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Subject: AIDS AT 25
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AIDS AT 25
Sabin Russell, Chronicle Medical Writer
Sunday, June 4, 2006
=20
On June 5, 1981, Dr. Michael Gottlieb, a young immunologist at the UCLA Sch=
ool of Medicine, reported five cases of a rare pneumonia among gay men in L=
os Angeles. Each had a profoundly depressed immune system. Two were already=
dead.=20
His report in the weekly bulletin of the Centers for Disease Control was th=
e first medical description of what would come to be known as acquired immu=
ne deficiency syndrome. It signaled the start of a global scourge that has =
since killed 25 million. Today, a quarter-century later, it is estimated th=
at 38.6 million people are living with HIV, the virus that causes AIDS.=20
Gottlieb had no idea that he had discovered a monster. "I thought this migh=
t be bigger than Legionnaire's disease," he recalled, referring to the disc=
overy five years earlier of a previously unknown bacterium that killed 29 a=
ttendees at an American Legion convention in Philadelphia.=20
Soon after Gottlieb's paper appeared, similar accounts of Pneumocystis cari=
nii pneumonia were trickling in from gay neighborhoods in New York and San =
Francisco. Those new reports also described outbreaks among gay men of Kapo=
si's sarcoma, a rare skin cancer that caused disfiguring purple lesions.=20
Amid the initial excitement of medical researchers on the trail of a new di=
sease, no one knew that 250,000 gay men in the United States were already i=
nfected with HIV.=20
Twenty-five years later, the world is still playing catch-up. One million A=
mericans are living with HIV, but 25 percent of them do not know it. Worldw=
ide, 9 out of 10 people carrying the virus have yet to be tested, according=
to estimates from UNAIDS, the United Nations program on HIV/AIDS.=20
The hidden toll is a grim tribute to the insidious nature of the human immu=
nodeficiency virus. A tiny package of just nine genes, HIV is a lentivirus,=
or slow virus, that gradually degrades the immune system, leaving the body=
vulnerable to fatal assaults from bacteria and other viruses. HIV can leav=
e a person healthy for 10 years, free to spread it to others through sex or=
contaminated needles.=20
It was in San Francisco's bacchanalian gay culture of the early 1980s that =
the virus fully demonstrated its capacity for chaos - silently infecting cl=
ose to half that community with a fatal, sexually transmitted disease.=20
As scientists and doctors struggled to understand what was happening, the u=
nidentified virus raced ahead. In 1982 and 1983, the infection rate within =
San Francisco's gay population was increasing at an astonishing 18 percent =
per year.=20
Since those first puzzling cases, at least 18,000 people in San Francisco h=
ave died of the disease - six times the estimated toll of the earthquake an=
d fire 100 years ago.=20
Like most natural catastrophes, AIDS brought out the best and worst of huma=
n nature.=20
"I saw incredible heroism," said Dr. Marcus Conant, a San Francisco dermato=
logist who encountered some of the earliest Kaposi's sarcoma cases. " I saw=
hundreds of gay men who stayed with their partners and watched their loved=
ones die horribly, knowing they faced the same death in a matter of months=
."=20
But Conant also encountered ugliness within his own profession, in his own =
city. "There were a lot of doctors who did not want 'those kind of patients=
' in their waiting rooms," he said.=20
A disease that first emerged among marginalized groups - homosexual men, pr=
ostitutes and injection-drug users - AIDS exploited social stigma wherever =
it emerged. Instead of sympathy, AIDS often aroused contempt; instead of co=
mpassionate care, it encouraged fear and neglect.=20
"This is the most political disease I have ever seen," said Dr. Mervyn Silv=
erman, who was director of the San Francisco health department when AIDS em=
erged in 1981. The city's signature encounter with AIDS in the 1980s would =
be replayed elsewhere, again and again, as the virus spread around the glob=
e.=20
"It is deja vu every time it hits a new country," said Dr. Anthony Fauci, d=
irector of the National Institutes of Allergy and Infectious Diseases. "Fir=
st it is denial: 'Nothing is happening.' Then it's 'someone else's problem.=
' Then it is, 'Oh my God, help us " Today, entire countries in southern Afr=
