Elizabeth T. Montgomery ’90 is an infectious disease epidemiologist, specializing in new biomedical and behavioral strategies to reduce HIV acquisition among women in Southern Africa. She works as an investigator in the Women’s Global Health Imperative (WGHI) within the Social and Statistical Sciences Group of RTI International, an international research institute.
Montgomery came to Hotchkiss as an upper mid from the American School in London and found the transition somewhat difficult. “I found a different culture around studying, much different than the experiential learning I had experienced at the American School. I had to learn better study habits. Socially, I had the benefit of one of my oldest and closest friends, Whitney Van Nes, in my class, and I also knew Will Price ’89 from the American School in London.”
Having considered herself to be oriented towards the humanities, Montgomery had not focused much on science at Hotchkiss. “I didn’t think of myself as a science person although I did fairly well in Mr. Merrill’s biology course (and I scored well on math SATs). I left Hotchkiss with a strong interest in international relations. But after completing my undergraduate degree at Johns Hopkins, I knew that I wanted more practical training, rather than theoretical, and public health spoke to the progression from international relations to international public health as a natural way to do this. I suppose the lesson here is to not allow oneself to be typecast in a certain field or set of disciplines.”
Montgomery followed her B.A. in international relations with an M.H.S. in International Health, also at Johns Hopkins, and then a Ph.D. in epidemiology from the London School of Hygiene and Tropical Medicine.
Today, Montgomery does HIV prevention research and is an epidemiologist by training. “My focus is on the social and behavioral risks of infectious diseases, specifically HIV in Africa.” She has been part of the same research group since 2001. “We were previously at the University of California at San Francisco, but our group moved to RTI seven years ago. Prior to my association with RTI, I worked at Stanford University, also researching AIDS prevention in Africa. I am interested in this work because it presents an interesting combination of addressing both a huge medical challenge—an epidemic, if you will—with the behavioral and structural reasons women are at risk. For women in Africa, many sexually transmitted diseases, including HIV, are not straightforward health problems that can readily be solved with the right drugs or a vaccine, so our challenge is to try to address this through innovative and effective interventions.”
For Montgomery, research is “an intellectual hook. I look for a creative aspect to try to figure out a new approach or strategy, which is very fulfilling. We are involved in several new projects investigating how young women in Africa respond to new technologies for HIV and pregnancy prevention. We are in search of a product to address HIV first, and ultimately pregnancy prevention as well, but nothing has proven to be totally effective yet. The challenge is often cultural – what works may not be acceptable to the husbands or partners of women, and often the male is in charge. We are looking for new and different inter-vaginal methods, like intravaginal rings that slowly release anti-HIV drugs such as microbicides, or implantable devices, or injectables, to prevent HIV. These methods must be easy to use consistently and easy to use secretly if a woman needs to.” Young women and girls in many areas of Southern Africa have a huge risk of HIV infection, according to Montgomery. “Prevalence can be one in three women of childbearing age, and women are disproportionately infected compared to men.”
Though cautiously optimistic, Montgomery does not think that we will reach the point of having no new cases of HIV/AIDS in our lifetimes. “There are approximately 35 million people living with AIDS around the world. Given what we know about polio and other infectious diseases that were almost eradicated before coming back, and considering the fact that you can live for years with HIV infection and may spread it during that time, HIV/AIDS isn’t going away any time soon. But we are at an exciting time in prevention. Previously, the only help was male condom use, but within the past several years, trials have shown that the use of oral tablets for Pre-Exposure Prophylaxis (PrEP) is effective. In fact, the World Health Organization just recommended PrEP for all people at substantial risk. There are massive efforts underway, including one by the United Nations, which has launched a fast-track approach, UNAIDS 90–90–90 treatment target. The goal is ensuring that 90 percent of people living with HIV know their HIV status, 90 percent of people who know their HIV-positive status are on treatment, and 90 percent of people on treatment have suppressed viral loads.”
Montgomery and her team have received several research awards, but she is most proud of one she recently received from the National Institutes of Health (NIH) for a grant she wrote. “I was awarded the R01, which is the Research Project Grant, the original and, historically oldest grant mechanism used by NIH.” The R01 provides support for health-related research and development based on the mission of the NIH. R01s can be investigator-initiated or can be in response to a program announcement or request for application. “This is the gold-standard for research proposals,” notes Montgomery. “Because it is a peer-reviewed process, which is quite stringent and competitive, I am particularly proud of the recognition our work received.”
The challenges of this kind of work are many, according to Montgomery. “There is a seemingly never-ending flow of data that needs to be analyzed. Once analyzed, there are new questions that need to be answered. In terms of HIV prevention, the challenge is in trying to effectively reach young women, and to come up with a strategy or the technology to prevent new infections. Young women don’t believe they are at risk, and condoms only work if you use them.”
When asked if more women are gravitating toward science, Montgomery notes that there are many more women working in public health, and in particular, in women’s health, as women identify with global health disparities. But she adds, “While I see some women in certain areas of medical research, I would love to see more women in fields such as biomedical engineering, for example, or immunology. We need bright and innovative minds to come up with new ideas and new approaches. I would definitely recommend my line of work to current Hotchkiss students.”
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