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The Assault on AIDS


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Christopher Mathews remembers how, two decades ago, a faculty member at the University of California San Diego medical school approached him with a wishful theory: AIDS, the deadly new illness reported as close as Los Angeles, would stay in bigger cities and never reach San Diego.

“It was naïve to think something 130 miles away couldn’t get to San Diego,” says Mathews, a UCSD doctor and professor whose hunch—sadly—proved correct.

In 1981—the year the Centers for Disease Control issued a report on the disease—acquired immune deficiency syndrome was diagnosed for the first time in a local victim. He succumbed to Kaposi’s sarcoma, a rare and aggressive skin cancer. Months later, a 38-year-old man entered UC Medical Center suffering from a rarely seen pneumocystis carinii pneumonia. The patient improved briefly but died within months. The autopsy revealed massive infections, many rarely seen in modern medicine. Something had disarmed his immune system, leaving him vulnerable to horrific complications. Mathews and J. Allen McCutchan, the UCSD professor and infectious disease specialist who documented the first San Diego AIDS deaths, began combing the city to find patients with similar symptoms. They were determined to investigate the fatal illness. In 1982, McCutchan gathered his evidence on the cases he observed and traveled to London to sound an international medical alarm. At home, Mathews and his colleagues started to alert the community to the threat of AIDS and—as best they knew how at the time—help people reduce their risk of getting it.

During the next two decades, doctors and researchers at UCSD and the San Diego Veterans Administration Hospital (which share a residency program) would emerge as leaders in the war against AIDS. Although there still is no cure or proven vaccine, the work at the two institutions has helped advance treatment and medication, dramatically prolonging the lives of many patients with the human immunodeficiency virus (HIV). That work is recognized nationally and internationally.

But in the early 1980s, few doctors specializing in AIDS research and treatment could have predicted the disease would become a sinister pandemic. Legionnaire’s disease, another mystery ailment that seemed to come from nowhere, took its toll in the 1970s and then disappeared. Even the flu epidemic that killed 22 million during World War I burned out in a few years.

AIDS would be different, showing no signs of dying out on its own. McCutchan describes the AIDS retrovirus as “diabolically well-designed to preserve itself.” First identified in the 1970s, retroviruses integrated themselves with healthy human cells. The AIDS-related retrovirus was particularly insidious, gradually destroying the T cells vital to the human immune system. When the virus is replicating, researchers estimate an infected patient produces a hundred billion viruses a day, with most living only a few hours. HIV’s rapid reproduction allows it to evolve in fast-forward, mutating to resist antiviral drugs.

Worldwide, it has become the most common infectious disease, surpassing malaria and tuberculosis. An estimated 60 million people are infected throughout the world, with 15,000 new cases diagnosed every day. In San Diego County, about 11,000 have been infected with HIV, and more than 6,000 have died.

Mathews, his soft voice a contrast to his words of outrage, says local politics interferes with curbing HIV infections. He criticizes the county Board of Supervisors for “muzzling” county health officers and adopting unsound policies that ignore the AIDS health threat. Specifically, county officials have failed to provide public funds for a methadone clinic, he says. (Methadone, used to wean addicts off heroin, is not administered by injection, thereby preventing the spread of HIV.) Nor would the board authorize a clean-needle exchange program for intravenous drug users, which might diminish HIV infections caused by sharing of contaminated needles.

Board of Supervisors chairman Bill Horn, a vocal opponent of needle-exchange programs, says, “We could break the law, but according to state law, it’s simply illegal. They wanted us to vote to do something illegal.” Furthermore, says Horn, a needle-exchange program here would “send a mixed message to youth about the dangers of drugs. And neither I, nor my colleagues, would do anything to aid and abet illegal drug use.”

According to Jeff Sheehy of the University of California at San Francisco AIDS Research Institute, it’s federal law—not state—that prohibits needle exchanges. But dozens of cities, including San Francisco and Los Angeles, have instituted needle-exchange programs by adopting emergency resolutions under state public health laws. The San Francisco City/County Board of Supervisors routinely approves a state-of-emergency resolution to maintain a needle-exchange program, he says, based on the premise that AIDS is a highly contagious disease that puts the public at constant risk.

San Diego Supervisor Ron Roberts, citing the San Francisco and Los Angeles programs, says he tried to persuade his board colleagues to adopt a pilot program here, “where we could at least test and see if we were helping people.” But, he says, he couldn’t muster any support for it.

As for a methadone program, Horn offers a personal anecdote. “I had a cousin on heroin. We used to surf a lot together,” he says. “He’d been on treatment—he’d been on methadone treatment—and it didn’t stop him.” The cousin went back to heroin and died of an overdose.

Mathews has found a more receptive audience at City Hall, where he chairs a task force focusing on AIDS prevention. On October 10, the city of San Diego came a step closer to authorizing a needle-exchange program when the Public Safety Committee voted 3-2 to send a proposal for a one-year pilot program to the full City Council.
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