ica are facing infection rates like those endured in San Francisco's Castro=
neighborhood. In Botswana and Swaziland, at least a quarter of adults are =
living with HIV.=20
It took the medical world an even longer time to wake up to AIDS in Africa,=
where the epidemic had been smoldering for decades. New York AIDS research=
er Dr. David Ho would eventually find HIV in a sample of blood from a patie=
nt in 1959 in what was then called the Belgian Congo.=20
European researchers had clues of the disease during the 1970s in a spate o=
f unexplained illnesses among Africans living in Europe.=20
In October 1983, Dr. Peter Piot, a Belgian tropical-disease specialist who =
had seen some of those early European cases, led a team of researchers to t=
he Congolese capital, Kinshasa. At the Mamma Yemo Hospital, he saw wards pa=
cked with emaciated, dying women.=20
"I knew this was really bad news," he said. "It looked like AIDS. We had so=
mething heterosexual going on there."=20
A heterosexual AIDS epidemic was, in fact, exploding in Africa. It followed=
soldiers in the bloody conflicts of the region, and along the trucking rou=
tes, where prostitutes serviced long-distance haulers. It spread to remote =
mining camps and squalid urban slums - where male laborers from rural villa=
ges worked for months, had sex with infected prostitutes and girlfriends, a=
nd then returned home to their wives.=20
When apartheid fell in South Africa in 1994, the previously isolated nation=
opened its borders to the rest of Africa, and AIDS walked in, too. Last ye=
ar, 5.5 million South Africans - including 1 in 5 adults - were believed to=
be HIVpositive.=20
Piot eventually would be named executive director of UNAIDS. The agency est=
imates today that there are 24.5 million people living with HIV in sub- Sah=
aran Africa. In 2005, the latest year for which statistics are available, t=
he region logged 2.7 million new infections, and 2 million men, women and c=
hildren died there of AIDS.=20
While AIDS roared unfettered through Africa, strategies to combat the pesti=
lence were evolving in the United States.=20
A new HIV test protected the nation's blood supply. San Francisco's gay men=
dramatically altered their sexual behavior. They used condoms, reduced the=
ir number of sex partners and avoided the most dangerous practices such as =
unprotected receptive anal intercourse.=20
Infection rates plummeted. A grassroots network of volunteer organizations =
melded with city and university clinics to provide the sick and dying with =
care. This "San Francisco model" was duplicated across the country and arou=
nd the world.=20
Epidemiologists experimented with needle-exchange programs to protect injec=
tion-drug users. Activists battled for the rights of the infected, for gove=
rnment aid and for a cure.=20
"AIDS has been a crucible that tested everybody," said Martin Delaney, a bu=
siness consultant who founded San Francisco's Project Inform in 1985. "Out =
of that furnace came a new model of medical care and for funding research f=
or the development of drugs."=20
Still, the virus continued to race ahead of its pursuers. AZT, the first AI=
DS antiviral, was approved by the Food and Drug Administration in 1987. But=
doctors soon learned that the virus could quickly develop resistance to it=
.=20
Activists pushed the FDA for speedier approval of experimental medicines. W=
ith each new drug, patients bought time for the day when something that rea=
lly worked might come along. That day came in the summer of 1996.=20
At the 11th International AIDS Conference in Vancouver, British Columbia, s=
cientists delivered the news that three-drug combinations of newly develope=
d antiviral drugs - particularly those using a new class called protease in=
hibitors - could tame the relentless killer. Death rates in Western nations=
that could afford the medicines soon fell by more than half.=20
"We'd literally see people recover miraculously with these rugs," said Dr. =
Paul Volberding, who ran the renowned AIDS program at San Francisco General=
Hospital.=20
At the time, the new triple-drug regimes were called "cocktails." Today, th=
e common word is an acronym - HAART - for highly active antiretroviral ther=
apy. There are 27 distinct antiviral drugs or combinations sold in the Unit=
ed States today.=20
For wealthy Western countries, HAART transformed the epidemic.=20
"I'll probably die from a heart attack or any of the various things that ru=
