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A woman's focus on AIDS Magee researcher's work targets killing the virus during transmission Tuesday, May 15, 2001 By Mackenzie Carpenter, Post-Gazette Staff Writer
Sharon Hillier's official title at Magee-Womens Hospital is professor of obstetrics, gynecology and reproductive sciences. But she doesn't spend any time delivering babies.
In fact, her real specialty doesn't exactly make for small talk at a family reunion, she told a group of women at a speech several months ago.
"They ask me what I do and I say, 'I'm a vaginal ecologist.' That's a real conversation-stopper," she said as the room broke up in laughter.
In reality, though, Hillier, 47, of Fox Chapel, has two other jobs: detective and soothsayer. For most of her 20-year career as a microbiologist specializing in women's health, Hillier has studied bacteria living in the vagina and how certain kinds of bacillus can help increase resistance to infection.
For the past six years, Hillier has focused on one scourge in particular: the AIDS virus, and how to stop it from spreading.
Since 1994, Hillier has been engaged in a worldwide effort with other researchers to develop a microbicide for use by women before sex that might protect against transmission of HIV, the human immunodeficiency virus that causes AIDS, and other sexually transmitted viruses.
She hunts for clues among the thousands of slides of Pap smears of women from all over the world that are stacked in her office at Magee. In fact, Magee is one of 10 centers in the United States conducting research into microbicides as a means to block transmission of HIV the way spermicides are used to kill sperm.
And it's one of only three medical institutions, along with Johns Hopkins and the University of California at San Francisco, that is performing the actual laboratory testing for the international trials, evaluating how these infections are moving through the population and what the risk factors are.
When she's not doing detective work, Hillier hits the road. In April, she was in Indianapolis and Boston and San Francisco. Her audiences are doctors and health-care workers in affluent communities, and she is there to deliver this politically loaded warning: your white, middle class heterosexual patients may be at risk for HIV.
Very often, she gets the same skeptical reception: AIDS is only a disease that affects the poor, or minorities, or gays, or drug abusers.
"There's a lot of denial out there," said Hillier. "When I was in Boston, I was speaking to a group of doctors, and one of them spoke up and said, 'none of the women in my practice have HIV. My patients are healthy, they're not at risk.' "
"Afterward, though, a woman came up to me and said she had had to tell a 16-year-old girl that day at her clinic she had HIV, and that this girl was from a middle-class family and she had no idea that she was at risk.
"I still hear this from nurses. They say, 'How can this patient be HIV-positive, she's not a [publically funded] clinic patient, she's a private patient.'
"We need to wake up and understand that HIV is being spread to women and female adolescents in affluent communities, too. When doctors see patients with chlamydia and herpes, do they think HIV is spread any differently?"
Another misconception: women are primarily responsible for the spread of HIV. "We still find many people focused on commercial sex workers as the source of infection," said Hillier.
One study of monogamous women in rural Uganda, where one in three of the women have HIV, found that their only risk factor was having sex with their husbands, who were having sex with other partners. Another source of frustration for Hillier has been the focus by the AIDS community on treatment of those with the disease rather than halting its spread.
Choosing a priority
Only recently has the World Health Organization identified microbicides as a high priority in AIDS research, after it became clear that the public health campaigns urging the use of condoms wasn't resulting in a massive change in behavior. Meanwhile, infection rates are increasing: in 1999, about 5.4 million people around the world were newly infected with HIV.
An AIDS update
Your Health this week takes a look at AIDS in advance of the seventh annual AIDS Walk in Pittsburgh next month. Here's a look at our coverage:
"After all the promotion of condom use, the majority of sexual acts are still not protected," Hillier said. "When we tell them to practice safe sex, the only thing we've had to offer is condoms, and unfortunately women aren't always able to negotiate condom use."
In a study of 90 young women conducted at Magee's adolescent medicine clinic, only about one in four had partners who used condoms, a rate matched in other studies done in Australia and Africa. And always, Hillier said, similar themes would emerge: "Women would say their partner would ask them, 'Don't you trust me?' Or they'd call them a slut and accuse them of having loose morals."
Other studies in Thailand, Africa and the United States found that men don't like to use condoms, and don't like their partners to use a female condom, a device that fits inside the vagina, since it interferes with their pleasure. So researchers began considering other means of protection: an affordable ointment or cream applied topically before sex.
"Women could use it in a secret way, without the agreement or cooperation of their partner," said Hillier. "It would be an invisible condom."
Initially, contraceptives were deemed promising. It was hoped that a common spermicide, Nonoxynol-9, could block HIV's transmission, but four large studies done in Africa have recently been completed and all of them show that N-9 doesn't work. That prompted researchers last year to redouble their efforts in developing other types of microbicides, and the National Institutes of Health has begun putting more money into research, a real change of direction for the agency, Hillier said.
"For the longest time, prevention hasn't been where they put their money, but rather in developing new therapies for AIDS."
Indeed, of the $1 billion in federal research dollars spent for AIDS, only about $220 million is spent for vaccine development and $25 million for microbicide development. Part of that is a function of the culture at NIH, she says.
"There's a lot more interest and excitement in treating a problem than in preventing a problem."
And part of that, Hillier believes, is gender-based. "Someone once described it like this: 'Men are the firemen, and women put in the smoke detectors. The men bring in their big hoses and fancy trucks, and women go around checking to see if the house is OK.' Well, that's what's been going on here."
An early realization
If Hillier, a Seattle native, sounds like a feminist, well, "I've been accused of that," she laughs. But her dedication to women's health issues stems from a meeting in 1983, "when I was sitting with a bunch of men talking about the causes of vaginal discharges in women. And some guy spoke up and said, this is all in their heads. It's because these women feel guilty, they're not comfortable with themselves sexually.'
"Well, I sat there and thought to myself, 'Boy, buddy, if you ever had your penis itch ... it would be a national emergency, but you're saying women do this because they're sexually repressed?'
"I guess I got crystallized very early with the idea that more work needed to be done on this subject."
Hillier's research focused on various types of bacillus that could help maintain a healthy environment in the vagina.
"The idea was, if we kept normal, beneficial bacteria in good shape, we could make the vagina more resistant to infection."
That led her, in 1994, into becoming involved in the search for a topical product that would also block HIV. The movement was led by Polly Harrison, who headed the Institute of Medicine and formed the Alliance for Microbicide Development. Grass-roots organizations across the country have sprung up to lobby for "the money and energy to find women tools to protect themselves, not just in America, but around the world," Hillier said.
But it's been a long, slow process. "I was at the first White House conference on HIV and AIDS in 1995, and we said then, 'We need to do microbicides,' and the prediction was we'd have them in five years. "Well, we don't have one six years later. Things were really stalled for a while. We had everything we needed to make a microbicide except the will and the money, and now, we're finally beginning to see the money and the will."
"When you drive by Magee, you should know that we're working not only to prevent HIV in Pittsburgh, but around the world. We get pap smear samples from women in Africa, South America, China, Thailand and Africa.
"And I can tell by looking at them if the woman has had sex, if she's douched or taken antibiotics," she said.
"But I can't tell what country she's from or what color her skin is. Because inside, women are all the same. The virus doesn't know if you're rich or poor. It's not a sin, it's an infection."
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The Pittsburgh AIDS Task Force for the first time is providing