The AIDS Epidemic

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The year 2021 marked the 40th anniversary of the official start of the AIDS epidemic here in the USA. On June 5, 1981, the Morbidity and Mortality Weekly Report (MMWR), a publication from the Centers for Disease Control (CDC; now the Centers for Disease Control and Prevention) noted that between October 1980 and May 1981, five young men, “all active homosexuals,” were treated for biopsy-confirmed Pneumocystis carinii pneumonia (PCP) at three hospitals in Los Angeles. Two had already died. On the basis of those cases, the CDC hypothesized that there was “an association between some aspect of a homosexual lifestyle or disease acquired through sexual conduct and [PCP] in this population.” This was prior to the discovery of the human immunodeficiency virus, or HIV.

I remember those days quite well. I was an intern at the now defunct St. Vincent’s Medical Center in Greenwich village. The hospital was located in an area with a large gay community. I remember reading that MMWR segment with my fellow interns and residents. It was quite striking for us because St. Vincent’s also had a number of cases of young men who were critically ill and dying from a type of pneumonia no one had ever seen before, and the only common denominator was that they were all gay. Even our instructors and faculty were stumped.

It was a very frustrating time because these young men were very sick and dying and there was nothing we could do about it. By the end of 2019, what had become known as AIDS had taken the lives of more than 700,000 people in the US and 32 million globally. At its peak, AIDS killed 50,000 people in the U.S. in a single year, primarily gay and bisexual men and IV drug users and their sexual partners. When, after 1995, effective anti-retroviral treatment became available, an AIDS diagnosis was no longer a death sentence. By 2018, approximately 1.2 million people in this country were living with a diagnosis of HIV, but progression to full-blown AIDS is now thankfully rare.

St. Vincent’s was a wonderful place to learn medicine, but the life of interns and residents back then was very difficult. One of St. Vincent’s buildings was the Seton building, which was built around 1900. It had terra cotta tile floors, 12-foot ceilings, ward rooms that held 10 to 12 beds (for poor and uninsured patients), and no air conditioning.   In those days, there were no phlebotomy teams or IV teams. The intern drew everyone’s blood, did EKGs, and was called to insert an IV when the nurse couldn’t do it, which is ironic because the nurse usually had much more experience than an intern fresh out of medical school. Interns and residents stayed at the hospital (on call) every third night and every third weekend. Weekends started Saturday morning and ended Monday night, with 3- or 4-hours sleep, if you were lucky, the whole time. There was no such thing as “post-call.” After the Libby Zion case, the life of house staff got much better, thank goodness. We did what we had to do because there was no other choice, plus we knew it wouldn’t last forever. Sort of a rite of passage, I suppose.

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 By Peter Galvin, MG

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