n in my family," said Bob Katz, 55, a real estate appraiser in San Francisc=
o who has been infected with HIV for 25 years.=20
Yet early hope that HAART could eradicate the virus was misplaced. Patients=
still developed drug resistance, and latent pools of infected cells allow =
HIV to roar back when medicines are stopped.=20
Side effects such as lipodystrophy - the destruction of fat tissue in the f=
ace and arms - have created a new face of AIDS: the hollowed cheeks of many=
patients on HAART. There are lingering fears that the long-term price of A=
IDS drugs may be cancer.=20
AIDS drug cocktails were nevertheless a reprieve for thousands and have tra=
nsformed HIV in developed nations from a death sentence into a chronic medi=
cal condition.=20
Ross Woodall's life was saved by the drugs. In 1987, his doctor gave him si=
x months to live. The former travel agency vice president watched his frien=
ds die by the dozens, but he weathered bouts of illness from bugs that expl=
oited his ruined immune system.=20
He eventually lost 95 pounds. He burned through every antiviral medicine th=
at came on the market. In 1998, the combination therapy turned his health a=
round. But side effects from years of antiviral medications have drained th=
e fat from his face and limbs, and he is legally blind from an AIDSrelated =
viral infection.=20
At the age of 53, Woodall remains upbeat. He works part time as a travel ag=
ent and volunteers for AIDS prevention and care programs.=20
"I've been to hell and back," he said. "If I can keep someone else from goi=
ng there, I'd like to do that."=20
Although modern medicine in the United States has caught up with HIV, the v=
irus maintains its edge in much of the rest of the world because the drugs =
that saved lives here remain out of reach for the overwhelming majority of =
people living with AIDS. They are just too expensive. Yet there are signs o=
f hope.=20
Driven by political activists demanding drugs for the poor, and by Indian p=
harmaceutical companies that could make the new pills for less than a dolla=
r a day, a global movement for universal treatment of HIV took wing in 2000=
. Generic drugmakers could copy Western AIDS medicines without having to re=
coup research, development and marketing costs. They could sidestep Western=
patent law. They put AIDS drugs within reach, if the West would only subsi=
dize the cost. Politicians took note.=20
Since it was founded in 2002, the nonprofit, U.N.-inspired organization Glo=
bal Fund to Fight AIDS, Tuberculosis and Malaria has provided $2 billion in=
assistance, and in 2003 President Bush began his own $15 billion overseas =
AIDS-relief effort.=20
Today, 1 million of the 6 million AIDS patients in the developing world who=
need antiviral drugs are taking them. The push for treatment has created f=
or the first time an incentive for Africans to be tested for the illness. S=
tudies show that once people know they are HIV-positive, they are less like=
ly to spread the virus.=20
"For the first time in a quarter-century," said Piot, the UNAIDS executive =
director, "we are in a position to get ahead of this epidemic. But it is go=
ing to require an enormous and sustained effort."=20
Despite these signs, there is no vaccine and no cure. Safer-sex behaviors h=
ave proved difficult to sustain. Ominously, in the United States, the disea=
se is burrowing into impoverished neighborhoods and disproportionately affe=
cting blacks. The CDC estimates that 40,000 new infections occur in the Uni=
ted States each year, and increasingly they are occurring among blacks and =
women.=20
Today, the harder edges of the local AIDS epidemic can be found in San Fran=
cisco's homeless population. "It's still a mortal illness in the Tenderloin=
," said Alexandra Monk, project coordinator for REACH - Research into Acces=
s to Care for the Homeless. "We've lost over 100 in the last four years."=20
DeShawn Patton, 41, said she has been HIV-positive for two decades. She liv=
es in a small and crowded hotel room off O'Farrell Street with her boyfrien=
d of six years, who is HIV-positive and has cancer.=20
Patton was born male, and grew up a gay teenager. Today, she lives her life=
fully as a woman. "The hardest thing for my family is not that I have AIDS=
but accepting me as transgender," she said.=20
Patton's health has been slipping. Her T-cell count - a measure of infectio=
