The AIDS epidemic has focused us, as individuals and as a community, on illness. Over the past 26 years we have come together (and sometimes driven each other away) to save lives from a horrible disease. When we weren't comforting those devastated by the recent news of infection, we were caring for those struggling to live and those preparing to die. Even our work with HIV-uninfected persons has been defined by the disease: we sought to prevent others from becoming infected as if health were the simple absence of HIV.
Given how many lives have been lost in our small city (over 18,000 persons ), it is not surprising that AIDS has defined us as a community. So it is a sign of how much progress we have made in combating AIDS that the San Francisco health department is commemorating World AIDS Day with a Health and Wellness Fair (December 1, 10 a.m. to 3 p.m. at the Harvey Milk Civil Rights Academy at 19th Street and Collingwood). It is our opportunity to provide HIV-infected and uninfected persons with a wide range of services focused on wellness, including blood pressure screening, smoking cessation, vaccination to prevent hepatitis, and health nutrition advice.
One of the benefits of a wellness approach is that it unites rather than separates HIV-infected and uninfected persons. We all need to promote our health and the health of our community. For example, the LGBT community has the highest rates of smoking of any community in San Francisco. In smoking we put ourselves and those around us at risk (and increasingly those around us are children for whom we need to set good examples, not only of acceptance and being who you are, but of not smoking!).
For most of my HIV-infected patients, issues of opportunistic infections and hospice have been replaced by discussions of the importance of exercising more, using less harmful substances, and controlling blood pressure. It is a wonderful circle for me because I began my career as a primary care doctor focusing on just these things. And I offer the same messages to infected and uninfected persons. In fact, to prevent new infections we need to place our HIV prevention efforts within the context of all of the ways that people can promote health and well-being.
One of the major insights of public health is that individuals cannot be well if their community is sick. Everything from the quality of our housing to the quality of the relationships we form affects our wellness. In fact, social cohesion is one of the most important factors affecting health. Many of us within the LGBT community have faced bias and prejudice from our families or communities of origin. That makes it more important that we celebrate the positive connections within our community, and seek to pull others into our circle.
Like many people who have lived in this city through the epidemic, I see ghosts. I see friends and patients of mine; and only when they get up close do I realize that it's someone who looks like someone I lost. It doesn't depress me the way it used to because I am not worrying so much about who will be next. Instead, I'm thinking about: how do we heal a community that has lost so much? How do we celebrate a community with such strength? And how do we individually and collectively promote wellness for ourselves and for the next generation?
Dr. Mitchell Katz is the director of the San Francisco Department of Public Health.