Human Biology 146 - The AIDS Epidemic:

Biology, Behavior and Global Responses


This course intends to bring an interdisciplinary approach to understanding the HIV/AIDS pandemic, encompassing the national and international public health and policy issues posed by the global epidemic.  Minimum requirements include lower division biology courses, although this course may be best-suited for Human Biology majors with a background and interest in virology and/or biomedical sciences.  This course may be of interest to clinical and pre-clinical medical students as well as graduate students in the biological sciences, international relations, economics, business, and education.


A primary aim of the course is to familiarize students with contemporary resources available at Stanford, other universities, and government, pharmaceutical, and advocacy organizations on the world-wide web. The introductory lectures and sections will provide information on web-researching, downloading and reading lectures and articles, and critically analyzing web-based resources.  This course involves assigned readings, class discussions, presentations, and a mid-term and final examination.


Course director: David Katzenstein, M.D. (

Course administrator: Sudeb Dalai (


Office Hours:    Monday 1-4 (D. Katz., S. Dalai) SUMC S-156

                        Wednesday 1-2 (S. Dalai) SUMC S-156


Course schedule and readings:




1-Introduction (9/25)

David Katzenstein, MD

Stanford School of Medicine


Course structure, syllabus, campus and web resources.  Required project, mid-term and final examinations.


Retroviruses: unique genomic and regulatory organization of retroviruses, including primate lentiviruses; regulation of HIV infection; transcription and translation at the cellular level.


2-The Global Epidemic (9/30)

 – D. Katzenstein


The crisis of endemic HIV infection in Africa and emerging epidemics in Asia and Eastern Europe.

UNAIDS (2002). AIDS Epidemic Update: December 2002. Geneva: UNAIDS.


Piot, P. (2000). Global AIDS Epidemic: Time to Turn the Tide. Science, 288, 2176-8.

Optional reading:

Garrett, L. (1994). Distant thunder: sexually transmitted diseases and injecting drug users (chap.10); Hatari: vinidogodogo; the origin of AIDS (chap.11). In Garret, L. The Coming Plague: Newly Emerging Diseases in a World Out of Balance (pp. 260-389). New York: Farrar, Straus and Giroux.

3-HIV and Tuberculosis (10/2)

Bouke de Jong, MD

Stanford School of Medicine


Global horsemen; synergistic epidemics.

Farmer, P. (2001). The Major Infectious Diseases in the World - To Treat or Not to Treat? New England Journal of Medicine, 345(3), 208-10.


de Jong, B, Israelski, D, Corbett, E, Small, P. (manuscript in press). Clinical Management of Tuberculosis in the Context of HIV Infection. Annual Review of Medicine, 55.  Read pp. 1-7.


Corbett, EL, Watt, CJ, Walker, N, Maher, D, Williams, BG, Raviglioni, MC, Dye, C. (2003). The Growing Burden of Tuberculosis: Global Trends and Interactions with the HIV Epidemic. Archives of Internal Medicine, 163, 1009-1021.

Optional lecture:

Special lecture at UC Berkeley (10/3)

– Dr. David Harrison

CEO of LoveLife, South Africa


"Young, Beautiful and Dead: Disease and Democracy in South Africa, 2003"

Friday, October 3, 2003, 12-2pm, at the Goldman School of Public Policy.  1893 LeRoy Street (Corner of Hearst and LeRoy)

Epstein, H. (2003). AIDS in South Africa: The Invisible Cure [Electronic version]. The New York Review of Books, 50(12), 44-49.



4-Host Responses and Pathogenesis (10/7)

– D. Katzenstein


The humoral and cellular immune responses to HIV infection; disease progression and transmission of HIV infection.  Is an HIV vaccine possible?  Strategies and goals, historical efforts, and perspectives on immunization and immunity.

Letvin, NL, Walker, BD (2003). Immunopathogenesis and Immunotherapy in AIDS Virus Infections. Nature Medicine, 9(7), 861-6.


