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AIDS and HIV

AIDS @40: Dr. Michael Gottlieb on the beginning of the AIDS Pandemic

Media painted the mysterious new diseases as Gay-Related Immunodeficiency Disease (GRID) or as it was more commonly called: the “gay plague.”

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Dr. Michael Gottlieb (Photo Credit: Elizabeth Nathane)

By Karen Ocamb | LOS ANGELES – In the beginning, the deaths and disappearances were isolated, frightening but shorn of consequence, like short, scattered tremors before a massive earthquake. Gay San Francisco Chronicle reporter Randy Shilts suggests in his extraordinary AIDS history “And the Band Played On” that the mysterious contagious disease that would claim the lives of millions silently exploded when sailors in ships from fifty-five nations came to New York Harbor on July 4, 1976 to join thousands celebrating America’s bicentennial.

Then death came home. Hugh Rice, director of the STD Clinic at the Los Angeles Gay and Lesbian Community Services Center during the height of the Disco era, recalled a very sick young, thin penniless gay man covered in purple lesions in 1979 who came in for his STD shot, disappeared, and died six weeks later in isolation at LA County Hospital. Matt Redman, the interior designer and disco fan who co-founded AIDS Project Los Angeles, suspected he had been infected with HIV in the late 1970s.

But it wasn’t until L.A.-based Dr. Michael Gottlieb and colleagues authored a report published June 5, 1981 in the Centers for Disease Control’s Morbidity and Mortality Weekly that identified the mysterious illnesses that would become known as AIDS.

At the time, Gottlieb was a 33 year-old assistant professor at the University of California Los Angeles (UCLA) Medical Center specializing in immunology who was fortuitously curious. He asked a postdoctoral fellow to go to the wards and ask interns and residents if there were any patients who had interesting immunologic conditions.  He found medical intern Robert Wolf, whose patient Michael had been admitted to the UCLA emergency room in January with fevers, some fungal infections on his skin, a 25 pound weight loss, and a mouth full of thrush, or candidiasis. Additionally, Gottlieb obtained a still experimental blood test looking at Michael’s T-cells that revealed that his CD4 (“helper cells”) “had essentially gone missing.

“This was a unique finding. We had never seen anything like this in any other immunologic or in any other medical condition,” Gottlieb tells the Los Angeles Blade.

Michael was discharged from the hospital but returned a week or two later with a lung infection.

“He came back to Robert Wolf. Ordinarily, you would not do a bronchoscopy for a community acquired pneumonia — ordinary bacterial pneumonia. But Robert astutely said, ‘you immunologists are telling us that this man is immune deficient. He is an immune-compromised host. We therefore should do a bronchoscopy  (an invasive procedure) to be sure he might have an opportunistic infection. And indeed, he had pneumocystis pneumonia. So that’s the story of patient number one,” says Gottlieb.

“Michael was a model. He had bleached hair. He looked like a rock star. A few months later, he developed a large lesion of Kaposi’s sarcoma on his chest. And that was a mystery also. He died within the first six months of his first emergency room admission,” Gottlieb says. Michael also “happened to be gay.”

Sexual orientation wasn’t a specific consideration until Gottlieb got a call from Dr. Peng Fan, who was the acting chief of Rheumatology at the Wadsworth VA in Los Angeles. He had been moonlighting at Riverside Hospital where Dr. Joel Weisman and Dr. Eugene Rogolsky had been admitting patients from their gay practice, two of whom had similar symptoms to Michael. They were transferred to the respiratory care unit at UCLA.

Pulmonary doctors immediately performed bronchoscopies “and low and behold, these two patients also had pneumocystis pneumonia. And now we had three gay men with pneumocystis pneumonia and absent CD four cells. That’s when we said, ‘oh, we have three gay men with pneumocystis pneumonia. That was the moment,” he said.

Gottlieb called the editor of the New England Journal of Medicine and asked for his advice on how to publish their findings there. “And he said, ‘well, have you spoken to CDC?’ As an immunologist, my orientation was not toward the CDC — infectious disease doctors are oriented toward the CDC. But I wasn’t an infectious disease doctor. So I said, ‘no, I haven’t.’ And he said, ‘well, maybe you ought to.’ So I called Wayne Shandera, the CDC person in Los Angeles assigned to the LA County Health Department as an epidemic intelligence service officer. I knew him from my time at Stanford because he was there as well. And I said, ‘Wayne, are you aware of anything unusual going on among gay men in Los Angeles or anywhere in the country?’ And there was an eerie silence on the other end of the phone. And he said, ‘no, but I’ll look into it.’ I told him, we think it might have something to do with the virus called CMV cytomegalovirus.’”

