A Date to Remember

Rose Blackburne, MD-NAACP National Health Committee;

June 27, 1981 I remember very well because it was 2 days after I graduated from high school; I was heading off to college to be ‘pre-med’. I vaguely remember hearing about a disease or syndrome that affected young gay men. It seemed very mysterious and far removed from my life. It was not on any global or national agenda, nor were there faith based initiatives, celebrity spokespersons; there were no national public health campaigns with cheeky taglines; no one was signing up for bicycle races or walks for the cure to rally around. HIV/AIDS was a whisper; even The Artist could not say it out loud, it was “the big disease with a little name”.  It was that scary.

The nineties were a little different. I was in medical school and during my clinical rotations I treated patients with AIDS. One patient that will always remember is a young woman, who, like me, was in her twenties; she was college educated, single, but, she was scared and angry. In performing her admission medical history and physical examination, I had to delicately ask her how she became infected with HIV, she grimaced and answered: “from a date.” This young woman, who, like me, should have been starting out in her career, but, instead was dying from AIDS. In 1991, there were not many anti-retrovirals that would allow persons with AIDS to live. At that time HIV/AIDS was essentially a terminal diagnosis, most patients presented for medical care  in full blown AIDS and the treatment consisted of a ‘cocktail’ of prophylactic medications to prevent the progression of the opportunistic infections associated with AIDS.

The stigma began to loosen a bit when sports icon, Arthur Ashe, announced his diagnosis after being infected from a blood transfusion. Magic Johnson sent shock waves when he bravely announced his diagnosis years later. Magic also was also a living example of the efficacy of anti-retroviral therapy. But, most infected patients did not have access to this therapy, and there was no national dialogue or cogent policy towards fighting this disease. Community organizations took the lead in advocating for better access to testing and treatment for affected and high risk populations, better access to care and grass roots health education initiatives in order to fight the spread of the disease.

As a practicing Obstetrician/Gynecologist, I routinely tested patients for HIV, but the conversation remained difficult. It was even more difficult when my patients tested positive and were married and or pregnant. I treated many more women who had contracted HIV from “a date.” Science caught up by having a developed and developing armamentarium of effective medicines which could potentially make AIDS the exception rather than the rule of HIV infection as in the previous decades. By 2000, there were established protocols for managing women during their pregnancies and during labor in order to reduce the risk of transmission to the fetus. There was a gradual paradigm shift from terminal disease with little hope to chronic disease that could be managed with medications and lifestyle adjustments. Patients could keep their jobs and health insurance would sometimes cover the costs of treatment. There was robust research for an AIDS vaccine and vaginal microbicides were showing phenomenal efficacy as a preventive measure. There was hope; but, still very little conversation around prevention and changes in behavior. It is still uncomfortable to discuss risk of infection from a needle stick, or from “a date”; we definitely are still uncomfortable with the details of “the date”: man with man, man with man with woman, man and woman with numerous partners. Condoms remain a touchy subject in relationships as well as casual dating.

Over a generation after June 27, 1981, I marvel that science has taken us into the fourth generation of HIV testing, where test results used to take 2 weeks and required confirmatory testing, now only a few minutes are required for results; we have moved into the 2nd and 3rd generation of effective medications that not only manage the progression of the disease, but are also effective in decreasing transmission, and, there is promising research for HIV vaccine in the coming years. It is no longer a question of whether one will live but, how well one can live with HIV. Thirty years of grass roots and civil rights advocacy has made fighting HIV/AIDS is a top priority for the World Health Organization, the United Nations and the White House. There is a body of state and federal legislation focused on continued research funding, access to adequate health care services and reducing disparities in HIV health outcomes, and, religious leaders are bringing the conversation about HIV/AIDS into the pulpits and active ministry. The conversation is no longer a whisper.

June 27, 2011 is a date to celebrate and remember!