Optional lecture:

The Tenth Thomas C. Merigan, Jr. Lecture at Stanford School of Medicine (10/7)

– Richard D. Klausner, MD

Executive Director, Global Health Programs

Bill and Melinda Gates Foundation


“The Grand Challenges of Science and Technology in Global Health”

Tuesday, October 7, 2003, 12-1pm, in the Fairchild Auditorium, Stanford University School of Medicine.


5-Clinical Pharmacology (10/9)

– Terry Blaschke, MD  and Katia Alves, MD

Stanford School of Medicine


Generic drugs and the Brazilian experience.

Galvão J. (2002). Access to Antiretroviral Drugs in Brazil. The Lancet, 360(9348), 1862-5.


FDA Center for Drug Evaluation and Research. (1999). FDA Ensures Equivalence of Generic Drugs. In From Test Tube to Patient: Improving Health Through Human Drugs. Rockville, MD: FDA.


Individual Members of the Faculty of Harvard University. (2001). Consensus Statement on Antiretroviral Treatment for AIDS in Poor Countries. Cambridge: Harvard University.


Optional reading:

Kristof, N. (2003). As Millions Die. The New York Times.


Norris, J. (2003). Seeking the Best Way to Combat AIDS. [Letter to the editor]. Financial Times, 16.


Blaschke, T, Merry, C, Ryan M. (2003). Generic Drugs for HIV/AIDS is Good News, But Manufacturing Standards Must be Monitored. [Letter to the editor]. Financial Times, 12.


Website for generic drugs information:

6-Policy and Practice (10/14)

– Thomas W. Zingale

Senior Policy Analyst,US General Accounting Office


– Kate Blumenreich

Analyst, International Affairs and Trade, US General Accounting Office


Scaling up global HIV/AIDS treatment and prevention.  Politics and policies of the US response.

Copson, RW. (2003). AIDS in Africa. Congressional Research Service: Washington, DC.



·   (2003). Global Fund to Fight AIDS, TB and Malaria Has Advanced in Key Areas, but Difficult Challenges Remain (GAO-03-601).


·   (2001). US Agency for International Development Fights AIDS in Africa, but Better Data Needed to Measure Impact (GAO-01-449). Read pp. 19-33.


·   (2001). Joint UN Program on HIV/AIDS Needs to Strengthen Country-Level Efforts and Measure Results (GAO-01-625). Read pp. 6-26.


Optional reading:

·   (2001). United Nations Faces Challenges in Responding to the Impact of HIV/AIDS on Peacekeeping Operations (GAO-02-194).

7-Epidemiology and Community-based Issues in San Francisco (10/16)

– William McFarland, MD, MPH

Department of Public Health, San Francisco

Chen, SY, Gibson, S, Katz, MH, Klausner, JD, Dilley, JW, Schwarcz, SK, Kellogg, TA, McFarland, W. (2002). Continuing Increases in Sexual Risk Behavior and Sexually Transmitted Diseases Among Men Who Have Sex With Men: San Francisco, Calif, 1999–2001. American Journal of Public Health, 92(9), 1-2.


Katz, MH, Schwarcz, SK, Kellogg, TA, Klausner, JD, Dilley, JW, Gibson, S, McFarland, W (2002). Impact of Highly Active Antiretroviral Treatment on HIV Seroincidence Among Men Who Have Sex With Men: San Francisco. American Journal of Public Health, 92(3), 1-7.

8-Stigma and Psychological/Sociologic Impacts of AIDS (10/21)

–Cheryl Koopman PhD

Stanford School of Medicine

Derlega, VJ, Barbee, AP. (1998). What is the impact of the HIV infection on individuals' social interactions and relationships? An introduction. In Derlega, VJ, Barbee, AP (eds.), HIV and Social Interaction (pp. 2-11), Thousand Oaks, CA: Sage.

Green, K, Serovich, JM. (1998). An eye to the future of HIV/AIDS and social relationships. In Derlega, VJ, Barbee, AP (eds.), HIV and Social Interaction (pp. 218-238), Thousand Oaks, CA: Sage.

