The Change Agent: Dr. Kathy Anastos

Kathryn Anastos, M.D., stands in a tea field in southwestern Rwanda. (Photo by Jonathan Wallen)

How Kathy Anastos, M.D., is advancing HIV/AIDS research and treatment on the global stage

By Teresa Carr

In late 2003, Kathryn Anastos, M.D., received an emailed plea from a grassroots organization of women widowed by the 1994 genocide in Rwanda. Many of the women had been infected with human immunodeficiency virus (HIV) through genocidal rape, and their organization was appealing for access to lifesaving treatment. “Men with HIV being tried for war crimes at an international tribunal were receiving state-of-the-art care,” says Dr. Anastos. “The women were outraged.” And luckily, Dr. Anastos was uniquely qualified to respond.

A woman from one of the NGOs pulled me aside and said, ‘You know, a lot of people come and visit, but nobody comes back.’
— Dr. Kathy Anastos

In the early days of the AIDS epidemic, Dr. Anastos’ research and advocacy helped convince public health officials that HIV—then viewed as largely limited to gay men and intravenous drug users—also spread to women through heterosexual transmission. In 2003, she was a professor of medicine and of epidemiology & population health at Einstein and an internist at Montefiore who was experienced in providing health services and committed to supporting women living with HIV. “I was in a position to respond,” she says, “and so I did.”

By April 2004, Dr. Anastos and four other women activists had secured a small foundation grant and were on a plane to Rwanda. Their arrival coincided with the 10th anniversary of the systematic killing of an estimated one million Tutsi and moderate Hutu over 100 terrible days. “It was an emotional time—for us, but much more so for the Rwandan people,” says Dr. Anastos. People infected with HIV in the wake of the genocide were now progressing to the most advanced stage of AIDS, without access to antiretroviral treatment that could help them.

On arriving in Rwanda, Dr. Anastos found that a network of well-organized nonprofit governmental organizations (NGOs) was already in place, with clinics providing palliative care for Rwandans with advanced HIV and AIDS. A brief interaction at one of those clinics would change the course of her life. “A woman from one of the NGOs pulled me aside and said: ‘You know, a lot of people come and visit, but nobody comes back.’ More than anything else, that compelled me to return.”

True to her word, Dr. Anastos, now also a professor of obstetrics & gynecology and women’s health at Einstein, has returned more than 50 times to Rwanda. She and three other women founded the nonprofit Women’s Equity in Access to Care and Treatment (WE-ACTx), which works with 24 grassroots community groups and the Rwandan government. WE-ACTx provides comprehensive medical and psychological care to thousands of Rwandans living with HIV, mostly women and children, and is now fully run by Rwandans.

Liberathe Uwimana, dressed in blue, director of Solidarity, a community-based organization, celebrates the start of the Rwandan Children’s Education program with Dr. Kathy Anastos. (Photo by Jonathan Wallen)

The Power of Persistence

“Persistent” is a word that colleagues often use to describe Dr. Anastos. Paul Volberding, M.D., a professor emeritus at the University of California San Francisco School of Medicine, was her research collaborator at the start of the AIDS epidemic. “Kathy is the most focused, persistent person I know,” he says. “She’s ambitious in that she has a clear sense of direction and is determined to make progress. I think that’s what the world needs.”

At age 72, sitting at her well-worn enamel-top table in her cozy kitchen, Dr. Anastos focuses like a bird, with a shock of short white hair, bright blue eyes highlighted by blue eyeglass frames, and shiny dangles on her ears. Her intensity is coupled with the warmth of human connection. Broad smiles crinkle the corners of her eyes, which mist over when she recalls the patients she lost to AIDS when no treatments were available. 

She recalls two influences that led her to medicine as a way to make a difference in the world. One was her mother, who became a Unitarian minister after she and Dr. Anastos’ father divorced. “My mother taught me that your obligation in life is to figure out the right thing to do and then do it,” Dr. Anastos says. The other was Oberlin College in Ohio—a place, she says, “where you are surrounded by the idea of social justice and personal responsibility.”

