June 5, 2021

40 years

On June 5th 1981, the CDC’s biweekly newsletter, the MMWR (the Morbidity and Mortality Report), reported 5 cases of an unusual cluster of a rare pneumonia in previously healthy gay men in Southern California. That was the harbinger of the AIDS Epidemic. Cases increased quickly but research started slowly with little government support, mostly because of the stigma regarding gays at that time. The disease was called “the Gay Plague” initially. Fear and misunderstanding were rampant. People worried you could get AIDS from a toilet or a mosquito, maybe from a hand shake or sharing a glass. Many patients were refused care. Families disowned patients. The disease was not understood. Experts realized the need for concerted research and activists began ACT UP and other actions and protests, affecting how research and access to new meds was conducted. Funding was slow to come. President Reagan didn’t publicly say the word ‘AIDS’ until 4 years later in September, 1985 when he finally promised funding. This inaction resulted in untold deaths. The ACT UP Timeline tells the story. Compare it to the CDC’s own timeline. The political activity worked. People began paying attention and research increased, although the stigma remains.

It took years to find treatments that worked. Not until 1996 was the first big success with a “drug cocktail” that was a combination of 3 antivirals that suppressed the virus and allowed people to live and recover. Since then treatments have improved, becoming safer and easier to take. No longer fistfuls of pills several times a day but just one combo pill daily, soon to be one shot every month for some. Strides have been made in understanding this viral disease and its treatments. Cooperation worldwide addresses this disease.

Challenges still exist. Diagnosis still carries stigma. Meds are necessary for health. A cure has not been found. After 40 years, the HIV pandemic has caused 33 million deaths, 76 million infections, with 38 million people living with HIV worldwide. Contrast that with the 3.7 million COVID-19 deaths over the past 18 months. I have been lucky enough to witness and help with these changes. When I was in Med School in the late 80’s this was a new and dreaded disease. I knew I wanted to take care of people affected by it. Now, my patients with HIV live normal lives, as long as they can get their meds. At the World AIDS Conference in Mexico City in 2008, I witnessed the creative and compassionate passion that people from all over the world have for treating and preventing this disease. Strides are still being made. Just today, I attend an on-line Zoom conference that presented new treatments. This is miraculous.

But still there is no vaccine. The HIV virus is wily that way. Fortunately, our novel coronavirus, Sars-CoV-2, is different and our vaccines work well. Miraculous that we have them in less than a year. The work done in HIV paved the way for the work done to help us with COVID-19. Many of the same experts helped now, as they did back then. And just like with HIV, our understanding of the disease has shifted since the initial cases.

But politics sadly interferes. Many of the people infected with HIV/AIDS in the US were gay, sex workers, or IV drug users, and the stigma stuck. Sars-CoV-2 affects minorities, the poor, and the elderly more readily because of their living circumstances and their health conditions. Therefore, others don’t feel at risk and don’t seem to care about the more vulnerable. They are misled and misinformed by their leaders, turning a public health issue into a political one, making it harder for the already stressed out health care workers.

This also threatens the strides made in the AIDS pandemic, prevention had been making a dent, but experts fear a reversal, at least for a while. We are lucky to have a president that is aware and has promised funding. Some worry that areas are at risk, like the Indiana county with a recent HIV outbreak related to IV drug use which made strides in treating and diagnosing those affected. They were using an effective needle exchange program that worked to reduce risk of new transmissions. The program is now cancelled by the county, which health officials fear will increase new infections. It seems that once again the public good is at the mercy of people who think they understand the concept of harm reduction and prevention, but only see the superficial aspects without looking at data. I wish it could be different.

We have come far with both HIV/AIDS and Sars-CoV-2/COVID-19. We have a lot to grieve and a lot be thankful for. The scientists, researchers, physicians, nurses, and others have made all the difference, along with the citizens who kept up with the new information forthcoming and followed recommendations, including getting vaccinated.

Wash your hands, cover your nose (yes, at times, it is still the right thing to do), and think about all the science and help we have received and be grateful.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.