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On the front lines of the fight against HIV/AIDS

 


Deep inside the Duke Clinic, there are quiet corridors lined with offices that look like many others. You have to have the right eye to see how this space of red and pink floor tiles is different.

As we walked down the hallway, Stuart Kerr, research program leader for Duke Pediatrics’ Infectious Diseases Division, remembered what the area looked like in the early 1990s when it was Duke’s infectious disease clinic. It was on the front lines of the fight against HIV/AIDS. Contagious disease.

stuart carr This wall wasn’t here, Carr explained. Instead, this was a small lobby where patients sometimes gave fake names to protect their privacy. . Carr pointed to the office where her Barlett Humphries, a longtime phlebotomist, draws blood and chats with reluctant patients from caregivers elsewhere.

“It was my favorite job,” said Carr, who was a clinic receptionist in the early 1990s when HIV patients had few options and high mortality. “We can’t cure you, we can’t make you healthy, but we can make it easier for you to handle the problems you’re dealing with.”

Mary CrotmanDecember 1st world aids day, provides an opportunity to remember the approximately 40.1 million people who died from AIDS-related illnesses. Duke is at the forefront of that battle by conducting research to improve treatment and find a vaccine for her HIV/AIDS around the world. That work is part of a proud legacy that began 40 years ago, when Duke staff and faculty (some of whom still work for Duke today) faced the epidemic with extraordinary courage and compassion.

When key questions about the deadly virus remained unanswered, scientists at Duke searched for answers. And at a time when many who suffer from the disease have faced fear and discrimination, Duke’s doctors and clinical staff have created a welcoming space for care.

Mary Crotman, dean of the Duke University School of Medicine, who was an infectious disease resident at Duke University in the early 1980s before embarking on a career in HIV research, said: “You’ve seen it at Duke. Doctors, nurses, social her workers, researchers really passionate and producing great work over the years.”

Fearless Science

In the very early days of the AIDS epidemic of 1983 and 1984, Dr. Barton Haynes and his small team at Duke University were among the first people anywhere to tackle the virus. At the time, it was not fully established how the virus spread. What was certain was that it was fatal.

Haynes, now Director Duke Human Vaccine Institute, he and research analyst Richard Skiers said they sometimes felt their share of fear while handling specimens through the rubber gloves and glass windows of the BioSafety Laboratory-4 unit. isolation facility).

Burton Haynes at work.But they, like everyone involved in infectious diseases, understood that the chance to stop something that could claim millions of lives was greater than any fear they might have. rice field.

“We knew it was our responsibility to do the job,” Haynes said. “That’s why we’re here.”

The foundation for Duke University’s primary HIV/AIDS research was laid in the early 1980s. Duke University scientists, such as Haynes, sought to slow the burgeoning epidemic by working to identify the cause of AIDS.

Beyond the fear of contracting a disease for which there is no cure, the fact that gay men make up the most visible segment of those living with HIV/AIDS is an indication that several segments of American society are determined to stop it. It meant that I felt that was not a priority.

Haynes recalls hearing some people question the value of AIDS-related work and even refuse to shake hands.

But among Duke’s leaders, a commitment to fighting the disease was never an issue. It received unwavering support from key decision makers such as David Sabiston, who was the Chief of Surgery at .

“Clinicians and researchers in the medical and surgical departments said, ‘This is part of humanity, and we’re either leading in the world or we’re trying to ignore it, and it’s here anyway.’ We don’t have the expertise to deal with that,” Haynes said.

parade marcherIn that spirit, scientists at Duke University contributed to early breakthroughs in the fight against viruses. In the early 1980s, Haynes and Bolognesi were early collaborators with Dr. Robert Gallo at his National Cancer Institute, one of his co-discoverers of HIV.

Haynes provided Gallo’s lab with samples from hemophiliacs through his connections with collaborators at the University of North Carolina. These specimens are one of his used by Gallo to isolate many strains of the virus and show that HIV-1 is the cause of AIDS.

