In the 1980s, the medical establishment didn’t always heed this call when it came to HIV/AIDS.
HIV/AIDS may be manageable now, but in the early days it was a mystery and often ignored, as it primarily affected gay men and was accompanied by stigma and shame. Many doctors and medical administrators stood by as the disease took its toll. Eric Goosby was one of the pioneers who shed light and provided much-needed treatment.
The fight against HIV/AIDS has consumed Goosby’s entire career, and millions of lives have been bettered thanks to the intensity of his commitment. Goosby received his M.D. in 1978 from UCSF, completing his residency there in 1981 — the first year AIDS was clinically observed by UCLA doctor Michael Gottlieb. By the time his fellowship at UCSF ended in 1983, San Francisco was in a full-blown crisis, and Goosby was on the front lines, a member of the revolutionary Ward 86, the first dedicated AIDS clinic in the country.
Credit: UCSF
Figuring out the nature of the crisis, while trying to treat it, absorbed the doctors of Ward 86, who developed the “San Francisco Model” of care: a patient-centered collaboration with a wide network of carers, including social workers, mental health care providers, addiction specialists and community organizers. This model has become the standard of care around the world. Goosby focused on establishing partnerships with methadone maintenance clinics to help addicts obtain HIV services, as IV users were less likely to seek treatment and the black community was overrepresented among injection drug users.
Even as Goosby and Ward 86 attacked AIDS on multiple fronts, patients were slipping away. Goosby and the other doctors fell into despair during therapeutic group sessions and struggled to maintain their personal relationships. The fight was further complicated by a lack of response from the federal government, who ignored the epidemic for many years. There wasn’t funding for research, education or treatment programs for this national health crisis. In cities that weren’t using the “San Francisco Model,” those with HIV/AIDS were suffering, especially patients from marginalized communities that were being misdiagnosed and poorly served.
Dr. Eric Goosby, U.S. Global AIDS Coordinator, gives his perspective on 30 years of HIV/AIDS in the U.S. Credit: HIV.gov
Fed up with inaction, and having lost his 500th patient, Goosby moved to Washington, D.C., in 1991 to direct HIV Services at the Health and Human Services Department, spreading the approach of the San Francisco Model throughout the country. Even as he took on this important federal role, he practiced part-time in an AIDS clinic in the city’s public hospital, D.C. General. As an administrator, he brought funding and services to 25 AIDS epicenters and to all 50 states and U.S. territories, and rose up the ladder to become director of the health department’s office of HIV/AIDS policy. He later became President Clinton’s senior advisor on HIV-related issues and helped initiate a dialogue on racial disparities in HIV/AIDS that formed the basis of the Minority AIDS Initiative.
As treatment slowly began to advance in the U.S., Goosby turned his attention to the rest of the world, where poorer nations, in particular, were finding themselves devastated by the disease. After working on scaling up treatment in Rwanda, South Africa, China and Ukraine as CEO of Pangaea Global AIDS Foundation, Goosby was nominated by President Obama to serve as the U.S. global AIDS coordinator and administer the President’s Emergency Plan for AIDS Relief (Pepfar), a $48 billion program credited with cutting AIDS deaths by 10 percent in some countries.
The remarkable career of Eric Goosby has no end in sight. In addition to serving as the U.N. special envoy for tuberculosis, Goosby is a professor of medicine at UCSF. And, of course, he returned to care for patients at Ward 86, which continues to provide treatment and set standards for prevention and care around the world.
“It’s just something that is almost like breathing to me. I love practicing medicine; I love helping people in that way; I like using my mind in that way; maybe I love pushing people around; maybe I love telling people what to do. I don’t know what it is, but I cannot imagine not doctoring.”
SUPPORT INDIGENOUS PEOPLES LIVING WITH HIV AND AIDS! CREATE PROGRAMS AND OUTREACH THAT CATERS TO EACH OF OUR TRIBES. THERE IS NO FIGHTING BACK IF YOU ARE COMPLACENT IN THE LARGER HIV/AIDS COMMUNITY THAT LEAVES OUT INDIGENOUS COMMUNITIES! - + #worldaidsday2019#WorldAIDSday #AwarenessIsResistance #hivaids - + cdc.gov/hiv/group/racialethnic/aian/index.html -
High resolution 12” x 18” poster of HIV/AIDS-related issues that affect Indigenous communities. This poster coincides with #WORLDAIDSDAY&#DAYWITHOUTART. As with all our posters, feel liberated to, share, print out, wheatpaste, and disseminate at will!
HIV/AIDS Among American Indians & Alaska Natives (CDC wedsite).
Fast Facts:
HIV affects AIs/ANs in ways that are not always obvious because of their small population sizes.
Over the last decade, annual diagnoses increased 63% among AI/AN gay and bisexual men.
AIs/ANs face HIV prevention challenges, including poverty, high rates of STIs, and stigma.
HIV is a public health issue among American Indians and Alaska Natives (AIs/ANs), who represent about 1.2%a of the U.S. population. Overall, diagnosed HIV infections among AIs/ANs are proportional to their population size. Compared with other racial/ethnic groups, AIs/ANs ranked fifth in rates of HIV diagnoses in 2015, with a lower rate than blacks/African Americans, Hispanics/Latinos,b Native Hawaiians/Other Pacific Islanders, and people reporting multiple races, but a higher rate than Asians and whites.
The Numbers: HIV and AIDS DiagnosescOf the 39,513 HIV diagnoses in the United States in 2015, 1% (209) were among AIs/ANs. Of those, 73% (152) were men and 26% (55) were women.Of the 152 HIV diagnoses among AI/AN men in 2015, most (79%; 120) were among gay and bisexual men.dMost of the 55 HIV diagnoses among AI/AN women in 2015 were attributed to heterosexual contact (73%; 40).From 2005 to 2014, the annual number of HIV diagnoses increased 19% (from 172 to 205) among AIs/ANs overall and 63% among AI/AN gay and bisexual men (from 81 to 132).In 2015, 96 AIs/ANs were diagnosed with AIDS. Of them, 59% (57) were men and 41% (39) were women.
Living With HIV and Deaths
Of the 3,600 AIs/ANs estimated to be living with HIV in 2013, 18% (630) were undiagnosed. By comparison, 13% of everyone living with HIV were undiagnosed.
Of AIs/ANs diagnosed with HIV in 2014, 78% were linked to medical care within 1 month.e
At the end of 2013, 53% of AIs/ANs who had been living with diagnosed HIV for at least a year were retained in care (receiving continuous HIV medical care), and 52% had achieved viral suppression.
During 2014, 51 AIs/ANs died from HIV or AIDS.
Prevention Challenges
Sexually transmitted diseases (STDs). From 2011 to 2015, AIs/ANs had the second highest rates of chlamydia and gonorrhea among all racial/ethnic groups. Having another STD increases a person’s risk for getting or transmitting HIV.
Lack of awareness of HIV status. Almost 1 in 5 AIs/ANs who were living with HIV at the end of 2013 were unaware of their status. People who do not know they have HIV cannot take advantage of HIV care and treatment and may unknowingly pass HIV to others.
Stigma. AI/AN gay and bisexual men may face culturally based stigma and confidentiality concerns that could limit opportunities for education and HIV testing, especially among those who live in rural communities or on reservations.
Cultural diversity. There are over 560 federally recognized AI/AN tribes, whose members speak over 170 languages. Because each tribe has its own culture, beliefs, and practices, creating culturally appropriate prevention programs for each group can be challenging.
Socioeconomic issues. Poverty, including limited access to high-quality housing, directly and indirectly increases the risk for HIV infection and affects the health of people living with and at risk for HIV infection. Compared with other racial/ethnic groups, AIs/ANs have higher poverty rates, have completed fewer years of education, are younger, are less likely to be employed, and have lower rates of health insurance coverage.
Alcohol and illicit drug use. Alcohol and substance use can impair judgment and lead to behaviors that increase the risk of HIV. Injection drug use can directly increase the risk of HIV through sharing contaminated needles, syringes, and other equipment. Compared with other racial/ethnic groups, AIs/ANs tend to use alcohol and drugs at a younger age and use them more often and in higher quantities.
Data limitations. Racial misidentification of AIs/ANs may lead to the undercounting of this population in HIV surveillance systems and may contribute to the underfunding of targeted services for AI/AN.
What CDC Is Doing
CDC and its partners are pursuing a high-impact prevention approach to advance the goals of the National HIV/AIDS Strategy, maximize the effectiveness of current HIV prevention methods, and improve HIV data collection among AI/AN. Activities include:
Working with the Indian Health Service (IHS) and tribal leaders of the CDC Tribal Consultation Advisory Committee to discuss methods for developing and implementing scalable, effective prevention approaches that reach those at greatest risk for HIV, including young gay and bisexual AI/AN men.
Providing support and technical assistance to health departments and community-based organizations to deliver effective prevention interventions.
Ensuring that capacity-building assistance providers incorporate cultural competency, linguistics, and educational appropriateness into all services delivered.
Providing capacity building assistance directly to the IHS so it can strengthen its support for HIV activities, including HIV testing capacity; We R Native, a comprehensive health resource for Native youth; and the Red Talon Project, which works to achieve a more coordinated national and Northwest tribal response to STDs/HIV.
Raising awareness through the Act Against AIDS campaigns, including
Doing It, a national HIV testing and prevention campaign that encourages all adults to get tested for HIV and know their status;
Let’s Stop HIV Together, which raises HIV awareness and fights stigma among all Americans and provides many stories about people living with HIV; and
HIV Treatment Works, which highlights how men and women who are living with HIV have overcome barriers. The campaign provides resources and encourages people living with HIV to Get In Care,Stay In Care, and Live Well.
In addition, the Office for State, Tribal, Local, and Territorial Support (OSTLTS) serves as the primary link between CDC, the Agency for Toxic Substance and Disease Registry, and tribal governments. OSTLTS’s tribal support activities are focused on fulfilling CDC’s supportive role in ensuring that AI/AN communities receive public health services that keep them safe and healthy.
a Percentage of AI/AN reporting only one race. b Hispanics/Latinos can be of any race. c HIV and AIDS diagnoses indicate when a person is diagnosed with HIV infection or AIDS, but do not indicate when the person was infected. d The term gay and bisexual men, referred to as men who have sex with men in CDC surveillance systems, indicates how individuals self-identify in terms of their sexuality, not a behavior that transmits HIV infection. eIn 32 states and the District of Columbia (the areas with complete lab reporting by December 2015).
World AIDS Day Observed on December 1st of every year, is dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection, and mourning those who have died of the disease. Government and health officials, non-governmental organizations and individuals around the world observe the day, often with education on AIDS prevention and control.
As of 2013, AIDS has killed more than 36 million people worldwide (1981-2012), and an estimated 35.3 million people are living with HIV,[2] making it one of the most important global public health issues in recorded history. Despite recent improved access to antiretroviral treatment in many regions of the world, the AIDS epidemic claims an estimated 2 million lives each year, of which about 270,000 are children.
Day With(out) Art Day Without Art (DWA) began on December 1st 1989 as the national day of action and mourning in response to the AIDS crisis. To make the public aware that AIDS can touch everyone, and inspire positive action, some 800 U.S. art and AIDS groups participated in the first Day Without Art, shutting down museums, sending staff to volunteer at AIDS services, or sponsoring special exhibitions of work about AIDS. Since then, Day With(out) Art has grown into a collaborative project in which an estimated 8,000 national and international museums, galleries, art centers, AIDS Service Organizations, libraries, high schools and colleges take part.
In the past, Visual AIDS initiated public actions and programs, published an annual poster and copyright-free broadsides, and acted as press coordinator and clearing house for projects for Day Without Art/World AIDS Day. In 1997 we suggested Day Without Art become a Day WITH Art, to recognize and promote increased programming of cultural events that draw attention to the continuing pandemic. Though “the name was retained as a metaphor for the chilling possibility of a future day without art or artists”, we added parentheses to the program title, Day With(out) Art, to highlight the proactive programming of art projects by artists living with HIV/AIDS, and art about AIDS, that were taking place around the world. It had become clear that active interventions within the annual program were far more effective than actions to negate or reduce the programs of cultural centers.
Yeah Remus Lupin is sexy, but you know what’s sexier? Reading a book that doesn’t use lycanthropy as an excuse to demonize gay people and the AIDS epidemic
