Taking Necessary ACTS against HIV

Taking Necessary ACTS against HIV

When HIV was first identified 30 years ago, Dr. Donna Futterman was an Einstein student interested in pediatrics, not yet aware that HIV and AIDS would emerge as the work of her career. Today, Dr. Futterman runs the Adolescent AIDS Program (AAP) at Montefiore and has developed ACTS, which stands for Advice, Consent, Test, Support, a program that is having a significant impact on how people are tested for HIV in the United States and in South Africa.

Donna Futterman, M.D.
Donna Futterman, M.D.
The opportunity for the Long Island native to create change began in 1980, when she entered Einstein. Already a seasoned activist, following her dream of becoming a doctor allowed her to continue her mission of providing social justice. During her second year, AIDS, which was then called Gay-Related Immune Deficiency, began making headlines.

"With the arrival of AIDS, my community was vulnerable," said Dr. Futterman, who has been in a committed lesbian relationship for 34 years. "And, in 1983, it became obvious that the disease was also affecting pediatrics."

Dr. Futterman became director of the AAP in 1989. In addition to guiding its clinical focus, she published numerous articles on the care of HIV and at-risk youth.

"Today, we have medicine that can literally bring people back from the dead," she said. "But before you can receive the proper treatment, you need to be tested for the disease."

Her commitment to and passion about addressing the issue have changed the way health practitioners look at HIV.  Through her efforts, she has reached out to approximately 25 percent of HIV-positive Americans — an estimated 250,000 — who have not been tested and thus do not benefit from life-saving treatment and prevention services.

She explained, "In 1996, we realized that AZT could prevent transmission of HIV from pregnant mother to child. As a result, there was a huge mobilization to test all pregnant women. It seems so obvious now, but it was then that we also realized that this idea could apply to the rest of the population."   

In 2002, the AAP conducted a survey in the Bronx and learned that HIV testing was not offered due to time constraints, inexperience and the belief that patients were not at risk. As a result, program physicians developed ACTS, to facilitate significant improvements in HIV testing and counseling in both clinical and community-based settings. Between the years 2003 and 2005, HIV testing at such facilities increased by an average of 133 percent.

The success of ACTS has led to its use in cities including Miami, Oakland, Houston and Philadelphia. In 2007, Dr. Futterman convinced the New York City Department of Health to create Bronx Knows, an initiative that increased testing in the Bronx by 20 percent in a matter of months. That same year, her team won a five-year grant from the President’s Emergency Plan for AIDS Relief to implement ACTS in South Africa.

Youth health center in South Africa
Youth health center in South Africa
"The prevalence of HIV in the Western Cape Province is 17 percent, though some communities have prevalence as high as 31 percent and, when I went to South Africa as a volunteer in 2001, it was exciting to see their health department mobilize the whole community to address the problem of HIV transmission from mother to child. Some of what I do in the States was inspired during that trip."

The Western Cape Province has since asked ACTS South Africa to provide planning implementation, training, mentoring and monitoring to increase routine HIV counseling and testing in all 480 of its public health facilities. Dr. Futterman returns several times a year to assist with the ongoing efforts.

"She’s a mover and a changer," said Einstein medical student Vanessa Scott.

"She is extremely passionate, too," added fellow student Nadav Lelkes.

Ms. Scott and Mr. Lelkes first met Dr. Futterman during a global health conference. Last summer, they joined her in Cape Town, assisting with a six-week study of ACTS.

"There's a stigma around being HIV positive in South Africa and when a person tests positive they often don't want to tell anyone" said Ms. Scott. "But they need a network for support, especially when they start treatment."

Erasing that stigma is important to Dr. Futterman. "HIV is not going away," she said. "Every five years there is a new generation that is not receiving the same level of information on HIV that we did several years ago."

She continued, "Everyone knows what Coca-Cola is, but millions of dollars are still spent every year to market the brand. We need to be in as diligent about HIV."

Dr. Futterman (center) with AAP staff members (from left) Dr. Elizabeth Enriquez-Bruce (research director) and Lissette Marrero  (deputy director)
Dr. Futterman (center) with AAP staff members (from left) Dr. Elizabeth Enriquez-Bruce (research director) and Lissette Marrero (deputy director)
Motivated by her passion, Einstein’s students have established HEART (HIV Education and Rapid Testing), a program connecting them with Bronx Community College students to conduct weekly HIV testing.

"One girl began crying when her test came back negative," recalled Ms. Scott. "She was in a very abusive relationship where the man refused to wear a condom and would often force sex on her. It was the first time she told anyone about it. It’s stories like hers that make programs like ACTS and HEART so important."

Dr. Futterman is encouraged by the advances she has seen.

"Physicians feel motivated to do testing and to have the skills necessary to address their patients. As more of them discuss HIV with their patients, I’m hopeful that screening for HIV will become as routine as screening for diabetes or hypertension." 

Those who have seen her in action believe her vision can become reality.

"She’s someone who keeps fighting for her patients," said Mr. Lelkes. "I hope I’m like her when I become a doctor."

Posted on: Friday, April 22, 2011