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Observation: On HIV/AIDS

Chapter One: The Psychiatrist to Whom Doctors Should Refer HIV Patients

By: Caroline Trent-Gurbuz

Jeffrey S. Akman, MD, two years into a psychiatry residency at the George Washington University (GW) Hospital, slipped a pen into the front pocket of his white coat as he methodically worked through his rounds. The hall was bustling with scrubs-clad hospital personnel, but within the rooms, patients — men in their 20s — sat quietly and alone. Some didn’t have family to hold their hands, friends to listen to their woes. Others caught the wariness and fear in the eyes of their doctors and nurses, the orderlies who slid meal trays through an open door rather than risk closer contact.

Observation: On HIV/AIDS

But Akman was one of them. Gay, like them; out, like them; young, like them. He was also intrigued by their conditions: rare disorders such as Kaposi’s sarcoma, a disease with bruise-like lesions of red, purple, and black; pneumocystis pneumonia, an opportunistic infection marked by a cough, night sweats, and weight loss. They’d also been diagnosed with a virus identified just two years earlier, but one that hadn’t appeared in D.C. — until now.

It was 1983, a burgeoning era of change: the political world welcomed Reaganism, with its trickle-down theories and new brand of conservatism; classic values shifted to the materialism and bespoke power suits of young urban professionals; and homosexuality and homophobia were in the midst of a tonal shift.

As Akman, now three decades separated from his residency, recalls, the Diagnostic and Statistical Manual of Mental Disorders, the bible of the psychiatry world, had removed its entry on homosexuality several years earlier in a landmark moment. The last vestige of that entry — ego-dystonic homosexuality — would appear until 1986. With the arrival of the human immunodeficiency virus, or HIV, however, homophobia would remain woven into the nation’s cultural fabric, requiring sustained activism and advocacy to unsnarl.

“It was politically a challenging time, both in the hospital and in the community and country,” says Akman. “We had issues [involving] doctors who were HIV positive, and then the issues became ‘what are the policies around doctors with HIV being engaged with patients?’ We also had the politics of Ronald Reagan and his unwillingness to say the word AIDS.”

Not far from Reagan’s White House, though, was Dupont Circle, the hub of the gay community; the laidback, colorful neighborhood was a source of shelter and pride against a still-disapproving nation, and was only blocks from the old GW Hospital, a gray monolith looming on the corner of 23rd and Eye streets.

“We were very much, it became clear, at the epicenter of this epidemic in Washington, D.C., really because of GW Hospital’s location,” Akman says. “In those days, we were very, very connected to the gay community in Dupont Circle. Plus, the … GW Health Plan, which was [then] an HMO that GW owned, also had a large number of gay patients.”

The patients presented with profound complications, some involving the brain. There was no antibody test and no real treatments; within 18 months, most of those patients died.

Akman, however, true to his nature and to his profession, calmly sat with them. He pulled his chair closer to their beds, leaning his head down to better hear them. He asked them questions about themselves, learned their personalities, who they loved, their fears of death and dying. He also volunteered roughly 20 hours per week at the newly established AIDS program of the Whitman-Walker Clinic, expanding the scope of his experience, welcoming more patients into the fold even as he bore witness to their tragedies.

“So many of my friends were dying,” he recalls. “I had a lot of patients who were dying, and then my friends were dying. The whole period from the 1980s into the 1990s was just horrible. People were really sick.”

But the young psychiatrist endured, driven by a need to understand the virus. “I just was curious,” he recalls. “It was also, again without having a test in those days, you didn’t know — I didn’t know if I was affected. None of us did. For me, it was like responding to this unknown pathogen. Why was it affecting gay men?”

Ignoring the stigma of illness and the uncertainty of infection, Akman continued to treat the men with whom he identified. He became, he says, “the psychiatrist that [doctors] should refer patients with HIV to.”

The infectious disease department was the first to send patients to him, while he continued to treat those already admitted at GW Hospital and Whitman-Walker. Others soon followed, and Akman’s clinical practice began to grow during his residency. He also attracted the attention of the National Institutes of Health; after completing his residency, he received a grant to travel the city, educating others on how to care for HIV patients.

“We educated literally thousands of people about HIV/AIDS,” he says. “It was a time when people were calling AIDS ‘AfrAIDS.’ So much of the anxiety and the fear of AIDS was related to ignorance.”

Akman was appointed to the American Psychiatric Association’s committee on AIDS, which eventually became a commission, and widened his educational influence across the country.

Those dips into teaching turned into a dive when he joined the faculty at his alma mater, the GW School of Medicine and Health Sciences (SMHS), from which he had graduated in 1981. As a young faculty member, Akman found himself a protégé of Winfield Scott, PhD, then associate dean for student affairs. Scott, a psychologist, had been a fixture of the school since the 1970s. He, like Akman, was openly gay, and he was involved in the lesbian, gay, bisexual, and transgender (LGBT) community.

But then Scott got sick. “He declined pretty rapidly,” Akman recalls.

Akman, at Scott’s urging, had become a fixture himself of LGBT health community organizations, and he continued advocating for compassionate and evidence-based psychiatric care of HIV/AIDS patients. He took over Scott’s academic responsibilities, including mentoring students.

Benny Waxman, MD, a renowned obstetrician and gynecologist and SMHS professor, also persuaded the young academician to share his boots-on-the-ground knowledge with medical students. Waxman, “a former teacher and very close friend,” Akman says, taught the human sexuality course — or he did until he, too, was diagnosed with HIV. Akman again took over.

Both mentors later died.

Since that time, however, Akman — now the vice president for health affairs, Walter A. Bloedorn Professor of Administrative Medicine, and dean of SMHS — has continued his trajectory upward, a path shaped by his own passion and memory of the faces of those he said goodbye to.

He’s served on the D.C. Commission and the Presidential Advisory Committee on HIV/AIDS, among others, through the start of the 21st century and the end of the Obama administration, and, like his mentors, has shaped younger minds on how to thoughtfully treat LGBT and HIV/AIDS patients. And like his younger self, puzzled by the makeup of the disease, he’s continued his pursuit of understanding the virus by building out the school’s HIV/AIDS research portfolio with top-notch basic scientists.

“If we’re involved in the cure — not if, the fact that we are involved in finding a cure for HIV/AIDS — that’s amazing,” he says. “It’s amazing. Certainly nothing I would have thought of when I was a young resident sitting at a bedside of a person at GW Hospital, holding their hand as they died, that someday we would actually be in the conversation around curing HIV. That’s hard to imagine.”