June 5, 1981. The U.S. Centers for Disease Control and Prevention issued its first warning about a rare pneumonia called pneumocystis circulating among a small group of young gay men. Unrealized at the time, it was the official beginning of the HIV/AIDS epidemic.
In October 1981 I met and cared for my first AIDS patient, while a student at the Middlesex Hospital, London, UK. Almost thirty years later, I remember him as if it were yesterday. He was a 32 year old family doctor, who had a busy practice helping a poor and homeless community in London’s Kings Cross. He wasn’t in it for the money or the glory, he just wanted to make a difference in people’s lives. He wasn’t promiscuous either. He had only one lover during his all too short life. Unfortunately that partner had a one night stand while visiting friends in San Francisco, and although he didn’t become sick, “George” did.
When I first met him he had just been diagnosed with pneumocystis carinii pneumonia (PCP) a rare opportunistic infection. And although the underlying immunodeficiency disease had not yet been identified or named, the press was already buzzing with stories of a “gay plague”.
Sadly, back then there were no medications and care was largely palliative. Essentially patients were given a terminal diagnosis and without exception they died quickly. In the beginning, we didn’t even know it was a viral infection. However, at least this meant we could care for “George” without the Haz Mat protection suits that we were later forced to wear, by naïve, but well-meaning infection control officials.
I was with him when he died and it was calm and dignified although the disease had taken its toll and he was no longer recognizable as the vibrant young man in the photograph on his bedside locker. Sadly, his friends and family were not there. In those early days the stigma associated with the disease was too great. His family didn’t even know that he was gay. I heard later that his partner had told “George’s” mother that he’d died from cancer.
In the thirty years that have passed since the first CDC warning, millions of lives have been touched by AIDS and much has happened in the fight against it, yet we still don’t have a vaccine to prevent it or a definitive cure.
Since AZT, the first antiretroviral drug, was introduced in 1987, and particularly since the commencement of treatment through a regime involving a cocktail of drugs- so-called highly active antiretrovial therapy (HAART)- in 1996, outcomes have improved so much that HIV is no longer regarded as a death sentence.
Instead, with the initiation of- and adherence to- the right treatment, HIV is viewed as a chronic but manageable condition.
What does the future hold?
Today there are 33 million people living with HIV/ AIDS , so HIV must remain a global health funding priority. The new head of the International AIDS Society, Bertrand Audoin, has called for investment, both scientific and financial, in pursuing a cure for HIV. Audoin, however, acknowledges that any cure could be 25 years away. On-going research is investigating potential HIV vaccine candidates, as well as microbicides that may allow HIV negative people to protect themselves from the virus. There is also compelling evidence emerging that early initiation of treatment can play a role in curbing the onward transmission of the virus, the concept of treatment as prevention.
Still, the key message remains one of prevention. Even the advances in treatment, and the increased availability of medication, do not address the fact that for every person who starts treatment, two more are newly infected with HIV. Basic HIV education is vital for the prevention of transmission in all its forms, enabling those who do not have HIV to protect themselves from infection.
“George” this blog’s for you. You may not have lived long enough to fulfill all your dreams, but you certainly made a difference to my life.
SRxA's Word on Health 