Sun 17 May 2015 In: Health and HIV View at Wayback View at NDHA
Retired Infectious Diseases specialist Rod Ellis-Pegler recalls the early days of the HIV/AIDS epidemic, as it moved from ignorance to fear to death and crept inexorably through our national community of gay and bisexual men. His address, slightly edited by GayNZ.com, was given at a recent HIV conference. It is presented here today to mark HIV/AIDS Candlelight Memorial Day. You can find detail on today's services here Dr Rod Ellis-Pegler I had had almost 20 years of medicine when the AIDS epidemic became manifest just over thirty years ago. The infected individuals, the population in general and those of us in medicine, all of us were thrown in at the deep end. And all responded in their own ways, reflecting their views of the world, their life experience and it wasn't always a very edifying response. But it was human. Everyone was agreed on one thing at least: No one in modern times had seen or experienced anything like the scale of this epidemic with its delayed but inevitable mortality. And I can lay claim to being the only infectious diseases physician in Auckland and perhaps in New Zealand when these events arrived here. I saw my first patient with AIDS here in Auckland in 1984 and yet in some ways it seems like it was just the other day. I can recall absolutely clearly how I first heard of it. I was crossing the road from Auckland Hospital heading towards the medical school in July of 1981. I was stopped by a colleague who was the professor of pathology. He asked me had I seen two articles in recent weeks in a medical journal and if so what had I made of them. In fact I hadn't seen them and rarely read that publication. I went straight to the library and there I found the first article, dated 5th of June 1981 called quite simply Pneumocystis Pneumonia, Los Angeles. It began: "In the period October 1980 to May 1981 five young men, all active homosexuals – the language of the time – were treated for biopsy-confirmed Pneumocystis Pneumonia at three different hospitals in Los Angeles, California. Two of the patients died." That was the very first account. At the end of the article the authors surmised that the fact that these patients were all homosexuals suggested an association between some aspects of the 'homosexual lifestyle' or disease acquired through sexual contact. So they were actually spot on with their second observation, back then in 1981. From that moment on I became a committed reader of that journal. Every week I would pull them out and virtually every week there was the progress of the epidemic, history unfolded as I watched from a distance here in New Zealand. It was seen through a very United States of America lens which sometimes seemed to distort rather than illuminate. The US Centres for Disease Control initially called this illness GRID, for Gay-Related Immune Deficiency syndrome. But a year later, after a two-day meeting – and my god I'd love to have been a fly on the wall there – they coined the term AIDS. By sheer chance a few months later I spent some months as the visiting professor in the infectious diseases department of the University of Colorado health services. There was a little discussion about this illness while I was there but I never saw anyone with AIDS in that Denver general hospital and no patient with that diagnosis was ever presented at any of the many clinical meetings I attended. I do, however, remember one afternoon when two speakers from the CDC flew across to talk to the ID department about the illness. Those talks were all about the immune system and the possible effects on it of rectal intercourse, of amyl nitrite poppers, of sperm antibodies and rectal mucosal antibodies. I do not recall infectious agents being discussed at all. As the months ticked by other at-risk groups were defined. Along with homosexuals were identified, again in the language of the time, Haitians, heroin addicts, hookers and haemophiliacs. To some, especially in the southern USA, the letter H seemed a unifying feature and in their minds it certainly wasn't by chance that Hades and Hell also began with H. I always found it rather amusing that they failed to recognise that Heterosexual began with an H as well. But in Africa a somewhat different epidemiology was being played out. I can recall very well an early paper from Belgium which reported that a Zairean engineer (Zaire used to be the Belgian Congo) had spent some time in Brussels and he managed to infect five, and I'll use their words, five non-promiscuous Belgian females. And so the epidemiological story was built up as a little more and a little more data from different parts of the world flowed in. I returned to Auckland in 1983 and soon met a young gay man, Bruce Burnett. He had lived in San Francisco and had sen at first hand the ravages of this epidemic as young gay men there were dying in quite extraordinary numbers. He did not want to happen here. Bruce and I talked a lot over the following months. My office was attached to Ward 9c, what was then the Infectious Diseases ward, and Bruce soon became the first coordinator of the AIDS Support Network, the precursor of the NZ AIDS Foundation. Within eighteen months of meeting Bruce I also became his doctor. He developed initially intracerebral lymphoma which rapidly disseminated around his body and he died very quickly, of course as a complication of the still undefined and undiagnosable HIV infection. I had come to admire Bruce's courage, both in health and in sickness. In Part Two of this feature Rod Ellis-Pegler describes the build-up of cases of fatal HIV against the backdrop of the associated fight for homosexual law reform. He recalls international intransigence in the face of the expanding epidemic and the disastrous effects HIV had on the health of individual gay New Zealand men. Dr Rod Ellis-Pegler - 17th May 2015