I had dinner with my daughter Mimi the other evening, and was ruminating about how things have changed since I started work as an Infectious Diseases doctor around 25 years ago.
Several years ago, one of my very brilliant colleagues posed an interesting question.
Why do ID specialists even exist?
The Conference on Retroviruses and Opportunistic Infections (CROI) returned to Seattle this past week for its 24th meeting. It's the 4th time CROI has been held in Seattle, an excellent city for a meeting of this size, which includes "only" 4200 people. The convention center is pleasant and user-friendly -- big but not cavernous, actually encourages interactions with colleagues -- and there are numerous hotels and restaurants within walking distance, plus more Starbucks per square foot than any place on the planet.
A couple of years ago, I reread some journals I'd kept during the worst years of the AIDS epidemic. I hadn't looked at them in more than a decade and was surprised not only by their vividness but also by the rawness of their content. They brought back memories of a time I'd almost forgotten or, rather, repressed because of the intense sadness they evoked. As a doctor, I was taught to keep an emotional distance from my patients. Too much emotion clouds one's judgment. But how does one keep an emotional distance from men who were like me at the time, young and gay and who ought to have had more tomorrows than yesterdays?
The people researching cardiovascular disease in HIV have quite the challenge.
Because when you think about it for a second, we HIV treaters are a pretty spoiled bunch when it comes to therapeutic success.
Working in the HIV field at a public hospital for 30 years has exposed me to a host of challenging clinical and social situations. I spend all of my professional time on HIV-related issues (mostly clinical, but also research, teaching and lecturing), yet only a small fraction of it is spent on matters directly related to HIV or antiretroviral therapy. Most is spent on primary care and social or insurance issues that are nonetheless important to our patients.
The New England Journal of Medicine has published the first well-documented case of HIV pre-exposure prophylaxis (PrEP) failure despite good medication adherence.
This year, the National African American MSM Leadership Conference on HIV/AIDS and Other Health Disparities met in Dallas, Texas, during the inauguration of Donald Trump as our 45th president. As our new commander-in-chief was being sworn in with no HIV policy in sight, over 500 black gay men were meeting to discuss the future of HIV prevention, treatment and care in our country as we move into unchartered territory. For many of us, this meeting was a necessary moment of self-care that allowed us as black gay, trans and queer people to be at peace with one another, knowing what the fight ahead is going to be. We all met together for the conference highlight, a session called "Convergence: Living and Working on the Front Lines."
On a conference call working out the details of a brochure about fertility and family building for gay men affected by HIV, something was nagging at me. Eventually I asked the question, "But what do we actually mean by 'men'?" The call was silent for a minute as we all thought about it. "When we're talking about gay men or 'men' in the context of family planning, fertility and reproductive technology, do we mean people who identify as men, or do we mean bodies that produce sperm? Because if we mean 'men' as a signifier, we also have to talk about fertility options for trans men, and if we mean 'bodies that produce sperm,' we also have to talk about trans women. Either way, the language is more complicated."
A lot of these "Best of ..." or "Top Stories in ..." lists have already been published, as they seem to be appearing earlier and earlier each year. Pretty soon we'll start reading them around the same time they sell Halloween Candy -- and that's just too early, sorry.
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