9-Developing Antiretroviral Therapies (10/23)

 – Nancy Shulman, MD, PhD

Stanford School of Medicine


Screening, testing, clinical trials, and the drug approval process.

Pomerantz, R, Horn, D. (2003). Twenty Years of Therapy for HIV-1 Infection. Nature Medicine, 9(7), 867-73.

10-Intellectual Property Issues and Drug Access (10/28)

– Amir Attaran, JD, DPhil

Harvard Center for International Development

Henry, D, Lexchin, J. (2002). The Pharmaceutical Industry as a Medicines Provider. The Lancet, 360(9345), 1590-5.


Attaran, A, Gillespie-White, L. (2001). Do Patents for Antiretroviral Drugs Constrain Access to AIDS Treatment in Africa? JAMA, 286(15), 1886-1892.


Friedman, MA, den Besten, H, Attaran, A. (2003). Out-licensing: a Practical Approach to Improvement of Access to Medicines in Poor Countries. The Lancet, 361(9354), 341-4.


Optional reading:

Attaran, A. (2003). Physicians and Patent Law. The Lancet, 361(9357), 613-14.


Attaran, A, Sachs, J. (2001). Defining and Redefining International Donor Support For Combating the AIDS Pandemic. The Lancet, 357(9249), 57-61.


Champ, P, Attaran, A. (2002). Patent Rights and Local Working Under the WTO TRIPS Agreement: An Analysis of the U.S.-Brazil Patent Dispute. Yale Journal of International Law, 27, 365-93.

11- HIV/AIDS, Health Care, and Legal Consequences (10/30)

– John Barton, JD

Professor Emeritus, Stanford Law School

Gostin, L, Webber, DW. (1998). HIV Infection and AIDS in the Public Health and Health Care Systems. Journal of the American Medical Association, 279(14), 1108-1113.


Outline of presentation due

Midterm exam posted online

12-AIDS and Health in Africa: Challenges to

Development (11/4)

– Dr. Teguest Guerma

WHO Senior Advisor to the UN on Africa; Representative from WHO Regional Office for Africa to the UN and in greater New York




13-Biology of Antiretroviral Drug Resistance (11/6)

– Rami Kantor, MD

Stanford School of Medicine


The evolution and selection of genetic mutations; genomic databases and phylogenetic analyses; the biology and epidemiology of drug resistance.

Weiss, RA. (2003). HIV and AIDS: Looking Ahead. Nature Medicine, 9(7), 887-91.


Shafer, R. (2002). Genotypic Testing for Human Immunodeficiency Virus Type 1 Drug Resistance. Clinical Microbiology Reviews, 15(2), 247-77.


Shafer, R, Kantor, R, Gonzales, M. (2000). The Genetic Basis of HIV-1 Resistance to Reverse Transcriptase and Protease Inhibitors. AIDS Reviews, 2, 211-28.

14-National and International Treatment Programs (11/11)

– Dennis Israelski, MD

Stanford School of Medicine

The Association-Based Model, global funding and NGOs; issues in access and care.

Bloom, DE, River Path Associates. (2000). Something to be Done: Treating HIV/AIDS. Science, 288, 2171-2173.


Binswanger, HP. (2000). Scaling Up HIV/AIDS Programs to National Coverage. Science, 288, 2173-2176.


Binswanger, HP. (2003). Willingness to Pay For AIDS Treatment: Myths and Realities. The Lancet, 362(9390), 1152-3.

15-Mother to Child Transmission (11/13)

– David Hill / D. Katzenstein

Stanford School of Medicine


The “Call to Action;” vertical transmission, breast-feeding, nutrition, and pediatric AIDS.

The Petra Study Team. (2002). Efficacy of Three Short-course Regimens of Zidovudine and Lamivudine in Preventing Early and Late Transmission of HIV-1 from Mother to Child in Tanzania, South Africa, and Uganda. The Lancet, 359 (9313), 1178-86.


