By Dr. Robert Bolan
Over the course of my medical career I have seen the profound impact of tragedies and triumphs on our community. I graduated from medical school and completed my formal training in the 1970’s when there was no education about LGBTQ health issues. The consequences of the Stonewall riots in 1969 for the social revolution we called Gay Rights were just beginning to be felt.
Inspired by those brave souls who stood up for their human rights to be respected and to love whoever they chose, I resolved to devote my career to improving health care for our community.
During my residency, I began volunteering at a Gay STD clinic in Milwaukee, Wisconsin. There I met many other dedicated health care professionals, including physicians from Milwaukee’s Public Health Department, all of whom would gather once a week and volunteer their services. I quickly came to meet others in nearby Chicago where they were doing the same work and learned that the Centers for Disease Control was very supportive of these Gay STD clinics around the country because they were addressing a need which local and state public health programs were unable to appropriately handle.
The fledging Gay Community Services Center on Wilshire Blvd. in Los Angeles was one of those places.
Although these were the days before HIV, the storm clouds were already gathering. Nearly everyone whose sexual freedom included having many partners learned that this particular freedom unfortunately comes at a price. Although there was nothing new about this reality—viruses and bacteria have always taken cruel advantage of human intimacy. The first documented syphilis epidemic occurred in Italy in 1495 and marked the beginning of countless tragedies brought about by sexually transmitted infections around the globe. Then, sometime in the 1970’s, a viral pathogen crossed over from the animal kingdom into humans.
I had moved to San Francisco from Milwaukee in 1979 because of the rapidly growing gay community there and because there was an organization of doctors like myself, the Bay Area Physicians for Human Rights. As my private practice began to grow, the first cases of HIV were beginning to emerge in 1979 and 1980—well before the first official reports in 1981—and we had no idea what we were seeing, or even that this was a new infectious disease. Very quickly the horror grew. The early attempts to label this new disease as a Gay Plague found receptive audiences around the globe—even in our own government—such that our community was fighting both a new infectious disease and deeply rooted homophobia, now emboldened, claiming that AIDS was “just retribution” for our community’s “unnatural” behavior.
Starting at Center in 1996
When I started working at the Center in May, 1996, I was employed as the Medical Director of the new HIV Program in the Department of Family Medicine at the University of Southern California. It was at the very beginning of the new “combination therapy” era of the HIV epidemic and the Center had “nurse clinicians” prescribing and managing patients with a limited number of medications.
From 1986 until 1994 we had only single drugs to treat HIV and the virus would quickly develop resistance mutations to them. The virus would continue its relentless course and people continued to sicken and die. But now we had new, more powerful drugs—the protease inhibitors—which, when combined with the older drugs, actually decreased hospitalizations and deaths.
With my USC connection, I was able to assemble a team of residency trained Family Physicians to provide full primary care and HIV management for our patients in the Jeffrey Goodman Special Care Clinic. Our program grew stronger as we incorporated primary medical care into the existing networks of specialty and social services in Los Angeles.
Among the things I am most proud was our HIV fellowship program where we were able to train three excellent physicians, one of whom is still with us—Dr. Jason Hall, our Medical Director of HIV Medicine.
“No Longer Just an HIV Clinic”
I am also proud of the fact that as we strengthened our primary care medical faculty and began to directly employ those providers, rather than have them “on loan” from USC. We were able to build a medical group that could provide continuity care for all members of our community without regard to a particular diagnosis. In other words, we were no longer just an HIV clinic.
Then we attained our Federally Qualified Health Center status in 2013 and it became financially possible for us to be health care providers for all members of our community without regard to insurance status.
The comprehensive nature of our services, including an integrated pharmacy and nursing case management, are what make the medical services work. In truth, no single discipline or leader could do what we have done together.
During this time, there have been incredible advances in HIV treatment. Now, not only is control of HIV infection possible, we can also prevent infection with Pre-Exposure Prophylaxis (PrEP). The task for the next several years is to work to remove all of the barriers that prevent the equitable uptake and consistent use of PrEP.
The Center will continue to be the beacon of hope, announcing to all that together we can do anything. I am proud to have been your Chief Medical Officer for the past 25 years and I have complete confidence that as Kaiyti Duffy takes over from me, you are in excellent hands.
She can lead the Center’s excellence in health care for the next generations of our rainbow community.
