The Pandemic of The 90s

#USA

Post#22

Long read alert !

The Pandemic of the 90s:

The covid pandemic is the second, not first pandemic I have lived through since coming to America. The account of my residency will not be complete without capturing the memories of the AIDS pandemic. 

In 1994 , the year I started my residency, Acquired Immunodeficiency Syndrome had become the leading cause of death for all Americans ages 25-44. Indeed those 3 years of my residency were page turning years in the history of HIV infection and AIDS. Within the short span of 2 years the disease went from being the leading cause of death ( in 1994) to seeing a decline in deaths for the first time( in 1996) since the disease first appeared in 1981. And the reason for this dramatic change was introduction of anti retroviral drugs, with AZT given to pregnant women to prevent perinatal transmission to protease inhibitors introduced in 1995 . This had ushered in a new era of Highly Active Antiretroviral Therapy( HAART).Also in 1994 the first oral test for detection of HIV antibody was introduced. As you can imagine it was the first time in over a decade since the pandemic that things had started  to look optimistic. In 1996 the International AIDS vaccine initiative was formed . 

What did this mean to me directly? LA county hospital was the single largest hospital in the country for people with HIV infection and AIDS to be seen, diagnosed and treated. We had an entire ward / floor dedicated to these patients. I had the good fortune to rotate through the department of Infectious Diseases for a month in each of my three years which in turn gave me the opportunity to work and learn directly from the professors, who were really scientists at the forefront of research in that field. As soon as the evidence or guidelines were out about certain therapies for the HIV infection itself or the opportunistic infections associated with it we would be ordering those for the patients under our care. Protocols were changing from week to week if not day to day. Writing orders for the treatment of PCP pneumonia, recognizing PCP pneumonia on a chest X-ray or Toxoplasmosis on a CT scan or identifying Kaposi sarcoma had become a child’s play due to the sheer volume of cases we saw in those years. 

While it was beginning to look encouraging on the diagnostic and therapeutic fronts it was still quite heartbreaking on the social side of the story. Majority of the patients were gay men. While gay lifestyle was still kept under wraps for obvious reasons the diagnosis of HIV completely removed their cover and inevitably exposed these men to their families and social circles. The miseries arising from this were countless and unimaginable. They were disowned by their own parents, shunned by grandparents, lost their jobs and died orphans. 

I could never forget this one young man in his 20s who was admitted under my care when I became a senior resident. He was slowly dying of advanced AIDS. His partner had died a few months before him. He was adopted as a baby by a couple who lived in New York. He gave us their number as next of kin. When I called to inform them about his condition they were not moved. He was no longer their son they told me coldly. I still called when he passed away. They did not want to claim his dead body . That sight of him dying with nobody in the whole world  who would call him their own is something I can never express in words or ever forget. I could only wish that such fate never came to another person ever. But that was wishful thinking. 

It took years since my residency before newer drugs finally made the deadly disease become curable in reality. Today the diagnosis of HIV no longer is synonymous with a death sentence. The laws have been strengthened to protect the privacy and jobs of affected individuals. 

While HIV was getting more love from the scientific community and governments across the globe, the realities for the LGBT ( Lesbian,Gay, Bisexual and Transgender)community were still grim. 

From my work in the medical field, especially during discussions with the professors in the Infectious Diseases department working with gay men with HIV it had become known and accepted to me that being homosexual is not a choice these individuals make. Their brains are wired differently. This is how they are programmed to live. Most of them if they truly had a choice would never choose homosexuality because of the extreme hardships it entailed. 

This knowledge and realization was a game changer for my outlook. Truth was I had never thought deeply over this issue when I was in India. When I was home for four years in America before residency whatever I saw on TV or heard from my social circle had created a rather negative perception of homosexual people. This completely changed after seeing the dying men( and women) in my care during residency. The truth that these are just human beings who are just as much in need of happiness and love as anyone else became firmly established in my heart and mind. 

My kids when they were teenagers once asked me Aai what would be your reaction if one of us came to you and said I am gay? The immediate natural reaction was to miss a heartbeat. But I thought over it seriously. I was sure I would not disown my kids but I would be worried because life would become extra hard for them in that situation. 

Well although their innocent yet testing question was purely hypothetical, it emerged as a reality for another mom in the family. Sheelatai ! Her younger son announced to them when he was in college that he is gay! The poor parents were stunned, shocked ,worried,angry and confused. They are both engineers and therefore did not have the scientific perspective into the biology like we did. And they had no one to share this rather catastrophic news with other than me and Abhay. 

The relationship between Sheela tai and me has always been extremely good. Mostly she was a benevolent elder sister to me ( we are 16 years apart) but after this revelation from my nephew the roles reversed. I became her counselor and confidante. I tried to instil the confidence in her that her son is a good human being, kind and caring , has not cheated or robbed anyone , has done nothing criminal and she should hold her head high , be proud of him and stand by him.  

She is close to her sisters in Pune and it became rather confusing when she shared the situation with them. Folks in India are miles away from accepting homosexuality as an inevitable identity and reality for anyone, leave alone any close family member. I can understand the pressures, the taboo, and embarrassment they felt in this situation. While I was trying to make Sheela tai accept her son as is , from India they were suggesting various things like pujas and homas and psycho therapy or even hypnosis to “cure” the boy. They were urging her to take him there. It was truly a very traumatic period for Sheelatai as well as her husband. But eventually she realized that she needs to support her son.

I am not sure at what point she reached the state of unconditional acceptance but I was really happy when she did. To the point that she started hoping he would soon find a nice partner to settle down with. And eventually he did. In January of 2019 he got legally married to his boyfriend Derek in the presence of family and friends. Not just their friends but also the friends of their parents. It was a remarkable ground breaking moment for the family in more than one way. Besides being the first same sex wedding it was also the first time when a non-Indian became a part of the family. Once the parents have opened their hearts it really doesn’t matter too much whether or not rest of the family follows suit. 

I know firsthand what a positive influence Derek has been on my nephew Jay and I feel content to see them happy together. I saw Jay as a five year old when I was newly married and visited San Diego for the first time with Baba. We are very close and now Derek has become close too and they both know where we stand on the issue. In fact I called Jay to take his permission to share this story that involves him and he was happy I was going to touch upon the issue. If Aai( MIL) was alive today I feel confident she too would have put aside old conditioning and opened her heart for her grandson and welcomed Derek into her brood. 

In honor of the LGBT community that is also known as the Rainbow community today I picked this silk saree with Kantha embroidery that celebrates color like no other.