AIDS Prevention Project and the New Paradigm Fund

Abstract

This paper explores the life and career of renowned anthropologist Edward C. Green. In conjunction with his life, this paper will also highlight the Harvard AIDS Prevention Project which was developed and directed by Edward Green in an effort to decrease the prevalence of HIV and other infectious diseases in Africa and other areas of the world. The Harvard AIDS Prevention program was soon translated into the New Paradigm Fund, which held similar views and operated in a similar fashion as its predecessor. There is a revolving world view on what HIV and AIDS is and how to prevent it. Anthropologist Edward Green however, had opposing views towards how AIDS could be combated and as a result devoted his life and career to improving health outcomes in under-served populations. This paper will present perspective that contrast the quintessential biomedical view of AIDS and its prevention. Finally, this article will do a cross dissection of the goals, methods and research findings of both projects to determine the research findings.

Edward C. Green:  AIDS Prevention Project and the New Paradigm Fund

Edward C. Green, B.A. ’67, dedicated his career as a medical and applied anthropologist to improving the health outcomes in medically underserved populations. Born in the year 1944, Edward Green was an American research scientist at the prestigious Harvard School of Public Health. Similarly, a life centered around research and field work led Edward Green to serve as the senior research scientist at the Harvard Center for Population and Development Studies for about 8 years. His last three years at Harvard University entailed him directing the AIDS Prevention Project. Later In his life (2011-14), Green was affiliated with the Johns Hopkins University Department of Population and Reproductive Health. For over 30 years, Green dedicated himself to a career in international development. Since the 1980s, a majority of his work revolved around AIDS and other sexually transmitted diseases predominantly in Africa.

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At the beginning of his career Edward Green attended the Groton School located in Groton, Massachusetts after which he attended the Seoul American High School in Korea. A man of profound interest in the social sciences, specifically the field of Anthropology, received his Bachelor of Arts degree from the George Washington University, his Master of Arts in Anthropology from Northwestern University, then later his PhD in Anthropology from the Catholic University of America. Edward Green established roots at Harvard University when he held post-doctoral fellowships between 2001 and 2002. (George Washington University, 2017). His teaching career soon erupted when he began to teach public health and anthropology at George Washington University and Boston University. Being an ethnographer and researcher required Green to travel around the globe and as such, he was able to experience a number of cultural practices, traditions and medical realities. It was clear to Green that his experience and interest in the anthropological field would lead him to doing meaningful and worthwhile things in the society. His interest in AIDS stemmed from his belief in the power community solutions and lifestyle changes as opposed to technological or biomedical interventions. Green is a pioneer in anthropological research on indigenous leaders and is considered to be one of the first to develop public health programs that combined traditional healing strategies with westernized biomedical styles of healing. A man of profound interest in the ideology of traditional healing, Green went on to writing a number of books that sought to enlighten readers on: Practicing Development Anthropology (1986), AIDS and STDs in Africa:  Bridging the Gap Between Traditional Healing and Modern Medicine (1994), and Indigenous Theories of Contagious Disease (1999). In 2004, Edward Green was awarded the Philly Lutaaya Award “for leadership role in increasing AIDS awareness through education and looking at prevention from an African perspective.” Awarded by President Yoweri Museveni, Uganda North American Association. (George Washington University, 2017). Many might wonder why Edward Green was first drawn to the field of Anthropology, and further devoted his entire life to the field. In the simplest explanation, Edward Green, like many anthropologists in the field, was initially attracted to the anthropological field as a result of an experience that he had abroad as a youth. Additionally, Green is probably most well-known for his open critiques of the western biomedical policies and practices of the AIDS establishments in their approach to Africa. Lastly, Edward Green has help numerous board memberships including but not limited to the Presidential Advisory Council for HIV/AIDS between 2003 and 2007, Office of AIDS Research Advisory Council, National Institutes of Health (2003-2006) and Member of UNAIDS Steering Committee, AIDS2031, UN Geneva, Switzerland (2008-2009).

