In 1981, as an assistant clinical professor in the Department of Medicine at the University of California, San Francisco, Dr. Eric Goosby watched with alarm as the AIDS epidemic was born. Two years later, while working as Medical Director at the Southeast Health Center at San Francisco General Hospital, he began his career treating people with HIV and AIDS. That career would culminate in a decade of public service, during which he guided much of the federal government’s AIDS treatment policies.
Dr. Goosby began working in the federal government in 1991, when he was named Director of HIV Services at the U.S. Public Health Service/Health Resources and Services Administration. From this post he oversaw the Ryan White CARE Act program, which is the primary vehicle for distribution of federal AIDS dollars and the nerve center supporting the treatment and prevention programs that the government funds. What he saw in this position, Dr. Goosby says, was that, nationally, African Americans living with HIV are simply not making it into medical care. “As a result,” he explains, “we have more frequent and more severe opportunistic infections, and die earlier than our white counterparts.”
In 1995, having become director of the Department of Health and Human Services’ HIV/AIDS policy division, Dr. Goosby watched as new drugs, dubbed protease inhibitors, revolutionized AIDS treatment. The drugs, taken in “combination therapy,” had great potential to prolong lives, but few doctors had working knowledge of them. So Dr. Goosby led the federal government in creating explicit recommendations to guide both people with HIV and their physicians in using these new medications. He created and chaired the federal “Guideline Committee on Standards for the use of Protease Inhibitors.” This now-famous committee hammered out recommendations on how to use the newly-discovered AIDS drugs. The committee discussed who to treat, what to start with and when, and how to change from one drug regimen to the next.
Since then, the new drugs have shown good but not perfect results— prolonging thousands of lives but proving useless for some. Many physicians treating African American patients say the demanding regimens, and their many possible side effects, are untenable in low-income populations, or among risk groups such as injection drug users. This mixed effectiveness, often hinging on a patient’s willingness to submit to difficult dosage schedules, has left some doctors debating when and how the drugs should be prescribed. But Dr. Goosby warns healthcare providers against indulging in such calculus.
“The offering of combination therapy to any given individual is not something that is dependent upon, or should be determined by, one’s socioeconomic class, or risk factor of HIV, or preconceived ideals [about a patient] that healthcare providers may have–” he argues, “–for example, that IV drug users will have a high incidence of non-compliance.” He believes those discussions do not belong in the initial stages of therapeutic intervention. He says HIV/AIDS patients will largely conform to treatment requirements when those individuals understand and trust that caregivers are honest with them, and are available to them for questions and concerns. “Black people should benefit from the medical advances in treatment. The drugs are effective, they decrease suffering and increase length of life.”
Recently, Dr. Goosby left government to accept the position of Chief Executive Officer and Chief Medical Officer for the Pangaea Global AIDS Foundation (PGAF), an affiliate of the San Francisco AIDS Foundation. PGAF is a non-profit agency that works to develop delivery systems for medical care and prevention information in resource-poor regions of the world. In this new venture, Dr. Goosby’s emphasis is again on finding ways to safely introduce antiretroviral medications to ailing populations. He and PGAF are already working on such a project in Rwanda, where they have established three clinics, serving around 1,000 people in each. Working with former President Bill Clinton’s foundation, Dr. Goosby also played a major role in helping South Africa, which has more HIV-positive people than any nation in the world, develop a plan to provide AIDS drugs free-of-charge to all who need and want them.