Finding a Purpose 

Kathy Anastos grew up in Natick, Mass., in a family of five children raised by a single mother struggling to make ends meet—even though her mother’s family, who had disowned her, were solidly middle class. “She taught me what propriety was so that I could reject it,” says Dr. Anastos. A self-described outlier, she graduated from high school in 1968—a heady time for a young woman determined to break free of societal constraints—and accepted a full scholarship to Oberlin College. 

Feeling directionless, she dropped out after her second year. She worked for three years on an organic vegetable farm in Vienna, Va., attending agriculture school and hitchhiking across Europe in the off-seasons. She eventually decided to return to college and, to earn some money, answered an ad to be a bike messenger in Washington, D.C. But it was 1973, and the company’s management didn’t think a woman could handle fast biking in heavy traffic. 

“Imagine saying someone couldn’t be a bike messenger because she’s a woman—what kind of BS was that?” Dr. Anastos asks.

Daniel Murokora, M.D., M.Med., an obstetrician-gynecologist working in partnership with Einstein and Montefiore, instructs Chantal Mukazayire how to screen patients for cervical cancer during a first-ever training of this type for Rwandan nurses. (Photo by Jonathan Wallen)

Although Dr. Anastos has a weak leg due to childhood polio, years of farm labor had left her strong and confident in her physical abilities. She talked her way into the job and, shortly thereafter, recruited her two sisters and a few women friends. “We were a gang of women bikers,” she jokes. Her future husband, Jon Wallen, now a photographer, also worked as a bike messenger that summer. “The two of us biked around D.C. in matching buzz cuts, wearing as few clothes as possible due to the heat,” she remembers.

On returning to Oberlin she found her groove, majoring in neuroscience and playing varsity basketball. But later, in medical school at the University of California San Diego, Dr. Anastos once again felt like an outlier: an openly bisexual liberal who had worked from the age of 12 and didn’t fit in with her classmates—mainly wealthy, conservative white males. A good therapist—and the specter of student-loan debt if she failed to finish med school and become a physician—convinced her to stick it out.

After graduating from medical school in 1980, Dr. Anastos accepted a residency in Montefiore’s social medicine program because of its mission to improve the health of underserved communities. “That’s why I went to medical school,” she says. “And it’s where I learned to love medicine.”

Dr. Kathy Anastos meets with researchers at Masaka District Hospital in Rwanda. From left are Isabelle Izimukwiye, M.D., M.Med., Jean Claude Dusingize, M.D., Ph.D., and Benjamin Muhoza, M.S. (Photo by Jonathan Wallen)

At Montefiore, Gerald Friedland, M.D., then a faculty adviser in internal medicine, selected Dr. Anastos as chief resident. “First of all, it was clear that she was an excellent doctor,” says Dr. Friedland, now a professor emeritus and senior research scientist at the Yale University School of Medicine. “But I was also struck by her leadership qualities—determination, clear focus, and a great sense of responsibility and commitment to women’s health.” 

He remembers that Dr. Anastos often biked to work in the Bronx from lower Manhattan. “That’s quite remarkable, given the rigors and long hours of medical training,” he says. “And just another mark of her strength and determination.” Dr. Friedland compliments his own foresight. “So I made a good choice,” he says, chuckling at the understatement.

She said that being a working mom to three girls was a gift to us, demonstrating what our lives could look like. She showed by her example that there’s value in work and modeled for us how strong women can change the world.

— Dr. Rebecca Anastos-Wallen

The Making of an Activist 

In 1983, midway through her stint as chief resident, Dr. Anastos was hit with intense nausea and vomiting. She was pregnant—something, she notes, that was “very much frowned upon [for someone in her job] in those days.” 

Maternity leave didn’t exist. In late 1983 she gave birth to the first of three daughters. “You can do all these things, but it ain’t easy,” is her message to younger women and, now, men. “Things have changed since the 1980s, but it’s still really hard to have small children and work as a young physician.” 

Dr. Anastos never felt guilty about being a working mom with young kids, says her middle daughter, Rebecca Anastos-Wallen, M.D., a physician and healthcare administrator who has two young sons herself. “Instead,” recalls her daughter, “she said that being a working mom to three girls was a gift to us, demonstrating what our lives could look like. She showed by her example that there’s value in work and modeled for us how strong women can change the world. It was sometimes hard for us, when she’d come home late or not at all because of her job. But she was an amazing mother who always managed to find time for us.”

