Letters to the Editor

Right now, more than a thousand people per year are diagnosed with AIDS in New York City at the same time they receive their AIDS diagnosis. We are seeing people, many of them young, many men who have sex with men, come in with symptoms reminiscent of the bad old days—fever, nausea, weakness, weight loss, thrush, and sometimes the big opportunistic infections: PCP, severe herpes infections, esophageal infections.

Yes we can still treat them, but it is not so easy. Often the immune system is quite slow to come back, and may never return to normal. Eighty percent of these co-diagnosed patients are African American or Latino. We need a strong public health system to end this problem, which is just what Commissioner Frieden is trying to do in removing barriers to testing.

We read in Osborne’s story that many question the doctors, that we will not offer testing in sensitive ways that carry a prevention message. That’s true, not all doctors are good at this yet. The answer is not to throw up our hands, but to work with them to incorporate screening and testing in the same way that they do other chronic problems. We feel urgency about people getting sick daily, and unwittingly exposing their partners to a still formidable disease—especially if left untreated for too long. We cannot afford to wait until doctors are perfect—that day will not come. We have faith that doctors can catch up and learn by doing. People with HIV, even newly diagnosed, are usually not so fragile and, after some initial very tough moments, will cope well with the information and get into care.

The other major issue has been the health department’s attempt to find those not doing well. While we think that Frieden was overreaching—that it is not possible or even desirable for the health department to single-handedly take care of all of these people—the sentiment of that effort should not be lost. Patients in these circumstances often DO need outreach. In our experience, people usually drop out of care not because they are willful, but because of other problems like depression, severe substance use, housing, or other social issues. Our nurses and doctors call patients to come back if we have not seen them in a while and the overwhelming attitude is gratitude that we care enough to make an effort.

We think the health department should be allowed to work with health care providers to offer people easy ways back into care. We are often operating short of crucial information such as resistance tests that allow us to plan the best treatment when we do get patients into care. There should be a way, with patient consent, to access some of the clinical information that the DOH has as part of surveillance epidemiology. Currently by law the health department is not allowed to work with us on that level.

Do we need to exercise some vigilance that overreaching or prejudiced individuals, a la Mississippi, don’t trample on rights in the process of pursuing public health goals? Absolutely. Do we want to help remove the handle from the Broad Street Pump? We have to.

Barbara E. Johnston, MD

Antonio Urbina, MD

Paul Galatowitsch, Ph.D.

Saint Vincent Catholic Medical Centers of New York

Manhattan

Spitzer, Paterson the Right Choices