|Dr. Lawrence Altman
With all we now know about AIDS and how to prevent it, a staggering number of people still are contracting and dying from the disease. In the United States alone, more than 1.2 million people are living with HIV and nearly 14 percent of them don’t realize they’re infected, according to the Centers for Disease Control and Prevention.
When AIDS was first discovered 34 years ago, there was much fear, stigma, skepticism and misinformation among the medical community, media and the public. Dr. Lawrence K. Altman has a unique perspective as a physician and journalist who wrote the first New York Times story on AIDS in 1981 and has since written more than 900 AIDS-related articles as information and interventions unfolded.
In the early 1980s, journalists considered AIDS an ephemeral syndrome, certainly not a disease that would become one of the worst pandemics in history, said Altman at the 11th annual NIAID-sponsored James C. Hill Memorial Lecture held recently in Lipsett Amphitheater.
“No sooner had the ink dried on my July 3, 1981, article [“Rare Cancer Seen in 41 Homosexuals”] than many gay men and at least one journalist ridiculed it,” said Altman, Times medical writer, senior scholar at the Woodrow Wilson International Center for Scholars and clinical professor of medicine at New York University. “A columnist for the Village Voice complained that my article wrecked the gay community’s July 4 weekend for no good reason.”
Back then, many in the medical community remained unconvinced that AIDS was an infectious disease, one that might be caused by an unidentified microbe, said Altman. But soon, with cases emerging among intravenous drug users and blood transfusion patients, doctors began suspecting a virus transmissible through body fluids.
“In the early years of AIDS…I rounded on AIDS cases at a number of hospitals and laboratories around the country,” recounted Altman. “The stigma was great. In some hospitals, food trays lay untouched in the hallways outside patients’ doors. Staff would not enter the room for fear of getting AIDS.”
In the journalism world, which includes medical and scientific journals, misinformation abounded. Doctors and journalists overlooked possible causes; their articles, even those in scientific journals, contained errors and omissions. “Arguably, such restrictions [on when journalists could report findings] helped delay thinking about and identifying the causative infectious agent,” said Altman. “It led some scientists to run down blind avenues.”
A breakthrough came in 1983 and 1984, when doctors in Paris and Dr. Robert Gallo’s team at NCI separately published research on a virus each had found in several AIDS patients. A battle of scientific and national pride ensued. An international commission named the agent HIV (human immunodeficiency virus) and the French team later won the Nobel Prize for its discovery.
In 1985, AIDS began to ravage Africa and the Times’ executive editor asked Altman to report from the field. But African officials denied that there were any AIDS cases and several African consulates refused him a visa. He eventually got visas and visited Kenya, Rwanda and Zambia. Altman found that ignorance about AIDS was widespread among African officials. Even U.S. officials working in these countries were not informed about AIDS. In Nairobi, Altman said he saw confirmed AIDS patients, yet Ministry of Health officials continued denying AIDS existed there.
“Health officials did not learn from the AIDS experience how to communicate as effectively as they should to educate the public about the strengths and weaknesses of epidemiology and understanding risk interpretation,” said Altman.
Photos: Bill Branson
“Almost everywhere I went, or tried to go, I met political opposition [yet] AIDS cases were abundant in the hospitals,” said Altman. “On rounds at the central hospital in Kigali, we had to dodge the pots and other items thrown by menacing patients…Although the doctors welcomed me, many patients did not.”
By the mid-1990s in the U.S., drugs such as AZT, antiretroviral therapies and protease inhibitors would begin to save countless lives. But the drugs were expensive and unaffordable in poor countries. Today, there are more than 30 effective drugs to treat HIV and, thanks to pressure placed on pharmaceutical companies, drug costs dropped dramatically in poorer countries.
While AIDS cases have declined from their peak years, about 50,000 new infections occur annually in the U.S. According to the CDC, as many as 70 percent of HIV-infected people don’t have the virus under control. Globally, in 2013 alone, 2.3 million people were newly infected and now are among 35 million others living with HIV; 1.6 million died.
”These statistics obscure the fact that each number was a human who had a name,” said Altman.
Today, there is still no effective AIDS vaccine. Meanwhile, some of the lessons of AIDS have gone unheeded, as evident in the Ebola epidemic in West Africa.
“Health officials did not learn from the AIDS experience how to communicate as effectively as they should to educate the public about the strengths and weaknesses of epidemiology and understanding risk interpretation,” said Altman. Journalists face that challenge too, he said, as they try to inform the public and avoid creating panic without downplaying the risks.
The AIDS pandemic did lead to improvements in medicine and public health, said Altman. Health officials have improved infection control standards in hospitals, labs and offices. Lab tests for HIV and other infectious agents have helped hospitals improve the safety of the nation’s blood supply.
“It was a sea change in attitude and behavior,” said Altman. “The aim is to avoid repeating the same errors and to be alert to other new and emerging diseases.”