On Call: A Doctor's Journey in Public Service

by Anthony Fauci

I learned in this instance and in several situations over the coming years that a leader, particularly in an area of controversy, cannot make everyone happy all the time. If you do, you are probably not a good leader and you soon will not be respected.

Patients who had been preparing for death soon found that they now needed to plan their futures.

HIV/AIDS had been almost exclusively a disease of hospitalized patients, where desperately ill people with HIV at one time occupied up to 40 percent of the beds in certain hospitals in cities such as San Francisco and New York. Now it became a disease that was managed in outpatient clinics.

We were now finally acting as healers as opposed to ministers to the dying.

When Cliff Lane, Henry Masur, and I were taking care of patients with HIV in the early 1980s prior to the availability of AZT, the median survival of our patients was roughly nine to ten months from the time they were diagnosed. This meant that 50 percent of our patients would be dead within that time frame. By 2007, more than ten years after effective combination anti-HIV therapy became available, a modeling study in the United States and Canada found that if a twenty-year-old individual with HIV was put on combination antiretroviral therapy, that person could be expected to live into their early seventies, providing a life expectancy approaching that of the general population.

This high-level suppression of the virus was ultimately shown to totally eliminate the possibility that a person with HIV would pass the infection on to an uninfected sexual partner.

And so what started out in 1987 as a completely unfounded movement instigated by a small group of misguided scientists turned out to be responsible for the avoidable deaths of hundreds of thousands of people.

History had taught us and it had always been in the front of my mind that nature was a more likely and more formidable bioterrorist than a human terrorist group.