Looking Back—AIDS in the Time of COVID

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I listened with interest to the recent online discussion Reflections on the AIDS Crisis in the Time of COVID-19 hosted by BAMMER with Eric Sawyer and leading AIDS physician Howard Grossman, as they described the history I lived through as a straight medical student and resident in the early 1980s.

We first learned about AIDS in microbiology class during our 1st year (’81-82), when we were taught about pneumocystis pneumonia and cytomegalovirus infections occurring in an unusual group of patients—the 4 H’s (Haitians, hemophiliacs, heroin addicts and homosexuals). The following year in pathology class, we learned about Kaposi’s Sarcoma occurring in this same group. There was very little other information and plenty of misinformation available at that point.

I was assigned to admit the first patient to “rule out AIDS” at the Polyclinic Hospital in Harrisburg, PA in the summer of 1983, and in that role, I was required to do a very thorough medical history and physical examination of him. I was not the most sexually knowledgeable person then. I was 23 years old and had only had sex with two women before then, and had no idea at all about gay sex.

During the admission, I pursued a regular course of inquiry and learned that he was gay and he’d recently developed red blotches on his skin. We knew so little about the diseases associated with AIDS and suspected his lesions might be Kaposi’s Sarcoma, one of the conditions found in this group of patients. (By this time in 1983, the condition was referred to as GRID—gay-related immune deficiency—in centers such as NYC and LA, where the great majority of patients were gay men. While I knew the relationship, I don’t remember the term being used at our hospital, where the gay population was small.)

I examined the young man, working my way through my normal routine, which ended with the rectal exam—a part of the exam with a mythology unto itself and one which took on greater meaning to me due to my limited understanding of gay sexual behavior. Blood had been drawn when he arrived, but it took days to get back his T-cell counts to determine if he had GRID. He stayed in the hospital, in isolation, during that whole time, worrying, as we did, if this would be his death sentence. There was no effective treatment for it. As it turned out, he was fine. All he had was an allergic reaction to antibiotics he’d been put on and was otherwise healthy.

That was the first patient I encountered who was suspected to have GRID. Luckily he didn’t. As I finished medical school and moved into general surgery residency, we continued to see occasional patients who were sick with this syndrome.

As chief resident in general surgery in 1990, I found myself advising a young student we’d admitted for a peri-rectal abscess that he was HIV positive, one of the only times I ever had to inform a patient of that diagnosis. A year later, during my training in plastic surgery, I treated a homeless man with a jaw fracture, known to be HIV positive. We were wiring his mandible together, using a device that looked like an awl with a hole in the end to put the wire through. The tip was sharp like a fork tine and, as I pushed it through the tissue over the bone, it moved a bit more quickly than expected and poked through my double-gloved hand and right into my finger. Pulling off the glove, I saw that I had a slight flesh wound and might have had contact with his blood. Raising concern that I might have been exposed to the virus, I was put on AZT, the first drug that seemed to have some effect at halting the infection of the virus. I took the drug five times a day for a month. I began to have headaches, nausea, and an assortment of other problems, but I had to work right through it all. It was perhaps a good thing for me to work and not overthink my situation too much—although I was low risk due to the mechanism, the disease still had a poor prognosis, and fortunately I was not infected.

Looking back today, not as a naïve young straight intern, but as a gay man (I came out in 2004) and well-wizened physician, HIV is no longer a death sentence. It’s still a serious, but, for most patients, manageable health condition. Now, however, we’ll have something new to fear—another killer virus with little treatment and no cure, as well as an inadequate healthcare system and government management team. This sadly sounds all too familiar to me.

Luckily, there were many things the medical community learned from the AIDS epidemic that are helping to fast-track current research into treatment, and hopefully a vaccine, for this new disease. And, perhaps, the family and friends of those who died back then, can take some solace in that knowledge today.