He limped in looking like a frail bag of bones, carefully supporting his weight with the cane he clutched with his right hand. He wore an eye patch on his right eye, a tragic casualty from his cytomegalovirus infection that marked the onset of AIDS.
I had met Pierre (name changed for confidentiality) once before, under another nurse's care. As I welcomed him into my office and got him situated to take a blood sample I thought to myself, Here it is in the flesh: the late stages of the disease; low T cell counts causing myriad problems. This is why I chose to work as an HIV nurse.
This scene didn't happen in 1989. It happened last year. Dying of AIDS is something we rarely hear about anymore in the United States, but it still happens -- particularly among minorities and the poor. Often, in 2013, the seriousness of the disease is forgotten, particularly among men my age. For me, it's very real.
I'm a 28-year-old infectious disease nurse working and living in San Francisco, the infamous viral hotbed for HIV infections among gay men. As a born and raised native of the Bay Area, I was conditioned, like everyone else, to be hyper-aware of the virus. To that point, my mother's immediate response to my coming out when I was 16 went something like, "I love you and will always love you, but... I just don't want you to get AIDS."
Talk about a lasting impression. Perhaps that is why I do what I do.
I focused my extracurricular activities during my undergraduate years around sexual health and HIV prevention, volunteering at the Berkeley Free Clinic's Gay Men's Health Collective. In nursing school, I put all of my attention toward studying HIV, including a six-week community health rotation at an HIV/Tuberculosis clinic in Gaborone, Botswana. After graduating and struggling to land a stable RN hospital position, I took an opportunity as a research associate at the San Francisco Department of Public Health in the HIV Prevention Section. I've had friends, lovers, partners, and now patients with HIV. Though I have remained HIV negative, the virus is, and continues to be, a part of who I am.
And now, I'm living my dream. I'm a registered nurse working in clinical trials in hopes of finding a cure for HIV. Yes, I said the "C" word. It's controversial and politically charged, but that's how revolutions begin. Many different "cure" notions are being tossed around, most of them aimed at mimicking what we saw in the Berlin Patient -- that is, permanently altering an individual's immune system, which is how and where HIV binds and attacks. This would make it next to impossible for HIV to propagate, rendering the virus obsolete in the new immune system. By altering an individual's peripheral T-cells or bone marrow stem cells using either gene therapy or stem cell therapy, we will see if any alterations might carry over into newborn T-cell populations, rendering the virus unable to replicate.
Which brings me back to Pierre.
He was in a tough spot when he came under my care last September. His virus was resistant to all classes of antiretrovirals (ARVs). He is someone we refer to as a "salvage patient." With no other drug options at his disposal, Pierre's immune system wasn't going to last much longer. His T-cell count was dangerously low, which meant he was extremely susceptible to secondary infections.
Pierre came to my clinic as part of a new program that hopes to find a cure for HIV. The research project tests cord blood from HIV-resistant donors to determine if their genetic makeup might be able to help salvage patients like Pierre. We just needed a small blood specimen from Pierre to see if there was a genetic match with any of our donors.
In addition to the previously spoken-of maladies, he also held a handkerchief close to his mouth. I could tell it used to be white, but was now an amber color. He was coughing up contagious sputum caused by his Pneumocystis pneumonia, or PCP, also an indication of his AIDS. This was it, I thought. This was full-blown AIDS like I never saw it and never lived it. This was what so many of my older friends survived, and what their dear friends suffered and died from in the '80s and '90s.
As I helped him to the exam room, I donned a respirator mask, which was something I had only ever done in the XDR (extremely drug resistant) tuberculosis clinic in Botswana. I put on my gloves and rolled up Pierre's sleeve, revealing his feeble left arm, hoping there would be some veins to draw blood from. His bicep was slightly smaller than the thickness of my wrist. There was one "roller," as us medical geeks like to call it: a vein that was very visible and palpable but would most likely roll sideways upon needle entry. With some delicate finesse, I collected the specimen and helped him out of the room.
Not all AIDS patients look like this. I saw several the week prior who looked healthy and fit but whose viral load and T-cell counts proved otherwise. Even though I live in a city where ARVs are omnipresent for most communities that need access to them, HIV/AIDS is still a problem.
I would caution readers of one thing: Be careful of placing blame on the victim. Aside from violent, non-consensual ones, I believe no act of intimacy, no matter how intoxicated or ill conceived, should be shamed for causing this chronic condition. A virus causes AIDS -- a virus whose spread is only made easier by our culture's stigmatization of the choices people make for their bodies. This is a global epidemic but the end is in attainable. We must join together to fight this virus and save lives.
Unfortunately, I never got the chance to visit Pierre in hospice care as he passed away shortly after our last visit. He was the only patient for whom I had a genetic match to test for an HIV cure in the new program. And so, we continue to care and continue to fight.