Renslow Sherer, M.D.
Remembering the Past, Planning for the Future
Renslow Sherer, M.D., senior physician at the old and now the brand-new Cook County Hospital, Chicago, was there at the beginning of the HIV epidemic. And, he says it's up to experienced providers like himself to make sure the newcomers put today's trends in perspective.
"We've gone from managing a uniformly fatal illness -- where we were organized to do things like arrange memorial services every few months, help with palliative and hospice care, and offer spiritual guidance and some relief from suffering -- to being medication technicians," he tells The Nexus. "We're having great success, but the transition has changed the nature of our relationships with our patients." Their expectations, he explains, have changed to the point where HIV-positive patients, "expect, if not a cure, at least long-term relative health and progress in reducing the toxicities of the medications and the frequency and number of pills in a regimen."
Today's veterans also have a duty to pass what they've learned on to a new generation of physician leaders, Sherer points out, so that their educational and practice management expertise can help lower the entry barriers to becoming an HIV Specialist. "It's remarkable how often I tell stories of the dark early days of AIDS to ensure that young physicians remember how bad it was and how far we have all come," he says. "This is an important responsibility for those of us who were there at the beginning of the epidemic. It's equally important to impress young physicians with the growing complexity of HIV care through structured training, such as the self-learning modules in the Academy's HIV Medicine Self-Directed Study Guide. A commitment to master HIV medicine is a serious one."
It was during just his second month as a general medicine attending in 1982 that Sherer saw his first patient with Pneumocystis pneumonia. "We were watching what was happening on the East and West coasts. Within several months, we began to get referrals and calls about young men with generalized lymphadenopathy." That's when he and Ron Sable, M.D., "an activist in the gay community and a physician at County," started what they called the Sable-Sherer Clinic in General Medicine within the hospital. It was so named, he notes, "so it wouldn't be known as an 'AIDS clinic'."
That happened in May of 1983. "We had 140 patients in the first three years. Then came the rapid escalation, and by 1987 or so we had 1,600 patients. In those early years we saw the full spectrum of HIV patients. We had a large Haitian population, injection drug users, women, and an infant born to one of the Haitian women, which was clearly a case of heterosexual transmission. Like so many other places, we did the best with what we were seeing." A large part of the clinic's success, he emphasizes, "was due to Ron Sable's reputation in the gay community. For indigent gay men in Chicago, it was the only place to go."
The clinic was a template for many of the HIV services organizations operating today. "We did community outreach fairly early. We started a volunteer support service and offered prevention counseling and then testing when it became available. We also provided HIV prevention counseling in the walk-in screening and STD clinic at the hospital, and were among the early providers to make a link between prevention and care." The clinic was part of the original demonstration project that preceded the 1989 Ryan White CARE Act.
"Long before the act came into being," he recounts, "we at County and others learned that the best outcomes for our patients were gained by addressing the expressed needs of patients. In a public hospital system, that often meant assisting with the basics of life, such as food, housing, and transportation. The act was conceived with that experience in mind, and built upon by providing support for those services, along with primary medical care, that otherwise were unavailable to patients."
The act, he adds, "enabled us all to learn how to manage and improve those services alongside existing health systems that were often dysfunctional and ill-equipped to handle the unique needs of people living with HIV. We were able to put the money where it was most needed, in primary care and support services. It was really very gratifying. The CARE Act had a huge impact here, as it did in most public hospitals and clinics." He and his colleagues also quickly developed programs in each title of the act, including programs for women and children under Title IV and HIV prevention programs for detainees at the Cook County jail under Title III.
The county government was "extraordinary in responding to the epidemic." Cook County still provides all medications at no cost to patients. "They've responded to the HIV epidemic right from the beginning," he points out. When the space and facilities were no longer adequate to meet the need, the County partnered with Rush Medical College to develop and implement the CORE Center.
The CORE Center is a freestanding facility for the care, prevention, and research of HIV and related infectious disease that Sherer terms, "a caregiver's dream come true. It has mental health services, case management, drug treatment, child daycare, complementary therapy, and STD screening all onsite." In addition, the center offers a volunteer area, a large conference and training area and a research wing. "We've been involved in clinical trials from the very beginning," he notes, "including the first AZT and fluconazole trials." The clinic now has about 3,800 patients.
Sherer has also been the co-principal investigator of the Midwest AIDS Education and Training Center at the University of Illinois for about 15 years. The AETCs are funded by the federal Health Resources and Services Administration and are charged, he points out, with "providing education and training of health care workers in HIV care, with a focus on public and Ryan White-funded clinics. They target physicians and other providers who may be less experienced, because clinical experience in HIV clearly affects outcomes."
That's also key to his work with the Academy, Sherer points out, as part of the faculty that developed the Academy's Core Curriculum. "It's been a tremendous effort to define what it is that an HIV clinician needs to know," he says. "Now, clinicians can easily take the self-assessment test and measure their knowledge against a reliable and timely standard. That hadn't been done before. Textbooks fall out of date pretty quickly, and the mass of HIV medical knowledge has become enormous and increasingly complex."
Now, he adds, it's time for organizations like the Academy -- and experienced providers like himself -- to turn their attention outward. "In fact," he says, "we need to look overseas. We who have the medications have a responsibility to use them to their best advantage because in so many parts of the world people are clamoring to have them. We also need to take some of the skills we've learned and use them to the advantage of the developing world."
It's happening already to an extent, he concludes. "There's a great push from the global public health and activist communities to not ignore what's happening in the developing world. We've neglected the developing world for decades, especially sub-Saharan Africa. But there's a growing intolerance for such neglect that seems very deep. I'm encouraged by the growing global will to address these important issues."
This article was provided by American Academy of HIV Medicine. It is a part of the publication The Nexus. Visit AAHIVM's website to find out more about their activities and publications.