Caging a Killer: Fighting AIDS for Two Decades
Often called the president's lead physician in the war against AIDS, Eric P. Goosby, M.D., has been a leading AIDS researcher for nearly two decades. He has directed HIV/AIDS policy for the U.S. Department of Health and Human Services since 1995.
In mid-1980s San Francisco, Dr. Goosby helped create and later ran one of the nation's first AIDS clinics. He and colleagues witnessed incredible devastation as they treated the illness, set up a model research facility and devised new approaches to diagnosis and treatment.
After becoming director of HIV services for the U.S. Public Health Service in 1992, he took responsibility for the $1.4 billion Ryan White Care Act, which treated hundreds of thousands of needy HIV patients.
The United States has made dramatic inroads against AIDS. Since 1995, the annual number of new cases has been halved to about 35,000. Deaths have fallen more than 60 percent, to fewer than 30,000 a year.
Dr. Goosby is often credited with providing leadership that helped turn the tide. But he frets over the "great tragedy of lives that are still being lost needlessly to HIV, because many people in our economically disadvantaged minority communities are not receiving treatment."
Q. In the early years, most AIDS patients died quickly. How hard was it to care for them?
Dr. Goosby: Oh, it was very, very difficult. Between 1986 and late 1990, I had more than 450 patients die with AIDS.... There was just a whole lot of loss that I couldn't put anywhere.
I found myself kind of wanting to pull away from all the death and dying, so I moved into doing more research. But unfortunately, research didn't really take it away -- because you also have research patients who die.... But I did like the research, because it was a way of fighting back against the disease.
Q. How did you come up with the continuum of care concept that you later incorporated into the federal government's HIV/AIDS approach?
Dr. Goosby: By the mid-1980s, it was becoming clear that the medical system... was not able to provide all of the various support systems that AIDS patients need. As a patient's T-cells [disease-fighting cells] begin to drop, you need more sophisticated care. You need rapid and readily available diagnostic capabilities, for example, and you need hospital backup to deal with admissions 24 hours a day.
Obviously, these patients needed all of that. But they also needed services like Meals on Wheels, and physical therapy, and transportation, and psychological counseling. They needed many different kinds of support, and so we coined the term "continuum of care" to describe the entire package. And then we set about designing an integrated system that would deliver it to them in a highly coordinated, efficient manner.
Q. Do you regard the continuum of care as your most significant contribution to AIDS treatment research?
Dr. Goosby: I was also very pleased to have helped develop the early standards of care for anti-retroviral therapy in this country. With the advent of the protease inhibitors in 1994, we realized that we had an enormously valuable weapon in the effort to curtail progression of immune disfunction.
At the time, however, nobody knew much about the best way to incorporate these drugs into treatment. So we sat down and began putting together treatment plans and protocols that we thought could best take advantage of these new drugs...We also worked hard to find ways to make the new drugs available to as many patients as possible, even though some of these therapies can cost up to $12,000 a year.
Q. You've said many times that you're very hopeful about AIDS in the U.S. today. Why?
Dr. Goosby: First of all, our ability to prevent deaths is still improving significantly. The death rate from AIDS is down by more than 60 percent since 1995, and that's primarily because of the protease inhibitors. There's just no doubt that if an HIV-positive individual is properly cared for, you can markedly slow down their [disease] progression.
It's my hope that AIDS will become just another chronic disease in this country within the next few years. Of course, the story is very different elsewhere in the world -- and especially in Africa, where estimates suggest that more than 20 million may now be infected. And that's a great human tragedy, obviously, that needs to be addressed by the world community.