Human Rights = Public Health

Remembering AIDS Pioneer Jonathan Mann

How great a loss was the death of AIDS researcher Jonathan Mann, killed in the crash of Swissair Flight 111? "I'm convinced that if someone other than Jonathan had been the first director of Global Programme on AIDS, the whole response to the epidemic would have been different," says Peter Piot, one of the earliest HIV researchers and now director of the United Nations AIDS program. "For example," he continues, "we may have gotten into a repressive approach, perhaps using quarantine. Because let's not forget that in the early days there were many calls for that."

Indeed, notes Newsday reporter Laurie Garrett in her definitive book The Coming Plague, by 1987, 81 countries had passed laws against people with HIV or risk groups, usually homosexuals and prostitutes. In Germany, a federal judge declared it might be necessary to tattoo and quarantine people with the virus. Cuba was already quarantining AIDS patients. Some Muslim states were jailing "promiscuous" people, and Chinese officials denied the existence of homosexuals, drug users, or prostitutes in the People's Republic. In the U.S., President Reagan's secretary of education, William Bennett, fought Surgeon General C. Everett Koop's plans for frank education about HIV prevention, favoring instead compulsory testing of all hospital patients, marriage license applicants, and immigrants. Quarantine loomed as a very real threat.

Amid this gathering storm, Jonathan Mann led public health authorities to perhaps their finest hour. Impeccably dressed in bow ties, yet with the gritty experience of running the first major African HIV research program (which, among many accomplishments, showed that HIV could be spread through heterosexual sex but not through mosquito bites), Mann managed to convene more than 100 national ministers of health together in London. There, as Garrett writes, almost 150 nations signed on to a condom-based, compassionate strategy to slow the spread of AIDS. A few months later, he convinced the World Health Organization to make human rights the core of its anti-HIV stratety. These coups played a crucial role in preventing the wholesale repression of people with the virus.

Mann orchestrated this historic consensus from his new position as director of the World Health Organization's Global Programme on AIDS. At first, recalls Daniel Tarantola, who joined the fledgling endeavor at the beginning, "the program was himself, a secretary, and one typewriter." Two years later, Mann had rocketed the budget to almost $100 million. His m.o.: hard work, personal modesty, and an eloquence that was at once fiery and logical. "Back at a time when only a few people were screaming" for a humane and effective response, says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, "Jonathan was an unbelievably articulate and passionate voice." Mathilde Krim, founder of the American Foundation for AIDS Research, adds that Mann persuaded people with "the force of the argument, the morality of behaving a certain way, and the practical usefulness of being ethical and respectful of others. He convinced people."

Mann's message: AIDS is a global crisis, in which no person or nation is an island. More important, human rights and public health go hand in hand: "In each society, those people who before HIV/AIDS arrived were marginalized, stigmatized, and discriminated against become those at highest risk of HIV infection... The French have a simple term which says it all: HIV is now becoming a problem mainly for les exclus, the 'excluded ones' living at the margin of society."

Mann, who moved to Harvard after leaving WHO, gave a shattering talk at the world AIDS conference two years ago in Vancouver. That was when protease inhibitors arrived, creating a sense of euphoria in the First World, where the expensive drugs were able to prolong life. But Mann warned that this breakthrough threatened the very solidarity among AIDS advocates that had allowed them to hold back repressive policies. In AIDS, he said, "we all started in the same place: with the same lack of treatment and with the same hopes... The industrialized world, shorn of its technologic armor, was forced into developing prevention and care strategies, to listen and learn from the universally available wealth of human experience and wisdom." He called for individual efforts, including for people with HIV in wealthy countries to "give the equivalent cost of a week of treatment" to give patients in developing countries basic treatment "or relief of pain."

In December 1996, Mann married Mary Lou Clements, a world-renowned expert on vaccines who founded the Center for Immunization Research at Johns Hopkins University. Clements-Mann, who early in her career worked in the worldwide effort to eradicate smallpox, has conducted more than 100 clinical trials on vaccines, from influenza to hepatitis. She worked on the recently approved immunization for rotavirus, which causes often fatal diarrhea in children in poor countries. She was also working on several HIV vaccines, as well as the first trial of one for hepatitis C.

The couple's untimely death, not two years after their wedding, was poignant in intimate ways as well. Fauci dined with the couple a few weeks ago and, he says, "Jon and Mary Lou seemed so happy about their future."

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