n-fighting white blood cells, has dipped to 119 - a healthy number is 600 o=
r more. She had a bout with pneumonia that sent her to San Francisco Genera=
l Hospital, but she bounced back, as she has all her life.=20
Around her, HIV still has a grip on the community in ways once seen in the =
1980s in the upscale Castro, just a few miles up Market Street.=20
In the Tenderloin, sickness and death rates are higher because of the natur=
e of life on the street, of substance abuse, poor diet, hepatitis C and unt=
reated mental illness. Blood tests of the poor and homeless in the Tenderlo=
in show that at least 11 percent of that population is infected with HIV - =
a higher rate than in Uganda, where the same UCSF researchers run an AIDS t=
reatment clinic.=20
Dr. Brad Hare, medical director of the Positive Health Program at San Franc=
isco General Hospital, is Patton's physician. When the AIDS epidemic was fi=
rst described 25 years ago, Hare, 36, was in elementary school.=20
Hare was a medical student at Duke when he saw his first AIDS patient, a Ne=
w York artist who had moved back to North Carolina to die. When the patient=
recovered under treatment with the new AIDS drugs, Hare was hooked. "That'=
s why I went into medicine," he said.=20
Half the patients he treats at San Francisco General today are black or Lat=
ino. They are often poor, living in ramshackle housing or in the streets, a=
nd they are very sick.=20
"We still see people come into our hospital for their first test for HIV, a=
nd they have pneumocystis pneumonia, cryptococcal meningitis and 10 Tcells,=
" Hare said. "We still see people die of classic, old-fashioned AIDS."=20
---------------------------------------------------------------------------=
-----
Today and Monday, The Chronicle examines the AIDS epidemic 25 years after i=
t was first recognized in the United States.=20
AN INTERACTIVE TIMELINE
A highlight of medical, political and local events over 25 years, and the p=
eople who focused attention on the AIDS crisis.=20
A GLOBAL MAP
A comparative look at AIDS around the world.=20
A PODCAST
A retrospective on the late Randy Shilts, Chronicle reporter and author of =
the landmark "And the Band Played On: Politics, People and the AIDS Epidemi=
c."=20
A VIDEO REPORT
A patient undergoes a new procedure that helps erase the facial wasting sid=
e effects of AIDS drug therapy, and meet three physicians who have been on =
the front lines of AIDS research since 1981.=20
---------------------------------------------------------------------------=
-----
Coming this week=20
MONDAY: AIDS hits African Americans hard.=20
LATER THIS WEEK IN DATEBOOK: AIDS and Bay Area theater. The many local arti=
sts lost to AIDS.=20
---------------------------------------------------------------------------=
-----
Commemorations=20
Events scheduled today to commemorate the anniversary of the discovery of A=
IDS.=20
Daly City: Opening ceremony of the AIDS/Lifecycle at the Cow Palace at 6 a.=
m. Nearly 2,000 cyclists plan to leave the arena with red helmet covers emb=
lazoned with "25," signifying the 25th anniversary of the start of the epid=
emic.=20
San Francisco: AIDS Candlelight March participants will gather at Harvey Mi=
lk Plaza at Market and Castro streets at 7:30 p.m. to begin a walk down Cas=
tro to a ceremony at 18th Street.=20
E-mail Sabin Russell at srussell@....=20
http://www.sfgate.com/cgi-bin/article.cgi?f=3D/c/a/2006/06/04/MNG6EJ88TR1.D=
TL&feed=3Drss.news
[Podcasts: Reflections on reporter Randy Shilts, who died in 1994 and an in=
terview with a long-term survivor.]=20
http://sfgate.com/cgi-bin/blogs/sfgate/detail?blogid=3D5&entry_id=3D5697
http://sfgate.com/cgi-bin/blogs/sfgate/detail?blogid=3D5&entry_id=3D5695
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<DIV><FONT face=3DArial size=3D2>
<H1><FONT size=3D4>AIDS AT 25</FONT></H1>
<H2><FONT size=3D3></FONT></H2><!-- END HEADLINE/DECK & SUBHEADLINE/SUBDECK=
-->
<P class=3Dauthor><FONT size=3D1><!-- START WRITER CREDIT--><A=20
href=3D"mailto:srussell@...">Sabin Russell, Chronicle Medical=20
Writer</A></FONT></P>
<P class=3Ddate><FONT size=3D1>Sunday, June 4, 2006</FONT></P>
<P class=3Ddate> </P>
<P>On June 5, 1981, Dr. Michael Gottlieb, a young immunologist at the UCLA=
=20
School of Medicine, reported five cases of a rare pneumonia among gay men i=
n Los=20
Angeles. Each had a profoundly depressed immune system. Two were already de=
ad.=20
<P>His report in the weekly bulletin of the Centers for Disease Control was=
