Doctor Spends Career Waging War On AIDS

Thirty years ago, doctors put a name to a disease ravaging the gay community. Michele Norris talks with Dr. Michael Saag, director of the University of Alabama-Birmingham Center for AIDS Research, about the evolution in understanding of and living with AIDS.

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ROBERT SIEGEL, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MICHELE NORRIS, host:

And I'm Michele Norris.

Thirty years ago, this week, doctors reported the very first cases of a disease that would soon ravage communities around the world. It came to be known as acquired immunodeficiency syndrome or AIDS. The disease changed the way both straight and gay communities talked about sex, how sex education was taught in schools. And it changed medicine.

In a minute, we'll hear from Youth Radio about young people's attitudes today towards AIDS.

But first, to a doctor who started his residency back in 1981, and since then, he's stayed on the front line of AIDS. His name is Dr. Michael Saag. He's director of the University of Alabama-Birmingham Center for AIDS Research, and he remembers clearly the first patient he encountered with AIDS.

Dr. MICHAEL SAAG (Director, University of Alabama-Birmingham Center for AIDS Research): Well, I was just in training, and this is in the early '80s. And there was a patient who came in who had fever and a bunch of skin lesions, skin bumps, and we couldn't explain it. And at that time, we'd heard of AIDS. It had already been announced. But this was presenting in a different way than any of the defined cases.

It turns out he had a fungal infection called histoplasmosis, which is picked up in the environment. It's kind of all around us but usually doesn't cause disease. And it wasn't one of the original AIDS-defining conditions, so we were kind of unknowingly paving a new course. It explains a lot about what it was like back then: unusual disease presentations in young people that we couldn't really explain and a new syndrome that had just been thrust upon us.

NORRIS: And to help us understand what was going back then further, once you discovered that it was AIDS, how did the medical community deal with that? I mean, I imagine that there was still a certain amount of stigma attached to that diagnosis.

Dr. SAAG: Oh, there was then, and actually there still is now, unfortunately. But back then, it was pretty huge. And even among medical providers, we were seeing some who embraced it and said: This is something we're called to do like a fireman or a policeman getting called to an emergency. You don't question how much danger you might be in as a provider. This is something that we're supposed to do. And on the other end of the spectrum, as you can imagine, there were those who said: I don't want any part of this. I didn't sign up for this. And so we were balancing between those two extremes.

NORRIS: I've had the pleasure of talking to you in the past, and I've read some of your work. There's a story that you tell about an early death of a patient and her funeral that says so much about the early stage of that disease. Would you mind sharing that story with our listeners?

Dr. SAAG: Well, this is a story of a woman who delivered a baby, and she didn't know that she was infected. The baby have - very soon after delivery, became ill and died. As soon as her family heard, they disappeared. They vanished. And when that baby was buried, it was basically a social worker, me and the mom at this burial.

NORRIS: Has that changed over time? And in your practice, have you been able to see how the face of AIDS and the reality of AIDS has changed in these 30 years?

Dr. SAAG: There's been an incredible transformation. If we divide the 30 years in half - literally, 15 years - the first half was death, dying, huge stigma, isolation and, to some degree, hopelessness. Through this remarkable investment - in particular, by the NIH and our government and pharmaceutical companies working together - within a very short period of time, the virus was discovered, drugs were identified that actually worked dramatically well, such that by 1996, we had what we now call HAART or triple drug therapy that totally transformed the face of AIDS. Such that over the last 15 years, HIV has been converted from a death sentence to a chronic manageable condition that someone diagnosed today can live a normal lifespan if they take the medicines regularly and they get the virus in check. That's remarkable.

NORRIS: And there is a different population that now is essentially in the bull's-eye of the epidemic.

Dr. SAAG: It's mostly people of lower income and especially minorities. And in Alabama, in rural areas, there is a large number of people who are HIV infected and don't know it, and that's the tragedy. News just last week from a study done in Africa showed that when you get somebody in care and on treatment, and the amount of virus in their bloodstreams drops to levels that we can't detect, they don't transmit to other people anymore. And that's a new angle: Treatment is prevention. It not only helps the person who's infected, it also prevents transmission to others. And that gives us hope that not only we keep people alive, but we can stop the epidemic.

NORRIS: Dr. Michael Saag, thanks for coming back to talk to us again.

Dr. SAAG: Thank you, Michele.

NORRIS: That's Dr. Michael Saag. He's director of the University of Alabama-Birmingham Center for AIDS Research.

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