It is of no surprise that Edward Green was appointed as the Director of the Harvard AIDS Prevention Research Project in 2007. The APRP a three-year program supported by a grant from the John Templeton Foundation. It was primarily based at the Harvard University Center for Population and Development Studies. At its crux, the APRP was established in an effort to support evidence-based research on the impact of behavioral approaches in reducing the transmission of HIV/AIDS worldwide. The AIDS Prevention Project incorporated a number of anthropological methodologies in order to gain research findings. Firstly, the project investigated and documented HIV prevention successes and other promising approaches that were focused on behavior-based approaches that would assist in guiding the development of evidence-based models of behavior change for generalized (transmission occurs primarily outside of vulnerable groups) and concentrated epidemics (Transmission occurs largely among vulnerable groups). There were a few major focus points of the APRP that ensured that the project achieved the goal that it set out to achieve. The researched HIV project included approaches that: Are behavioral, not primarily technological or biomedical in nature; Are appropriate to the type of HIV epidemic (i.e. generalized or concentrated); Learn from and build upon indigenous knowledge and local culture; Recognize the role of community values, including spiritual and religious beliefs, in influencing behavior; Are cost-effective, feasible and sustainable; In general seek to avoid risk, rather than mainly to reduce the risk of inherently risky behaviors; Are innovative and seek creative solutions that extend beyond the standard or heretofore most common approaches in prevention; Account for the role of gender in sexual risk and behaviors. The research was deconstructed into certain particular areas. The areas of research that were decide on by Edward and his team were multiple concurrent partnerships among urban young adults in South Africa, Community-based HIV prevention, including the contribution of community and faith-based organizations and indigenous healers, the potential impact of male circumcision and partner reduction on HIV transmission. In essence, the project sought to pull more in depth on the sociocultural factors that influence the widespread of sexually transmitted diseases such as HIV and AIDS primarily in Africa. Edward Green and others that were behind the project saw an area of research that lacked attention and were interested enough to view the problem from a different lens. Generally, when we consider HIV and AIDS, automatically we pursue avenues of biomedicine or technology to ensure protection. Green on the other hand, believed that community intervention was the first step in providing any real cure. The pivotal role of partner reduction as well as other behavior-based prevention strategies that have been shown successful in reducing HIV prevalence in generalized epidemics were investigated and communicated. Similarly, the project sought to promote a deeper understanding of the level of influence that beliefs, spirituality and values such as responsibility and respect can have on human health and behavior. The AIDS Prevention Research Project coordinated and co-hosted a 2-day conference with the World Bank and the UNAIDS to address Multiple and Concurrent Partnerships in South Africa. The meeting brought together about 40 representatives from various organizations working in the southern Africa region with the aim of establishing a common vision and agenda to guide interventions and strategies that addressed MCP. By the end of the grant term, the APRP had established a number of AIDS prevention approaches and made a number of suggested implementations for making global AIDS prevention programs more Effective. The project called out a number of findings during the time of research including the fact that most of the HIV infections around the world are transmitted sexually through the actions of having multiple sex partners as well as having concurrent partnerships. While these have been proven to be the most dangerous ways of driving the HIV epidemic, prevention programs funded by major donors have not explicitly promoted monogamy or even partner reduction. This shows that prevention programs are focusing only on the technological intervention aspect of the problem, without addressing the room cause. This seemed really interesting to me because the most important step in the prevention process seems to have been neglected. Educating communities of people on how to prevent sexually transmitted diseases on a community level without intervention from outside corporations should have always been the most essential point. As a result, the project was able to identify a few factors that contribute to the epidemic as well as implemented suggestions on how to decrease AIDS prevalence. Based on randomized controlled Trials, it was established according to the USAIDS multi-center study that male circumcision is one of the major predictors of regional HIV variation in Africa. In regard to religion and faith, most people belonged to one of three faith communities namely Catholic, Anglican or Muslim. Faith based organizations brought in behavioral focused perspectives where members learned about faithfulness (partner reduction). Many faith communities accepted condoms, but monogamy and abstinence remained primary factors. Uganda was one of the countries that were very open about AIDS and sexual behaviors. The message that was stream lined was that “everyone is at risk”. Such an approach led to less stigma, resulting in people living with HIV/AIDS speaking publicly about their infection and becoming more involved in prevention within schools and communities.

