A Global Health Evangelist Is Shocked To Hear He's A 'Genius'

Oct 4, 2018
Originally published on October 6, 2018 9:52 pm

Gregg Gonsalves took a wild, meandering path to the Ivory Tower. His route to becoming a professor at Yale started in street protests and spanned the globe.

On Thursday he was honored with a prestigious MacArthur Fellowship.

Gonsalves is one of this year's MacArthur "geniuses." The award from the John D. and Catherine T. MacArthur Foundation comes with a $625,000 no-strings-attached stipend.

Gonsalves says he was shocked to learn that he's getting this award. "I had no idea that anybody was scrutinizing what I've been up to lately," the 54-year-old says with a laugh.

This national honor for creativity may redeem him with his parents, who were disappointed when he dropped out of college in the mid-1980s and drifted around waiting tables.

"That was about the time I was coming out of the closet and realizing I was gay," says Gonsalves, who grew up in a conservative family of Portuguese and Italian Catholics.

"Then I met somebody who was HIV positive and that changed my life. There were no treatments for the disease then, and it was terribly scary to think about what the future was for both of us."

That moment that set him on a path for which he's now being feted as one of the nation's leading thinkers on global health and social justice. Back in the '80s he just wanted to understand HIV and found there was very little information about the disease.

"This was before the Internet," he says. "And if you wanted information on medical things you had to sneak into medical libraries or ask medical students."

He ended up joining the legendary activist group ACT UP (AIDS Coalition to Unleash Power) in the late 1980's and moved to New York as the epidemic was exploding.

"I got swept up in this movement," he says. "I joined the treatment data committee of ACT UP New York and was working on science policy and clinical research and trial design and basic immunology. I was teaching myself all these sort of things that I never sort of bothered to study in school."

Amid street protests and handcuffing himself to the gates of drug companies, Gonsalves was trying to reform how HIV research was conducted at the nation's top research institutions. They were pushing for better treatments and a broader understanding of the disease.

In 1992, still without a college degree, he co-founded the Treatment Action Group or TAG.

"One of the first advocacy projects that Gregg and I did was a review of the entire National Institutes of Health AIDS research portfolio," says TAG co-founder Mark Harrington. "And we made some sweeping recommendations to reform it and to create a stronger office of AIDS research that would have the power to create a research agenda."

Their review led to significant reforms at NIH.

But NIH wasn't the sole barrier to getting treatment for people with AIDS. The disease was far more than a medical condition. AIDS was political and it was polarizing. The Reverend Jerry Falwell called the virus "God's punishment for homosexuals." People with the disease were written off as "whores, fags and junkies," Gonsalves says describing how critics dismissed the victims and downplayed the importance of the epidemic.

"You know in a weird way the HIV epidemic was an X-ray on to the pathologies of American society and global society as well," Gonsalves says. "There was a lot of debate about who lives and who dies, who had social worth and who didn't."

He says the epidemic shaped his views on global health.

"AIDS was a wake-up call for me," he says. "It wasn't just a virus. The epidemic was man-made. It was created by inaction, sluggish responses from the federal government. And all you have to do is to move ahead in time to 2018 and you can see it all happening again. Whether it's with Ebola or other infectious diseases like cholera in Haiti, we see these outbreaks of infectious diseases that again are man-made. Infectious disease will always be with us but epidemics are a human creation."

What he's saying is that the problem is not just the disease, it's how people respond or don't respond to these outbreaks. He's taken a similar social justice-centered approach to other problems.

While working in a South African township in 2015 he analyzed the correlation between the distance women had to walk to get to an outdoor toilet and rates of sexual assault.

"The city of Cape Town was saying they can't afford to upgrade sanitation in [the township of] Khayelitsha," he says of the study. City officials, he says, argued, "It's too expensive. We can't do it."

Gonsalves ran mathematical models analyzing assault rates and the cost of sanitation upgrades. Installing more toilets, he found, would save money.