the=20
first medical description of what would come to be known as acquired immune=
=20
deficiency syndrome. It signaled the start of a global scourge that has sin=
ce=20
killed 25 million. Today, a quarter-century later, it is estimated that 38.=
6=20
million people are living with HIV, the virus that causes AIDS. </P>
<P>Gottlieb had no idea that he had discovered a monster. "I thought this m=
ight=20
be bigger than Legionnaire's disease," he recalled, referring to the discov=
ery=20
five years earlier of a previously unknown bacterium that killed 29 attende=
es at=20
an American Legion convention in Philadelphia.=20
<P>Soon after Gottlieb's paper appeared, similar accounts of Pneumocystis=20
carinii pneumonia were trickling in from gay neighborhoods in New York and =
San=20
Francisco. Those new reports also described outbreaks among gay men of Kapo=
si's=20
sarcoma, a rare skin cancer that caused disfiguring purple lesions.=20
<P>Amid the initial excitement of medical researchers on the trail of a new=
=20
disease, no one knew that 250,000 gay men in the United States were already=
=20
infected with HIV.=20
<P>Twenty-five years later, the world is still playing catch-up. One millio=
n=20
Americans are living with HIV, but 25 percent of them do not know it. World=
wide,=20
9 out of 10 people carrying the virus have yet to be tested, according to=20
estimates from UNAIDS, the United Nations program on HIV/AIDS.=20
<P>The hidden toll is a grim tribute to the insidious nature of the human=20
immunodeficiency virus. A tiny package of just nine genes, HIV is a lentivi=
rus,=20
or slow virus, that gradually degrades the immune system, leaving the body=
=20
vulnerable to fatal assaults from bacteria and other viruses. HIV can leave=
a=20
person healthy for 10 years, free to spread it to others through sex or=20
contaminated needles.=20
<P>It was in San Francisco's bacchanalian gay culture of the early 1980s th=
at=20
the virus fully demonstrated its capacity for chaos =97 silently infecting =
close=20
to half that community with a fatal, sexually transmitted disease.=20
<P>As scientists and doctors struggled to understand what was happening, th=
e=20
unidentified virus raced ahead. In 1982 and 1983, the infection rate within=
San=20
Francisco's gay population was increasing at an astonishing 18 percent per =
year.=20
<P>Since those first puzzling cases, at least 18,000 people in San Francisc=
o=20
have died of the disease =97 six times the estimated toll of the earthquake=
and=20
fire 100 years ago.=20
<P>Like most natural catastrophes, AIDS brought out the best and worst of h=
uman=20
nature.=20
<P>"I saw incredible heroism," said Dr. Marcus Conant, a San Francisco=20
dermatologist who encountered some of the earliest Kaposi's sarcoma cases. =
" I=20
saw hundreds of gay men who stayed with their partners and watched their lo=
ved=20
ones die horribly, knowing they faced the same death in a matter of months.=
"=20
<P>But Conant also encountered ugliness within his own profession, in his o=
wn=20
city. "There were a lot of doctors who did not want 'those kind of patients=
' in=20
their waiting rooms," he said.=20
<P>A disease that first emerged among marginalized groups =97 homosexual me=
n,=20
prostitutes and injection-drug users =97 AIDS exploited social stigma where=
ver it=20
emerged. Instead of sympathy, AIDS often aroused contempt; instead of=20
compassionate care, it encouraged fear and neglect.=20
<P>"This is the most political disease I have ever seen," said Dr. Mervyn=20
Silverman, who was director of the San Francisco health department when AID=
S=20
emerged in 1981. The city's signature encounter with AIDS in the 1980s woul=
d be=20
replayed elsewhere, again and again, as the virus spread around the globe.=
=20
<P>"It is deja vu every time it hits a new country," said Dr. Anthony Fauci=
,=20
director of the National Institutes of Allergy and Infectious Diseases. "Fi=
rst=20
it is denial: 'Nothing is happening.' Then it's 'someone else's problem.' T=
hen=20
it is, 'Oh my God, help us " Today, entire countries in southern Africa are=
=20
facing infection rates like those endured in San Francisco's Castro=20
neighborhood. In Botswana and Swaziland, at least a quarter of adults are l=
iving=20
with HIV.=20
<P>It took the medical world an even longer time to wake up to AIDS in Afri=
ca,=20
where the epidemic had been smoldering for decades. New York AIDS researche=
