David Kessler, dean of the UCSF School of Medicine and vice chancellor for medical affairs today, delivered a heart-felt message praising the work of the UCSF community for its leadership in tackling HIV/AIDS.
"HIV/AIDS work is a vivid example of the power of multidisciplinary research and translational science - fundamental to our ability to drive important findings from our basic research labs to clinicians and, ultimately, to patients," Kessler noted.
Here is the full text of his message:
On World AIDS Day, I wanted to write and share with you how proud I am, and how proud we all can be, of UCSF's role, especially that of the faculty, staff and students who have dedicated themselves to the fight against HIV/AIDS. For without a doubt, HIV/AIDS is the worst of epidemics, with some 5 million new infections and 3 million deaths worldwide this year.
As many of you know, UCSF was one of the first health centers confronted by the emerging disease, in 1981, when Donald Abrams, Marcus Conant, Paul Volberding and the late Constance Wofsy were treating gay men presenting with the rare cancer Kaposi's sarcoma in Ward 86 at San Francisco General Hospital. They called on colleagues from throughout this institution and attacked from every scientific angle possible what was later characterized as AIDS. They tapped UCSF's culture of collaboration, a cooperative spirit rarely found in academic medicine.
Then as now, UCSF faculty, staff and students help save and mend lives everywhere - not just in the many countries in which UCSF conducts research, training and patient care, but throughout the world, as UCSF research is published and promulgated and sets global standards.
Today, we see the dramatic impact of Peter Stock and Michelle Roland's work that has proven the value of organ transplants in people with HIV. Or Diane Havlir's research that helped establish the powerful multi-drug "cocktails" that keep people with HIV alive. Or the outstanding programs led by Nancy Padian, empowering women in developing nations to prevent infections. Or David Bangsberg's research on medication compliance in underserved populations. Or the policy research led by Stephen Morin to help others navigate the ethical and policy dilemmas of HIV vaccine research in developing countries.
Most importantly, at every step, in every lab, in every clinic, the focus is where it should be: on our patients.
Stu Smith, who has been living with HIV since 1989, hesitated to switch his care from his HMO to UCSF's clinic at SFGH until he saw it. "The whole staff was kind, generous, patient, tolerant and dedicated to giving attention equally and thoroughly to each patient," said Smith. "I believe I get the finest care available anywhere thanks to UCSF and my personal doctors there."
UCSF's HIV/AIDS work is a vivid example of the power of multidisciplinary research and translational science - fundamental to our ability to drive important findings from our basic research labs to clinicians and, ultimately, to patients. As Jay Levy, head of the
Laboratory of Tumor and AIDS Virus Research, puts it,"UCSF has been at the forefront of practically every major finding in HIV/AIDS."
From the very beginning, UCSF physicians worked side-by-side with basic scientists, policy experts, nurses, social workers and others to address the emerging epidemic with every intellectual resource possible. Much was achieved because people were willing to challenge conventional thinking, to question authority, and to do the right thing for our patients, our communities and global public health.
"The University allowed us to create an interdisciplinary care service that was fully integrated with community agencies. Both parts of that were innovative and revolutionary, in their own way. We violated the strong organ system divisional model in care, and we worked extremely closely with the gay community," says Paul Volberding, now chief of the medical service at the SF VA Medical Center and vice chair of the Department of Medicine.
Bringing together a multidisciplinary team led to key laboratory findings, such as Levy's discovery of HIV in 1983 and vital clinical findings, such as the identification in 1984 by John Greenspan and Deborah Greenspan of hairy leukoplakia as an early sign of AIDS, enabling better treatment and transmission prevention. John Greenspan now serves as director of UCSF's
AIDS Research Institute (ARI), which organizes the efforts of hundreds of scientists and more than 50 programs from throughout the university and affiliated labs and institutions, including the
Gladstone Institute for Virology and Immunology and others, into one of the premier AIDS research entities in the world.
A staggering amount of research has been accomplished because of the intellectual curiosity, the perseverance, and the commitment to the patients we serve of so many scientists here at UCSF, and because of the support they have received from many sources, ranging from government programs and elected officials to caring individuals. The dedication and medical skill of our clinicians has taken this research and translated it into incredible advances in care and outcomes. Collectively, they have saved thousands of lives.
