A Reflection on Psychology's Fight Against HIV/AIDS
As the new director of APA’s Office on AIDS, David J. Martin is revamping the office’s programs to reflect new realities about HIV/AIDS and to advocate for social science solutions to HIV-related problems. Below is his reflection on the early challenges of HIV/AIDS prevention and treatment:
I saw my first AIDS patient in 1983, a time when its etiology was unknown and when everyone — community members and health care professionals alike — was terrified about the prospects of contracting a rapidly fatal illness. I remember having to don a hospital gown, gloves, booties, surgical cap and a mask prior to entering the isolation room where he was hospitalized to talk to him about his loneliness and social isolation and afterwards reflecting on the irony and seeming futility in the encounter (how much more alienating can it be than to have everyone who enters your room dressed in a moon suit?). I also can recall sitting with a medical student who approached me, white-faced and still in shock — she had been working with an AIDS patient and got stuck with a needle used in his care — her anxiety was palpable, and she was convinced she would not finish medical school, let alone go on to become a doctor. And a discussion I had with a neurology resident who thought that our AIDS patients got what they deserved and who vehemently expressed her resentment at having to care for them; I got a little heated and felt compelled to suggest that she reread the Hippocratic Oath — my own feelings of fear and helplessness got in the way of understanding the fear behind her anger.
Thirty years later, new treatments have extended the life span and improved the lives of people with HIV. People don’t regularly die within months of their diagnosis. We don’t feel as helpless as we did back then. But HIV stigma still exists and people with HIV still experience isolation and shame over having HIV. About 50,000 people contract HIV each year in the United States; more than 1.1 million are living with HIV and a fifth of them don’t know they have HIV.
Each year on Dec. 1, we remember those people who have died from HIV-related illnesses; it is also a day to support those who have HIV and to renew our commitment to reducing new infections, to ensuring that those who have HIV are cared for, and to working toward elimination of HIV-related stigma.
We still have much to do. As HIV/AIDS has made inroads into ethnic/cultural minority communities discrimination and poverty have assumed a greater role in sustaining the epidemic; risk-reduction campaigns and programs to engage people with HIV in care are critically needed to address these factors. We are moving into a new era of funding for HIV healthcare, there will be challenges in working to ensure that all people with HIV receive the care they need (including initial engagement in care, mental health care, substance abuse treatment and other services to help them stay in care) and that they do not get lost in the transition from care under the Ryan White CARE Act to care under the Affordable Care Act.
I hope you will join me in remembering those whom we have lost, in supporting those we still have with us, and in working toward the ultimate goal of ending the epidemic. It’s a long road. Our contemplation reminds me of Robert Frost’s Stopping by Woods on a Snowy Evening; and his observation on life’s journey that:
"The woods are lovely, dark and deep.
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep."1
1. Robert Frost, “Stopping by Woods on a Snowy Evening” from The Poetry of Robert Frost, edited by Edward Connery Lathem. Copyright 1923, © 1969 by Henry Holt and Company, Inc., renewed 1951, by Robert Frost.