r Dr.=20
David Ho would eventually find HIV in a sample of blood from a patient in 1=
959=20
in what was then called the Belgian Congo.=20
<P>European researchers had clues of the disease during the 1970s in a spat=
e of=20
unexplained illnesses among Africans living in Europe.=20
<P>In October 1983, Dr. Peter Piot, a Belgian tropical-disease specialist w=
ho=20
had seen some of those early European cases, led a team of researchers to t=
he=20
Congolese capital, Kinshasa. At the Mamma Yemo Hospital, he saw wards packe=
d=20
with emaciated, dying women.=20
<P>"I knew this was really bad news," he said. "It looked like AIDS. We had=
=20
something heterosexual going on there."=20
<P>A heterosexual AIDS epidemic was, in fact, exploding in Africa. It follo=
wed=20
soldiers in the bloody conflicts of the region, and along the trucking rout=
es,=20
where prostitutes serviced long-distance haulers. It spread to remote minin=
g=20
camps and squalid urban slums =97 where male laborers from rural villages w=
orked=20
for months, had sex with infected prostitutes and girlfriends, and then ret=
urned=20
home to their wives.=20
<P>When apartheid fell in South Africa in 1994, the previously isolated nat=
ion=20
opened its borders to the rest of Africa, and AIDS walked in, too. Last yea=
r,=20
5.5 million South Africans =97 including 1 in 5 adults =97 were believed to=
be=20
HIVpositive.=20
<P>Piot eventually would be named executive director of UNAIDS. The agency=
=20
estimates today that there are 24.5 million people living with HIV in sub-=
=20
Saharan Africa. In 2005, the latest year for which statistics are available=
, the=20
region logged 2.7 million new infections, and 2 million men, women and chil=
dren=20
died there of AIDS.=20
<P>While AIDS roared unfettered through Africa, strategies to combat the=20
pestilence were evolving in the United States.=20
<P>A new HIV test protected the nation's blood supply. San Francisco's gay =
men=20
dramatically altered their sexual behavior. They used condoms, reduced thei=
r=20
number of sex partners and avoided the most dangerous practices such as=20
unprotected receptive anal intercourse.=20
<P>Infection rates plummeted. A grassroots network of volunteer organizatio=
ns=20
melded with city and university clinics to provide the sick and dying with =
care.=20
This "San Francisco model" was duplicated across the country and around the=
=20
world.=20
<P>Epidemiologists experimented with needle-exchange programs to protect=20
injection-drug users. Activists battled for the rights of the infected, for=
=20
government aid and for a cure.=20
<P>"AIDS has been a crucible that tested everybody," said Martin Delaney, a=
=20
business consultant who founded San Francisco's Project Inform in 1985. "Ou=
t of=20
that furnace came a new model of medical care and for funding research for =
the=20
development of drugs."=20
<P>Still, the virus continued to race ahead of its pursuers. AZT, the first=
AIDS=20
antiviral, was approved by the Food and Drug Administration in 1987. But do=
ctors=20
soon learned that the virus could quickly develop resistance to it.=20
<P>Activists pushed the FDA for speedier approval of experimental medicines=
.=20
With each new drug, patients bought time for the day when something that re=
ally=20
worked might come along. That day came in the summer of 1996.=20
<P>At the 11th International AIDS Conference in Vancouver, British Columbia=
,=20
scientists delivered the news that three-drug combinations of newly develop=
ed=20
antiviral drugs =97 particularly those using a new class called protease=20
inhibitors =97 could tame the relentless killer. Death rates in Western nat=
ions=20
that could afford the medicines soon fell by more than half.=20
<P>"We'd literally see people recover miraculously with these rugs," said D=
r.=20
Paul Volberding, who ran the renowned AIDS program at San Francisco General=
=20
Hospital.=20
<P>At the time, the new triple-drug regimes were called "cocktails." Today,=
the=20
common word is an acronym =97 HAART =97 for highly active antiretroviral th=
erapy.=20
There are 27 distinct antiviral drugs or combinations sold in the United St=
ates=20
today.=20
<P>For wealthy Western countries, HAART transformed the epidemic.=20
<P>"I'll probably die from a heart attack or any of the various things that=
run=20
in my family," said Bob Katz, 55, a real estate appraiser in San Francisco =
who=20
