Unlocking access to HIV care worldwide

A pioneering HIV/AIDS researcher, epidemiologist, and clinician, Frederick L. Altice, M.D., M.A., has traveled the world pursuing his work on the interface between infectious diseases and substance abuse. He has helped to improve access to care and treatment programs for HIV-infected drug users in Malaysia, the Ukraine, Iran, Russia, Kazakhstan, and Peru. Director of Clinical and Community Research and the founder of the School of Medicine’s HIV in Prisons program, he also provides care to current and former prisoners very close to home, at the New Haven Community Correctional Center, less than two miles from the medical campus.

Altice’s global commitment has now been recognized with a gift from the Indonesia-based Nusantara Trust Fund Foundation, a private philanthropic organization that provides aid and assistance for humanitarian programs in Southeast Asia, particularly through projects that address rural development, education, and health disparities. The gift, which includes a resource fund of $2 million, will enable Altice, professor of medicine and public health, to expand on the research infrastructure he’s helped to build in Southeast Asia over the last decade.

“We have been impressed with the research programs that Dr. Altice has developed in Malaysia and hope to encourage an expansion of these programs to Indonesia and other countries in the region . . . in line with the vision and mission of the foundation,” says Tatag Wiranto, Ph.D., chairman of the Nusantara Trust Fund Foundation and Deputy Minister for the Development of Disadvantaged Regions in Indonesia. “We believe that through strategic partnership with researchers and educators from the best institutions in the world, such as Yale, we will be able to build our capacity to ensure success and the sustainability of our efforts to improve the lives of our people.”

Altice’s interest in HIV/AIDS took root three decades ago. As a medical student in the early 1980s, while conducting research at the Centers for Disease Control and Prevention, Altice began to describe the early epidemiology of the disease. Later that decade, he was part of a group of Yale researchers who had established one of the first needle exchange programs in the U.S., providing drug users in New Haven with clean syringes in an effort to prevent the spread of HIV (see related story). Since 1991, Altice’s prison program has promoted HIV prevention and care for prisoners and former prisoners in Connecticut and elsewhere. In 1993, Altice established the Community Health Care Van, a free mobile clinic connected with New Haven’s needle/syringe exchange program (NSEP), which integrates drug treatment and care.

In 2005, Malaysia’s former Prime Minister, Abdullah Ahmad Badawi, announced health policy changes that included implementing NSEPs and introducing methadone, a synthetic opioid used to treat addiction to opioid drugs such as heroin.

Earlier that year, Altice had formed a close collegial relationship with Adeeba Kamarulzaman, M.B.B.S., F.R.A.C.P., professor of medicine and now dean of the Faculty of Medicine at the University of Malaya in Kuala Lumpur and president of the Malaysian AIDS Council from 2006 to 2010. Aware of Altice’s expertise as an interventionist, Kamarulzaman enlisted his help in implementing Badawi’s changes throughout Malaysia.

“I said, ‘Sure, but I need to understand the epidemic,’ ” Altice recalls. Altice’s role in fighting the Malaysian HIV/AIDS epidemic has been broad, but he began with both feet on the ground—literally. His outreach took him to many locations on the streets of Malaysia, including “under bridges where people shot up drugs,” he says.

In persuading Malaysian leaders to adopt some of his recommendations, Altice was able to point to his past work in Iran—like Malaysia, a Muslim country—where he provided guidance in the introduction of methadone treatment in prisons.

“Rick understands cultural and religious sensitivity. These things can make or break partnerships with countries like Malaysia,” says Kamarulzaman. “We love him because of his accessibility, generosity of spirit, and knowledge.”

Working with the Malaysian anti-drug agency Agensi Anti Dadah Malaysia (AADK), the Ministry of Health, and the Prison Department, Altice has been deeply involved in expanding methadone, HIV, and tuberculosis (TB) treatment in Malaysian prisons and community settings. His current work in Malaysia includes the introduction of preventive HIV and TB therapies into prisons and a program for reforming compulsory drug detention centers that detain suspected drug users without fair trials.

The new resource fund donated by the Nusantara Trust Fund Foundation will enable Altice to expand on and replicate these efforts in other Southeast Asian countries, especially Indonesia, where Altice plans to expand and adapt innovative care delivery models for prisons and rural settings.

“We are developing new research methods and adapting innovative models of care that are transcending the usual academic boundaries to create new knowledge,” Altice says. Eager to collaborate with colleagues at other universities and research institutions throughout Asia, he says his work is “less about ownership and more about mission.” Before seeking funding on an even larger scale, “we’re going to examine multiple pilot projects initially,” he says, “and expand our training . . . to get more people interested. I would really like to shift the mentality towards research and treatment.”

Altice, who holds an appointment as a visiting professor at the University of Malaya, received his M.D. from the Emory University School of Medicine and completed his residency in the Department of Internal Medicine and a fellowship in the department’s Section of Infectious Diseases at Yale. From 1991 to 1992, he received additional training in the Robert Wood Johnson Clinical Scholars program. In 1993, after observing the untreated health problems of many people participating in the New Haven NSEP, Altice helped to launch the Community Health Care Van, a mobile clinic offering a range of health care services to members of the New Haven community.

“Rick has always been committed to helping less fortunate people, in New Haven and throughout the world,” says Robert J. Alpern, M.D., dean and Ensign Professor of Medicine. “This gift acknowledges this and provides ongoing support for his research efforts at the interface between substance abuse and the spread of HIV.”