franchini
Head of Animal Models and Retroviral Vaccines Section of Basic Research Laboratory at National Cancer Institute, Bethesda, MD

Current Project: Testing therapeutic vaccines that induce cell-mediated immunity to SIV viruses in animal models.

Her Take: "We've seen protection not against infection but against SIV viremia [in macaques]. What we are seeing is encouraging. I hope the people with HIV will understand that we are trying to do our best."

Nancy L. Haigwood
Senior Scientist, Seattle Biomedical Research Institute; Associate Professor of Pathobiology and Microbiology, University of Washington

Current Project: Genetic vaccines that can reduce viral load.

Her Take: "With so many individuals infected and dying from this epidemic, it is imperative that we make a vaccine to stop or at least slow this scourge."

Patricia Fultz
Professor of Microbiology, University of Alabama at Birmingham, AL

Current Project: HIV-specific immune responses, vaccines and SIV

Her Take: "The future of HIV research, of course, will include vaccine development. It is clear that the current array of antiretrivirals is not the answer."

Janis Giorgi
Director, UCLA AIDS Institute Flow Cytometry Core Facility

Current Project: CD8 T-cell-mediated immunity and vaccinia recombinant HIV vaccine.

Her Take: "We cannot ignore that much of transmission of HIV to women is occurring in situations where they lack self-determination and access to knowledge. We seem willing to accept the status quo instead of striving to be the best society. It's nuts."

Julie McElrath
Associate Professor of Medicine, University of Washington, and Associate Member, Fred Hutchinson Cancer Research Center, Seattle, WA

Current Project: Studying mucosal immunity and early events in HIV infection to determine why some individuals appear resistant.

Her Take: "We are looking very closely at individuals who may be resisting infection. We can look at their partner's [virus] isolates and different components of the immune system and what's controlling [HIV]."

Zeda Rosenberg
Scientific Director, HIV Prevention Trials Network, Family Health International. Arlington, VA

Current Project: HIV prevention strategies and microbicide development

Her Take: "For women to have a woman-controlled method [of HIV prevention] is very important so they can protect themselves."

Susan Zolla-Pazner
Professor of Pathology, New York University Medical Center, New York, New York

Current Project: The basic science behind HIV vaccines.

Her Take: "I keep thinking I've heard the worst stories about women and HIV, and then I read another one and it's worse. It's still not appreciated in this country that this is a disease of women as well as men."

World Vision - Kathleen Squires
Kathleen Squires has quite the cosmopolitan background. Born in Australia, she and her family settled in the United States when she was in high school. In between, they lived all over the world—Indonesia, Nigeria, Brazil—wherever her father's oil company jobs took them. It was on these early travels that her desire to be a doctor first surfaced.

"I noticed there were major differences betwen the people who worked for the oil company and the people who were natives of that land," she recalls. "And my father always told me that one of the major differences was health care, that these people didn't have access to the health care that we did. And as a little girl, I supposedly said, 'I want to do something about that.'"

So she did. But instead of traveling the world to take care of people, Squires stayed in the United States, where she was introduced to HIV. It has proved the perfect field for her. On the one hand, it satisfies her interest in infectious diseases. "I became fascinated with the disease process itself, because this is a cell-mediated immune deficiency state," she says. On the other, the epidemic gives her an outlet to make a difference—her childhood dream come alive. "I like the feeling of being involved in more than just the medical aspects of taking care of someone—understanding the impact of the disease on themselves and society."

Squires is known in HIV circles as a talented clinician and as a leader in research on women with HIV. She works at the 1917 Clinic in Birmingham, Alabama, where she sees plenty of people who don't have access to the best health care—people who go years before being diagnosed, who don't get the right kind of treatment, and who may have a difficult time taking care of themselves. Many are women. "I try to set up a system first and foremost to make sure that women who present with the infection get optimal care," she says. "One thing we have to do is understand what's going on in a patient's life and help them figure out how they can incorporate [care] into that life." In addition to giving day-to-day care, she's a firm believer in learning from the women in her clinic through research and clinical trials that "look at gender and sex-specific issues—like genital HPV (human papillomavirus) infection."

It's a tough job, but Squires has no complaints. "I really like what I do. To be a good physician, you have to know your patient very well and to me, it's a great honor, because my patients tell me things that I'm sure they tell very few other human beings. So it's an obligation, it's a responsibility, but basically it's an honor to be allowed into another person's life in a way that I am."

-Geri Clark

Activist Physician - Kathryn Anastos
"I'm a child of the '60s. I went to medical school as a vehicle for social change," says Dr. Kathryn Anastos, a tough, charismatic HIV doctor who is blazing new paths in research on women with HIV and AIDS. With a crown of short, silver hair framing strong features, Anastos is both passionate and cool-headed, a scientist with a sharp political consciousness. The combination has brought her to the forefront of the battle against the epidemic.

A self-described "activist physician," Anastos recalls how she gravitated to social medicine, beginning her primary care practice at New York City's Montefiore Medical Center in the Bronx, then moved to nearby Bronx-Lebanon, located in a poor, drug-ravaged area. It was there, in the 1980s, that she quickly realized "if you wanted to make a difference in the South Bronx, you needed to know how to take care of HIV." Along the way, she found herself propelled into research. "I was outraged at the ways women and men of color were discussed in the medical literature on HIV," she says. The standard view at the time was "you don't need to include women [in studies] because they're the same as men...but you'd better not include them because if there is a difference, it dilutes the power of the study. It was a double whammy." Women, says Anastos, were viewed mainly as vectors of transmission to men and children, "rather than as individuals with an illness whose natural history needed to be defined." Exasperated with this kind of thinking, she began studying gender differences in HIV.

She's still first and foremost a clinician but also a key investigator at the Women's Interagency Health Study, where she's spearheaded studies of differences in viral load and CD4 T-cell levels among women and men, whites, and people of color, research she thinks is critical to understanding HIV. As a doctor, she wants to know whether such differences mean different responses to treatment. "Women at higher T-cell counts than men have lower viral loads, so you'd think we'd be more likely to obliterate the virus in women than in men." Armed with this theory, Anastos hopes to solve the puzzle of what determines how effective a treatment can be. "It's a window into pathophysiology," she says. "The difference could inform our investigations of how the disease makes people sick in the first place."

Anastos is also keeping her eye on the long-term effects of HIV therapy on women. Looking ahead, she sees vaccine development and such side effects as lipodystrophy and drug resistance sharing the spotlight in HIV research, alongside studies of demographic differences. But on the public health front, she says it's still got to be "prevention, prevention, prevention! We've got to get innovative with prevention." And, on a global note, "we need universally available drugs."

- Stanya Kahn