A Physician Reflects on AIDS During COVID-19

LGBT Heritage Month, Pride

Many of us watched with bated breath in December 2019 as the novel coronavirus spread through Wuhan, China, then into other countries.  Little did we know at the time that it would bring our planet to a halt. Seeing the virus spread from city to city gave us the grim realization that it was not a matter of “if,” but “when,” the virus would reach the United States.

Conversations have swirled comparing COVID-19 and early days of the 1980’s AIDS epidemic – the fear of coming in contact with someone who is infected, the overuse of personal protective equipment (PPE), the hysteria of the unknown, the list goes on. Reflecting on my experiences as a new physician in the 1980s to now, I can say yes, I identify some similarities and similar emotions, but I feel there are more differences than parallels.

It was 1981 and I was just finishing medical school in San Juan, Puerto Rico getting ready to jump into my residency in New York City. It was during this time that we were hearing rumblings in the news about “some illness killing gay men,” and that New York was a hot spot. At the time, they didn’t even really know how it was being spread.

When I got to New York, I quickly realized that the fear of the unknown brought about a sense of brotherhood and comradery amongst the LGBT community. While many were caught up in discrimination and prejudice against gay men and IV drug users, we worried about each other and looked out for each other because during that time, we didn’t really know what we were dealing with.

In 1986, I had just moved to Los Angeles to join Kaiser Permanente when I had to fly back to New York for my best friend George’s funeral. As I sat in the airport headed to New York, I remember writing a letter to my parents who were, at the time, still having difficulty accepting that I was a gay man. The gravity of George’s death hit me hard and I realized that I didn’t want my parents to receive a letter that I was dying, but rather that I was okay. In my letter, I recall feeling the need to reiterate that while yes, I was a gay man, and yes, there was a disease out there killing people in the gay community, I was committed to staying as safe as I could. Like with early COVID-19 care standards, people diagnosed with AIDS were quarantined in hospitals, treated by medical staff suited from head to toe in PPE. Doctors, nurses and even family members were often too afraid to care for those who were ill. People were even scared to touch the pets of those who had died just in case the animal was able to transmit the virus. I remember a lot of pets being sacrificed because people were too afraid to take them – animals like my friend George’s ferret. I’ve always wondered what happened to George’s beloved Ferret.

Unlike COVID-19, it took years to identify and diagnose HIV/AIDS. Once we were able to identify the virus, we were able to develop treatments because we finally had a better understanding of what we were dealing with. AZT, also known as azidothymidine, seemed to be the first beneficial drug to treat patients. Because we didn’t even know that this illness was a virus, having an effective treatment drug was a glimmer of hope after so many years of despair. Experiencing COVID-19 through a patient’s eyes and listening to the frustration when testing took over a week to receive results, I often thought about the years we never had the luxury of days or even weeks or even years to diagnose someone living with HIV/AIDS. With COVID-19, were able to determine early on that it was a virus transmitted through air droplets and we put in place guidance and protocols to address the situation accordingly.

Since the beginning of the COVID-19 pandemic, I have remained optimistic that we would find a vaccine or a cure in the near horizon. I didn’t have that hope back then as I watched members of my community, and several of my own friends die.

One of the biggest differences between what we are experiencing with COVID-19 and what we experienced with the AIDS epidemic is the way in which information is spread. Back then, it was just word of mouth, limited television options and newspapers. Information sharing was not as readily available as it is now. We are able to lean on the power of technology, social and traditional media to share key learnings in the blink of an eye. We can educate the public in ways we never could in the 1980s.

In my current role as Area Medical Director for Kaiser Permanente Los Angeles Medical Center – the tertiary care hospital for the Kaiser Permanente Southern California region – I understood the gravity of working in partnership with my colleagues to spearhead our response to protect our members, employees, physicians and community from this invisible enemy. Together, at a moment’s notice, we reimagined the way we provide outpatient care and we transformed many of our hospital units to prepare to treat positive patients and for an anticipated surge. I firmly believe that to persevere through any large-scale public health crisis, we need well-organized recommendations and processes to help the community understand what we are collectively facing and work together to adjust to a new normal. Adopting a new lifestyle was as challenging then as it is now.

The government didn’t want to get involved in the 1980s because it was impacting communities that were seen as undesirable, and while COVID-19 mostly impacts more diverse communities, there were still many demographics that were targeted and ostracized – especially in the early days of the pandemic.

As we navigate this unpredictable time, we must be mindful while also remaining present. We must seek to understand and not rush to judgement. Leaders must remain calm and collected to prevent public fear.

Experiencing a pandemic of this magnitude allows us the opportunity to grow and support one another. In reflecting my experiences with the AIDS epidemic, and now the COVID-19 pandemic, I realize I am able to understand the fears people are facing and meet them where they are to address their concerns.

Unfortunately, I don’t think this will be the last pandemic we will face, so we must remain vigilant to prepare now for what may happen in the future. While there is a natural inclination to fear the unknown, I posit that we can get through this because we have done it before. If I could go back and speak to my younger self, I would simply tell him not to be afraid of being a gay man and to use this lived experience to help, guide and educate others in times of fear and uncertainty.