Moodley, D, Moodley, J, Coovadia, H, Gray, G, McIntyre, J, Hofmyer, J,

Nikodem, C, Hall, D, Gigliotti, M, Robinson, P, Boshoff, L, Sullivan, JL (South African Intrapartum Nevirapine Trial (SAINT) Investigators). (2003). A Multicenter Randomized Controlled Trial

of Nevirapine Versus a Combination of Zidovudine and Lamivudine to Reduce Intrapartum and Early Postpartum Mother-to-Child Transmission of Human

Immunodeficiency Virus Type 1. The Journal of Infectious Diseases, 187, 725-35.

Call to Action / Student Internship Program

Elizabeth Glaser Pediatric AIDS Foundation

16-Communities at risk (11/18)

– Vivian Levy, MD

Stanford School of Medicine


Sexual networks, politics, and migration in the local and global epidemic; ethnic and social crossover amongst homosexual, heterosexual, and drug-using populations in the US; the science of demography and intervention; models of behavioral change.

Grosskurth, H, Gray, R, Hayes, R, Mabey, D, Wawer, M. (2000). Control of Sexually Transmitted Diseases for HIV-1 Prevention: Understanding the Implications of the Mwanza and Rakai Trials. The Lancet, 355(9219), 1981-7.


Aral, S. (1999). Sexual Network Patterns as Determinants of STD Rates: Paradigm Shift in the Behavioral Epidemiology of STDs Made Visible. Sexually Transmitted Diseases, 26(5), 262-4.


Decosas, J, Pedneault, V. (1996). Preventing Sexually Transmitted Diseases through Individual and Population Based Public Health Approaches: Social and Political Implications. Journal of Infectious Diseases, 174(Suppl 2), S248-52.


Rothenberg, R, Narramore, J. (1996). The Relevance of Social Network Concepts to Sexually Transmitted Disease Control. Sexually Transmitted Diseases. 23(1), 24-9.

17-Prevalence and Management of Opportunistic Infections and HIV in the US (11/20)

– Jose Montoya, MD / Debika Bhattacharaya, MD

Stanford School of Medicine


18-Clinical Management of HIV Infection in Africa (11/25)

– Seble Kassaye, MD

Stanford School of Medicine

Kassaye, S. (manuscript in press). Treatment of AIDS in Africa. AIDS Reviews.

19-Public Policy and Public Health (12/2)

– D. Katzenstein


Legislation, stigma and confidentiality; HIPAA and bioterrorism; case studies in privacy/confidentiality vs. public health; criminalizing the transmission of infectious disease; quarantine and court-ordered treatment (lawsuits, civil penalties).


20-Non-governmental Organizations and Medical Care (12/4)

– Debrework Zewdie

Global AIDS Director, World Bank


Drug access, financing, and global responsibility.


Week 11 - Presentations

Final exam posted online



Within the first two weeks of the course, each student should choose a “focus area” in which he or she will be expected to become familiar with current literature, develop a hypothesis on a current topic, and begin compiling a bibliography.  You are encouraged to bring your personal experiences and interests to bear on this topic.  Students are expected to use the internet and the medical library to obtain references and information.


Course Requirements


1)      Students will produce an outline for a brief paper with a list of the literature and sources to be reviewed or contacted.  A 2-3 page outline and list of reference materials is due by the end of lecture on October 30.

2)      At the end of the quarter, each student will be expected to hand in and present a well-written, referenced discussion of a focused question about diagnosis, treatment, prevention, policy, or history of HIV infection in a specific population, risk group or country.  No restriction is placed on the scope or direction of the focus area, but we would like to discuss your interests together (both in class and during office hours) over the quarter as you complete your initial outline and bibliography.

3)      Students will prepare a 10-15 minute presentation of their focus area to deliver to the class, followed by discussion.  Each presentation should not exceed ten (10) overheads or PowerPoint slides.

4)      Students will be given a midterm and final exam.  Both exams will be online, multiple choice, and assess basic knowledge of AIDS virology, health policy, and epidemiology.




Midterm: 20%

Final: 30%

Presentation and Outline: 50%