has been infected with HIV for 25 years.=20
<P>Yet early hope that HAART could eradicate the virus was misplaced. Patie=
nts=20
still developed drug resistance, and latent pools of infected cells allow H=
IV to=20
roar back when medicines are stopped.=20
<P>Side effects such as lipodystrophy =97 the destruction of fat tissue in =
the=20
face and arms =97 have created a new face of AIDS: the hollowed cheeks of m=
any=20
patients on HAART. There are lingering fears that the long-term price of AI=
DS=20
drugs may be cancer.=20
<P>AIDS drug cocktails were nevertheless a reprieve for thousands and have=
=20
transformed HIV in developed nations from a death sentence into a chronic=20
medical condition.=20
<P>Ross Woodall's life was saved by the drugs. In 1987, his doctor gave him=
six=20
months to live. The former travel agency vice president watched his friends=
die=20
by the dozens, but he weathered bouts of illness from bugs that exploited h=
is=20
ruined immune system.=20
<P>He eventually lost 95 pounds. He burned through every antiviral medicine=
that=20
came on the market. In 1998, the combination therapy turned his health arou=
nd.=20
But side effects from years of antiviral medications have drained the fat f=
rom=20
his face and limbs, and he is legally blind from an AIDSrelated viral infec=
tion.=20
<P>At the age of 53, Woodall remains upbeat. He works part time as a travel=
=20
agent and volunteers for AIDS prevention and care programs.=20
<P>"I've been to hell and back," he said. "If I can keep someone else from =
going=20
there, I'd like to do that."=20
<P>Although modern medicine in the United States has caught up with HIV, th=
e=20
virus maintains its edge in much of the rest of the world because the drugs=
that=20
saved lives here remain out of reach for the overwhelming majority of peopl=
e=20
living with AIDS. They are just too expensive. Yet there are signs of hope.=
=20
<P>Driven by political activists demanding drugs for the poor, and by India=
n=20
pharmaceutical companies that could make the new pills for less than a doll=
ar a=20
day, a global movement for universal treatment of HIV took wing in 2000. Ge=
neric=20
drugmakers could copy Western AIDS medicines without having to recoup resea=
rch,=20
development and marketing costs. They could sidestep Western patent law. Th=
ey=20
put AIDS drugs within reach, if the West would only subsidize the cost.=20
Politicians took note.=20
<P>Since it was founded in 2002, the nonprofit, U.N.-inspired organization=
=20
Global Fund to Fight AIDS, Tuberculosis and Malaria has provided $2 billion=
in=20
assistance, and in 2003 President Bush began his own $15 billion overseas=20
AIDS-relief effort.=20
<P>Today, 1 million of the 6 million AIDS patients in the developing world =
who=20
need antiviral drugs are taking them. The push for treatment has created fo=
r the=20
first time an incentive for Africans to be tested for the illness. Studies =
show=20
that once people know they are HIV-positive, they are less likely to spread=
the=20
virus.=20
<P>"For the first time in a quarter-century," said Piot, the UNAIDS executi=
ve=20
director, "we are in a position to get ahead of this epidemic. But it is go=
ing=20
to require an enormous and sustained effort."=20
<P>Despite these signs, there is no vaccine and no cure. Safer-sex behavior=
s=20
have proved difficult to sustain. Ominously, in the United States, the dise=
ase=20
is burrowing into impoverished neighborhoods and disproportionately affecti=
ng=20
blacks. The CDC estimates that 40,000 new infections occur in the United St=
ates=20
each year, and increasingly they are occurring among blacks and women.=20
<P>Today, the harder edges of the local AIDS epidemic can be found in San=20
Francisco's homeless population. "It's still a mortal illness in the=20
Tenderloin," said Alexandra Monk, project coordinator for REACH =97 Researc=
h into=20
Access to Care for the Homeless. "We've lost over 100 in the last four year=
s."=20
<P>DeShawn Patton, 41, said she has been HIV-positive for two decades. She =
lives=20
in a small and crowded hotel room off O'Farrell Street with her boyfriend o=
f six=20
years, who is HIV-positive and has cancer.=20
<P>Patton was born male, and grew up a gay teenager. Today, she lives her l=
ife=20
fully as a woman. "The hardest thing for my family is not that I have AIDS =
but=20
accepting me as transgender," she said.=20
<P>Patton's health has been slipping. Her T-cell count =97 a measure of=20
