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There When AIDS Began: An Interview With Michael Gottlieb, M.D.

June 2, 2011

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Dr. Gottlieb the Activist; Remembering Elizabeth Taylor

Nelson Vergel: Talking about Africa, I was reading on your Web site, michaelgottliebmd.com, about your involvement with the Global AIDS Interfaith Alliance project. Can you tell us a little bit more about that?

Michael Gottlieb: Thank you, Nelson. This is something called GAIA, on the Web at thegaia.org. It is a nonprofit founded by Bill Rankin in San Francisco that works in the villages of Malawi, Africa, providing AIDS relief and other services.

It's been in existence since 2003, and it has several functions. It provides care to orphans; it helps village women with employment, testing and care; it provides microloans to village women so that they are economically more independent of men there; and it also sponsors nursing scholarships for girls from the villages to go to nursing school and become economically independent and part of the health care workforce there.

We also have the Elizabeth Taylor Mobile Health Clinics program, which Elizabeth funded to provide Land Rovers to go out through the villages to do HIV testing and provide other medical services.

GAIA is an organization in which I'm very confident that funds donated to it get where they're supposed to go.

Nelson Vergel: Were you a friend of Elizabeth Taylor's? How did you come about meeting her?

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Michael Gottlieb: I met Elizabeth in the context of her visiting her friend, Rock Hudson, when he was at the UCLA Medical Center. I would accompany her on visits to Rock. I was fortunate in being one of the very first people to help educate her about HIV/AIDS.

Following Rock's death, together we founded the American Foundation for AIDS Research, with Dr. Krim in New York. Elizabeth became the national chairwoman of amfAR. And we continued to be in touch over the years. When I got involved with GAIA, I asked for her help and, as usual, she was there and ready to help.

Her loss is an incredible loss to the HIV/AIDS community. No one was ever better suited to be our advocate. She had all the glamour, the international fame -- and, most importantly, she had the heartfelt commitment to this cause.

Nelson Vergel: I know. It was a huge loss for the HIV community this year.


Are HIV Doctors a Dying Breed?

Nelson Vergel: One more question: I want to switch topics a little bit. I've been reading, and I've been talking to different doctors around the country, about the concern that HIV as an actual specialty has been abandoned by many doctors. New doctors who are coming out of medical school are not really specializing in treating HIV.

Do you have any concerns about HIV treatment and care in the next few years in the United States, as the trends show that more and more doctors, experienced doctors like yourself, are no longer practicing in HIV? You're one of the few, by the way, who haven't left the field; we're lucky to still have you.

Michael Gottlieb: I feel a little like a dinosaur. I think the workforce of people who know about HIV treatment -- that is, doctors and PAs [physician assistants] and nurse practitioners -- it's a substantial workforce. I agree, and I worry that few young doctors are entering the field of HIV medicine. We have to do everything we can to encourage that.

But on a more basic level, I worry that the trend toward integrating HIV health services into general health services has some drawbacks. I'm an unapologetic proponent of HIV/AIDS exceptionalism. The reason for that is that the populations who are disproportionately affected by HIV are unique: They're frequently marginalized. They're often poor. And they're going to be underserved or neglected by any kind of approach that lumps HIV/AIDS in the context of general health services.

I think it's fine to have HIV health services in the same building with a general clinic. On the other hand, a dedicated staff -- as you point out, knowledgeable about HIV/AIDS -- is going to be necessary to choose the right treatments and, more importantly, to keep people in treatment. Because one of the hazards in marginalized populations is that people will drift out of care. And that will be damaging, both to the patients and to potential sexual partners or drug-using partners who may be exposed to the virus because those patients were not retained in treatment.

The last thing is that -- particularly in this era of budget cutting, concerns about health care expenditures, and cutbacks in ADAP -- I just think we're courting disaster by underfunding programs and, of course, in the long run, by not replenishing our HIV workforce.

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This article was provided by TheBody.com.
 
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