Mark Lawrence moved from Utah to San Francisco in 1982 and was living with a friend. Not long after Lawrence arrived, his friend was diagnosed with AIDS. Six months later, he died.
It was the early days of what would grow into an epidemic. “It was a completely different attitude [than in Utah] because everyone knew somebody who was sick or who had died,” Lawrence said.
He remembers he would go to a club or a party and see people he knew and the next time he went back, they would be gone. At its peak the local weekly newspaper would include between 100 and 200 obituaries for people claimed by the disease.
Today, the risk of HIV seems abstract. It wasn’t then.
“It was terrifying,” he said. He responded by withdrawing and focusing on his work. But in 1989, he got the news: He was HIV positive.
“I thought, well, I wasn’t going to be around much longer,” he said. “In 1989 an HIV diagnosis was pretty much a death sentence, it was time to get your things in order.”
Lawrence told the owner of the restaurant he managed about the diagnosis and he was fired. He started treatment at San Francisco General Hospital, but eventually ended up getting treated by Kristen Riess, a pioneer in the field of HIV treatment.
Lawrence was one of the lucky ones who beat the odds. Since the first reported case in 1981, an estimated 700,000 people have died from AIDS in the U.S., more than died in the Civil War. In 1995, AIDS deaths reached their peak, claiming 99 Utahns and approximately 50,000 people nationwide.
Advances in treatment and prevention have led to a sharp decline in deaths. Treatments can knock down the disease to the point it can’t even be detected in the blood stream — although it cannot be completely eliminated.
It is, with treatment, a chronic condition, one which 2,965 Utahns are living with, according to a report last month from the state Department of Health. Their life spans are virtually the same as people without HIV.
And while treatments have improved, huge strides have also been made on preventing the spread of the virus. In 2012, the U.S. Food and Drug Administration approved a medication that reduces the transmission of HIV through sex by 99% and by 74% among intravenous drug users.
“If you could get everyone on it, we could end the epidemic. We could end the spread of HIV,” said Adam Spivak, a doctor of infectious disease at the University of Utah who specializes in HIV treatment and research. “Unfortunately, in our current health care situation in the United States, that’s a fantasy.”
A month supply of the daily pills costs about $7 to make, but Gilead Sciences, which has patented the drug, charges about $1,800, putting it out of reach for the uninsured. (The federal government is suing Gilead, alleging the drug was actually developed by government researchers.)
Last year, based on the recommendation of his students, Spivak got the OK from the university to open its Redwood clinic when it’s not in use and he and his medical student volunteers provide testing for HIV and other STDs, and prescribe a 90-day supply of the preventive drug — which Gilead provides for free with a doctor’s prescription to uninsured patients.
Spivak said that, when it opened in 2018, it was only the second fully free HIV prevention clinic in the country and, since then it has seen more than 250 at-risk patients recommended by the Utah AIDS Foundation and other community organizations.
Now Spivak wants to expand its scope — working with Naloxone Utah, which runs the state’s needle exchange program, to conduct more outreach to intravenous drug users, a difficult high-risk population with whom to connect.
They are also exploring using telehealth to reach into rural Utah, which continues to have high rates of sexually transmitted diseases, but few resources and little HIV testing.
The preventive treatment pays off. Keeping two people from contracting HIV offset the costs of operating the clinic for an entire year.
But it’s not free. Thursday night, the Utah AIDS Foundation is partnering with Spivak to split the proceeds of its annual “Red Party 2019,” held to mark World AIDS Day, which was this week. (Tickets are available at utahaids.org.)
The foundation uses its resources to do its own free HIV and STD testing, provides case management services for HIV-positive individuals, helps to connect people to treatment resources, hosts support groups and offers a food pantry and holiday meals to HIV positive Utahns.
With an HIV diagnosis no longer a death sentence, the aim, said Utah AIDS Foundation Executive Director Ahmer Afroz, is “focusing [patients] on going from surviving to thriving.”
The stigma of HIV remains, however.
A national survey released last week, for example, found that 28% of HIV-negative millennials have avoided hugging, talking to or being friends with someone with the virus.
That stigma, Afroz said, can keep people from getting checked and can deter doctors from testing for the virus.
So, starting in January, the Utah Department of Health will launch a public awareness campaign to drive home the point that, “here in Utah, HIV affects our friends, our neighbors and our families,” said Erin Fratto with the state’s Division of Disease Control and Prevention.
All of this is contributing to a goal that seemed unimaginable two decades ago: Eradicating HIV.
“We have the ability,” Spivak said, “to knock this disease out.”
“Dr. Reis told me that, too: ‘We’re going to see a cure,” Lawrence said. “Back in 1989, it’s something I never thought I’d be around to see.”