Deep in the bowels of a stifling Mumbai, India slum built of corrugated tin and wallpapered with old newsprint is about the last place you’d expect to find a Golden Globe- and Emmy-nominated star named to People magazine’s "50 Most Beautiful People" list three times. But since becoming the global ambassador for YouthAIDS, an international campaign to raise awareness and combat the spread of HIV/AIDS, Ashley Judd has spent almost as much time among the destitute, ill, and sexually exploited in Third World countries as on film sets.
Judd, 39, is best known for her gripping performances in thrillers like Kiss the Girls and Double Jeopardy as well as for her critically acclaimed turn as Cole Porter’s wife, Linda, in De-Lovely. The Kentucky- and Tennessee-raised actor -- whose latest film, Crossing Over, a drama about immigration co-starring Harrison Ford and Sean Penn, opens Nov. 16 -- is used to being in the spotlight alongside her family. That includes mother Naomi and half-sister Wynonna, country-music superstars, as well as her husband of eight years, IndyCar Series champ Dario Franchitti, a Scottish race-car driver of Italian descent. But these days, she’s just as likely to make headlines for her commitment to using her fame to bring global attention to issues she cares about, including HIV/AIDS, women’s health, and reproductive rights.
Her fans will be able to see this newer side of Judd in action on Dec. 1, World AIDS Day, when a National Geographic–televised documentary shot during Judd’s spring 2007 journey to India broadcasts in 170 countries. With another pilgrimage for YouthAIDS planned in early 2008 -- to Zimbabwe or the former Soviet Union, where AIDS deaths are increasing in some countries that were part of the Communist bloc -- she recently took a break to tell WebMD what she’s learned about the disease, global health care, and herself over these last five years of working with YouthAIDS.
Ashley Judd: Traveling the World
Judd’s work dates to 2005, when she traveled to Africa for nearly a month, touring Kenya, South Africa, and Madagascar. She held hands with gravely ill AIDS patients in a hospice, talked about condom use with commercial sex workers, and hosted HIV education events for villagers in communities where the sexually transmitted disease rate approaches 20%. Since then, she has made similar journeys to Guatemala, Honduras, Nicaragua, Thailand, Cambodia, and most recently India.
One memory that continues to drive Judd is her encounter with an HIV-positive Indian woman named Kausar. In March of this year, her travels brought her to Mumbai, formerly known as Bombay and the most populous city in the world. In a settlement where tens of thousands of people live on top of one another in decrepit hovels, Judd followed Kausar through dirty standing water and dangerously jury-rigged electrical wires to the tiny one-room shack she shares with her son and daughter.
"When I entered this slum, all the light was immediately blotted out. The corridors were very narrow, and children would appear in cracks in the walls, these dirty, ragged faces full of excitement to see us," Judd says. "To get to Kausar’s home, we climbed a bamboo ladder secured with twine, and when we got there, we both burst into tears."
Kausar became HIV-positive when her husband had sex outside of the marriage, contracted the virus, and infected her. "She fell ill, and in the midst of dealing with that, she had the guts -- in a society where it is very taboo -- to be tested for HIV," Judd says. "Her doctor, clearly grasping her poverty and disempowerment, told her it was a death sentence. She tore up her test results and slapped him across the face."
Instead of giving up, as her doctor did, Kausar became an HIV advocate, working with YouthAIDS. "She spends her time educating others, and is constantly with people when they get positive results on their HIV tests. She escorts them through the process, gets them counseling, helps them get antiretroviral drugs. Through this work, she’s managed to not just survive, but to transcend the most grim reality imaginable," Judd says.
Fiercely passionate about the sexual exploitation and lack of status of women and girls in developing nations, Judd focuses much of her activism on advocating for these vulnerable women -- women like Kausar and her daughter, a beautiful girl of about 13, who when her mother was ill scrounged on the streets and begged food from teachers to help her mother get her strength back.
"A child like that is so vulnerable to human trafficking and sexual exploitation," Judd says. "I had a really wonderful conversation with her about how special she is, and that her body is sacred, and how important it is that she believe that she could help create for herself a different destiny. But we need to make that happen for millions of women and girls in places like this."
Without taking gender issues seriously, there’s not much hope for controlling the HIV pandemic, says Michael H. Merson, MD, director of the Duke Global Health Institute and former director of the World Health Organization’s Global Program on AIDS. "Women in sexual relationships don’t have power, particularly in developing countries like India and African nations," says Merson. "They’re at risk in terms of their social, educational, and economic status. Why do so many women go into sex work and risk their bodies getting infected? Why, they need the cash -- to feed their child or get a piece of clothing."
In Africa, Judd met sex workers so desperate for the 15 cents earned from each encounter that they had sex on the sidewalk. In addition to their thriving sex trade, says Merson, many African countries have a shockingly high rape rate -- in southern Africa, as many as 70% to 80% of women report being forced to have sex.
Ashley Judd: Connecting Personally
Only recently has Judd come to a deeper understanding of why she feels such a powerful, personal connection to these vulnerable women and children.