Shandera found some CMV growing from a patient sample from Santa Monica. “He went down to Santa Monica hospital and spoke to the patient and indeed, it was a gay man with pneumocystis, pneumonia and CMV as well. And so he unearthed a fourth patient,” says Gottlieb.

It was after Gottlieb’s fifth patient, Randy, referred to him by a doctor at Brotman Hospital, that he decided it was time to write up a report for the CDC, with a more explanatory article published later in the New England Journal.  He sat down at Shandera’s dining room table in the Fairfax district and typed up the report on an IBM Selectric typewriter, after which it was sent it off to CDC.

The editor of the CDC’s MMWR returned it with some modifications and corrections. “Interestingly, we called it ‘Pneumocystis Pneumonia Among Homosexual Men in Los Angeles.’ The CDC changed the title to ‘Pneumocystis pneumonia, Los Angeles.’”

Gottlieb doesn’t see anything nefarious in the change since the MMWR was focused on disease outbreaks like the salmonella outbreak in Idaho. Additionally, “if CDC had called it Pneumocystis Pneumonia Among Homosexual Men in Los Angeles,’ it might’ve even worked against us,” says Gottlieb, “although, ultimately, it got characterized as a gay disease anyway.”

The focus on gays may have been prompted by the article in the New York Times one month later, on July 3, 1981. The small story, “Rare Cancer Seen in 41 Homosexuals,” was published on page 20 and focused on Kaposi’s Sarcoma.

“The cause of the outbreak is unknown, and there is as yet no evidence of contagion. But the doctors who have made the diagnoses, mostly in New York City and the San Francisco Bay area, are alerting other physicians who treat large numbers of homosexual men to the problem in an effort to help identify more cases and to reduce the delay in offering chemotherapy treatment,” Lawrence K. Altman reported. “The [violet-colored] spots generally do not itch or cause other symptoms, often can be mistaken for bruises, sometimes appear as lumps and can turn brown after a period of time. The cancer often causes swollen lymph glands, and then kills by spreading throughout the body.”

The next day, July 4, 1981, the CDC reported 36 more cases of KS and PCP in New York City and California, linking the two coasts. The following month, the CDC reported 70 more cases of KS and PCP that included the first heterosexuals and the first female. By December, when Gottlieb’s New England Journal article was finally published, the CDC reported the first cases of intravenous-drug users with PCP. But also, by then, the media had painted the mysterious new diseases as Gay-Related Immunodeficiency Disease (GRID) or as it was more commonly called: the “gay plague.”

Editor’s Note:

This is Part One of a series looking at the 40th Anniversary of AIDS. Part Two looks at the panic, confusion and efforts to fight the mysterious disease in the face of intentional government neglect; Part Three looks at Gottlieb, Rock Hudson, Elizabeth Taylor and founding of amfAR; and Part Four covers Clinton to COVID. 

Karen Ocamb is the Director of Media Relations for Public Justice, a national nonprofit legal organization that advocates and litigates in the public interest.

The former News Editor of the Los Angeles Blade, Ocamb is a longtime chronicler of the lives of the LGBTQ community in Southern California. 

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AIDS and HIV

Governor Newsom signs HIV & Aging Act authored by Sen. John Laird

Sponsors of SB 258 include Equality California, AIDS Project Los Angeles (APLA) Health, Services & Advocacy for GLBT Elders (SAGE)

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Photo Credit: Office of the Governor of California

SACRAMENTO – On Friday Governor Gavin Newsom announced the signing of Senate Bill 258, the HIV & Aging Act, authored by Senator John Laird (D – Santa Cruz). Senate Bill 258 will ensure HIV+ seniors are included in the definition of “greatest social need”.

“When I was the Santa Cruz AIDS Agency Director in the 1980’s, it was our dream to have people living with HIV live into old age,” said Senator Laird. “To be very clear, this group was not supposed to age. Governor Newsom signing the HIV & Aging Act is a historic moment for the LGBTQ community, and all those who have been affected by the HIV crisis.”

With the recent advancements in HIV treatment, people with HIV can keep the virus suppressed and live long and healthy lives. For this reason, the number of HIV positive older people is increasing. According to a 2018 California HIV Surveillance Report published by the California Department of Public Health, over half of the people living with the virus in California are now aged 50 years or older. This same report shows that 15 percent of newly diagnosed patients were age 50 and older in that same year.

