HIV Experts Tread Carefully With New CDC Director

Public-health experts are eager to work with Robert Redfield, but they’re carefully watching his decisions on HIV-related policies and the opioid epidemic.

AP Photo/David Goldman
April 2, 2018, 8 p.m.

HIV experts and advocates say they are cautiously optimistic about working with the new Centers for Disease Control and Prevention director. But Robert Redfield, who brings decades of experience in the field of HIV and AIDS research and treatment, has drawn controversy as well.

The University of Maryland medical researcher, who was sworn in officially last week, will look to prioritize the opioid epidemic, biothreats, and gun violence as well, according to a former colleague.

But it’s his work in response to the HIV epidemic that is raising the most questions among public-health professionals and the top Democrat on the Senate health committee, who hope that his thinking on certain issues—such as his alleged view on quarantining people with the virus—has evolved.

“In the past, some of Dr. Redfield’s positions have served to exacerbate stigma while not being based in science and evidence, including supporting mandatory HIV testing, barring persons with HIV from military service, isolating people with HIV, and emphasizing abstinence as the primary means to prevent HIV. We hope that he will clarify his current stance on these issues,” Melanie Thompson, chair of internal medicine at the HIV Medicine Association, wrote in an email.

But Thompson said Redfield’s experience in HIV research and his work to curtail the opioid epidemic will be valuable in leading the CDC. She added that he has promised community members and HIV clinicians that he will support evidence-based policies and programs in his new role.

“We look forward to hearing a commitment from him that these policies will include fighting stigma and discrimination in all its forms, including upholding the dignity and rights of gay and bisexual men, transgender persons, and those who fight addiction and mental health disorders, and that he will support comprehensive HIV prevention, including preexposure prophylaxis, syringe exchange, and sexual education programs,” she added.

Redfield on Thursday appeared to address one of these concerns during a CDC staff meeting in Atlanta. “I have never been an abstinence-only person. Ask my wife,” he said, according to the Associated Press.

In fulfilling his new position, Redfield leaves the University of Maryland’s Institute of Human Virology, which he cofounded with William Blattner and Robert Gallo. He also served as the chief of infectious diseases and vice chair of medicine at the University of Maryland School of Medicine.

Gallo said “he brings intelligence, dedication, knowledge,” to the CDC, adding, “We cannot always say that about every director of every agency.

“I talked to him a few nights ago. He called me, and I asked him what he thought were the most important things he had to face, and he said, ‘No. 1, I want to get rid of the epidemic of AIDS in America, permanently,’” Gallo told National Journal on Thursday.

The second important area, Gallo said, was opioids. “He’ll pour himself into the opioid epidemic because he was impacted by it with his patients here in Baltimore and he regards it as extremely important,” he said.

The Associated Press reported that during Thursday’s meeting, Redfield pledged to bring the opioid epidemic “to its knees” and said that the AIDS epidemic could end within three to seven years.

Gallo said Redfield also wants to focus on security against biothreats and has “great concerns” about gun violence, a subject on which some lawmakers are looking to reinvigorate the CDC’s research.

Democratic lawmakers were divided over Redfield as the administration’s choice to lead the CDC.

“Although I seldom agree with the Trump administration, I am in complete agreement that Dr. Bob Redfield is the best choice to lead the CDC,” Rep. Elijah Cummings of Maryland said in a statement.

But Senate Health, Education, Labor, and Pensions ranking member Patty Murray questioned Redfield’s ability to run the agency, citing concerns over his alleged support for segregation of HIV-positive Army members and mandatory HIV testing. “The pattern of ethically and morally questionable behavior leads me to seriously question whether Dr. Redfield is qualified to be the federal government’s chief advocate and spokesperson for public health,” Murray wrote to the president earlier this month.

Gallo said Murray’s charges were off base. “I am surprised that a senator would speak out without even knowing what the real facts are,” he said.

He said that if Redfield had ever advocated quarantining people with HIV, he did not bring those views to the work at the institute. “That’s not been his thinking or policy since 1996,” he said, adding that before then he did not know Redfield well.

“If there is evidence, you know, I will accept the [evidence] that he did, but if he did, he certainly evolved past that long, long ago,” he said.

The CDC said Redfield was not available for an interview at press time.

Another point of concern Murray raised was an incident in 1993 when the Army investigated Redfield’s work regarding an HIV vaccine. The investigation ultimately found no evidence of misconduct, she wrote, but she added that Redfield’s analysis and trial data were faulty and the Army criticized him for prematurely presenting information.

Gallo said Redfield and “many other clinical scientists” at the time believed they might be able to enhance the immune system fighting HIV by a therapeutic vaccine.

“What I think of it was hyper- and overenthusiastic related to the beginning results; that’s the guilt,” he said. “Sometimes we get too excited when a hypothesis of ours seems to be right. And the scientific mode should be to try to prove yourself wrong—it is sometimes hard to remember in your excitement to want to do good. It wasn’t fame and glory, it wasn’t that he was going to get more power, it wasn’t malicious, it wasn’t fraud. It was hyper-enthusiasm for the early results without waiting to get it statistically, properly analyzed ultimately.”

Mitchell Warren, executive director of HIV advocacy group AVAC, echoed those sentiments, adding that it’s important not to allow enthusiasm and the need for a vaccine to outweigh scientific integrity. Warren said in the event that there are questions about his work at the CDC, Redfield will be in a “hotter seat” than his predecessors because of concerns about his past.

“I am not aware of any other questions of his scientific integrity since then, and certainly I’m not suggesting at all a free pass, and I think it was clear that not all was clear back in 1993 about the data and what they were and how accurate they were,” Warren said. “I do believe that one need not be totally clouded by an incident. I think there is a track record since 1993 of scientific integrity with a number of investigators working with the [National Institutes of Health], working with other agencies. I don’t think there was a pattern of that.”

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