In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, this week’s blog post will feature a conversation with Dr. Amanda Castel, MD, MPH.
Dr. Amanda Castel is a Professor of Epidemiology at GW. She received her BA in Biology from Brown, her MD from the University of Pennsylvania, and her MPH from Johns Hopkins. I was honored to speak with Dr. Castel about her work at GW, experiences as an infectious disease expert during a global pandemic, and her thoughts on health inequality and stigmatization.
From a young age, Dr. Castel wanted to be a doctor, and in particular a pediatrician. Born in Liberia in West Africa, Dr. Castel’s mother frequently told her about another baby born around the same time. They were both ill, but because Dr. Castel’s family is American they were able to fly her to the US for treatment. As she grew up, her family traveled internationally quite often for her parents’ work. She was able to see how other parts of the world deliver healthcare and was inspired by the idea she could “possibly make a difference and improve people’s lives.” During the course of her education, Dr. Castel took a year off to do a Fulbright Fellowship in Senegal, doing research on prevention and mother/child transmission of HIV. Through this experience, she caught the “public health bug” and decided to join her clinical interests with her public health experience. Speaking to Dr. Castel you can see her understanding of how privileged we are as Americans and her drive to create more equitable healthcare access.
After finishing her degrees, Dr. Castel worked in the CDC’s Epidemic Intelligence Service Program and was assigned to the Maryland Department of Health in their Communicable Disease Program. She describes the experience as being “a foot soldier. You are in the trenches, you’re working with county health departments… you’re doing all kinds of disease investigations.” This gave Dr. Castel the training to marry her clinical experience with her public health experience.
In early 2020, Dr. Castel watched as severely understaffed and under resourced health departments braced for the impending COVID-19 pandemic. On March 14th, 2020, Dr. Castel rolled up her sleeves, walked over to the DC Health Department, and told them “I’m here. What do you need?” In the early days of the pandemic, Dr. Castel recalls scrambling to keep ahead of the curve. The health department worked on case investigations with very limited contact tracing. The numbers were increasing so quickly they just didn’t have the bandwidth and workforce to keep up with them. As scary as those days were, from a scientific perspective they were “fascinating.” Learning how this virus worked, the transmission and symptomatology - it was a firsthand experience not many people get. Dr. Castel describes it as “professionally a very fulfilling experience.”
Alongside her work with the health department, Dr. Castel has been teaching infectious disease epidemiology at the GW School of Public Health. As part of that course, Dr. Castel tries to drive home the point that these diseases are everywhere, if you look at the news you can probably find something about an outbreak every day. January 2020, she and her students began tracking this new respiratory virus. As time went on and the pandemic progressed, these students had the opportunity to learn more about COVID within the course. When GW pivoted to online learning in March, that created a new set of challenges for educators. Dr. Castel commented on the difficulties that arise from not being in the same room as your students, that “the dynamic is different,” but even with these challenges “the students are continuing to learn and grow.” These same students are now working with health departments doing case investigations or other COVID response tasks. Those in the current cohort will be working in public health moving forward. Looking for a silver lining in times when finding them is hard, the preparation Dr. Castel gave these students is having a palpable impact on people’s lives.
Given her research in HIV/AIDS, Dr. Castel was uniquely situated to understand the ways this pandemic might unfold. In July 2020, Dr. Castel and some of her colleagues from the School of Public Health published an article discussing the synergies between HIV and COVID-19. Despite the major differences between the two viruses, it is astonishing to consider the similarities. Looking back at the beginnings of the HIV epidemic, the process of learning “which populations were most at risk, how to get testing to people, how we prevent infections, contact tracing, these core public health methods” have all been applicable to COVID-19 as well. And what we have learned through these processes are incredibly similar. The populations most disproportionately affected, racial and ethnic minorities, are the same.
Dr. Castel has researched the social ramifications of HIV, the stigmatization and public misconceptions, and the way these intersect to make treating people living with HIV harder. She does see parallels with COVID-19, especially now as vaccines become more available. Seeing the different numbers coming out from Moderna, Pfizer, and Johnson & Johnson, Dr. Castel had a genuine concern that “the general public wouldn’t understand the nuances,” and that might translate into stigmatization based on the type of vaccine being offered. It might raise questions like “If you only offer me the one that’s less effective are you discriminating against me?” And that is part of why it is so important for medical professionals and public health professionals to be able to explain these differences to the public, to understand their fears and concerns and respond to them with the facts in a way they can understand. Dr. Castel felt this especially strongly “as an African American woman working in the field,” with friends and family coming to her with their questions and concerns. Translating that information can be difficult, but it’s a vital part of the work Dr. Castel does, and a crucial part of what she teaches her students.
Despite the difficulties of the past year, Dr. Castel is hopeful. The urgency with which the scientific community responded to the pandemic has the potential to impact other areas of healthcare as well. Perhaps there will be a chance to “take some of that innovation and technology and apply it to HIV research.” But she has tempered that hope with the understanding that “the calculus is different.” COVID-19 is a pandemic that has impacted everyone, put us all at risk. The population most at risk from exposure to HIV is not one that is prioritized in the same way. It’s a stark reminder that even in the United States healthcare is not inherently equitable. Despite the fact that HIV “drastically alters the world [of those infected] in the ways that COVID has altered the rest of ours” there is an unwillingness to apply the same sense of urgency to HIV. Hopefully, as we begin to return to some sense of normalcy, those of us in the health sciences will be empowered to advocate for this kind of research. Those of us in positions of privilege who can speak to the healthcare needs of stigmatized populations need to work on communicating those needs to the general public. We can advocate for change, and call on our government to end the cycle of failing people living with HIV. We need to reevaluate our current healthcare system and public health professionals, like Dr. Castel, are ready to rise to the occasion. Of the lessons we’ve learned from the COVID-19 pandemic, one of the most important is that with a sense of urgency, adequate funding, and research, it’s possible to develop long-term solutions to viruses and diseases that still harm marginalized communities.
To learn more about the history of HIV/AIDS health policy in the US, take a look at this article covering 35 years of policy. To learn more about advocating on behalf of people living with HIV/AIDS, read this commentary from Topics in Antiviral Medicine. To learn more about Dr. Castel’s work, browse her publications indexed in the Health Sciences Research Commons.
