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Monday 10 April 2017

HIV and AIDS - The Earliest Days, Pt.2

Posted in: Health & HIV
By - 31st May 2015

In part one of this feature, taken from a speech given by Dr Rod Ellis Pegler, the first NZ infectious diseases specialist to be confronted by the HIV epidemic amongst gay and bisexual men, he recalled the period leading up to the emergence of AIDS in New Zealand.

Dr Rod Ellis-Pegler
All these events were being played out against the extraordinary background of the acceptance or non-acceptance of homosexuality and nowhere were those events more polarised than they were in the USA. And as now the USA was so noisy that everything that happened there we seemed to hear. But it wasn't really until the death of Rock Hudson from AIDS in 1985 that mainstream USA woke up to what was going on around them. Hudson was a big Hollywood screen idol who always played womanising, muscular, cowboy-type roles, a symbol of American heterosexuality of the time. He was in fact a gay man and this became widely known upon his death.

A few years later Rudolph Nureyev, an extraordinary ballet dancer, who I was lucky to see just once, who erupted onto the stage – I had never imagined that a human being could move in such a way, he also died of AIDS, in London, and like Rock Hudson had elected not to acknowledge his homosexuality.

The American journalist Randy Shilts published a 630 page book in 1987 called And The Band Played On, about the politics of the AIDS epidemic. The analogy of course was to the band that played on as the Titanic sank around them.

In spite of the events in the USA it was not until the middle of 1987 that Ronald Regan, then into his second presidential term and, as we now know, afflicted with early Alzheimers, gave a speech in which he mentioned AIDS for the first time. By that time there were 36,058 US citizens diagnosed with AIDS and 20,849 had already died. And the band played on. Such were the times.

But back to 1984 in New Zealand. I recall very well the first patient admitted to Ward 9c with AIDS. He was a young New Zealander who came off an Air New Zealand flight, transferring from St Vincent's Hospital in Sydney en-route to his family in New Plymouth. He had terrible cryptosporidium diahrroea and he was the first person in New Zealand to die from AIDS, on the 4th of April, 1984.

The second patient was a New York man who transferred from a cruise on the Queen Elizabeth which was docked in Auckland Harbour. He had hematemesis [vomiting blood], was covered in Kaposi's sarcoma [red, blotchy cancerous tumours] and was bleeding in his stomach. Luckily he stopped bleeding spontaneously, cancelled the remainder of his cruise and flew back to New York a few days later. In the face of this terrible disease he had the most extraordinary sense of humour. He was a beautiful man.

As the number of infected patients increased through the 1980s the biggest medical complication was pneumocystis pneumonia. About a third of these cases were complicated by pneumothorax [collapsed lungs] which was both scary and painful. Their lungs, crammed with pneumocystis jiroveci and inflammatory exudate, were almost solid and re-expansion was difficult and often prolonged. We often had two or three patients on the ward with pneumothorax... and those bloody underwater chest drains, they were really painful things.

Most of the time through the latter 1980s and early '90s when the epidemic of AIDS diagnoses and death was peaking we had five or six patients with AIDS in 9c at any time.

The number of patients with AIDS and deaths peaked in the late 1980s and early '90s and we were losing close to one a week of those in our care. I know those numbers are not Sydney or Los Angeles or Londson or Capetown, but in Auckland it was an awful lot.

1986 was the year of the homosexual law reform bill. As part of the education around the bill at the time the Hon. Justice Kirby, who was then Chief Justice of New South Wales, was invited to New Zealand. At one meeting he spoke of judicial inequities, including those relating to homosexual people. He finished his talk with a poem... if I struggle reading it now I apologise, it brings back memories of an awful lot of young people whose lives were cut so short.

Had I the heavens' embroidered cloths,
Enwrought with golden and silver light,
The blue and the dim and the dark cloths
Of night and light and the half-light,
I would spread the cloths under your feet:
But I, being poor, have only my dreams;
I have spread my dreams under your feet;
Tread softly because you tread on my dreams.

- William Hunter Blake.

- 31st May 2015

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