What It Was Like to Be a Doctor During the AIDS Crisis
A doctor shares his experiences as one of few treating AIDS in Pittsburgh.
Posted March 2, 2021
A show about a group of young gay men during the height of the AIDS epidemic might sound like a bit of a downer, especially these days. But It's a Sin, which released all five episodes on HBO Max two weeks ago after finishing its run in the UK, devotes plenty of time to showing us the best parts of these men's lives: exploring their identities, falling in and out of love, succeeding in their careers. That is, It's a Sin is partly a story of a group of men who didn't fit in growing up finally flourishing after finding a welcoming and thriving gay community after moving to London.
But it's sadly also a story about the ensuing tragedy that befell them, once the men in that community started getting sick with a mysterious illness.
It's a lovely series that succeeds in making you first care about these characters and then understand their fear and confusion about AIDS and their outrage over others' indifference and cruelty about it.
It's a Sin is fictional, though it is based on creator Russel T. Davies' personal experiences. After watching the series, I was curious to hear from someone who experienced the AIDS crisis first-hand. So I spoke with Dr. Martin Seltman, a family doctor and geriatrician with an interest in LGBTQ care (retired as of 2019). Dr. Seltman was one of the only primary care physicians treating AIDS patients in Pittsburgh in the 1980s. (Dr. Seltman is my wife's uncle.)
In the following edited transcript of our conversation, Dr. Seltman talks about the fear that HIV patients sometimes elicited even in medical staff, his approach to treating HIV patients, and one parallel he sees between the AIDS epidemic and the current coronavirus pandemic.
How did you get involved in treating men with AIDS?
It actually started when I was a resident before AIDS existed. I went to a Family Practice Review conference. And there was a speaker named Jim Huggins, who had started, with his partner, a mental health agency for LGBT called Persad. And he was talking about the issue of access to care for lesbian and gay people, that most people were not out to their doctors, and there were starting to be some issues with some health problems related to gay men, and it was important that people could talk to their doctors about it, but most people weren't comfortable.
I was just interested in that — I was interested in underserved populations. I had some good friends in college who were gay and I just went up to this guy afterward. I was a first-year resident, and I say, you know, I'm really interested in this, how can I help? The number of doctors in Pittsburgh interested in this was so small that the agency started referring patients to me. So as a resident, my practice involved a lot of gay men and lesbians. This was before HIV, and then I went off to the Indian Health Service in Arizona.
When I moved back in 1985, a lot of my patients started coming back to me. At this point, HIV existed, and I would start testing patients. And when I tested someone positive, I would say, "You have to go off to this specialty clinic at the University of Pittsburgh where they deal with just AIDS." And one of my patients very early, he said to me, "No, you're my doctor, I want you to treat me." I said, "Well, I don't really know how to do this." And he started bringing me copies of a newsletter called "AIDS Treatment News," which was published in San Francisco. And it talked about the treatments for HIV-AIDS. And at this point, there was just one drug. It wasn't really that complicated. So I said, "Okay, I'll start treating you." And so I kept up from there.
One of the things depicted in the show is, in the early days of the epidemic, there was a lot of fear and also a lot of misinformation about the virus. Did you see any of that in your practice?
Oh, absolutely. I remember the first patient that I had actually moved here from San Francisco. And he needed to be admitted to the hospital. And when he went into the hospital, he was one of the first HIV patients there and people were afraid to get near him. The food service would put his tray outside the door. Nurses were hesitant to come in; they came in fully gowned and gloved with booties and way more than was necessary.
Also at that point, I was teaching in a family practice residency and we had a separate clinic there. And I wanted to have patients be able to come to that so the residents would learn how to do this. And there was a lot of fear on the part of the staff at that point. And so we had a staff development day. And I talked about HIV and let people talk about their concerns. And in particular, I remember one of the nurses — a really great nurse, cared about patients a lot — she said, "You know, I'm afraid, I don't want to bring this home to my family." And I was pleased that she was comfortable enough to say that. And we talked about what was known about risk and transmission and she eventually became totally comfortable taking care of these patients.
