HIV病毒和其引起的疾病AIDS的生物学特点。影响这一疾病的传播和预后的社会、经济和政治因素。科学研究和治疗手段的发展情况。关于艾滋病的恐惧和希望的来源。(想预览课程论坛上已有的材料，请前往@AIDSFAH或#AIDSFAH)
01.06 - Memories of the Beginning: Chicago and Philadelphia
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來自 University of Michigan 的課程
AIDS：恐惧与希望
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從本節課中
Unit 1 - Beginnings: A New Disease Surprises The World
HIV Basics, Stigma, Three Books, Chimps to Humans, Some Memories
與講師見面
Richard Meisler, Ph.D.Lecturer
Department of American Culture, University of Michigan
In this session, I ask my colleague, Dr. Joel Howel, to remember the beginnings
of the epidemic as he experienced it in Chicago and Philadelphia.
Dr. Howell is a remarkable person.
I explain why I think so by beginning with his advanced degrees.
He is both an MD from the University of Chicago, and a PhD in the history and
sociology of science, from the University of Pennsylvania.
At the medical center at the University of Michigan,
Dr. Howell takes care of patients in the area of internal medicine.
As he does this, he trains medical students, interns, and residents.
Dr. Howell is a music lover and a musician.
And he runs a program in the arts for medical students and young physicians.
He helps them see connections between caring for patients and
the way creative artists respond to the puzzles, puzzles of human life.
Perhaps I can com, capture some of the diversity, of Doctor Howell's work
by listing the range of his affiliations within our university.
Doctor Howell is a professor of Internal Medicine in our Medical school,
professor of Health Management and Policy in our School of Public Health, and
a professor of History in our liberal arts college.
In this excerpt of a conversation with him, Dr. Howell discusses his memories of
his beginning of the epidemic, and makes fascinating comments about how
medicine was practiced in those days and how it has changed.
In the conversation, Dr.
Howell mentions a friend of his, a gay man who questioned him about the disease.
It's not hard to imagine the dread that people experienced as they
went about their lives, had sex, and
were uncertain about whether they were putting their lives at risk.
This is reminiscent of the conversation with Larry, who said that sex and
death had always been associated, for him, because of AIDS.
Doctor Howell's discussion of the immune overload theory,
which is now largely forgotten.
Is also quite interesting.
Along the way Dr. Howell mentions a cover photograph on LIFE magazine, a major large
circulation magazine of those days, the picture showed a sick baby who had AIDS.
The, the story it was referring to was titled The Innocent Victims of AIDS.
Dr. Howard reflects on the rather clear
assumption that there were guilty victims of AIDs.
Can you place yourself and
your career chronologically in the context of the HIV/AIDs epidemic?
>> Sure.
I started medical school in 1975 at the University of Chicago.
I finished medical school in 79 and immediately went into my
residency in internal medicine, and was a resident there from 79 to 82.
So I was training right when the epidemic really came into the full public view.
And I remember very clearly discussions that we had.
About just what in the world was this strange disease,
you would see people with unusual cancers sarcoma which we normally didn't see.
And we would, we would go read about it and you'd read articles and
go to the library and then pneumonia which you know,
we kind of new about as a rare disease of.
Immuno compromised transplant patients but
now was showing up in a different group of patients.
So it was a medical mystery that was certainly something we talked about.
And so during my career I went through in my early years
the strange disease that nobody understood.
All the way to the understanding of our,
our basic current understanding of HIV and AIDS.
>> In those early years did you find yourself taking care of HIV patients?
>> Absolutely, absolutely.
Probably taking care of HIV patients who I didn't know were HIV patients.
this, this was an era when I started at least in which things that we now take for
granted in terms of precautions against contact with blood simply weren't there.
It was not uncommon to come home and you know,
spend a fair amount of time scrubbing the blood off your fingers because you
hadn't been wearing gloves, it just wasn't standard, start of ease.
>> So now we have what we call universal precautions.
>> Right.
>> And is that a result of HIV?
>> Absolutely.
We didn't, first of all, we had a lot of contact of blood.
Even though we knew about a lot of blood borne diseases.
When I was at the University of Chicago there was a faculty member her
almost died from hepatitis that he had acquired in the operating room.
So we knew hepatitis, for example, was a blood borne disease, and
contact with the blood could potentially lead to infection.
But it didn't lead us to double and triple glove or to be careful about blood.
Then along came HIV and AIDS and when we realized that it was transmitted by blood
the first response as idiotic as it sounds today.
Is that we would take special care with people who
we were suspicious might be of a group that might have HIV.
