HIV medications are widely regarded as a miracle of modern medicine. They have turned the HIV epidemic on its head; while HIV was once the leading cause of death among young Americans, life expectancy among people with HIV is now nearly normal.
HIV medicines are also much easier to take in 2013 than they were in the 1980’s and 1990’s when patients with HIV took dozens of pills each day on a byzantine schedule that made adherence almost impossible. Side effects were legion, and frequently debilitating.
In 2013, most patients with HIV take one pill once a day and side effects are much less severe. A patient who recently started HIV therapy in my clinic berated me afterwards for frightening him. He said, “Your doom and gloom warnings about ‘the possible side effects’ were the worst side effect of all.”
Even today, HIV medicines don’t cure HIV—treatment is lifelong. Skipped doses and treatment interruptions can cause viruses to grow resistant, and treatment to fail. By not taking his medicine, Bill was playing Russian roulette.
Bill and I met again several times in the ensuing months. The conversation was always the same: He was frightened by his decision to abandon lifesaving HIV drugs but felt bound to follow his faith. I told him I was deeply worried, and urged him to reconsider. But I reassured him I would not abandon him, whatever his decision.
I checked Bill’s labs. When the virus was under the medication’s control, his immune system was strong, but now there were millions of viral particles in each drop of blood and his immune system was in tatters. Bill grew tired. He lost weight. Common colds terrified him; each cough could be a harbinger of the end.
There’s an old joke about a faithful climber who hangs by a branch off the edge of a cliff. He turns away a rope and a helicopter rescue, and even declines to fly when he magically sprouts wings, each time proclaiming “God will save me!” Eventually, he falls, and accuses God at St. Peter’s Gates of abandoning him.
“What do you want from me?” God asks. “I sent you a rope, a helicopter, and wings. You can’t help some people.”
Watching Bill was like watching a car accident in slow motion. But during one clinic visit, midway through the collision, Bill was radiant.
“This time is different, Dr. Lahey. I can feel it.” That Sunday in church a faith healer from another community had visited Bill’s Pentecostal congregation, and had singled out Bill from the dais.
“The healer put his hands on me, here.” Bill put his palms on his forehead. “He told me ‘the sickness you have struggled with is now cast out. You are healed.’” Previously, Bill had confided his HIV diagnosis to his pastor, but he trusted the pastor had not revealed this secret to the visiting healer. Bill talked excitedly about the service that followed, the music, the singing, Bill’s public confession of his HIV infection, and the love he felt from his congregation. “I used to be a pariah,” he said, describing years of ostracism for his homosexuality. “Now look at me,” he said, beaming.