Recognizing dermatologists for their role in the fight against HIV and AIDS, according to journal

Their practice encompassed the study of sexually transmitted infections until the 1950s, note the authors of this landmark review, at which point they “left” the care of these patients to others. Several decades later, the HIV / AIDS epidemic once again required their expertise in the study of STIs, also known as venereal diseases, “due to the skin manifestations of HIV”.

They quickly became the primary advocates for these marginalized patients. And yet their contributions have been largely shelved in place of the more widespread recognition accorded to doctors, scientists, public health experts, community activists and grassroots organizations.

Marcus Conant, MD, and James Groundwater, MD, were practicing dermatologists in San Francisco in the early 1980s when they first discussed the appearance of rare patches of KS on a young gay man. Conant had previously collaborated with Alvin Friedman-Kien, MD, of New York University, on the recent occurrence of a cluster of KS cases among young gay men in the city, the authors note. The former soon after established a KS clinic at the University of California at San Francisco with the help of its dermatology department.

Friedman-Kien subsequently noted in Journal of the American Academy of DermatologyOften times the first contact of an HIV-1 infected patient with a health care provider is the dermatologist. In particular, people who are unaware that they are infected with HIV-1 may turn to dermatologists. “

And according to the authors, acclaimed historian Sally Hughes, PhD, points out that during the first 2 years of the AIDS epidemic, Conant’s KS clinic and study group facilitated the biomedical response to AIDS in San Francisco and its chef has become a strong advocate for his patients. .

Other areas of dermatological research during this period included transmission of HIV through dendritic cells in the skin, the immunology of AIDS in psoriasis, and therapeutic and drug adverse effects. “The contributions of dermatology have been and continue to be immense,” note the review’s authors.

At the same time, however, as many dermatologists strive to unravel the mysteries surrounding HIV and AIDS – including through the Gay and Lesbian Dermatology Association – the neglect and homophobia towards these patients were endemic, including from others in the field of dermatology. Many were unwilling to treat patients, often denigrating them, and at large meetings, such as those held annually by the American Academy of Dermatology.

The authors of this review also note that more could have been done but dermatological research was limited due to “overt homophobia” and minimal funding, which in turn affected the publication of results and advocacy for patients. In JAMA Dermatology alone, “only 3 articles on HIV / AIDS and associated skin conditions were published in the 24 issues between 1984 and 1985,” they point out.

“It is essential that this story be remembered; 40 years after the start of the HIV / AIDS epidemic, we hardly recognize the dermatologists who took over and dedicated their lives to affected patients, ”the authors concluded. “This story contains an important lesson, describing a model of engagement of dermatology in clinical care, education, research and advocacy for vulnerable populations around the world.”

Reference

Milbar H, James WD. The role of dermatologists in the early HIV / AIDS epidemic: a historical assessment for the 40th anniversary of HIV / AIDS. JAMA Dermatol. Published online February 10, 2021. doi: 10.1001 / jamadermatol.2020.5545