"It made sense to increase the number of toilets in Khayelitsha both to reduce sexual assaults, but it also financially would save the city money on the downstream effects of sexual assault that they didn't think they were paying for. But they were paying for medical care, increased policing, people being out of work, families being out of work, all because of sexual violence."

Nicoli Nattrass, an economist at the University of Cape Town who worked with Gonsalves in the late 2000s in South Africa. says one of his greatest assets as an activist is his calm demeanor.

She remembers in 2008 when they were trying to convince a panel of experts at the World Bank that it was worth funding an effort to increase the number of HIV-positive people on anti-retroviral treatment — and that would slow the epidemic.

"He had those personal skills I often lack," Nattrass says, "which allows him to talk rationally and very convincingly to people even when they're being rude and hostile."

The concept of "treatment as prevention" that Nattrass and Gonsalves were pitching more than a decade ago is now widely accepted as one of the most important strategies against the global HIV pandemic.

It wasn't until Gonsalves was in his 40s that he finally decided to go to college. He applied to Yale and has been there ever since. He's now an assistant professor of epidemiology.

In 2012 he co-founded the Global Health Justice Partnership, which is a project hosted by both Yale's law school and the Yale School of Public Health.

Lately he's been looking at the link between the war on drugs in Brazil and that country's tuberculosis problem. Brazil is ranked by the World Health Organization as having one of the highest TB burdens in the world, and the problem is particularly bad among prisoners. Another recent paper he worked on considers what factors caused an HIV outbreak among opioid users in Indiana to be as bad as it was. The paper shows that if more medical services for drug users had been available, the outbreak potentially could have been dramatically smaller.

"A lot of my work is about how you get services to people who need them — and these are often marginalized and poor people," he says.

And these people could be anywhere in the world. To Gonsalves global health is about social justice. It's become a proxy for who gets access to resources, who gets sick and who doesn't, who lives and who dies.

He holds no punches in saying how he feels about nationalist movements globally including the America First ideology of President Trump.

"The entire world is moving toward a much more brutish cruel corrupt system. And you know nobody's health is going to fare well in that system because health care is way down the list of what oligarchs care about."

The MacArthur Foundation in naming Gonsalves as one of this year's fellow says he might just be part of a movement to counteract the global inequities in health. In a statement announcing the awards, the Foundation praised Gonsalves' current role at Yale.

"Gonsalves is training a new generation of researchers who, like himself, work across public health and human rights sectors, scholarly research and activism to correct disparities in global public health," the Foundation said.

Gonsalves says correcting those disparities is important whether political leaders realize it or not.

"We can't wall ourselves off in these gated communities," he says, "and think what happens in the rest of world doesn't matter."

Copyright 2018 NPR. To see more, visit http://www.npr.org/.


Now we want to head into the Barbershop to put a bow on this incredibly divisive and emotional week in Washington, D.C. The Barbershop is where we gather interesting people to talk about what's in the news and what's on their mind. So we're going to go back to the major story of the week - the confirmation of Brett Kavanaugh to the U.S. Supreme Court.

Now, we've been hearing a lot from senators and spokespersons and activists, but we wanted to see if we could broaden things out to hear other conversations. And we thought, who better to talk to than local radio call-in hosts and journalists who hear directly from their audiences on a regular basis? So we called Liz Ruskin. She's a reporter with Alaska Public Radio who has been closely following one of the most closely watched senators, Republican Senator Lisa Murkowski, who ultimately decided not to support the Kavanaugh nomination, the only Republican not to do so. She's here with us in our studios. Welcome. Thanks for coming.


MARTIN: Charlie Sykes is with us once again. He hosted at a conservative political talk show for many years in Wisconsin. He's an author and a political commentator. And he's with us once again via Skype. Charlie, welcome back.

CHARLIE SYKES: Good to be with you.

MARTIN: OK. Great. I'm glad you're here. And then, finally, on the phone with us is Kerri Miller. She is the host of MPR News With Carey Miller. That's at Minnesota Public Radio. Kerri, thank you so much for joining us.