Now, >> And that meant mainly gay men.
>> Right.
As if one could accurately identify, in a hospital setting or
anywhere else, who was and was not a gay man.
And so, if you looked like you might be somebody who could have HIV then
we would be very careful.
And if you didn't then we wouldn't.
>> Do you remember, instances of,
of people not wanting to go into the hospital rooms, or not wanting to serve.
Food to people who had HIV?
Absolutely. People would leave the food at the door
and walk away, they wouldn't go into the room.
They would minimize the amount of time they spent in the room,
they wouldn't touch the patient.
And I think far more seriously,
there were questions about doing procedures on patients.
Now, I'm not.
Unsympathetic to the notion that you are,
to some extent, putting yourself at risk when, for
example, doing surgery on somebody who had, who you know is HIV positive.
On the other hand, there were, nor do I think that that's still.
The, that kind of fear and resonance isn't still there.
But it certainly was more explicit there in terms of people who you would and
would not operate on and whom you would or would not want to care for.
>> Doctors and other health care workers do have to confront probably.
With some frequency the question of putting themselves at risk.
Putting their own health at risk in their work.
How do you deal with the young doctors who are confronting those issues for
the first time?
>> I think the world is different now than it was in the late 70's and early 80's.
I think that people go into medicine with different sets of expectations
then they do today.
This is not a new question for doctors.
>> Of course.
>> It's a question that's been there since the days of plaque and
the days of epidemic.
And the question of, should, does going into the medical profession mean that you
are obligated to put yourself at risk, personally, to care for patients.
I think that when you go into medicine you make that choice.
And I think that to refuse to care for somebody because it might put you at risk,
means that maybe you should choose another field.
Now the extent of the risk of course is.
Something that has to be thought about.
>> Do you want to tell our students this story of the intensive care unit,
and the baby born, which is a dramatic example of this issue.
>> Sure, there was a women in the intensive care unit who was pregnant.
She was also unconscious.
She was also infected with HIV.
She went into labor prematurely, early, and because it was an early labor the,
the baby came out very quickly and almost before anybody realized what was going on.
The baby was born not breathing.
This meant that everybody was confronted with the question, what do we do now.
The ability to mechanically ventilate the baby would require equipment that
simply isn't there in an, in an adults intensive care unitr s,
at least wasn't there in those days.
And the pediatric intensive care unit was too far away to be, to be of use.
And so the question was, was somebody going to give mouth to
mouth resuscitation to this baby who wasn't breathing?
Now the risk was real,
this wasn't a hypothetical this person looks like they might have AIDS.
Situation.
This was a we know full well that this woman has AIDS.
And we know of course that the baby is covered in blood and
bodily fluids as are all of us when we are first born.
But if the baby doesn't breathe for some finite period of time it's going to die.
On the other hand, if you do give you mouth to mouth resuscitation.
No matter how carefully and quickly you wipe off the baby's mouth,
there's still going to be virus present.
And if there is some way for the virus to get into your body because you flossed
a little too aggressively that morning or have some cut you were unaware of.
You are at risk for developing HIV.
And this decision, of course, has to be made in much less time than it's taken to
explain the situation to, to, >> Mm-hm.
>> To you right now.
The decision was that somebody did give the baby mouth-to-mouth resuscitation.
The baby did not survive.
And the person did not come down with HIV.
But that was an example of somebody putting their own life at direct risk in
order to save another human being.
>> Let's jump ahead in time.
I know that you went from Chicago to Philadelphia.
>> Mm-hm.
>> Tell us about your experiences with HIV and AIDS a few years later.
In your career.
>> Well, I got to Philadelphia in 1982, and, which is an important year as,
as, as you know, for the, the history of the AIDS epidemic.
And while I was in Philadelphia,
I got to know a gentleman who had recently come out of the closet.
He had discovered that he was gay.
And he was grappling with what that meant in the setting of this as yet
poorly understood disease that seemed clearly to be afflicting lots and
lots of gay men up and down the East Coast.
As it happened, we would often find occasion to walk with each other, to and
from our houses.
And there was another theory that was afoot in those days.
And it's very, very interesting,
because it's interesting because of what it says about our ideas about AIDS.
It's also interesting because nobodies every heard of it.
And since so called Immune Overload theory.
It makes sense.
The idea was that if you were stimulated by foreign antigens, let's
say by anal intercourse, in which they're sharing the bodily fluids, and the person.
Immune has to respond to somebody else's antigenic stimuli.
And you can do that once, and you can do it twice and you can do it a dozen times.