Sponsors of SB 258 include Equality California, AIDS Project Los Angeles (APLA) Health, Services & Advocacy for GLBT Elders (SAGE), and the Los Angeles LGBT Center.

Sen. John Laird speaking at PRIDE with the LGBTQ Legislative Caucus June 2021 (Blade File Photo)

Equality California Legislative Director Tami A. Martin notes, “After surviving the darkest days of the AIDS epidemic, many Californians living with HIV are now over the age of 50, but in dire need of support. Thanks to Governor Newsom, Senator Laird and HIV advocates, the Golden State will now make sure that our elders living with HIV have access to food assistance, job training, transportation or any other vital services. We applaud Governor Gavin Newsom for signing the HIV & Aging Act into law, making California just the second state to ensure older Californians living with HIV don’t just continue to survive, but thrive.”

“Thanks to effective treatments, people with HIV are living longer than we could have ever imagined just a few decades ago and now a majority of people with HIV in California are over 50 years old. Unfortunately, our current health and social service systems are not yet prepared to address the unique needs of this population,” APLA Health Chief Executive Officer Craig E. Thompson said adding; “Many older people with HIV are long term survivors of the AIDS epidemic. They have lost countless loved ones and entire networks of social support. They also continue to face discrimination and alarming levels of stigma. We thank Senator Laird for his leadership on this historic bill to ensure that people aging with HIV have the resources and support they need to thrive and age with dignity.”

“We must ensure that LGBTQ seniors have the affirming care and support so they can age in peace with dignity,” stated Laird. “It’s incumbent upon us to not force individuals back into the closet for them to access adequate care. Once again, I’d like to applaud the Governor for his continued support of the LBGTQ community and to my colleagues for making this a priority bill.”

The HIV & Aging Act received unanimous bipartisan support through both chambers of the Legislature and is a legislative priority for the California Legislative LGBTQ Caucus.

Senate Bill 258 will go into effect January 1, 2022.

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AIDS and HIV

HIV & Aging Act sails through legislature; awaits Newsom’s signature

“When I was Santa Cruz AIDS Agency Director, it was our dream to have people living with HIV age into the senior category.”

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California State Senator John Laird (D-Santa Cruz) (Photo courtesy of the Senate of State of California)

SACRAMENTO —  The California Assembly passed SB 258, the HIV and Aging Act, by Senator John Laird (D-Santa Cruz), Thursday sending the bill to Governor Newsom for signature. The bill advanced from the Assembly consent calendar and received no “no” votes in either chamber.

Pending Governor Newsom’s final approval, California will become only the second state — after Illinois in 2019 — to designate older adults living with HIV as a population of “greatest social need.”

“When I was Santa Cruz AIDS Agency Director, it was our dream to have people living with HIV age into the senior category,” said Senator Laird. “To be very clear, this group was not supposed to grow old. While the drug cocktail transformed the fight against HIV, and there are more HIV positive seniors than ever before, older people living with HIV face a number of behavioral health challenges in addition to physical illnesses. By easing the burden of connecting this vulnerable population to supportive aging services and programs, this bill provides another life line to assist this uniquely disadvantaged group.

“I would like to express my utmost thanks to the sponsors of SB 258 for their steadfast partnership and the large coalition of supporters who highlighted the critical need for historic recognition and support of those living with HIV.”

With recent advancements in HIV treatment, people with HIV who take antiretroviral therapy can keep the virus suppressed and live long and healthy lives. For this reason, the number of older people living with HIV is increasing and over half of people living with HIV in California are now aged 50 years or older. However, older people with HIV continue to face unique challenges and barriers in health and well-being. A 2020 report by SAGE’s HIV and Aging Policy Action Coalition (HAPAC) identified that older people with HIV are more likely than their HIV-negative counterparts to have multiple comorbidities, including certain cancers, cardiovascular disease, fractures, and hepatitis C. Older people with HIV also face a number of behavioral health challenges, including rates of depression up to five times greater than their HIV-negative peers and greater levels of stigma, social isolation and loneliness.

“As a person living with HIV since 1983, I thank the Assembly for passing SB 258 – the HIV & Aging Act – recognizing older adults with HIV face unique and profound challenges as a population of ‘greatest social need.’” said Tez Anderson, Executive Director of Let’s Kick ASS-AIDS Survivor Syndrome. “For too long, survivors of the AIDS pandemic have been overlooked and forgotten. None of us imagined aging, but over half of all Californians living with HIV are aging and urgently in need of social services and programs which address our physical and mental health. I urge Governor Newsom to sign the bill and give us hope for a better quality of life.”

