When it comes to one of the world’s deadliest epidemics, Dr. Paul Volberding knows better than anyone how important San Francisco has been in the fight against HIV and AIDS.
On July 1, 1981 — his first day as an oncologist at San Francisco General Hospital — Volberding treated The City’s very first patient with Kaposi’s sarcoma, a previously rare disease that became one of the original AIDS-defining illnesses. The patient was among the first with AIDS to be cared for at the hospital.
Less than two years later in 1983 at the hospital, Volberding became one of two doctors to open the first treatment unit in the U.S. for patients with the then-mysterious virus.
Today, Volberding — who serves as director of the UC San Francisco AIDS Research Institute — is confident that San Francisco could very well be the first city in the nation to eradicate HIV and AIDS once and for all, a goal announced by health officials in 2013.
“Theoretically, if you could find all of the infected people in a city, like San Francisco, and treat them all successfully, you could stop the epidemic,” Volberding said. “It’s going to take a communitywide effort, but we know how to do that.”
The Getting to Zero initiative of having no HIV infections, deaths and stigma in The City begins with three initial objectives, the first being to expand access to pre-exposure prophylaxis (PrEP) for San Francisco residents at-risk of HIV infection, city health officials said in December.
In fact, taking a daily dose of Truvada, the only approved HIV-prevention medication in the U.S., can reduce acquisition of the virus by more than 90 percent, according to health officials.
Diagnosing HIV early and attacking it with continued care are also among the three primary initiatives, health officials said. Treatment can stop the virus’s damage to the immune system, which if left untreated for long enough will progress into AIDS. As health officials move closer to Getting to Zero, Volberding’s influence is forever embedded in their work.
“Nothing would be possible in San Francisco without the work Paul Volberding did,” said Dr. Diane Havlir, who succeeded Volberding as chief of the HIV/AIDS service at San Francisco General in 2002 and is one of the primary forces behind eliminating the virus.
“We would not be where we are at today in the epidemic without the courage and dedication of Paul,” Havlir added.
Volberding began his career at San Francisco General that memorable day in 1981 after completing a three-year fellowship at UCSF. He had trained to become a cancer specialist and had intended to work in a laboratory under Dr. Jay Levy, a renowned virologist who would become one of the first doctors to identify human immunodeficiency virus, or HIV.
But on his first day as a faculty member at the hospital, Volberding ended up treating San Francisco’s first known patient with Kaposi’s sarcoma associated with AIDS.
Volberding remembers the patient with clarity.
“Twenty-two-year-old man, grew up in the Deep South, and as I recall he was estranged from his family,” Volberding. “He ended up in San Francisco working basically sex for food, and had innumerable previous sexually transmitted infections.”
The man died within a few months, without his family present.
Nothing was known about AIDS at the time, as the term itself was yet to be established. Volberding — who worked with his wife, Dr. Molly Cooke, the hospital’s then-chief resident in medicine — likened the job being done then with what health care workers are experiencing with Ebola patients after last year’s widespread West Africa outbreak.
“In the early AIDS epidemic, we did not know that we weren’t going to catch this by taking care of patients,” Volberding said. “We just had to decide to keep working.”
Volberding said he was not necessarily worried that he would catch the virus, but that somehow his children would become infected. His first son was born in 1981, followed by another son in 1984 and a daughter in 1987.
“The nightmare that I remember is that I had given the virus to my kids,” Volberding said. “Molly and I … didn’t even talk about it to each other. It was so frightening that we didn’t even talk about how frightened we were.”
However, Volberding said it never occurred to him to not treat patients. Within two years, the esteemed doctor would establish what would make San Francisco General the model for HIV care: the country’s first AIDS treatment center.
As the months progressed and Volberding continued treating patients suffering from cancers associated with AIDS, his colleague — the late Dr. Connie Wofsy, another pioneer in the field — was taking care of other related infections.
“We were seeing patients together as it turns out on Ward 5-B at the hospital, but at the time, it was used by interns and residents as their sleeping rooms at night,” Volberding said. “I would see patients with AIDS and use the beds as exam tables during the day, and then the interns would sleep there at night.”
In late 1982, a pregnant resident asked Volberding if it was safe to house health care workers in the same place where AIDS patients were treated. The hospital in turn offered space for Volberding and Wofsy’s clinic in another area.
“They found us space for a clinic in Building 80 on the sixth floor. Ward 86,” Volberding said.
The world’s first AIDS clinic opened in the now-iconic space on Jan. 1, 1983.
The following June, the first in-patient clinic in the world opened up in Ward 5-B, where Volberding and Wofsy initially treated patients. Dr. Donald Abrams, another oncologist, soon transferred from UCSF Parnassus to join their efforts.
As Volberding, Wofsy and others were expanding the clinics, it was Volberding’s wife, Molly, who encouraged other health care workers to become involved in fighting the AIDS epidemic. Concern arose that students might not attend UCSF because it was a major center for AIDS treatment early on, but Volberding’s wife quelled those fears.
“She did studies on that and proved it wasn’t the case,” Volberding said.
Today, Ward 86 is the biggest AIDS clinic on the West Coast.
A CHANGING VIRUS
Volberding and his wife continue to treat AIDS patients in San Francisco today.
However, the advancement of therapies has severely reduced the number of those who become sick enough to require hospitalization. Even within the past seven years, the number of new HIV cases in The City has declined by 30 percent.
In academic hospitals, medical care includes a senior physician, a resident, at least one instructor, and several interns and medical students. Teams typically manage 20 or so patients. At the height of the AIDS epidemic in the 1980s, more than half of the patients cared for by teams had AIDS.
“People have forgotten how amazingly bad this virus is,” Volberding said. “Now the interns that used to see all these patients all the time don’t see them at all anymore.”
HIV and AIDS are much more fatal than Ebola, he emphasized. With good care, Ebola is survivable. But without the current drugs, HIV kills 98 percent of those who contract it.
“You can’t possibly imagine how bad it was, the wasting,” Volberding said of the virus’ emergence in the 1980s. “These were healthy young people. They’d be just gaunt.”
Cancers, blindness and dementia were among the associated health care issues brought on by AIDS.
“People would get to the point [where] they literally couldn’t raise their hand off the bed,” Volberding recalled.
One aspect of care lives on from the early days of AIDS: the nontraditional family units that emerged as a way to support those with the virus and who were alienated by their loved ones. Community organizations, particularly within the gay community, emerged to take their places.
“Even my poorest patients with cancer at San Francisco General tended to have families that would help in their care. A lot of the early [AIDS] patients really didn’t have that,” said Volberding.
LIFE AFTER S.F. GENERAL
In 2001, Volberding took a job as chief of medicine at the Veterans Affairs clinic in San Francisco after overseeing AIDS care at San Francisco General for two decades. At the VA — one of three UCSF facilities where students, residents and fellows rotate through in their training — Volberding oversaw 100 physicians and continued to treat AIDS patients.
But the virus that Volberding treated on his first day at San Francisco General in 1981 would soon become part of his career again. In 2012, he was named director of the UCSF AIDS Research Institute. Volberding also co-directs the Center for AIDS Research with Dr. Warner Greene of UCSF-affiliated Gladstone Institutes.
Volberding acknowledges that his career in medicine is unique, having been able to work with HIV and AIDS for so long that he has seen it go from a global epidemic to a controllable virus.
“Not many people have had that privilege,” he said.
Volberding turned 65 in September, and he has no plans to retire anytime soon. The revered physician enjoys watching the next crop of doctors at work at UCSF, particularly at the Mission Bay campus where he has worked since October.