"We kept trying to find out what the problem was and weren't able to," recalls Beny J. Primm, M.D., who discovered his first case of HIV before the illness had a name. A young man had lymphadenopathy, a lymph node infection, whose baffling cause soon led the doctor's knowledge about substance abuse down an unexpected path that intersected with HIV.
After that first enigmatic encounter in 1981, Dr. Primm went on to become one of the preeminent authorities on drug addiction and HIV/AIDS, advising several presidential administrations and speaking before the World Health Organization. His expertise made the now-82-year-old medic an international arbiter of program development, policies and initiatives related to research, prevention and treatment.
A Track Record in Substance Abuse
When the HIV/AIDS pandemic caught the medical world off guard in 1981, Dr. Primm was directing the Addiction Research and Treatment Corp. (ARTC) in Brooklyn, N.Y. -- one of the country's largest non-profit, community-based, substance-abuse programs -- which he founded in 1969 and continues to lead today. "It helped me greatly to have been involved in substance abuse," he says, "a problem that has become very much associated with infections of all kinds."
The disinhibiting nature of drugs, especially intravenous drugs, threw up particular hurdles in educational outreach during the new HIV/AIDS crisis. "We had a great number of problems convincing people that the paraphernalia were also vectors of the disease," Dr. Primm says, "the cotton that's used, needles, syringes, the practice of 'booting the drug,' " wherein one draws blood into a syringe and then injects it.
By 1987 Dr. Primm's track record was formidable, and President Ronald Reagan tapped him for his newly established Presidential Commission on the HIV Epidemic. Although the president's first term had coincided with the advent of the AIDS crisis in 1981, he only publicly mentioned that four-letter word for the first time in 1985 -- a silence that exasperated activists and moderates alike.
"The administration was far from being as vocal about AIDS as they are today," Dr. Primm admits, "but there were a group of us who were." While on the commission, Dr. Primm voted to endorse federal antidiscrimination legislation in both public and private sectors that would support people with disabilities, including those "with symptomatic or asymptomatic HIV infection." He also prioritized dealing with the problematic relationship between drug abuse and HIV infection.
Bemoaning a Loss of Focus
Now, with the country 30 years into the AIDS crisis, Dr. Primm asserts that on the one hand, pharmacological success has brought us to a better place. But on the other hand, he suggests, that same success has made the general public prematurely complacent.
"Certainly, all the retroviral agents that have been effective in keeping the viral load nondetectable have been a great improvement in treating the disease and its evolution," Dr. Primm says. He notes that even people who experience success after beginning antiretroviral medication late are proof positive of its general effectiveness.
But he also observes that the old sense of urgency -- that once threw its shoulders so vigorously against the disease's progress -- no longer exists. "It's kind of moved off the radar screen of the whole AIDS conversation," Dr. Primm says.
Ongoing stigma is part of the problem. "I think the knowledge that HIV/AIDS has now shifted its focus to the African American and Latino populations -- and the disdain that people still have for the gay community -- has caused some diminution of concentration on prevention of this disease," he observes.
Poor funding is another constant setback. "Drug-treatment programs have never really been adequately funded relative to their importance to AIDS," Dr. Primm says. And despite the knowledge that substance abuse contributes to the spread of sexually transmitted diseases and HIV infection, he adds, even government health-monitoring agencies, such as the Centers for Disease Control and Prevention, lack proper funding. "There's not enough talk about it on the secretarial level of the administration -- nor at the level of domestic policy at the White House."
What Does This Reality Bode for the Future?
"I don't think we can ever accomplish what this administration has said we need to accomplish by 2015," Dr. Primm says of the country's first National HIV/AIDS Strategy, "because we're not focusing on it as we should."
Although the intolerance Dr. Primm sees ruling health policy in many cities and states troubles him, he says he is heartened that at least three or four openly gay Black men on the Presidential Advisory Council on HIV/AIDS are now positioned to influence national policy. But still, a shadow persists.
"We've got about 58,000 people still being infected every year," Dr. Primm says. So when he looks at the present state of AIDS treatment around the world and identifies "certain African countries where the impact of research and so forth has changed the fervor of the disease more dramatically than in our own nation," the irony takes him aback.
"The prevalence of this disease is so great in the nation's capital, and still we're not doing what we should," Dr. Primm says. "So I'm concerned particularly, with the International AIDS Conference coming to Washington next year, about us having egg on our face. We should be embarrassed to have the numbers we have and not the kind of programs that we should have in the District of Columbia.
"I think we need ombudsmen that are bombarding Congress with this message," he adds, "to sustain the effort so we accomplish some of the goals that we set out to do."
Eric K. Washington, the author of Manhattanville: Old Heart of West Harlem, is the 1995 winner of the National Association of Black Journalists first prize for his Out magazine profile of AIDS activist Phill Wilson, who went on to found the Black AIDS Institute and is its current CEO.