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The Future of Ward 5B

By Michelle Konstantinovsky

Doctors Diane Havlir and Paul Volberding represent the past, present and future of pioneering AIDS and HIV treatment in San Francisco. (Spencer Brown)

The past is present at Zuckerberg San Francisco General Hospital, where the legacy of the first AIDS inpatient unit continues with a crusade to reduce the City’s HIV infections and deaths.

Diane Havlir was a medical student at Duke University when she read about the first cases of a mysterious new illness. It was 1981 and on June 5, the Centers for Disease Control and Prevention published a report chronicling five cases of previously healthy young men who developed life-threatening lung infections — two had died. Inspired to take action, Havlir took a summer internship at the CDC and joined the newly formed task force assigned to investigate the issue.

“I answered phone calls pouring in from New York, Miami and San Francisco of possible additional cases of this new disease that still didn’t even have a name,” Havlir says. “I was hooked.” It would take another year for public health officials to begin using the diagnosis “acquired immunodeficiency syndrome,” or AIDS, to describe the occurrences of deadly infections, cancers and pneumonias striking once-healthy individuals. And it wasn’t until 1983 that scientists pinpointed the precursor to the lethal illness: human immunodeficiency virus, otherwise known as HIV.

Havlir felt compelled to continue her workin the field and completed her medical training at UCSF because of its location “in one of the epicenters of what by then was being called the AIDS epidemic.” By the time she began her internship there in 1984, San Francisco General Hospital had already made a concerted effort to combat the outbreak with the opening of Ward 86, the world’s first dedicated AIDS outpatient clinic, and Ward 5B, the first inpatient unit. “My second month as a newly branded physician brought me to caring for patients on 5B,” she recalls. “Looking back, this was a transformative moment of my professional career.”

Today, Havlir wears many hats: Not only does she run the HIV division at the hospital, now called Zuckerberg San Francisco General Hospital and Trauma Center, but she’s also a professor of medicine at UCSF and the co-founder of Getting to Zero San Francisco, an independent consortium that unites multiple organizations and agencies as part of a mission to drive down HIV infections and HIV-related deaths by 90 percent before 2020. When she began her career nearly four decades ago, there was no precedent for the care she sought to provide.

“No one is really ever ready for a new epidemic, and that was certainly the case in the 1980s when AIDS first appeared,” she says. “We knew so little — but we also saw so much so fast. No one would’ve thought that this new disease would kill over 30 million people in the next 30 years.”

Dr. Paul Volberding, one of the founding physicians of SF General’s AIDS clinics, concurs, recalling: “5B from the start was nursing-led and-operated when we had absolutely nothing to even slow the course of [patients’] devastation and death.”

By the time the New York Times ran a story titled “Ward 5B: A Model of Care for AIDS” in 1985, every region in the world had experienced at least one case of the disease, with a world-wide total of 20,303 people affected. For many, the statistics feel as freshly devastating now as they did nearly four decades ago, which is why Ward 5B remains an iconic and internationally significant institution. It closed in 2006, a major sign that experts were making headway in the fight against HIV and AIDS. The unit’s legacy continues with the documentary 5B, which opened in theaters this summer and collects testimonies from Volberding and more.

After completing her education at UCSF, Havlir worked as a physician and clinical researcher at UC San Diego, where she contributed to studies on cutting-edge treatments, including combination drugs that transformed HIV from a uniformly fatal disease to a chronic one. “I remember the day and moment that the early results came on fax showing that the combination of three drugs worked,” she says.“At that moment, I knew from a treatment standpoint that everything would change — we could help people live with HIV, not just die of HIV.”

While great strides have been made, Havlir is adamant that the fight is far from over and that San Francisco must continue to lead the crusade. The U.S. has about 40,000 new HIV diagnoses every year — more than any other high-income nation in the world — and that includes 200 cases in the City each year. Havlir believes these statistics highlight the health disparities driving new infections and deaths; HIV disproportionately affects people of color and those of lower socioeconomic means. “We need to change that and we can,” declares Havlir, whose organization, Getting to Zero San Francisco, is “making great progress.” Over the past four years, SF has seen a 50 percent reduction in new HIV diagnoses compared with the nation’s six-year drop of 16 percent.

Havlir still oversees care for the 2,500 patients at Ward 86. “Under the leadership of Dr.Monica Gandhi, we started the Golden Compass program, providing specialized services to the aging population with HIV in our clinic,” she explains. “We also recently launched the POP-UP program, which provides on-demand HIV chronic care for homeless persons.”

While a cure may still be out of reach, veteran physicians such as Havlir and Volberding remain optimistic. “We have along way to go, but we’ll never find it if we don’t look — so we’re investigating a lot of ways to find a cure, which is really exciting,” Volberding says. “Meanwhile, we’re looking at ways to deliver the tools we have now more effectively to try and bring the epidemic to an end.”

For Havlir, San Francisco is the Silicon Valley of innovation — at least in terms of the ongoing battle to treat, and manage, a virus that once led to mass tragedy across America. “The progress we’ve made in HIV would not have happened without the partnerships between the City, the community, the scientists, front- line health providers and industry,” she declares.

“We will not let up until we’ve provided the best care for those living with HIV and prevented new infections for those in our city, in our country and around the world.”

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