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Shedding new light on an underacknowledged epidemic

Yale Medicine Magazine, 2021 Issue 167

It took only weeks to appreciate the threat of COVID-19 as it raced around the world in early 2020. But nearly 40 years ago, before the arrival of social media and the smartphone, people had considerably greater difficulty coming to grips with the HIV/AIDS epidemic. Its resolution was a process that stretched from years into decades.

Community in a Time of Crisis: Yale, New Haven, and HIV/AIDS, 1981–1996, an exhibit sponsored by the Yale School of Medicine’s (YSM) Program for Art in Public Spaces (PAPS), examines the early years of discovery, defining the newly emerging disease, and treatment of HIV/AIDS. With both online and in-person components, the Yale exhibit uses videos, photographs, historical documents, and articles to tell the story of how HIV/AIDS arrived on the national and New Haven scenes. The exhibit is on view at Sterling Hall of Medicine, 333 Cedar Street.

Much like COVID-19, HIV/AIDS was poorly understood at first—a characteristic that led to stigmatizing the illness. “In the early years, HIV/AIDS became associated with what were thought of at the time as marginal communities: the gay community, impoverished communities affected by drug use, communities of color,” said Sarah Pickman, a member of a team of PhD students in the History of Science and Medicine Program (HSHM) within Yale’s History Department who were responsible for curating the exhibit. The curatorial team also included Kristine Ericson, Megann Licskai, Maya Sandler, and Beans Velocci.

Experts—along with the testimonies of celebrities affected by HIV—were able to change the public’s understanding over time. Meanwhile, researchers at Yale and elsewhere were working hard to develop effective treatment protocols along with the prospect of a vaccine or cure. To date, there is no preventive or therapeutic vaccine for AIDS, though antiretroviral therapy (ART)—personalized combinations of drugs from six different classes—can arrest the disease’s advance, effectively turning it into a serious but manageable chronic condition.

It is easy to forget how damaging it was socially and professionally to receive an HIV/AIDS diagnosis, which was seen in the early 1980s as a public death sentence. This fact scared off many physicians and scientists, but a few leaders at the School of Medicine and in New Haven saw opportunities to make a difference.

“We wanted to capture and commemorate the outstanding work done by the Yale and New Haven communities in the early years of the AIDS/HIV epidemic as the country came to grips with this crisis,” said Darin A. Latimore, MD, deputy dean of diversity and inclusion, associate professor of internal medicine, and co-director of PAPS, along with Anna Reisman, MD, director of the program for Humanities in Medicine and professor of internal medicine.

One conspicuous innovation focused on prevention of bloodborne diseases. The New Haven Needle Exchange—an attempt to distribute clean needles to intravenous drug users in the community—was started by a Yale School of Public Health (YSPH) student, Jon Parker, in violation of the law and protocol. Parker clandestinely collected used needles and exchanged them for new ones. The program was run out of a storefront and a van that evolved into a mobile clinic. Staffed by YSM faculty and students, the Community Health Care Van still offers a broad range of services to New Haven’s vulnerable populations and is now being used to help fight COVID-19.

The needle exchange program grew, and was sponsored by the city’s government from 1991 to 2017. The New Haven program was so successful in its early years that it was ultimately adopted by the City of New York, and has since gone on to justify the prevention efforts of many communities in and outside the United States.

Other prominent Yale faculty played roles in combatting the epidemic on a variety of fronts or worked to raise awareness, including Yale President Peter Salovey, PhD; Gregg Gonsalves, PhD, assistant professor of epidemiology (microbial diseases), and co-director, global health justice partnership; Edward Kaplan, PhD, the William N. and Marie A. Beach Professor of Operations Research, professor of public health, and professor of engineering; and Rick Altice, MD, professor of medicine (infectious diseases) and of epidemiology (microbial diseases), and director, Clinical and Community Research, director, HIV in Prisons Program, and director, Community Health Care Van. “There were so many who contributed to the efforts around understanding HIV/AIDS, laying the groundwork for where we are today,” said Reisman.

Over time, Yale and New Haven were able to bring HIV/AIDS under relative control. This success, more than anything else, is what Community in a Time of Crisis hopes to explain.

“There tends to be a narrative when we look at epidemics of the past; there’s a sense that only bold medical treatment options got rid of the disease,” said Pickman. “We hope through this exhibit to show that ‘treatment’ has a broad definition, and [that] the response was driven by many individuals motivated by compassion and community. It was a group effort.”