The HIV & Aging Act updates the Welfare and Institutions Code to ensure older people living with HIV — who are likely to turn to government and community-based services due to multiple comorbidities, behavioral and mental health issues and limited social support — have access to the programs and services administered through the California Department of Aging. The legislation is co-authored by Senators Toni Atkins (D-San Diego), Susan Talamantes Eggman (D-Stockton), Scott Wiener (D-San Francisco) and Assemblymembers Sabrina Cervantes (D-Corona), Alex Lee (D-San Jose), Evan Low (D-Campbell) and Chris Ward (D-San Diego) and co-sponsored by APLA Health, Equality California, the Los Angeles LGBT Center and SAGE.

“Thanks to effective treatments, people with HIV are living longer than we could have ever imagined just a few decades ago,” said APLA Health Chief Executive Officer Craig E. Thompson. “Unfortunately, our current health and social service systems are ill-equipped to address the unique needs of this population. Many older people with HIV are long term survivors of the AIDS epidemic. They have lost countless loved ones and entire networks of social support. They experience significantly higher rates of depression, anxiety and other comorbidities. They also continue to face discrimination and alarming levels of stigma. APLA Health urges Governor Newsom to sign SB 258 into law to ensure that California’s aging network is prepared to support the state’s rapidly growing population of people aging with HIV.”

“As the number of older people living with HIV continues to increase, so should our state’s commitment to support this resilient population,” said Equality California Legislative Director Tami A. Martin. “We are thrilled that SB 258 received overwhelming, bipartisan support in the California legislature, and we look forward to pro-equality champion Governor Newsom signing this timely bill into law. Older Californians living with HIV deserve to have the resources and support they need to thrive with dignity.”

“SAGE applauds California State Senator John Laird and his colleagues for taking action in support of LGBT elders and people living with HIV,” said SAGE Director of Advocacy Aaron Tax. “This legislation would update the Older Americans Act in California, which funds critical programs like Meals-on-Wheels, to designate older people living with HIV as a target population. As older people living with HIV continue to face challenges in getting the aging services and supports that they need, it’s time for the law to catch up with the aging of the epidemic. Everyone should have access to the aging services and supports that they need, regardless of their identity or HIV status. This legislation will bring us closer to that reality.”

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AIDS and HIV

UCLA Fielding School awarded $5.2 million in grants for HIV prevention

The grants will study the use of a variety of techniques – personalized, daily text message reminders; and individual and group counseling

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UCLA Fielding School of Public Health Photo Credit: UCLA

LOS ANGELES – A team of researchers co-led by UCLA Fielding School of Public Health epidemiology professor Dr. Matthew Mimiaga has received more than $5.2 million in grants from the U.S. National Institutes of Health (NIH) to develop and test interventions in the U.S. and Brazil.

The projects, funded by three separate NIH grants, all have the goal of reducing the spread of HIV, the virus that causes AIDS, through the use of antiretroviral medications for HIV primary (PrEP) and secondary (ART) prevention among sexual and gender minority groups.

“Whether used as PrEP for HIV negative individuals or as ART treatment as prevention for those living with HIV, antiretroviral medications are highly effective at reducing HIV acquisition and transmission, but its efficacy is highly dependent on uptake and excellent adherence,” said Mimiaga, director of the UCLA Center for LGBTQ Advocacy, Research & Health. “However, sexual and gender minority groups face specific barriers to PrEP and ART access, uptake, adherence, and retention in care. Because of this, we are testing interventions that are culturally-tailored to address the lived realities and barriers among these vulnerable groups.”

The grants, announced by the NIH this month, will study the use of a variety of techniques – personalized, daily text message reminders; video vignettes; peer navigation; and individual and group counseling – to facilitate access and adherence to antiretroviral medications among those who would benefit the most from its use. These grants will be implemented in Los Angeles County; Providence, RI; Boston, MA; and Rio de Janeiro, Brazil.

This will give the researchers a wide variety of data on how these approaches work for different populations, ranging from LGBTQ adolescents, ages 15-24, to transgender women, and men who engage in transactional sex with other men. Dr. Katie Biello, a Brown University behavioral and social sciences and epidemiology professor, will co-lead this work with Mimiaga.

“Our goal is to develop HIV prevention interventions that are highly scalable and sustainable in the real world,” Biello said. “As such, this work takes into account the future of PrEP and ART access, while simultaneously addressing the barriers surrounding access, aiding in navigating linkage to PrEP and ART care programs, and reducing barriers to, and building skills to support, medication adherence.”

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