That is no exaggeration.
"I love my life. I know I am lucky, and I am not taking this opportunity lightly," says Tom Stearns, who three years ago became one of the first adults with HIV to receive a solid organ transplant almost. After a hospital in another city sent Stearns home as doctors considered his progressive liver disease untreatable because of his HIV infection, he came to UCSF, where he received the transplant in surgery done by Chris Freise.
"Three years ago, an HIV patient couldn't get a transplant anywhere outside of San Francisco and one or two other places, now the horizon has completely changed, and everybody is doing it. UCSF was on the forefront; they took a big risk, they knew it was worth fighting for my life, that with the new class of HIV drugs, HIV was not necessarily a death sentence as it had been."
Saving lives means not only giving the best treatments to people who are infected but preventing new infections from occurring. The reduction in pediatric AIDS is a wonderful example of high-impact interventions. In 1991, when Diane Wara and Rick Sweet founded the
Bay Area Perinatal AIDS Center (BAPAC) at SFGH, the first center to care for pregnant women with HIV, about eight children a day became infected with HIV in the United States because their mothers were HIV positive. Just three years later, the rate was cut in half as Wara and nurse practitioner Maureen Shannon demonstrated the efficacy of a new standard of care for mothers with HIV and their babies and shared their findings worldwide. In San Francisco, the rate now is close to zero. (There were two cases recorded last year.)
Making such dramatic changes is possible only when we recognize the diversity of our patients and the diversity of their complex health needs. That is what Ruth Greenblatt did in 1993, when she established the Women's and Children's HIV Program to address the concern that seropositive women often neglect their own medical needs when caring for dependents. The program is designed to provide expert, culturally sensitive care for HIV-infected women as well as their children, who may be HIV positive or negative.
"We all want to see healthy babies, so everybody is incredibly motivated," says social worker Becca Schwartz at BAPAC. "One father told me he and his girlfriend had been poor and homeless most of their lives, but here they were treated with respect and got quality care and information, something they had never had before."
While research and care continues in the Bay Area, UCSF projects and scores
of researchers and clinicians work tirelessly to extend that success around
the globe:
- • Nancy Padian and her team in the Women's Global Health Imperative lead
efforts in the Dominican Republic, Egypt, India, Kenya, Mexico, Nigeria, South
Africa, Tibet, the United States, and Zimbabwe to address gender imbalances
and to use expanded educational and economic options for women as effective
means to fight HIV and other diseases and promote reproductive health.
- • The Center for AIDS Prevention Studies (CAPS), through programs such as
the Traineeship in AIDS Prevention Studies (TAPS), the Collaborative HIV Prevention
Research in Minority Communities Program and the CAPS/Fogarty International
Visiting Scientist Program, has trained more than 183 fellows and visiting
scholars from more than 35 countries on HIV prevention.
- • Among the nations in which investigators from the UCSF AIDS Research Institute
are involved are Angola, Argentina, Brazil, Burkina Faso, Cambodia, China,
Croatia, Guatemala, India, Japan, Kazakhstan, Kenya, Kyrgyzstan, Latvia, Lesotho,
Malawi, Mexico, Mozambique, Peru, Russian Federation, Rwanda, South Africa,
Swaziland, Tajikistan, Tanzania, Thailand, Uganda, United Kingdom, United
States, Vietnam, Yugoslavia and Zimbabwe.
- • Outreach tools such as HIVInsite, a virtual encyclopedia on HIV and AIDS,
and telephone lines to guide clinicians treating pregnant women with HIV or
health care workers concerned about needlesticks or other body fluid exposures,
extend UCSF's reach even farther.
There are too many examples like this to include here, but I encourage you to read more about UCSF's wide-reaching programs on HIV/AIDS on the School of Medicine
homepage. There is much work to be done, but much has been accomplished. I hope that all of us can learn from this experience that great things can be achieved when people work together toward a common goal.
As always, I welcome your thoughts.
Sincerely,
David Kessler