Last year, when Wynonna was receiving treatment for food addictions at the Shades of Hope Treatment Center in Buffalo Gap, Texas, the counselors at the center approached Ashley about her own needs -- co-dependency, depression, and "numbing, denying, and minimizing my feelings." She spent six weeks in the treatment center herself. "Because my addictions were behavioral, not chemical, I wouldn’t have known to seek treatment. And those behaviors were killing me spiritually," she revealed at the time to the media.
Judd described years in which she was "doing the same thing over and over again and praying that somehow, some way, this time the result would be different. But that wasn’t going to get me out of the pickle I was in," she says. "The problem wasn’t other people, it was my own thinking, and I have to keep the focus on myself and what I can do differently." One of the issues Judd confronted while in treatment was the chaos of her early years, when she attended 13 schools in 12 years all over the country, shuttled between living with her mother, grandfather, and father, and became fixated on perfection. She realized she had bought into a childhood myth in which her sister was the "messed-up" one and she was the "perfect" one, feeling she had to perpetually live up to that image. She’s also spoken out about having suffered sexual, emotional, and physical harassment as a child; though she won’t go into detail, she says the experience is always with her in her travels on behalf of HIV/AIDS victims.
"I have a lot more insight into why this work is so fantastically meaningful to me -- what it is about orphans and vulnerable children that touches me in a way I can’t describe," she says. "My circumstances weren’t remotely comparable to what these kids go through, but I identify powerfully with the neglect and the abandonment and the vulnerability because I was a vulnerable child, too."
Seeking treatment for her depression and other health issues has made her a more effective advocate for YouthAIDS, Judd says. "On my first trip, I was so troubled by anxiety and insomnia and resentment. I was just eaten alive with rage at the way things were," she says. "Now, I’m able to do the work, sleep at night, and deal with what’s in front of me to focus on the solution."
Judd’s sleep troubles, anxiety, and brooding over the disturbing scenes she witnessed are classic symptoms of depression that many women feel, says Bonnie Strickland, PhD, professor emeritus of psychology at the University of Massachusetts and a past president of the American Psychological Association. "Women are twice as likely as men to be depressed," she says -- and you don’t need to be an actor from a famous family to feel the pressures that can drive depression.
"Women are expected to be feminine yet strong and emotionally supportive of everybody else. We can’t live up to all these expectations of us, and yet that’s what we’re socialized to do," says Strickland. "Ashley Judd is quite right that we’re trying to be perfect, to take care of everybody, and we feel it’s our fault if there’s any sort of failure around us."
Ashley Judd: Facing Tomorrow's Challenges
Next on Judd’s agenda is a pilgrimage for YouthAIDS in 2008. She may go to the former Soviet Union, where human trafficking also is rampant. "It’s especially silent in eastern Europe, where the trade is run by Mafia and gangs," she says. "Human trafficking is the third-largest money-making industry in the world, behind drugs and arms, and it’s poised to become the single most lucrative economy in the world."
Judd and Franchitti have recently relocated their household -- including their menagerie of cats and dogs -- for a temporary move to Vancouver for her next film, Helen. The drama has a special resonance for Judd, with its focus on a music professor and mother who suffers from a debilitating, isolating depression. "By the grace of God, my depression was never so severe, but when I read the script, I so identified with everything," she says. "I actually sent the script to my mentors to make sure it was appropriate to do the film and wouldn’t be too triggering. They said they couldn’t wait for me to do it -- I have the tools, and it would be service work."
No doubt, Judd’s life remains stressful. In addition to the strains and travails of an A-list acting career, the tragedies she witnesses in her advocacy, her childhood memories, and family health issues (her mother, Naomi, has been open about her hepatitis C diagnosis), her husband’s career isn’t exactly a tame and reassuring one. Within one week in August, Franchitti -- who races at speeds up to 230 miles an hour -- twice crashed on the track, both times in harrowing "How did he walk away from that?" spectacles.
But her new self-awareness has left her better able to cope with these pressures -- and more appreciative of her relationship with her husband and family, she has said. And she no longer strives to be perfect; if she needs help, she seeks it out. Judd says she would return to treatment in a heartbeat if she needed to. "Because I finally faced my past, and realized that where I come from, and what happened to me, and how I participated, is not who I am -- today I can live happy, joyous, and free.
"I’ve learned that I am a precious child of the universe, and I have a right to be here, and I can share that. It’s wonderful," Judd says.
Blues Gene: Does Depression Run in Families?
Ashley Judd sought treatment for depression and co-dependency at the same center where her half-sister Wynonna was being treated for food addiction. She has said she was clinically depressed at the age of 8. Do depression and related mental and emotional health issues run in families?
"There can certainly be a family predisposition to depression," says psychologist Bonnie Strickland, PhD. Research in families, twins, and adoption shows that genetics definitely plays a role -- while no single "depression gene" exists, multiple genes appear to affect susceptibility to depression and other mood disorders.
Of course, since sisters and brothers usually grow up together, shared major life events also can put family members at greater risk for depression. The important part, says Strickland, is to recognize when you need help. She praises Judd for taking her struggle public and talking openly about seeking treatment.
"There are many paths to depression, but there is no need to stay depressed. You don’t have to live with depression, because really effective treatments are out there," says Strickland.
Originally published in the November/December 2007 issue of WebMD the Magazine.