At its ending in 2010, the APRP succeeded in a number of its goals, however there was still much work remaining. The New Paradigm Fund emerged in 2010 as a follow-on project to the Harvard-based IDS Prevention Research Project. In the very short time that the NSF has existed, it has funded several projects across Asia, Africa and Eastern Europe. Based on our new-found information on Edward Green, it is not surprising that the area of direct and primary interest was sub-Saharan Africa. The New Paradigm Fund would pick up where the APRP left off with a few differences in ideology. The New Paradigm was established by Edward Green in 2010 and remains an ongoing project today. The Fund seeks to identify, develop, evaluate and share superior models for bettering the health and well-being in underserved populations around the world. At its crux, this is similar to the foundational goal and purpose of the PRP. According to its website, the NSF has a purpose to provide strategic support to applied research and pilot programs in health and well-being that embrace indigenous people and their traditional beliefs and practices with solutions that come from within the community. A major focus has been to assist in the reduction and elimination of the spread of HIV/AIDS and other infectious diseases, while also exploring rain forest and primate conservation, and aspects of poverty associated with stateless and minority peoples. The NPF has also added an additional significant area of support: alcoholism and drug addiction. This is a major public health problem, particularly in Africa, which gets little donor attention or support. The solutions that are proposed by the fund involve ideals that are grounded within local cultures. The foundation believed that it was more important and far more superior to make use of sustainable resources within local communities than to rely upon continuing outside assistance (which can lead to dependence and a devaluing of even the best aspects of indigenous culture). Recognizing that local people have a greater capacity to make fundamental changes in behavior was a major driving point for the NPF. The project itself has led to the establishment of numerous other programs that flood the globe. A few of the recent sub-projects include; an ecumenical project to prevent HIV transmission through strengthening marriages in Uganda, strengthening drug addiction treatment and recovery via the Yakita Center program in Indonesia and Technical assistance to analyze and publish results of research in international scientific journals. The New Paradigm fund has made and continues to make numerous accomplishments in the global health field. Numerous meaningful accomplishments have been made through the approach of using local personnel, resources and cultural establishments to attain the best health outcomes. With the support of the NFP, The Ubuntu Institute in southern Africa has increased its scope to work and grow its staff. This improvement has allowed for the corporation to be officially designated as a state 3 local NGO. As a result of this, it qualified to receive indirect USAID grants and non-US grants. The development of the alcohol and substance abuse in Swaziland to evaluate treatment and counseling efforts with under resourced populations was made possible with the assistance of the New Paradigm Fund. Another accomplishment of the fund includes the Feasibility assessment, implementation, and evaluation of a program in Uganda designed to strengthen couple’s relationship satisfaction and to enhance fidelity. Lastly is the exploration of Africa-based and other collaborative funding opportunities.

An essential question might be why and how these projects represent the anthropological and more specifically he applied anthropological community. It is essential to point out that both of the projects spearheaded by Edward Green place emphasis on the sociocultural and behavioral aspects of HIV in contrast to the typical technological and biomedical aspects. Anthropology according to Merriam Webster represents the science of human beings and their ancestors through time and space and in relation to physical environment, social relations and culture. Applied anthropology takes this definition a step further to include the anthropological methods that are used in obtaining the resolution of real problems. In other words, applied anthropology is exactly what it sounds like; taking anthropological notions and applying them to the field. It is fairly simply to recognize why these two projects are all anthropological in all senses. The projects sought to view the problem of the spread of AIDS from a more holistic point of view rather than through the biomedical lenses that we are so used to looking through. Rather than focusing on condoms and other technologies or medical devices that are most often projected on individuals of local communities, the projects looked deeper and asked more specific questions. As a result, they were able to find information on condom use, illustrating that condoms do not in fact affect the prevalence of diseases because of a ton of other factors that are rarely considered. Taking into consideration the social aspect however opened the door for better implementations and suggestions for preventing the diseases from further prevailing and leaving more populations affected.

Overall, the two projects of the Harvard AIDS Prevention Research Project and the New Paradigm Fund have both been transforming factors in the field of Global Health in that they initiated a paradigm shift that would allow for future foundations to think outside of the norm when issuing policy implementations. Now we are more aware of the sociocultural factors that surround the increasing rates of HIV/AIDS and other sexually transmitted diseases and more importantly, why it is of utmost importance to explicitly promote monogamy, partner reduction as well as male circumcision. I especially liked how the articles and research projects brought about the importance of using condoms, but also addressing the fact that if local people are not taking fundamental steps to prevent AIDS acquisition, condom use will not result in much change.

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