Breaking the Chain (continued)


How Concurrency Accelerates a Virus

This computer animation developed by Martina Morris and colleagues at the University of Washington simulates the spread of HIV in a population of 10,000 young adults over a period of 10 years. Over time, as partnerships form and dissolve, the virus spreads outward from the original vectors. Infection occurs in both monogamous and concurrent relationships, but transmission is accelerated in concurrent partnerships, which give the virus more paths along which to spread. Source: Center for Studies in Demography and Ecology.

Nearly 2,500 miles, much of which can be traversed on Interstates 84 and 80, separate Portland from Cleveland, Ohio, where Morris grew up. Her first exposure to Reed came in the 10th grade when she visited her high school library and pulled the massive College Board catalog of all U.S. colleges and universities from the shelf.

Reed caught her eye for two central and somewhat contradictory elements of its reputation, both of which are still celebrated today. The college gave its students vast amounts of freedom—in loco parentis was apparently not in the vocabulary, despite the college’s longstanding tradition in classics. At the same time, Reed maintained a highly demanding academic environment.

“Well, actually there were three reasons, I guess,” says Morris. “It was about as far away from home as I could get.”

Cleveland in the 1960s and ’70s was defined by social unrest and environmental disaster, including the infamous 1969 Cuyahoga River fire. The unfortunate “Mistake by the Lake” moniker seems to date to that era. This is perhaps why Morris was drawn to campuses known for their rigor and their beautiful settings. She considered Stanford and University of California, Santa Cruz, before deciding on Reed.

Morris proceeded to have what she says was a typical Reed experience in the 1970s. She dropped out twice, traveled to prerevolutionary Iran, hitchhiked through Europe, and studied dance in New York. More important, she was profoundly influenced by the notoriously demanding professor John Pock [sociology 1955–98]. She still remembers sitting in Sociology 210 and taking furious notes during his lectures.

“I was hooked, basically, from then on,” she says. “He is the reason I am where I am now. . . the things that he showed me remain important to me, to this day.”

Pock has vivid memories of his former student. “She was the kind of student that the founders of Reed were thinking about when they set up the college,” he says. “She never took the easy answer. She investigated. She wanted to find out how things worked instead of just writing down a pat response. I’m proud of her.”

Morris felt Pock’s pull even in New York during her encore as a dropout. She’d traveled east to study dance, but on a whim wound up taking a course at Columbia from Robert Merton, among the country’s most eminent sociologists.

“As soon as I got in his class, it was, like, ‘Oh, my God, of course this is what I want to do.’” she says.

At a Chock Full o’Nuts coffee shop at 116th and Broadway in Manhattan, across the street from Columbia, Morris figured out the topic of her Reed thesis, which she would eventually finish, under Pock’s guidance, in 1980. Why, she wondered, did all the leftist organizations from the 1960s, particularly the Students for a Democratic Society (SDS), eventually implode?

Her conclusion, relevant to the Occupy Wall Street movement today, was that the participatory democracy espoused by SDS is not a viable form of political organization. The only way it works, she found, is if individuals completely submit to the collective will, which of course is exactly the opposite of the reason people join such groups in the first place.

Morris, subject to withering attacks by colleagues in recent years, is not one to submit easily. Maybe studying the tumultuous activist movements of the ’60s inoculated her to this sort of criticism—or maybe it was defending her thesis before John Pock.


Both the tone and substance of the conflict were on full display on October 7, 2010. That was the day of a World Bank–sponsored debate on this simple proposition: concurrent sexual partnerships have been and remain a key driver of HIV epidemics in southern and eastern Africa, and interventions to this effect should receive the majority of prevention resources.

That proposition is the central focus of Morris’s recent professional life, so it was perhaps only natural that she spoke first. At the end of her opening statement, Morris calmly looked into the camera and summarized her reasoning: “Concurrency can have a dramatic impact on network connectivity and offers the possibility of large prevention impact.”

The debate was structured as a three-on-three format, and as other presenters stood to make their case or rebut others, it soon became clear that real passion and quite likely even personal animosity simmer just beneath the surface. 

Speaking via video conference from Johannesburg, South Africa, Brown University epidemiologist Mark Lurie all but accused Morris and other advocates of the concurrency hypothesis of shoddy work or even of outright lying, urging those in the audience to be wary of tricks and sleight of hand.

“You might believe that empirical evidence for concurrency is as rock solid as Mount Everest,” said Lurie. “In fact, rather than a mountain of evidence, the hypothesis rests on a very thin layer of ice.”

Lurie’s remarks are consistent with the stridency of the debate, which has been hashed out in academic journals in recent years. Stripped to its essentials, the criticism of the concurrency hypothesis is that there is little field evidence to support it: areas with high HIV prevalence do not always show high rates of concurrency, and areas with high rates of concurrency do not always have high HIV prevalence.

One big problem is that collecting reliable scientific data about sexual behavior is extremely difficult, especially in Africa, where levels of trust in the government are low. Surveys of sexual behavior are usually designed to be conducted in private. Respondents are supposed to be given assurances that their answers will be recorded anonymously. Epstein, Morris’s collaborator, who has seen several such surveys administered in Africa, says that in practice these guidelines are almost never followed. 

“Think about it,” Epstein says. “Someone comes to you with a questionnaire and says, ‘I’m from the government. I’d like to know how many sexual partners you have and when you’ve had them.’ People might be tempted not to answer honestly. I know I would.” 

Epstein, who earned a PhD in molecular biology from Cambridge before turning to journalism, prominently featured Morris in her 2007 book The Invisible Cure, which chronicled the catastrophic failure to reverse the AIDS epidemic in Africa. Convinced the concurrency hypothesis is correct and can save lives, Epstein has gone on to publish academic articles with Morris and speak on the topic to audiences around the world years after the publication of her book, which the New York Times Book Review described as a “bolt of clarity from the blue.”    

“I guess I feel very strongly that she was right and that she’s been right for a long time,” says Epstein. “Until the rest of the world begins to really understand this and appreciate the meaning of this, and implement the right sorts of programs that I think really have a chance at success, I don’t think I can quite let it go.”

Morris, measured throughout her interview with Reed and in the World Bank debate, becomes animated when asked about the resistance to her work among American and European academics.  

“In some ways it’s a crime at this point that people are arguing that we shouldn’t even make this information available to people through a public health campaign,” she says.