(PHOTO CREDIT: ELVERT BARNES)
By Joan Grzybowski, DO, FACOFP; member, ACOFP Health & Wellness Committee
Forty years ago this month marked the beginning of a worldwide epidemic that infected 75 million people and killed 35 million.
In 1981, five men from California were diagnosed with pneumocystis pneumonia, an opportunistic infection known to have deadly outcomes. Similar cases were also being reported on the East Coast in New York. The common denominator was that the patients were gay men.
It wasn’t until the following year, in 1982, that the U.S. Centers for Disease Control and Prevention (CDC) used the term “Acquired Immunodeficiency Syndrome (AIDS)” and identified the lethal killer. A physician you know very well today was also very present during that health crisis.
Dr. Anthony Fauci was then a very pivotal and respected figure in the communication of this illness to his colleagues and to the government, as he is today regarding the COVID crisis. He was a much-needed catalyst in speeding up the communication, attention and education that needed to be brought to the public spotlight.
In 1983, a health model of care was introduced called the San Francisco model. This model came from the first AIDS clinic. It addressed respect and compassion for the patient and collaboration with the community and health departments to help educate the public and provide healthcare and social services to those in need. This model seems very similar to what we as osteopathic family physicians espouse today in our treatment style. It stressed an all-encompassing view of the patient, the problem and the solution.
During the early ‘80s, we had no targeted treatment to help these patients. Many health facilities and institutions would not treat these patients, calling it the “gay disease.” The disease was first thought to be only associated with gay men. This narrow theory of transmission lead to fear of these patients and an HIV-related stigma developed, leading to broad-based discrimination. Many of those most vulnerable to HIV faced poor healthcare access, limited social support, limited employment opportunities, violence and psychological trauma. It wasn’t until the disease was found in other populations—like heterosexual women with at-risk partners, hemophiliacs and at-risk children—that we started to see the beginning of a kinder approach to these patients.
In 1983, Congress passed funding for AIDS research, and President Reagan addressed it in his speeches. The disease was no longer an unknown entity without champions. Also at this time an organization called ACT UP was founded as a political activist group designed to bring information and awareness about the disease and to help protect those with AIDS.
In 1984, the CDC identified the cause of AIDS to be a retrovirus and developed a blood test to detect it.
In 1985, Rock Hudson became the first national figure to state he had been diagnosed with AIDS. That marked the beginning of change in the perception the public held about this disease. In 1987, the first panel of the AIDS Memorial Quilt was made to honor Marvin Feldman. It was 3’ x 6’—the size of a grave plot. Later that year, the quilt was displayed in Washington D.C., then with 1,920 pieces. Also in 1987, the first drug to treat AIDS was developed. It was named zidovudine (ZDV), otherwise known as azidothymidine (AZT). The Western blot test was also developed to help diagnose AIDS.
Decades later, now in 2021, we have markedly improved our treatment of this disease. It is no longer considered a death sentence, nor does it strike fear in the hearts of healthcare workers. The medical community over these last few decades has achieved much success in the treatment of AIDS patients and the education of our physicians and the public. We now have both preventative treatment regimens, known as pre-exposure prophylaxis (PrEP), in addition to post-exposure prophylaxis (PeP) treatment regimens. The drug developed in the early 2000s and commonly used for PrEP was Truvada.
I bring this topic to the table today because it is Pride Month, and the LGBTQI+ community has always been a population plagued with health disparities that we continue to address to this day. But today’s medical community has a lot to be proud of when it comes to conquering this disease and unraveling the ball of unknown threads and prejudices wrongly associated with it. We now have curriculum embedded in medical schools to address the health disparities found in many of our minority populations and the LGBTQI+ community.
Many of you were not physicians and some of you were not even born during the early days of this disease. Knowing a bit of a problem’s history gives you a better understanding of solutions that can be used to address other health challenges our patients face.
Albert Einstein said, “Logic can take you from point A to point B, but your imagination can take you wherever you want to go.” I will add: Always remember to be of value to your patients; your success and happiness will come from that.