RESEARCH TRIANGLE PARK -- When AIDS was first diagnosed almost 30 years ago, many overreacted, fearing the disease could be spread by casual contact with infected people.
Today, public concern about HIV and AIDS has dwindled in the United States even as it remains a serious and persistent health problem, with an estimated 50,000 new infections a year.
But those involved in the fight against AIDS have never relaxed, and one researcher credited for persistence and determination is Wendee Wechsberg, senior director of the Substance Abuse Treatment Evaluations and Interventions Research at RTI International.
Wechsberg and her colleagues at RTI, a private research organization based in RTP with a mission of "improving the human condition," have dedicated themselves to helping the hardest-to-reach segments of the population.
Wechsberg and her team are increasingly recognized as leaders in prevention methods. Last summer at the 18th International AIDS Conference in Austria, Wechsberg presented a major paper about gender inequities and HIV among women who inject drugs.
"The themes of all the interventions we've been doing with women are to empower them and to help them learn to take care of themselves better," Wechsberg said.
These interventions have helped researchers come up with what Wechsberg describes as "realistic, culturally relevant prevention strategies that [women] can apply to their lives."
Through studies Wechsberg and her colleagues have conducted locally, including in Raleigh and Durham, Wechsberg's team has developed an expertise they rely on internationally. They have had successful programs in South Africa and Russia, and are planning programs in Namibia and Botswana.
The 56-year-old North Raleigh resident describes the focus of her research succinctly: "drugs, sex and violence."
Time to make a change
To understand what Wechsberg does, it helps to understand her motivation. In 1984, when she was working at a methadone treatment program in Raleigh, she realized she needed to expand her work.
She had just told a patient of the program that he was HIV-positive, and it devastated her that his angry response was to threaten to intentionally infect others.
"Everybody remembers that salient moment in their life when they realize they're going to have to make a change, and that was the one for me," Wechsberg recalled. "I had been working in [treating] addictions since 1977, and at that point I realized that it wasn't enough."
She decided to pursue a doctorate in community psychology, which she earned from N.C. State University in 1993. She went to work for RTI International, eventually leading the organization's substance abuse research team.
Wechsberg and her colleagues have spent many years studying the combination of problems faced by the down-and-out and developing methods to fight those problems. It took the head of a social scientist and the heart of a social worker for her to keep going.
"I never thought I would become a scientist," Wechsberg said. "I keep asking the next question. I'm never getting it right. Each study, I say, 'I didn't get that so I have to ask this next piece.' And it keeps building."
Reaching out to women
A key lesson Wechsberg and her team members have learned is to meet women "where they are at."
This is not always easy. Her team works with sex workers, methamphetamine users, crack addicts. Many are mired in poverty and lack education, or are unemployed or homeless.
A key intervention came in 1998, when an RTI team led by Wechsberg began a study of African-American women in Raleigh and Durham who used crack cocaine.
The intervention included such elements as role-playing to teach and practice negotiation for condom use, referrals to local service organizations for needs that required extensive counseling, a personalized plan for reducing risk from sexual behavior and drug use, and access to HIV testing. The researchers followed clients for up to seven years to determine how well their methods worked.
The intervention, known as the Women's CoOp, was considered a huge success. The National Institutes of Health provided funding to adapt the methods internationally, and the U.S. Centers for Disease Control and Prevention labeled the approach as a "best-evidence" HIV behavioral intervention program.
Globally, an estimated 33 million people are living with HIV/AIDS, and women increasingly bear the brunt of the pandemic. In sub-Saharan Africa, women represent 61 percent of infections among adults.
Wechsberg's team first began an intervention in South Africa in 2001. They had to adapt their models to conform to cultural norms there. For instance, the researchers discovered that a new pair of underwear and a hot bath - luxuries for many in that country - proved hugely helpful in preparing the women for counseling.
Redonna Chandler, chief of the Services Research Branch of the National Institute on Drug Abuse, lauds Wechsberg not only for the type of research she does, but how she does it.
"Wendee goes to where the people are," Chandler said. "She is very active in seeking out those individuals who have substance abuse problems, seeking out those individuals who are at high risk of contracting and spreading HIV, seeking out individuals who fall through the cracks of health disparities. She is very committed to a public health mission."
The treatment methods are effective, Chandler added, because they are tailored to meet individual needs. Clients "don't feel like [methods] were developed for someone else. They feel like they were developed for them," she said.
Wechsberg said she continually comes back to the passion that started her on her journey.
"One person can make a difference," she said, "but you have to think big, you have to think globally. You always have to say, 'It's not enough.'"
