Susan Desmond-Hellmann
speaker
362 appearances
1 recordings
1 series
first heard Apr 2025
last heard Apr 2025
Susan Desmond-Hellmann’s voice in public audio — every appearance, attributed to the second.
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Appearances
Just on the brink.
If you were in Uganda at the time, gosh, especially amongst males, but also males and females, it's so hard to give those numbers. But I would say about a third of patients who sought medical attention probably had KS, some KS.
Depend on the population you treated. It was double digits in the country as a whole. If you were 16 years old, if you were a 16-year-old girl and you went to the STD clinic, you had a 50% chance of being HIV positive. 16, and most of those girls, it was their first and only sexual partner. It was Russian roulette to have sex in Uganda then.
You got the bullet in one of the two chambers. Yeah, yeah. And the best business in town, Coffin Maker. We would go, we would drive back to where we stayed, and you would see, if you've ever been in an African village, like they'll prop up the coffins made of wood, and you just see them because that was so astounding.
The feeling of being scared and sad in San Francisco in 1982, multiply that by a thousand in 1989. It was... terrifying. If we hadn't gotten ARVs, this was killing people. But, you know, the same time, the first time we went back to San Francisco from Uganda was six months after we had left.
I went back to the Kaposi Sarcoma Clinic that I had led and said to the nurse, oh, yeah, ask about your patients. I had so many great guys who I cared for. All my patients were dead, all of them, six months. The sense of how bad HIV was before antiretrovirals, it's impossible to overstate it, just impossible. And when we were in Uganda,
It was really clear that you could see someone's immune status with a good physical exam if they had Kaposi's sarcoma. I wrote a paper that I think is a good paper if you do global health and you have limited resources. It was a paper that had one observation. If you had Kaposi's sarcoma on your soft palate, on the roof of your mouth, you had HIV. 100% predictive.
Kaposi sarcoma, there's a Mediterranean form and an African form. It happens on your skin. It can cause elephantiasis, but it doesn't go in. The mouth is just a surrogate for your GI tract. Doesn't happen unless you're immunosuppressed with HIV.
Many would die from pneumonia. There was severe cachexia, and then they were prone to pneumonia and other problems. But Kaposi's sarcoma in the lungs or the stomach can also cause bleeding, and you can die from that.
We knew most of the clinical syndromes associated with HIV.
Yeah, Bob Gallo was one of the, Luke Monnier was, you know, they had a fight over who deserved the credit. But yeah, we knew about HIV then. And we knew the biology. And we knew as soon as we got to Uganda and examined patients that this was heterosexual transmission of HIV. And we knew that untreated STDs were a big reason. And that was a very important thing.
It wouldn't be that high, no. So one of the really important aspects of STDs is high frequency of herpes and chancroid, really open lesions that are very, very, if not treated.
High viral load and transmissible. Yes, yes. So we knew all of that. Now, we also knew that some of these were treatable, that both medication, also Museveni, the still leader of Uganda, had this very funny campaign called Zero Grazing. So they raised a lot of cows, and this is very important in Uganda is having a herd of cows. It means you're an important man, you know.
Museveni always wears this hat like he's raising cows. So Zero Grazing, the farmers and many people knew what that meant. One wife, one partner, no grazing. And so there was a pretty good public campaign. We did a lot of condom distribution.
They were very on board. They also knew that this was going to be a geopolitical problem for them if people were dying in the prime of their lives at the rates they were. They got that. This was really clear to them.
In East Africa, there was quite a bit. There was a lot of HIV in Kenya, and there were programs like the one that we had in Kenya, Tanzania. There were others where it was more unknown, I think not talked about. I mean, the program I know about... most today is the program my husband's been working with for 15 years, which is Elizabeth Glazer Pediatric AIDS Foundation.
They work now, I think, in 12 countries in sub-Saharan Africa, and many of the southernmost countries are heavily affected by HIV still.
Oh, no, I can't estimate it.
Yeah.
If there's 16 million people, it wouldn't have surprised me if there were a million people who died. I mean, it's that kind of numbers. I'm probably exaggerating, but not by much. And I think the sense of feeling overwhelmed is just really important. What I realized I was doing, I don't know if you've interacted with people in the military much, but if they were on the battlefield, they triage.
Showing 41–60 of 362 · page 3 of 19
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