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Veterans Of The AIDS Epidemic Reflect On The Lessons That Apply To This One


Doctors Anthony Fauci and Deborah Birx appear almost daily during White House briefings on the coronavirus. And for many Americans, their presence brings back memories of the fight against AIDS. Both doctors are part of the public health response to that epidemic, which began as a medical mystery in California and New York City. Scott Shafer at KQED in San Francisco looks back 40 years for the lessons the early fight against AIDS might have for today's pandemic.

SCOTT SHAFER, BYLINE: I moved to San Francisco in 1981, ready to start an exciting life in a big city. I was just out of college and recently out of the closet as gay. The last thing I expected was this.


UNIDENTIFIED PERSON: ...Released results of a study, which shows that the lifestyle of some male homosexuals has triggered an epidemic of a rare form of cancer.

SHAFER: Dr. Paul Volberding was just starting his career at San Francisco General Hospital.

PAUL VOLBERDING: In 1981, I had just finished my training as a cancer specialist and on rounds the very first day saw the first patient with Kaposi's sarcoma that was admitted to the hospital.

SHAFER: He remembers being fascinated by what he saw.

VOLBERDING: To me, it was, wow - in a 22-year-old, which was my first patient. And I looked in the books. And, you know, it wasn't supposed to be in 22-year-olds at all.

SHAFER: When COVID-19 first appeared in China, the virus behind the disease was discovered pretty quickly. But with AIDS, it took a few years before scientists discovered the HIV virus. Until then, there was a lot of fear among gay men, of course, but also everywhere. Some thought the disease could spread through sneezing or touching, just like the coronavirus today.

ROMA GUY: Well, I remember it as there's this mystery disease. And people are falling like flies. We have no idea why.

SHAFER: Back then, Roma Guy was an organizer for lesbian and women's rights. Later, she became a San Francisco health commissioner. She remembers AIDS as almost a medical earthquake.

GUY: The public health system had to go through a whole transformation.

SHAFER: I was in my early 20s at the time, living in the Haight-Ashbury neighborhood. I knew lots of people who were scared, myself included. Did I have it? Could I get it? How could I avoid getting it? No one knew. I asked my doctor, who said incorrectly that I wasn't the kind of person who was likely to get it - whatever that meant. He said not to worry. But I was worried. Then, just like today, there was no way of knowing exactly how many would become infected, how many would die. Dr. Mervyn Silverman was San Francisco's public health director at the time.

MERVYN SILVERMAN: We didn't know what we were doing back then in those early stages.

SHAFER: Silverman says that before AIDS, public health focused on more mundane things, like inspecting restaurants. Silverman says that all changed with AIDS. The city started giving public health money directly to gay and lesbian community groups. And they took the lead on testing, counseling and home health care.

SILVERMAN: I can't remember us funding other things in those days like that. But it made our life easier. And it made what we did much more effective.

SHAFER: That was called the San Francisco model.

Diane Jones was a nurse at that time. She says LGBT health care workers like herself felt a special obligation to come out as a sign of solidarity with AIDS patients.

DIANE JONES: I identified with him not so much as a patient but as a community member. And I think that occurred over and over and over again.

SHAFER: The coronavirus response leaves plenty to criticize - not enough test kits, not enough masks and gloves and mixed messages from the federal government. Dr. Volberding says what they learned back then about the need to collaborate is relevant today.

VOLBERDING: Some of the most important lessons were the connection between medicine, especially academic medicine, the public health system, the political system, the linkages that formed.

SHAFER: Activist Roma Guy thinks that's why the country is turning now to some of the same people like Dr. Anthony Fauci and Nancy Pelosi, first elected to Congress in 1987 on a promise to get more AIDS funding. They learned essential lessons about responding to health challenges.

GUY: How it becomes part of public health and then part of the governing structure - that is an amazing lesson on the backs of people who died early from HIV.

SHAFER: When the coronavirus came to the U.S., San Francisco was one of the first cities to impose social distancing orders. Roma Guy believes the city's experience with AIDS helps the current health director move faster.

GUY: He says there's a coronavirus. This is public health. I'm going to talk to the mayor. It's a whole different dynamic.

SHAFER: The lessons are there for the taking. But the question is whether it's happening fast enough. For NPR News, I'm Scott Shafer in San Francisco. Transcript provided by NPR, Copyright NPR.

Scott Shafer