KERRI MILLER, BYLINE: Hi, Michel. Thank you.

MILLER: And let me start by saying that nobody is pretending that this is scientific research, but I did want to reach out to all of you because I know that people - your audiences reach out back to you. And, Kerri, I'm going to start with you because you host a call-in show, and we pulled some tape from it. Let's just play a little bit of it. Here it is.


UNIDENTIFIED PERSON #1: I think that the Democrats have got completely crazy. I used to be a Democrat. I will not be voting Democrat. I'm just going to go Republican all the way down the line. It's like we have turned against each other. It's brother against brother. It's sister against sister. This is really bad climate that we're in right now.

UNIDENTIFIED PERSON #2: I am very dismayed with the choice of picking party over morals or character. And also, I think it was fairly obvious from the proceedings that Kavanaugh wasn't fully truthful.

MARTIN: So, Kerri, as you can hear, you're getting people from all across the political spectrum. But I understand that you were actually telling us that the comments aren't falling neatly along the usual partisan lines. Tell us a little bit more.

MARTIN: Exactly right. In the show that you're playing the comments from, my question to the audience was - is - what's going on with Brett Kavanaugh and the confirmation hearings motivating you as a voter? Is it influencing the way you're thinking of some very competitive races in Minnesota? And, you know, I can usually predict how the calls are going to come in. What I am seeing is people are highly engaged and really knowledgeable about what was happening. And they were calling with some unexpected things to say.

I mean, you hear that one caller saying, I'm disappointed that it's all about party. You hear the other caller saying, I usually vote Democratic, this has turned me off. And I think that's pretty representative of the calls that I've been getting over the last couple of weeks about this. People are really turned off.

MILLER: Charlie, what - I'm sorry. Go ahead. They're turned off by...

MILLER: They're turned off by the bare politics of this.

MARTIN: Charlie, what about you? What are people tweeting you and saying to you on social media and elsewhere?

SYKES: Yeah. I wanted to mention, of course, I don't have a radio talk show anymore. But yeah, there's no question about it that you have a high level of engagement. And there's - this is one of those moments where there's an intersection of emotion and substance. Virtually every issue that you could imagine is in play here, which explains why you have this really bitter partisan divide, you know, much more divisive and crucial, I think, than even the health care vote because the health care vote is a piece of legislation that could be re-voted upon. This will determine the fate of the courts for 30 years.

So there's no question about it that there is a Kavanaugh bump on the right, that there is a rallying around - among Republicans who feel that he has been treated unfairly. But obviously, you know, that doesn't mean that there is not anti-Kavanaugh no bump at all. The big question that I have is, is this a sugar high for Republicans, or is it really a game changer? And nobody knows because we've never been here before.

MARTIN: So, Liz, Alaska Senator Lisa Murkowski is one of only two senators to vote across party lines. She voted against Kavanaugh. Joe Manchin of West Virginia, the Democrat, being the other, he voted for Kavanaugh. I was wondering - you've been covering not just her, but you've also been covering the people who are trying to influence her vote. Tell us about that. What do you think based on what you have been reporting influenced her thinking on this?

RUSKIN: I think she was very much moved by all the women that came to Washington, women in Alaska jumped on last-minute airplanes, got on red-eyes and got up the next morning off the plane without any sleep and, you know, went to lobby her and went to talk to her. And a lot of them were sexual assault survivors. Alaska has a sky-high rate of sexual assault. And a lot of them told their stories. And the ACLU sponsored a big group of Alaskans. So a lot of them were lawyers. And they, you know, made their case, especially about judicial temperament. They actually brought the judicial code of conduct into their meetings with her, and she cited that on the floor. So a lot of the survivors and attorneys I talked to who've met with Lisa Murkowski in the last couple of days felt like they heard their arguments and their stories in her statement, at least to some degree.

MARTIN: And you also, though, were the reporter who asked her if she had - she herself had had a #MeToo moment, which is something that a lot of reporters have picked up on. Do you think that was relevant?

