Picturing Progress in AIDS Treatments

Just in time for World AIDS Day, Pulitzer Prize winner and former Houston Chronicle photographer Smiley Pool has published a book of photographs documenting the lives of HIV-impacted children and their communities from the era of the newly discovered HIV medicines. Through the White Door is a 200-page love letter from the photojournalist, meant to show the faces and stories of people living with the virus.

“The big hope is that [by reading about] the lives of these people, we can open viewers’ hearts,” Pool says. “It’s always been my hope that through photography you can expose people to things in a way that might connect with them. I hope they can get connected with these characters and see their lives in a way they haven’t seen before.”

Pool didn’t actually set out to make a book at first. Instead, the ambitious project was the result of a chance photo assignment he was given while working for the Houston Chronicle in the 1990s. Pool’s editor tapped him to follow a medical writer on a trip to Romania for a feature on a new treatment for HIV. What began as a story turned into an experience that altered the course of Pool’s life after meeting Dr. Mark Kline, who was researching new protease-inhibitor treatments.

“Mark wound up with the very first protease-inhibitor trial for pediatrics,” Pool recalls. “Mark had 12 kids in his care on a study. At that moment in history, the protease inhibitors were in trials in adults and showing tremendous progress. This was the ‘Lazarus’ moment for HIV. Mark had gone from treating symptoms to watching kids get better. Then he sees all these kids in Romania who need care.”

Romania was suffering from the aftermath of Nicolae Ceausescu’s regime that had created a large population of HIV-positive people. Kline introduced Pool to a group of young Romanians who agreed to be captured on film for the assignment. Once back in the United States, the Chronicle ran an 8-page feature on the story. However, there was little public response to that initial coverage.

Relentless in his pursuit of new treatments, Kline went back to Romania for another trial. Pool wanted to cover the topic once more, so he pitched his editor on the idea of comparing the lives of children in Romania with children receiving protease-inhibitor treatment in the U.S.

“Let’s show what is possible in our community, and how we can bridge the gap with access to this care. It took a number of different patients [before we found] the right family and the right patient. We had to have consent, then we had to get consent of those around the patient,” Pool says. “Somehow, it landed me in the living room of a housing unit at Goodfellow Air Force Base with the Queen family. They were coming to Houston to be a part of Dr. Kline’s trial. I had a life-changing experience with this amazingly strong, open family who let me come in and share their lives.”

After several photo shoots, both in the U.S. and Romania, the Chronicle ran a 24-page section titled “Worlds Apart.” This time, people noticed. Dr. Kline received the grant money to continue his medical research in a major way.

What started as an endeavor supported by Texas Children’s and Baylor College of Medicine now had the funding to make a real impact. It was named the Baylor International Pediatric AIDS Initiative at Texas Children’s Hospital, or BIPAI.

The payoff looked a little different for Pool, though. By this point, he had been indoctrinated into the fight to help affected youth in whatever way he could. He volunteered at Camp Hope, a place where HIV-positive campers learn how to navigate the complexities of their diagnosis while also experiencing a week of fun, barrier-free activities, and quality time with their friends. Six of the children from Romania were invited to attend Camp Hope.

“I became very attached to Janie and to the kids at Camp Hope. Then the two storylines collided [with the introduction of the Romanian children], so I followed it. Janie became fast friends [with the youth from] Bucharest. She was playing with all of the kids in a group home, and for me it was like all of the big-picture stuff didn’t matter. These kids shared the same medical condition, but in wildly different ways. For me, the fact that they could become so connected to each other was how I got hooked. These kids weren’t just photo subjects for me,” Pool says.

He followed the children’s lives over the next two decades, often using his vacation time to travel and photograph them on a pro bono basis. He also followed the growth of Kline’s treatment initiative as it expanded across the globe. Originally a small study of a new drug, it had grown into an operation serving more than 300,000 children and families.

In addition to Romania and the U.S., Pool traveled to Botswana, Eswatini, Lesotho, Malawi, South Africa, Tanzania, and Uganda. Along the way, he covered the stories of Ingrid Kealotswe (who sought the new medications for herself and her son), Dr. Rodica Matusa (who continues to serve children in need, even in retirement), Steven Doyle (who works with homeless Romanian children and is a surrogate father to one of the HIV-positive youth), and BIPAI’s staff, donors, and many brave children who shared their lives with the photographer.

CAPTURING CHANGE- Smiley Pool’s photography in Through the White Door documents the lives of HIV-impacted children and their communities during the era of the newly discovered treatments.

After two decades and more than 22,000 photos, the thought of producing a book surfaced. The occasion of BIPAI’s 20th anniversary provided Pool with the inspiration to follow through with the challenge.

“Because these families allowed me to be a part of their lives and tell their stories, they deserve to have a record of it. Some of these kids did not make it, [but now] they’re immortalized in a way that honors their contribution to this planet and their struggle,” he says.

With the help of David Jack Browning (design), Kevin Martin (photo editing), and Jessica Johns Pool (text), Through the White Door finally came together.

The book’s title stems from a testimonial regarding HIV treatment trials in Botswana that is featured in the book:

“Before the Botswana government was able to bring in medications for children, the only way that kids could get medicines was through a trial that was started, something called the BANA trial. Next to the Princess Marina inpatient ward, we renovated what really had just been a small closet into a clinical trial room, and the door on it was white. The mothers on the ward would say to the other mothers, ‘Take your child to that white door and see if you can get on those pills. Because the kids who go through the white door live, and the kids who don’t, don’t live.’”

Pool and his publication team felt the story summed up the transformation that occurred with the advent of antiretroviral HIV therapy, and its subsequent spread throughout the world.

Pool’s final product is an accomplishment that anyone would be proud of, but he says the work is not finished yet. Proceeds from book sales will support HIV/AIDS initiatives.

“It will go back to the programs that serve the people in the book: Camp Hope, BIPAI— anyone who is doing work on the ground,” he notes.