For a grade-school assignment, asked to picture her future self on a cereal box, Dr. Anastos-Wallen drew herself as an AIDS researcher like her mom.

After her Montefiore residency, Dr. Anastos joined the Einstein faculty, working as a primary-care physician/researcher in the South Bronx and specializing in HIV. She quickly realized that research ignored patients like hers—mostly women and mostly people of color. 

“The NIH had funded a big study on the natural history of HIV in men, but we had no such information on women,” she says. “It made me angry.” 

It also made her an activist and researcher. In 1993, when the National Institutes of Health (NIH) bowed to pressure and finally agreed to fund a study of women with HIV at six centers across the country, Dr. Anastos applied to participate in what became known as the Women’s Interagency HIV Study (WIHS). WIHS eventually enrolled nearly 5,000 women infected with HIV or considered at risk for acquiring the infection across the United States; it is the largest and oldest ongoing, prospective study documenting the health outcomes of women living with HIV.

“At that time I didn’t actually know much about what research entailed, but I wrote a good grant application,” she says. In 1993, she took on the leadership of the WIHS study for the New York City area. “We asked the women why they were enrolling,” she says. “The most common reason they gave was ‘to help my sisters,’ meaning other women with HIV.”

Fellow AIDS researcher Dr. Volberding credits Dr. Anastos with making him aware of issues affecting women with HIV. “It helped me understand how important it was to make sure that we were bringing women into clinical research,” he says. “It absolutely directed my work, and I think that’s true for the entire field.”

Dr. Anastos has been similarly influential in what she considers one of her most important roles: mentoring young clinicians and researchers. “She has fostered the research careers of many people, including me, and given us so many opportunities to grow,” says David Hanna, Ph.D., research associate professor of epidemiology & population health, who came to Einstein a decade ago, fresh out of graduate school, in large part to work with Dr. Anastos. “Her leadership has led to extremely productive and collaborative science that has helped us better understand the complexities of HIV, particularly among women. I’m fortunate to work with and learn from her.”

Advancing Research on HIV/AIDS

Today, Dr. Anastos is a principal investigator on three large HIV-related studies funded by the NIH—one in the United States and two in Africa.

• The MACS/WIHS Combined Cohort Study
In 2019, the NIH merged Dr. Anastos’ and other national WIHS sites with a parallel study of more than 7,000 gay and bisexual men called the Multicenter AIDS Cohort Study (MACS). The resulting MACS/WIHS Combined Cohort Study is investigating the progression of chronic diseases affecting people living with HIV.

Backed by a $27 million NIH grant, Dr. Anastos is heading up the Montefiore/Einstein Bronx MACS/WIHS research site, one of 13 in the country. Her co–principal investigators are Anjali Sharma, M.D., M.S., professor of medicine at Einstein and an internist and infectious-disease doctor at Montefiore, and Dr. Hanna.

“Thanks to the miraculous success of antiretroviral therapy, people are highly unlikely to die of HIV today,” says Dr. Anastos. “But we’ve discovered that even people who no longer have detectable virus in their blood face chronic inflammation. Their immune systems are effectively stuck in high-alert mode, increasing the risk of a host of diseases affecting the heart, liver, kidney, bones, and nervous system, as well as certain cancers.” 

The NIH had funded a big study on the natural history of HIV in men, but we had no such information on women. It made me angry.
—Dr. Kathy Anastos

• The Central Africa International Epidemiology Databases to Evaluate AIDS (CA-IeDEA)
Begun more than a decade ago, CA-IeDEA studies the treatment and care of tens of thousands of people living with HIV/AIDS in Burundi, Cameroon, the Democratic Republic of the Congo (DRC), the Republic of the Congo, and Rwanda—five countries with a substantial burden of HIV infection. In 2021, the NIH awarded researchers a five-year, $14.5 million grant to continue and expand the study’s research efforts.