There was a particular resident who just wouldn't hear it and still, even later, maybe mid-to-late-'80s, if he had to go to round on somebody with HIV, he would still put the whole thing on — it was unnecessary. You know, it made patients uncomfortable, certainly.
Did you gradually notice a change in people’s attitudes though?
Yeah, absolutely. By a certain point, maybe late-'80s, patients were mostly treated well, though there was always somebody uncomfortable. Also, their rooms would sometimes not be cleaned, because of the cleaning staff. I mean, in the early days, it was terrible.
As you know, among political leaders the disease was largely ignored and dismissed because of who it affected. In the show, you get a sense of what that was like from the perspective of the gay community. I'm wondering if that affected your medical practice at all?
One thing around that is AZT, the original HIV drug, was initially approved just for people with full-blown AIDS. And a lot of people were concerned that, you know, here's a drug that's available, why should they wait until they're that sick? And why shouldn't they take it early? And there were randomized controlled trials being done, which is the way you learn whether it makes any difference to do it early. But I had patients who said, "I don't want to be in a trial, I want to start this medicine early."
And so I would do that. HIV patients were pushing the medical establishment who wanted to do things in the sort of usual slow way. And I certainly understood that and talked to patients about how it’s important to know for sure whether this works. But if you don't want to be part of that, I'm comfortable treating you early, so patients were making that decision.
Do you see any parallels between the AIDS epidemic and the pandemic that we're in right now?
Yeah, I think, definitely. Early on, that initial fear, people were so terrified about getting HIV, getting AIDS. Early on, it was a death sentence. And so early on in this pandemic, even though the percentage of people dying from COVID was much smaller than people dying from HIV, there was still that same sense of "Oh my God, I better do everything I can to avoid this." And different levels of fear and caution.
And personally, there were discussions about this in our family. And I was more comfortable, having spent a lot of my time around people with HIV at a time when a lot of people stayed away. So I didn't feel the need to be quite as safe as a lot of other people, which I think made my family a little nervous (laughs).
Is there anything else that you would want people to know or anything else that you remember that you want to share?
One thing: I think it was the first patient that got admitted to the hospital. He told me the story of how he was diagnosed. He was a headhunter kind of thing. And he was sitting in his office with a client and his telephone rang and he picked it up. And it was his doctor who said, "Just calling to tell you that you have AIDS. Better wrap up your business." And he hung up the phone and he’s sitting there with his client totally devastated.
He chose to close his business and moved to Pittsburgh to be near his family. I remember him saying this should never happen to anybody, you know, and so after hearing that, my policy then was, I never would test anybody and then tell them, "I'll give you the results over the phone." So in the early days, when it was so devastating, I would always say "Okay, I’m testing you today, I want you to come back in a week and give the results in person." And most of the time the results were negative, and they were thrilled.
Another thing: Here in Pittsburgh, we had something called an AIDS healing weekend, where once a year, all the local AIDS service organizations got together and, and actually, they still do this. They would invite people to come and spend a weekend together at an undisclosed place so that people could be more private. And we would spend a week together. Everybody there either was dealing with people with HIV or had HIV. And there were ongoing discussion groups and presentations, there'd be a dance, there'd be lots of, you know, playful stuff and educational stuff.
And I remember people there would talk about how, you know, in their lives, particularly early on, they had to sort of hold this close and deal with it on their own. And here was this whole group of people, they could be open and share — it was just an amazing experience.
And for me as a doc, you know, I would see people in the office every month or every 3 months and for 20 minutes or half an hour. And here I was living with people. And I saw that early on with AZT you had to take it every four hours; you literally had to set your alarm and wake up in the middle of the night to take this drug. And so I could see what that was like, see these complicated regimens that people later on were taking. So it was an amazing kind of experience to be able to be part of this and to live with this group of people who are going through something pretty devastating.