The work of UCLA public health researcher and educator Dr. Roger Detels has had a significant impact on how the countries of Southeast Asia are handling the HIV/AIDS epidemic.
“One of the really fun things about working in different cultures is that you really can't work in another culture unless you learn about it. I often tell my students that I have the same strategy for working in developing countries that I had for raising teenage sons: It's called big ears, small mouth.”
By Peggy McInerny, Director of Communications
UCLA International Institute, March 3, 2016 — Dr. Roger Detels was recently recognized for his contributions to the health and well-being of the Vietnamese — and to the development of medicine in the country — in a certificate of thanks signed by the Minister of Health of Vietnam Nguyễn Thị Kim Tiến. The commendation is one of a series that the renowned HIV/AIDS* researcher and educator has received from Asian countries, including Cambodia, Thailand and China.
Although Detels has a dual appointment in the UCLA Fielding School of Public Health and the Geffen School of Medicine at UCLA, he considers himself “a public health man.” The distinguished professor of epidemiology and infectious diseases is the former dean of the School of Public Health (1980–85), where he has several times chaired the department of epidemiology and, since 1988, directed the UCLA/Fogarty AIDS International Training and Research Center.
Detels began working as a doctor in 1966 — in the midst of the buildup of U.S. forces in Vietnam under President Lyndon Johnson. Over the course of his impressive 50-year (and counting) career, he has seen a sea change in relations between Southeast Asian nations and the United States. He himself has played a significant role in that change, training at least two generations of health professionals from Southeast and East Asia in modern epidemiological techniques and research methods to combat the HIV/AIDS epidemic and other infectious diseases.
The UCLA professor’s early research in public health concerned such topics as air pollution, multiple sclerosis, hypertension, and infectious diseases. Detels has been working on the epidemiology of HIV/AIDS since 1981. Beginning in 1983, he led the Los Angeles portion of one of the largest natural history studies of HIV/AIDS in the world (the Multicenter AIDS Cohort Study). Five years later, he founded the UCLA/Fogarty Center (then called the UCLA/Fogarty International Training Program in Epidemiology Related to HIV/AIDS) with funding from the National Institutes of Health (NIH).
Training public health professionals
The UCLA/Fogarty Center initially focused on training health professionals from developing countries (including Hungary, Brazil and The Philippines) in the prevention and treatment of HIV infection, forging direct collaborative relationships with Thailand and China. In 1993, it began to focus on countries in Asia with high rates of HIV prevalence and its roster of collaborating countries subsequently expanded to include Myanmar, Vietnam, India, Indonesia, Laos and Cambodia. To date, some 75 to 100 students have completed higher degrees at the center.
HIV/AIDS peer education group, Poitpet, Cambodia. (Photo: Asian Development Bank
on Flickr, 2011; cropped). CC BY-NC-ND 2.0.
And what an impact the Center has had. Two of its graduates have become ministers of health in their respective countries, another established the first school of public health in Cambodia, and yet another played a leading role in the creation of such a school in Chennai, India. Several graduates have also become deans of public health schools and/or leaders of national AIDS programs. And virtually all former Center students continue to do collaborative research on HIV/AIDS prevention and treatment. One graduate, together with a colleague from the University of Hawaii, even developed the Asia Epidemic Model, which forecasts the future of the epidemic in Asian countries.
“One of the nice things about training health professionals is that they go back and assume important positions,” says Detels. “You want your students to do better than you did.” He points out that when the Fogarty International Center of the NIH began to fund epidemiological training in HIV/AIDS prevention, most universities chose to focus on short courses. But Detels says, “I felt very strongly that you're going to have the biggest impact if you concentrated on giving advanced training at the master's degree and Ph.D. level. And I think that I've proven that.”
The UCLA/ Fogarty Center does, upon request, offer in-country workshops for health professionals in Southeast and East Asia, as well as a three-month postdoctoral training program. But its primary focus is master’s- and doctoral-level training in AIDS prevention and epidemiology more generally. It offers foreign students from targeted countries an amazing opportunity, paying their airfare, fees and tuition, providing them a living stipend and a computer (with software), and requiring only that they conduct their research in their home countries and commit to returning home to work.
“Now that we've been running this program for well over 25 years, I have graduates in each of these countries,” notes Detels. “They know what the qualifications are for students to come, so I don't have to do quite as much direct interviewing because there's a whole team of them out there that can do it for me.”
