In 1983, Ronald Reagan was president of the United States. The Philadelphia 76ers won the NBA championships. Sally Ride, aboard the Space Shuttle Challenger, became the first U.S. woman to head into space. The Academy Award-winning “Return of the Jedi” was a box office hit.
That same year, scientists also discovered the human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome or AIDS.
HIVattacks the immune system, which the body uses to fight off most illnesses. The virus is found in and transmitted through bodily fluids, particularly semen and blood. The most common forms of transmission are through having anal or vaginal intercourse without condoms. When someone with HIV develops two or more HIV-related illnesses — oftentimes called opportunistic infections — that person is diagnosed as having AIDS.
In 1985, Bob Fuller thought his world was in a downward sprial when he received a diagnosis that he was HIV-positive, which meant, at the time, he had an illness no one really knew how to manage. Like many of the 1,000-plus people diagnosed with the virus at the time, he believed the diagnosis was a death sentence. “We were going to memorials and funerals several times a week,” Fuller remembered.
That same year, the doors opened to Madison Clinic, a center that provided medical care and social services for those living with HIV/AIDS in the region, regardless of income.
The clinic is still open. On Dec. 3 it will celebrate its 30th anniversary. It has grown to be Washington state’s largest public health provider for people with HIV/AIDS. Currently, there are 14,000 people living with the virus in King County and 1.2 million people in the U.S. This past year, 3,000 people have come through the clinic’s doors. Fuller is a patient.
“The first time I ever went to the clinic was with friends,” explained Fuller, 72, who called himself the unofficial gay mayor of Capitol Hill back in the day.
Part of the community
Nestled in the sprawling campus of First Hill’s Harborview Medical Center, a public hospital managed by University of Washington Medicine, Madison Clinic sits on the second floor of the West Building. Dr. Robert Harrington, medical director of the clinic, has worked there since 1989 and has witnessed the changes in care for those living with HIV/AIDS in Seattle.
Back in the 1980s, more than 1,000 people were diagnosed with HIV. “The clinic was a little smaller. We didn’t have the resources or the medications that we currently have available,” Harrington recalled. “At one point early on, we had nothing.”
The clinic outgrew several locations over the decades before settling into its current space, which it shares with the UW AIDS Clinical Trials Unit (ACTU), a branch of a national network of research sites conducting clinical trials on adults living with HIV. But it may have been the clinic’s previous location that solidified its place in the community.
“We moved right into the heart of Capitol Hill, which is where the gay community is centered, so we became a part of the community,” Harrington said. “We integrated with the people that are most affected by the infection, and we became a trusted partner, which I think has a lot to do with our success.”
In addition to HIV-specific care, case managers provide social services for patients. Fuller, who originally started receiving medical care from a different clinic, followed his doctor to Madison Clinic because of the financial assistance and convenience. “I wanted to have it all in the same place,” he said.
Beyond medical services, Fuller said a number of other factors have kept him at the clinic for more than 10 years: easy access to medical staff and numerous opportunities for community involvement, such as patient advisory boards. The actu research conducted next door, while run independently of the clinic, is another draw for some patients.
“I like being part of the solution,” Fuller said. “Everyone likes to talk about the problems, but let’s be a part of the solution.”
New era brings new difficulties
While there are more solutions today, such as drug therapies to keep the virus in check, there was a sense of desperation about HIV in the ’80s.
Harrington recalled that no matter where the clinic moved, there was a whiteboard placed in the provider room that had the names of patients who died that day.
“Back in the late ’80s and ’90s, we were writing names up there every day,” Harrington said. “It was crazy, it was busy and it was difficult because we knew in the end, most people were going to perish.”
The whiteboard still exists today, but thanks to significant advancements in treatment, the number of deaths has plummeted. While the number of new HIV cases locally and nationwide has decreased over the past few decades, some significant demographic shifts have highlighted issues with medical care.
In the late ’80s and early ’90s, HIV/AIDS predominantly affected gay and bisexual men. While cases among men who have sex with other men have been on the decline, they still represent a large percentage of the population most at risk to get HIV. Meanwhile, the number of HIV cases within communities of color and among immigrants and refugees is on the rise.
“I think that we have a fairly high African-born population here, many of whom may be coming into the country with HIV, or they might get it here within their own African-born community,” he said. “But the rates of infection are way out of line in that population compared to others.”
Harrington credits a historic lack of accessibility of medical services. He also admits that more needs to be done to combat this shift, and researchers at the clinic are trying to understand HIV stigma in immigrant communities.
With Gov. Jay Inslee’s 2014 commitment to End AIDS in Washington, more resources have been dedicated to “address the disparities in race and in those individuals who are least likely to get diagnosed and maintained in care, including those who are mentally ill, have chemical dependency, or unstable housing.” Washington is the second state in the nation that has made this commitment a priority.
Finding a home
Federal funding received through the Ryan White Care Act and financial assistance from Harborview help Madison Clinic lower barriers to access to life-saving treatments. Additionally, the clinic uses grant funding and community partnerships to operate four satellite clinics to treat patients outside King County.
Affordable and non-medical treatments in places such as Madison Clinic are critical, as people living with HIV/AIDS these days have a longer life expectancy than those diagnosed decades ago. Fuller said he didn’t expect to still be alive today, and after taking life one year at a time, he now counts life in
Next year, he plans to get married. He also devotes time to supporting others through Seattle Area Support Groups, which create space for those dealing with addictions, living with HIV/AIDS and more.
With a variety of organizations across the city working to provide support and services for people living with HIV, those who work at Madison Clinic want to ensure continued access to public health services.
“Seattle’s a pretty great city in terms of acceptance and tolerance,” said Harrington, “I think there’s a place for people here that are HIV-positive, and they can find a home and support here.”