In addition to Dr. Anastos, CA-IeDEA’s principal investigators are Marcel Yotebieng, M.D., Ph.D., M.P.H., associate professor of medicine at Einstein, and Denis Nash, Ph.D., M.P.H., distinguished professor of epidemiology and the executive director of the Institute for Implementation Science in Population Health at the City University of New York Graduate School of Public Health and Health Policy. 

“This award allows us to enroll more children and adults with HIV who visit health clinics in our five partner countries,” Dr. Anastos says. “Our overall goal is to increase access to HIV services and improve outcomes for patients.”

Kathy is very much attached to Africa and its people. She has a true passion for creating new clinical programs and improving research skills in areas such as HIV/AIDS and oncology.
— Dr. Marcel Yotebieng

• The Einstein/Rwanda/DRC Consortium for Research in HIV-Associated HPV-Related Malignancies
In 2020, Dr. Anastos, with Dr. Yotebieng and other Einstein colleagues, received a five-year, $4.9 million NIH grant to establish a research center to investigate cancers related to HIV and to HPV (human papillomavirus) among people living with HIV in Rwanda and the DRC. (Kaposi’s sarcoma affects people with HIV/AIDS almost exclusively, and people with HIV are more likely to develop HPV infections—by far the leading cause of cervical and anal cancer and a major cause of other types of cancer.)

Dr. Anastos was co-director of Einstein’s Global Health Center from 2010 to 2017 and is now the associate director for global health at Montefiore Einstein Cancer Center. She  leads a team of more than a dozen Einstein researchers from a range of specialties, who partner with multiple institutions in five African countries. The new center will expand programs Dr. Anastos previously initiated in Rwanda. Those programs have already contributed to a better understanding of HPV infection and disease among Rwandans living with HIV, and to improvements in Rwanda’s research ability and laboratory capacity.

In addition, the center will launch similar programs in the DRC, plus two research projects in both countries: the first population-based assessment of an HPV vaccine’s effectiveness in women living with HIV, and a study of HPV prevalence and disease burden in men who have sex with men.

“We aim to develop a cadre of Rwandan and DRC scientific leaders and build the physical and administrative infrastructure needed to sustain this project,” says Dr. Anastos, the lead investigator on the grant. “The goal is for our African colleagues to be able to direct their own research, set their own research priorities, and apply for funding independently. We want them to collaborate with us forever. But we don’t always need to be ‘in charge.’”

Dr. Kathy Anastos meets with Rwandan oncologist Fidel Rubagumya, M.D., M.Med., on the front porch of her Yonkers home during his visit to Montefiore Einstein Cancer Center in August. (Photo by Jonathan Wallen)

Medicine is an excellent vehicle for social change, but progress isn’t always immediately evident. You have to take a really long view.
— Dr. Kathy Anastos

A Sustainable Vision for Africa

Over the years, one of Dr. Anastos’ closest research collaborators has been Dr. Yotebieng, a co–principal investigator on both of her NIH-funded projects in Africa. “Kathy is very much attached to Africa and its people,” says Dr. Yotebieng. “She has a true passion for creating new clinical programs and improving research skills in areas such as HIV/AIDS and oncology, where research can have a huge impact. And she’s determined to see everything through before she retires.”

Dr. Anastos says she’s not quite ready for retirement. “Big things remain unachieved—in particular, building sustainable research capacity in our teams in Africa,” she says. Her goal is a $5 million endowment that Einstein would help create. It would fund an institute for research and education in Central Africa that wouldn’t depend on the vagaries of grants. To launch the effort, she has committed $400,000 of her own money over six years.

Looking back, Dr. Anastos says, there are “a couple of things” she wishes she could have told her younger self. For one, medicine is an excellent vehicle for social change, but progress isn’t always immediately evident. “You have to take a really long view,” she says.

She could also offer her younger self some reassurance regarding advances in healthcare and with respect to the discrimination people can experience because of their race, gender, or sexuality: “It does get better,” she says, “although we still have a very long way to go. There are periods of discouragement when it feels so hard, when you think ‘I don’t want to do this, I can’t do this,’” she says. “But you can, and you will. In time, you’ll feel better about the world and your place in it. In fact, if you’ve persisted long enough, you’ll feel great.”

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