infection-fighting white blood cells, has dipped to 119 =97 a healthy numbe=
r is=20
600 or more. She had a bout with pneumonia that sent her to San Francisco=20
General Hospital, but she bounced back, as she has all her life.=20
<P>Around her, HIV still has a grip on the community in ways once seen in t=
he=20
1980s in the upscale Castro, just a few miles up Market Street.=20
<P>In the Tenderloin, sickness and death rates are higher because of the na=
ture=20
of life on the street, of substance abuse, poor diet, hepatitis C and untre=
ated=20
mental illness. Blood tests of the poor and homeless in the Tenderloin show=
that=20
at least 11 percent of that population is infected with HIV =97 a higher ra=
te than=20
in Uganda, where the same UCSF researchers run an AIDS treatment clinic.=20
<P>Dr. Brad Hare, medical director of the Positive Health Program at San=20
Francisco General Hospital, is Patton's physician. When the AIDS epidemic w=
as=20
first described 25 years ago, Hare, 36, was in elementary school.=20
<P>Hare was a medical student at Duke when he saw his first AIDS patient, a=
New=20
York artist who had moved back to North Carolina to die. When the patient=20
recovered under treatment with the new AIDS drugs, Hare was hooked. "That's=
why=20
I went into medicine," he said.=20
<P>Half the patients he treats at San Francisco General today are black or=
=20
Latino. They are often poor, living in ramshackle housing or in the streets=
, and=20
they are very sick.=20
<P>"We still see people come into our hospital for their first test for HIV=
, and=20
they have pneumocystis pneumonia, cryptococcal meningitis and 10 Tcells," H=
are=20
said. "We still see people die of classic, old-fashioned AIDS." <BR>
<HR>
<P>Today and Monday, The Chronicle examines the AIDS epidemic 25 years afte=
r it=20
was first recognized in the United States. </P>
<P>
<H3>AN INTERACTIVE TIMELINE</H3>
<P>A highlight of medical, political and local events over 25 years, and th=
e=20
people who focused attention on the AIDS crisis.=20
<P>
<H3>A GLOBAL MAP</H3>
<P>A comparative look at AIDS around the world.=20
<P>
<H3>A PODCAST</H3>
<P>A retrospective on the late Randy Shilts, Chronicle reporter and author =
of=20
the landmark "And the Band Played On: Politics, People and the AIDS Epidemi=
c."=20
<P>
<H3>A VIDEO REPORT</H3>
<P>A patient undergoes a new procedure that helps erase the facial wasting =
side=20
effects of AIDS drug therapy, and meet three physicians who have been on th=
e=20
front lines of AIDS research since 1981. <BR>
<HR>
<P>
<P>Coming this week=20
<P>MONDAY: AIDS hits African Americans hard.=20
<P>LATER THIS WEEK IN DATEBOOK: AIDS and Bay Area theater. The many local=20
artists lost to AIDS. <BR>
<HR>
<P>Commemorations </P>
<P>Events scheduled today to commemorate the anniversary of the discovery o=
f=20
AIDS.=20
<P>Daly City: Opening ceremony of the AIDS/Lifecycle at the Cow Palace at 6=
a.m.=20
Nearly 2,000 cyclists plan to leave the arena with red helmet covers emblaz=
oned=20
with "25," signifying the 25th anniversary of the start of the epidemic.=20
<P>San Francisco: AIDS Candlelight March participants will gather at Harvey=
Milk=20
Plaza at Market and Castro streets at 7:30 p.m. to begin a walk down Castro=
to a=20
ceremony at 18th Street.=20
<P><I>E-mail Sabin Russell at <A=20
href=3D"mailto:srussell@...">srussell@...</A>.</I> =
</P>
<P><A=20
href=3D"http://www.sfgate.com/cgi-bin/article.cgi?f=3D/c/a/2006/06/04/MNG6E=
J88TR1.DTL&feed=3Drss.news">http://www.sfgate.com/cgi-bin/article.cgi?f=
=3D/c/a/2006/06/04/MNG6EJ88TR1.DTL&feed=3Drss.news</A></P>
<P>[Podcasts: <A=20
href=3D"http://sfgate.com/cgi-bin/blogs/sfgate/detail?blogid=3D5&entry_=
id=3D5697">Reflections=20
on reporter Randy Shilts, who died in 1994</A> and an <A=20
href=3D"http://sfgate.com/cgi-bin/blogs/sfgate/detail?blogid=3D5&entry_=
id=3D5695">interview=20
with a long-term survivor.</A>] </P>
<P><A=20
href=3D"http://sfgate.com/cgi-bin/blogs/sfgate/detail?blogid=3D5&entry_=
id=3D5697">http://sfgate.com/cgi-bin/blogs/sfgate/detail?blogid=3D5&ent=
ry_id=3D5697</A></P>
<P><A=20
href=3D"http://sfgate.com/cgi-bin/blogs/sfgate/detail?blogid=3D5&entry_=
id=3D5695">http://sfgate.com/cgi-bin/blogs/sfgate/detail?blogid=3D5&ent=
ry_id=3D5695</A><!-- END STORY --></P></FONT></DIV></BODY></HTML>
------=_NextPart_000_004D_01C687E4.DA082D20--
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