"The most important thing that has happened," said Dr. Alvin E. Friedman-Kien of the New York University Medical Center, in a recent newspaper interview, "is that the medical community and the world community have become aware of this illness [AIDS] as a major threat to the health of all people, people of all backgrounds. The disease is no longer seen as restricted to only homosexual men or intravenous drug users." (Dr. Friedman-Kien was among a team of physicians and researchers at NYU who recognized the beginning of a new health crisis we now call AIDS, Acquired Immune Deficiency Syndrome.)
The disease, believed to be caused by an unidentified virus, has been called an epidemic because it has struck more than one percent of the population. According to the Centers for Disease Control, as of July 2, 1984, 5,037 AIDS cases have been reported since 1981 nationwide (most of the cases are in New York City). Of that number, 2,274 are now dead. Dr. Friedman-Kien has said that "...[W]e're recognizing cases now that we'd previously missed, or misdiagnosed due to either the patient or the physician who just didn't know what the manifestations of the disease were. The reporting is better.... And there is an increase in cases seen in New York City. My impression is that AIDS is in fact not going away at all but is perpetuating and continuing." (New York Native, July 2-15, 1984) Those who are most at risk for the disease are gay or bisexual men, IV drug abusers, hemophiliacs, and Haitians. (Those in this latter group are thought to be included in the other risk groups.) "My suspicion," said Dr. Friedman-Kien, "and it's only a guess, is that, aside from an agent which causes the ultimate disease, an individual must be predisposed in some way by being immunosuppressed."
One black doctor in Harlem who has shown interest and involvement with AIDS is 36-year-old Donald A. Dayson. He is connected with Harlem Hospital and shares a private office in the Riverton Apartments with Dr. John Holloman. Dr. Dayson, who graduated in 1979 with a medical degree from the State University of New York at Stony Brook, is presently treating a former IV drug abuser for AIDS, a black man in his mid-thirties. Dr. Dayson's patient is among the 26 percent of people with AIDS who are black.
Charles Michael Smith: Do you see AIDS as a major health threat to the black community?
Donald A. Dayson: That's a difficult question to answer because we don't really know the extent of AIDS here. AIDS is something new that we don't quite know how to care for.
CMS: How did you become interested in this disease?
DAD: First of all, I trained at Harlem Hospital which sees a lot of IV drug abusers. More than any other hospital within the city. The first person I ever saw who had immune deficiency was not diagnosed as [having] AIDS. It was a woman who didn't use drugs. She was not related to a gay male. I still don't know what the woman died from but her immunological defenses were totally absent. We didn't do the studies that are now being done with patients who have AIDS such as lymphocyte studies. These [lymphocytes] are different types of white [blood] cells. A lymphocyte is a special form of white cell that is used by the body to fight off infections. A lymphocyte study would be a study of a special type of white blood cell called a lymphocyte. She did not fit the criteria for AIDS.
CMS:You are presently treating an AIDS patient.
DAD: Yes, a former IV drug user.
CMS: At what stage of the disease is he?
DAD: He's in one of the early stages. The diagnosis was just made. I actually suspected the diagnosis in July of 1983. That was when I first encountered the patient. [ Note: His symptoms were weight loss, fatigue, and swollen lymph glands--CMS.] The diagnosis was actually confirmed to the point where we could speak to him directly within the last few months. We were telling him that he should be careful of who he gets in contact with because there is all kinds of problems out there. AIDS being one of them. I didn't want to tell him that he had AIDS until I was pretty sure that we could rule out any other reason why he was sick. It was during the height of the [AIDS] hysteria [when people thought] that once you got AIDS, you're dead. We didn't want him walking around feeling like a dead person, if he had something else. We were looking at other diseases that could give him this problem, other diseases where there was a hope of some cure. He had asked early on if he had AIDS. We said it could be AIDS, it could be this, it could be that, it could be all these other things.
CMS: How does a doctor treat a person with AIDS?
DAD: You have to understand a little bit about the way we defend ourselves against the ocean of germs that surround us. On everybody's skin there's a germ called staphylococcus which once it gets into your bloodstream, it can kill you very quickly. Once it gets past the skin, we have a good antibiotic for it that can kill it. The skin is one of our major defenses [against germs].
CMS: Do you feel the medical establishment is doing all it can to solve the problem?
DAD: Yes. People in this country tend to think of the medical health system as being well-integrated, that is, all of the different parts of the health system working in unison. It's not. Sickle cell anemia is a well-known disease because it was a bio-chemical breakthrough that led to the knowledge that we have about sickle cell. We're still a long way from treating that [disease]. And that's from 1948 that we identified the bio-chemical link in sickle cell. We have no cure for [it]. The only thing we can do is treat the disease symptomatically. The only way we can prevent it is to tell someone with the sickle cell trait to be aware that if you marry someone with the trait that you can end up with a child who has sickle cell.
A lot of money has been put into [sickle cell research]. Not because they wanted to see black people treated for their sickle cell but because there was money to be made in it. All of the knowledge that we have, on a scientific basis, we can bring to bear on it. AIDS, scientifically, is a fascinating disease. What is it about the human body that's been turned off with a patient with AIDS?
CMS: There have been stories reported in the media about AIDS patients being mistreated in hospitals by health care workers. Have you found this to be true at Harlem Hospital?
DAD: It varies. The way the media has handled AIDS, I think, has been somewhat irresponsible. Because it has produced a level of fear that makes it difficult to treat some very sick people and also created a fear that might hinder some basic research. I know about the recommendations of the CDC[Centers for Disease Control in Atlanta]. If you're treating someone with AIDS, you have to treat them as if they have hepatitis, an infectious disease. Initially, they [AIDS patients] are placed in isolation. The hepatitis patient is placed in isolation when a question about shedding the virus [arises]. When someone first contracts hepatitis, the virus is still active. When I say isolate them, I don't mean we're really isolating them. What we take is called hepatitis precautions. As long as you wash your hands after seeing them, don't come in contact with their secretions by wearing gloves, and try to avoid people spraying their droplets on you, there's no problem. By shedding [the virus] we mean that the patient is still actively producing the hepatitis virus that can affect someone else.
I don't think it [AIDS] is highly infectious. We don't recommend reverse isolation where everyone coming into contact [with the patient] has to be gowned up. That's because the infections that would wipe out an AIDS patient are ones most people's bodies can control.
The treatment of an AIDS patient [requires the physician] to control the infections, to watch the infections. If you had AIDS, and you have the sniffles, rather than just listening to your nose and describing some symptomatic vindication, I'd make sure I'd get an X-ray and make sure that the sniffles are not a harbinger of something more acute.
CMS: What are your thoughts about the Haitian connection in the AIDS mystery?
DAD: I attended one of the conferences of the New York [City] Department of Health. A member of the panel raised the issue that for Haitians coming to this country, you're asked two questions: "Are you a Communist and are you a homosexual?" If you answer yes to either one, you know that you won't get your visa approved. And something that's not talked about much is that Haiti, while being a very poor country, also seems to have an influx of gay men vacationing there.
This is an excerpt from an unpublished article that I wrote on August 8, 1984.
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