RUSKIN: It was relevant. I don't think it was, you know, it wasn't the direct cause of how she reacted. But she didn't tell us much about her #MeToo moment, but the emphatic way that she answered immediately without thinking about it told me that she identified to some extent with the #MeToo stories and that these stories must have really resonated with her more because she had that experience.

MARTIN: So, Kerri, we're hearing so much about anger - right? - that anger's so much a part of our political environment now. Are you hearing that? And what is it that people say they're angry about?

MILLER: I am hearing that. I hear kind of short fuses. And, you know, I've been doing the show for over a decade. I can tell when people feel like they're kind of at the end of their rope, and this is one of those times. It feels chaotic and disordered. And we have a bunch of highly competitive races in Minnesota. And so the atmosphere already feels elevated and then you throw this Kavanaugh situation into that. And the - I think the anger is kind of hair trigger. One wrong comment by one caller can trigger a big social media reaction or three other calls into the show, you know, and still with four weeks to go. I think people are experiencing this at a, you know, at a kind of level that we haven't seen in our state - again, with a bunch of competitive races thrown in.

MARTIN: Charlie, what about you? I know that in the past, just when you were concluding your long stint as a talk show host in Wisconsin, you wrote about the anger. And, frankly, you wrote with some regret about your - what you saw as kind of your role in stoking it. And now that you've had a little bit of distance from it, what do you think is - do you agree that this is just a hair-trigger moment and everybody seems elevated? What's your take on why that is?

SYKES: No, she's absolutely right that it is very much a hair-trigger moment. You can really see that on social media. It's interesting that you put it that way because just the slightest wrong turn or the use of the wrong word or any attempt at nuance and you're going to be flattened on social media. And I think that this is a reflection of the tribalization of our politics and the substitute of rage for argumentation. You really get the sense that no one any longer is trying to persuade anyone or to change anyone's mind. The goal seems to be just to beat the other side, to make heads explode.

And I think that's been a culture that's been coming a long time, and it's really come to a head right now at this particular moment. And, you know, it's very much a - maybe a, you know, a landmark in the the Trump era where everything seems to be about, you know, smash-mouth politics and the politics of, you know, deny, deny, deny and attack, attack, attack and without much regard for the long-term consequences to the culture or to the institutions that we're talking about.

MARTIN: And, Liz, of course, here's where I'm going to have to ask you to speculate, but we already know that, you know, the president's already said that Lisa Murkowski is going to pay a political price for this. Sarah Palin, the former governor of Alaska, former vice presidential nominee, tweeted about this, saying that Lisa Murkowski is going to pay a political price for it. I do have to say that, you know, my inbox all afternoon has been filling up with interest groups from both sides of the aisle identifying either party who they say is going to pay a political price for this. But talk to me about the Alaska case and about - Senator Murkowski. What is your sense of it?

RUSKIN: My sense of it is that Senator Murkowski is more popular than Sarah Palin in Alaska and that President Trump might not have his finger on the pulse of Lisa Murkowski's base. Among her base, this is - this was the position they wanted her to take.

MARTIN: Really, across party lines or among Republicans or?

RUSKIN: Yeah. A lot of her base is moderate Democrats. I had Democrats this week tell me that she was the only Republican they've ever voted for, and they expected her to do the right thing. And they thought that she would listen to them. And I think among her base, this was the move that they wanted her to make.

MARTIN: Well, we'll have to see. I'm sorry I don't have time to dig into this even more. And I thank you all so much for the kind of rare calm conversation that we seem to be having difficulty having these days. I want to thank all of you for that. Liz Ruskin is a reporter with Alaska Public Radio. Charlie Sykes is an author and political commentator. Kerri Miller is the host of NPR News at Minnesota Public Radio. Everybody, thank you all so much for talking with us today.

SYKES: Thank you.

RUSKIN: Thank you. Transcript provided by NPR, Copyright NPR.