Evolution of the public health response to HIV/AIDS in Asia
Although he initially encountered resistance from certain countries in Southeast Asia when recruiting for the UCLA/Fogarty program, Detels says, “As the epidemic spread, the various ministries of health became aware that they had to do something about it.” In fact, he believes that because of the disease, many countries in the region have changed their social attitudes toward injection drug users, sex workers and homosexuals in a much shorter period than those same attitudes changed in the United States.
According to Detels, Thailand has spearheaded the public response to HIV/AIDS in Asia, instituting data-gathering and public education programs that have provided a template for other countries in the region. In 1989, at the request of Thai colleagues, Detels led a workshop that helped the country institute a sentinel surveillance program that identified and monitored groups likely to be infected with HIV. “By using that system, they were able to document the spread of the epidemic from a few drug users into the commercial sex worker population and then into the general population,” remarks Detels. “And that system was then adopted by Cambodia.”
Information display at the 11th International Congress on AIDS in Asia, held in Bangkok, Thailand.
(Photo: USAID in Asia on Flickr, 2013; cropped). CC BY-NC 2.0.
“It's been very interesting to watch the different countries deal, for example, with the issue of commercial sex,” he recounts. “The Thais were very realistic. They realized that they weren't going to get rid of commercial sex, so they didn't even bother to try.” The advantage of Thailand, he notes, is that most commercial sex work is based in establishments. That fact allowed Thai public health officials to deal directly with brothel owners, advising them to use condoms and offering free inspections of their sex workers every three months. The result was a well-known campaign that became famous for the signs that adorned brothel walls in Thailand: “This is a 100% condom house.”
Although Cambodia adopted a similar approach, it has had less efficacy because commercial sex workers in that country tend to work freelance instead of in organized establishments. The same holds true for Vietnam and, to a lesser extent, China. “It’s a huge problem,” relates Detels, “because if you can’t access the populations [vulnerable to HIV infection], then you can't provide health education to them.” China in particular has seen a huge spike in commercial sex since the country began to rapidly modernize in the 1990s, with a concomitant jump in the rates of sexually transmitted diseases.
At the same time, explains Detels, cultural aversion to homosexuality and the high premium placed on maintaining the family line means that most men who have sex with men in Asian countries tend to be married. “And that makes them very difficult to access in terms of trying to get prevention messages across and getting them tested,” he observes.
Yet Detels’ students are making a difference. One of his graduates now heads the national AIDS program in China. “He realized,” recounts the UCLA expert, “that if you're going to do something about the epidemic, you've got to deal with these populations — and not in an up-down kind of relationship, you have to deal with them on a peer relationship, because you're not going to get into that population any other way.” As a result, the public health professional chose to engage directly with nongovernmental organizations working with the gay male population in China, which has been very effective. Thailand and China have made great progress in reaching this at-risk population, says Detels, while Vietnam and Myanmar are still struggling to effectively access this group.
Teaching and learning at the international level
Detels treasures working at the international level and appreciates what he learns from his colleagues and students. “You meet some amazing people when you do this sort of thing,” he says. “One of the really fun things about working in different cultures is that you really can't work in another culture unless you learn about it. I often tell my students that I have the same strategy for working in developing countries that I had for raising teenage sons: It's called big ears, small mouth.”
To counter the tradition of vertical academic scientific systems in Asia, Detels uses the course "Critiquing the Literature" to teach his students at the UCLA/Fogarty Center to disagree with him. “Disagreements are what advance science,” he says. “You have different opinions and then you come together and you discuss those different theories and ultimately, you come to some sort of resolution — that's how science advances. . . . What I'm trying to do is to teach them is how to disagree in a collegial manner, because that’s absolutely essential. And it’s not the usual system [in Asia].”
Asked about overcoming cultural aversions to populations at risk for HIV infection, Detels again refers to the role of education. “The idea is to educate people not from a moralistic perspective, but from the idea that if you're in public health, it’s your responsibility to do something about the health of the public. And if you're going to do something about the health of the public, you have to work with very diverse populations and you've got to understand them and you've got to be sympathetic with them.”
UCLA freshmen will be able to benefit from Detels' wealth of experience through a new Global Health in Asia Fiat Lux course, to be offered for the first time in spring quarter 2016. Shaped by Detels, the course will feature a series of faculty guest speakers who will address different aspects of public health in Asia; it was developed with Title VI funding of the Asia Institute.
*HIV/AIDS – Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome.