AIDS PERSPECTIVE
PERSPECTIVE
The perspective, or more accurately, perspectives, from which I was able to view the evolution of the epidemic is I believe somewhat unique in its diversity. When AIDS was first recognized I had long standing professional associations with virologists and infectious diseases experts in academic medical institutions, as well as with experts in sexually transmitted infections. Moreover, my work at that time as a physician included providing medical treatment for sexually transmitted infections to homosexual men in New York City. I was thus familiar with the health of those who were to be the first to manifest and succumb to this disease. In this way I was able to observe the evolution of AIDS in New York City as a virologist, as an infectious diseases expert and as a community physician treating sexually transmitted infections in gay men in New York City.
I arrived at this vantage point through a series of fortuitous events, starting in 1973 with my acceptance of a faculty appointment in the Department of Medicine at the State University of New York (Downstate). A strange and surprising set of circumstances followed, resulting in my decision, at the age of 44, to start a private medical practice in the Greenwich Village area of New York City in 1978, devoted to the treatment of sexually transmitted infections. This was to be the commanding location from which I was able to view the first manifestations of the epidemic. Until this time, my entire professional life had been spent within academic institutions. Less than a year before opening my practice, the thought of doing so would have been inconceivable. I had already been Associate Professor of Medicine at the State University of New York (Downstate) for four years, and Associate Professor of Microbiology at the Mt Sinai School of Medicine for four years prior to this. I came to thispost, and to the United States, from the National Institute for Medical Research in London ( http://www.nimr.mrc.uk/ ). I had been a member of its scientific staff, working in the virology division, on the mechanisms of interferon’s antiviral action, with Alick Isaacs, the co discoverer of interferon. ( http://en.wikipedia.org/wiki/Alick_Isaacs)
In 1973, I was hired by the Chairman of the Department of Medicine, Ludwig Eichna, to work in the Infectious Diseases section of the Department. Dr Eichna supported my research interest in interferon, an activity more usually undertaken in a department of Microbiology. I was unable to establish a virology laboratory in the Department of Medicine, and my equipment was placed in the Microbiology Department, where I worked with an old colleague and friend, Dr Rostom Bablanian, a distinguished expert on vaccinia virus. When Dr Eichna retired, his successor did not renew my contract. I was 44 years of age. Needless to say this news came as a severe shock. I had known nothing but institutional life, and so I frantically tried to find another academic job. However, since my earnings had not been supplemented by any practice income, I only had three months in which to do this. It soon became quite obvious that finding an appropriate position in this short time would be almost impossible. My response to this pressure, following an initial inability to accept my predicament with a terror of leaving the protection of institutional life, was a complete change in attitude. I now
actually wanted to escape from a dependency on institutional support – which until this moment, was all I had know –my father had also been a University Professor. I wanted to find a way to make a living independently, without the need for institutional support and the privileges that go with it. Maybe this was the first manifestation of a “do it yourself” approach to facing problems that was to be a fairly constant feature of my subsequent activities. I was soon to learn both the advantages and drawbacks of following such an independent path.
As a physician, licensed to practice in New York State, opening a private practice was perhaps the only way to do this. However, my clinical expertise was in infectious diseases, which had become largely a hospital based activity. But yet another strange circumstance was to make it possible to practice within my specialty in an independent capacity. While still working at Downstate Medical Center I took a part time post in the Bureau of Venereal Disease Control in the Department of Health of New York City. In doing so, I became even more proficient in the management of sexually transmitted infections. I also became familiar with the incidence, prevalence and distribution of reported sexually transmitted infections in New York City. The director of the Bureau, Dr Yehudi Feldman, who was also associated with Downstate medical center encouraged me to devote my practice to the treatment of sexually transmitted infections. This was the one field in which I felt I could responsibly practice on my own; although I had come to regarded myself as an expert in this field I also knew where to turn if I needed help. I borrowed $25,000, and started the practice in 1977. At that time the prevalence of sexually transmitted diseases among gay men in New York City had reached an unprecedented high level. Most of my patients were gay men, and those gay men who were to first show evidence of AIDS were disproportionately represented in my practice.
Since I will be commenting on a wide range of subjects, here is a link to a short account of my training and experiences. which will give some indication of the credentials that enable me to take on this task. In addition the New York Public Library has my papers and the contents, which can be seen here: Joseph A Sonnabend papers, New York Public Library will give an idea of the activities in which i have been engaged
The Contents section is arranged by subject. The articles and other material will appear under four general categories: Science and Medicine, Society, Collaborative work, and a Miscellaneous section for material that does not neatly fit into the first three general categories. The articles and other original material posted will sometimes be accompanied by contemporary comments. These may expand on such issues as the circumstances under which the original articles were written, responses to them, or how the ideas presented have fared with the passage of time.
The Contents section will look like a conventional table of contents, but each topic will be followed by a link to the actual article and in some cases to additional comments on the article in question.
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