On the other hand, Voronesi and Kent Weinhold, Ph.D., now emeritus professors of surgery at Duke University, said that azidothymidine, also known as AZT, is effective. One. In the mid-1980s, doctors at Duke University, led by Dr. Katherine Wilfert, also helped demonstrate that giving a pregnant woman her AZT could prevent the disease from being passed on to her baby.

Burton HaynesSince then, Duke Human Vaccine InstituteHaynes and several Duke colleagues have continued this breakthrough work We are close to discovering an HIV vaccine that has the potential to develop a cure and spread globally. And many of the lessons learned in the early days of the HIV epidemic were learned by infectious disease researchers at Duke University. Rapid development of a COVID-19 vaccine.

Searce, who retired as a full-time staff member in 2019 but is still working part-time, said: A researcher at the Duke Human Vaccine Institute. “That wasn’t the case with HIV. It really brought together scientists. We all knew this was going to be a difficult project, so we wanted to be a part of if.”

Compassion drives

I love to tell the story of Dr. John Bartlett when he ran the Duke Infectious Diseases Clinic for patients living with HIV/AIDS in the late 1980s and early 1990s, and it involved typists throughout the hall. increase.

John Bartlett In 1987, five years after Duke first saw his sick patients, a clinic opened on the lower level of the Orange Zone next to the typing pool at Duke University Hospital.

“At first, there was a lot of anxiety that people would use handkerchiefs to turn doorknobs,” said Bartlett, a professor of medicine and global health.

Over time, things changed as typists got to know patients better and the clinic became a welcoming place for people living with difficult realities.

“By time, the typist was baking cookies for his patients,” says Bartlett. “It was wonderful.”

In the 1980s and early 1990s, AIDS stories didn’t often have happy endings. There is no proven cure to stop the disease, and the diagnosis often blamed those already living on the margins. The clinic has become a place where a dedicated team of Duke staff members give patients hope and acceptance.

Julia Giner, who served as a clinical research nurse at the clinic from 1993 to 2006, said, “Back then, if people were infected, they would just disappear. We would be their family.”

Working in a clinic, where patients often participate in clinical trials and receive treatment for their symptoms, didn’t look like many others.

1998 Clinic staff.“We’ve been committed to patient-centered care, which sometimes meant doing unconventional things,” says Bartlett.

He understands that many of his patients are afraid to be hospitalized, and in many cases their partners are not allowed there, so Bartlett’s team can do what they can to keep them at home. I did what I could, made home visits, and worked closely with home care. Providers can find ways to serve their patients.

Many of the clinic’s patients were uninsured. Also, some people who have insurance worry that using insurance for HIV-related care will put them out of work. As such, the clinic’s team was adept at working with pharmaceutical companies, government programs, and other sources to find ways to finance treatment.

Also, there was a time when some funeral homes in the area did not serve people who died of AIDS. When the patient died at home, Bartlett placed the body in the back of a blue Ford Ranger pick-up truck and took it to Duke University Hospital, then a crematorium.

Things began to change in the mid-1990s when improved antiretroviral drugs allowed for happier endings. Clinic staff recall seeing previously frail patients gain weight and regain the ability to care for themselves. Bartlett, who said he only knew the patient for about six months, now has a patient he’s known for 30 years.

John Bartlett This progress was evident on World AIDS Day 1996 when clinic staff listened to the names of patients who had died from the disease the previous year.

“By 1995, the list was growing,” said Patricia Bartlett, wife of Dr. John Bartlett and a former social worker at the clinic. “By 1996, there were about 30 names.”

According to the Centers for Disease Control and Prevention, in the United States, HIV-related mortality has declined by more than 80% from its peak in the mid-1990s.

With the World Health Organization estimating that about 38.4 million people were living with the disease at the end of last year, HIV remains a global threat to public health. And since 2005, Dr. John Bartlett has Duke AIDS Research Centercollaborated with the Kilimanjaro Christian Medical Clinic in Tanzania to improve care for HIV patients in sub-Saharan Africa.

But for Bartlett and his colleagues from the early days of Duke’s first HIV-specific clinic, the memory of the care they provided and the progress they witnessed won’t fade anytime soon.

“I’m very proud of it,” said Bartlett. “That’s why I’ve been doing this for his 40 years and why I’m looking forward to tomorrow.”

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