But, after a while, after the body is stimulated over, and over, and over, and
over again, it eventually just gives up and the immune system breaks down.
And you get to manifestations of HIV that we see with the,
with the infections in the neoplasms.
>> And this idea was made more plausible because, anecdotally anyway,
many of the men, the gay men, who came down with.
Had had many sexual partners.
>> And not just anecdotally, but epidemiologically,
the more sexual partners you had, the more likely you were to get AIDS.
>> Right.
So was it because your immune system was being overloaded with stimulation?
>> Right.
The al, an alternative theory is that this is an infectious agent that's spread from
person to person, and
if you have sex with multiple people you increase the likelihood that
you're going to get infected by somebody else, that's another plausible theory.
>> In 1982, we didn't know.
>> We didn't know.
There were people who.
Thought they knew and
worked hard to find out proof of what they thought was the case.
But because we didn't know, and because my friend was not a physician, or
in science, he wanted to know from me what I thought as a physician,
as someone who read the literature.
And what it, what he really wanted to hear.
He wanted to hear that the immune overload theory was correct because
he had just come out.
He had a relatively small number of sexual partners and
he wanted to hear that as long as he kept his total number of
partners down to some reasonable number he wasn't going to get AIDS.
On the other hand if it was an infectious agent he was putting himself at risk.
If its an infectious agent if you go from partner number four to
partner number five, your risk is the same as if
you're going from partner number 120 to partner number 121.
On the other, on the other hand if its an immune overload theory, going from
partner number four to partner number five doesn't really do much to your risk.
So we would talk about this.
What I think is interesting about the theory is that it lays bare
our fundamental biases and prejudices.
>> How so?
I think until the epidemic came along most of
straight America really didn't think much about what was going on the gay community.
When the epidemic started to become public news the number of
partners that people reported.
Hit the papers.
And I think that straight America responded with a collective gasp and
just an oh my gosh kind of a response.
So this together with the notion of
the guilty victims of AIDS you remember the famous Life cover caption.
The innocent victims of >> Who were babies.
>> Who were babies.
Well, if they're innocent victims there also guilty victims.
So somehow you were moe guilty if you had more sexual contacts.
And thus more deserving of becoming ill.
>> So, the straight world's disapproval of homosexuality and
disapproval of, increased sexual activity by gay men,
made the immune overload theory, attractive to people.
>> Absolutely.
>> Yeah.
It was not, it was plausible.
It supported their beliefs.
It explained, to some extent, the known epidemiological patterns.
And in my particular friend's life, it justified.
A set of behaviors that he wanted to adopt.
>> So this a very interesting chapter in the history of the interaction between
public attitudes and the way scientific theories are colored.
>> Well.
All scientific theories are developed in a world that has public attitudes.
It can not be otherwise.
>> Of course.
>> And infectious disease has seen this before.
For example, Florence Nightingale, back in the 19th Century,
was violently opposed to the germ theory of disease.
The historian Charles Rosenberg.
Who was at Penn now is at Harvard has written brilliantly about this.
In the same way that the immune overload theory brought out
Biosys the germ theory brought out Biosys.
If you get sick because you are leading a filthy life and you don't clean
up your latrine and you don't get rid of rotting food well you deserve to be sick.
You know, if you were a good person you wouldn't get sick.
On the other hand, if you get sick because you're a decent upstanding human being and
a germ just happens to come along and [SOUND]-
>> Florence Nightingale didn't like that?
>> No, she wanted, she thought that life, life ought to be moral, and
people who lived good lives ought to be rewarded, and
people who lived bad lives ought to be punished.
Going back to our epi, epidemic it wasn't too long
after you got to, to Philadelphia that HIV was discovered and
it became clear that it was an infectious agent.
>> Right. >> Do you remember that news coming,
coming across?
>> I remember talking about it, I don't remember I don't think I,
think I heard about it before I read about it in the papers.
I was deeply embedded in the study and history at that point and so at that point
it, it started to get slotted into a particular kind of a history.
>> We should explain that you were a physician and, and working as a doctor.
But also working on a PhD in history.
>> Correct, yeah.
>> Yeah. >> And
it, it made a lot of things make sense.
It also gave us a perhaps appropriately an avenue for treatment and for control.
The tension is always between should,
should the emphasis be on creating antiviral agents to treat the disease or
on changing behavior patterns to prevent the disease.
And the answer, of course, is yes.
It should be on both.
>> It should be both.
>> And if it's not an infectious agent,
then it's very hard to work on anti viral agents.
Of course we didn't even know it was a virus then.
