Today, I’m thankful for the colors of the season and all it reminds me of the power of life.
As we embark upon the month of December, we enter a festive year-end season filled with numerous religious holidays, including Hanukkah, Kwanzaa, and Christmas. Each holiday carries with it its own significance from a theological, cultural, or ethnic standpoint; yet, each also carries a central theme of hope and ‘light’ in the oft-dark world of winter. Not surprisingly, these December events are also categorized by certain seasonal colors – the green, gold, and red of the holidays.
For centuries, the evergreen plants of holly, ivy, and mistletoe have been used to decorate our homes during this glorious season. The flora serves as a fitting, optimistic symbol that life goes on, even as most plants and deciduous trees lose their luster. More recently, the tradition of adorning our homes with a Christmas tree, of some evergreen variety, helps to also usher in freshness and color into our winter homes. During the month of December, tradition calls that we also covet the color gold as a symbol of prosperity and light. The stars in the sky and the fire in our hearths, both of which carry a golden hue, grant us direction, comfort, and warmth during the winter months. Hence, gold is a fitting reminder that light always trumps darkness. Finally, we turn to the color red as an emblem for the holiday season. The berries from the holly bush, the leaves of the poinsettia plant, and, of course, the clothes on the back of the master gift-giver, Santa Claus, serve as powerful reminders why red is such an overt fixture during this last month of the year. As for that last reference to the famed resident of the North Pole, you can probably thank the cartoonist Thomas Nast, who in an 1881 caricature of Santa Claus, dressed St. Nick in a red suit.
Why? Well, because everyone looks jollier in red.
Interestingly, on this first day of December, several historical events also place ‘red’ in the forefront. On this day (Dec 1) in 1977, the amazing singer, Bette Midler, held her first television special, Ol' Red Hair is Back. As a takeoff on Frank Sinatra’s Ol’ Blue Eyes is Back, the show would eventually win an Emmy Award for Outstanding Special – Comedy-Variety or Music. On this same day in 1887, the world was also introduced to a swash-buckling detective (Sherlock Holmes) and his flat-mate and physician-turned-accomplice (Dr. John Watson). Arthur Conan Doyle’s tale, A Study in Scarlett, was first published on this day in Beeton’s Christmas Annual without much fanfare, but the short story would usher in a dynamic duo in constant pursuit of nasty vagabonds, ruthless thieves, and cold-blooded killers.
But, there’s another cold-blooded killer that we recognize on this day as a fitting reminder why our fight against infectious diseases can never cease.
The first World AIDS Day was celebrated on this day (Dec 1) in 1988. For the last 32 years, World AIDS Day has been dedicated to the constant awareness of the AIDS pandemic caused by the spread of the human immunodeficiency virus (HIV), as well as a mourning those who have died of this debilitating disease. On this day, many choose to wear an iconic red ribbon as a symbol of support and solidarity for persons living with HIV infection (PLHIV) and a reminder of the senseless loss of life caused by this virus. Sadly, since its inception nearly 4 decades ago, HIV has claimed the lives of over 35 million people.
As a medical student training at a large, publicly-subsidized hospital in Atlanta (Grady Memorial Hospital), I vividly remember the sorrowful wards of AIDS patients in the winter of 1992. At that time, the only option we had for PLHIV was zidovudine (AZT) monotherapy, which was often rendered ineffective over time, once the virus mutated and became resistant to the antiviral. The majority of my patients in my internal medicine rotation suffered from end-stage AIDS. Conditions such as pneumocystis pneumonia (PCP), disseminated Mycobacterium avium complex, cytomegalovirus (CMV) retinitis, and/or AIDS dementia had turned relatively young, healthy men and women into frail, debilitated individuals. I recall filling out my fair share of death certificates, wondering if and when the epidemic might finally abate. Yet, somewhat miraculously, by 1996, an amazing transformation took place. Highly-active antiretroviral therapy (HAART) regimens containing indinavir (CRIXIVAN®), AZT, and lamivudine (3TC) had become commonplace at Massachusetts General Hospital, where I trained, and other major institutions. I remember caring for a 22-year old, cachectic, ventilated man and a severe case of PCP; after the initiation of HAART, he blossomed in six months into a healthy, functioning member of society. As newer classes of HIV drugs have materialized over the next 3 decades, HAART has saved the lives of millions.
With HAART’s advent, PLHIV can now live relatively normal lives with decades of life, provided they adhere to their daily antiviral regimens. In most developed countries, the mortality associated with HIV has also precipitously fallen. Recent studies confirm that treatment as prevention helps prevent transmission to non-infected partners. Finally, once-daily regimens to prevent HIV acquisition using preexposure prophylaxis (PrEP) are now readily available for high-risk populations.
But, World AIDS Day reminds us that the fight against this vicious pandemic is far from over. Currently, across the globe, nearly 37 million people live with HIV infection. Each year, an additional two million new faces are added to the registrar of PLHIV. Even with today’s agents, more than one million PLHIV will suffer an AIDS-related death in 2020. To put this in perspective, over 5,000 individuals will be infected today with HIV, and another about 2,750 will die today from AIDS. In the US, we estimate 1.2 million PLHIV, and approximately 40,000 more individuals will contract HIV in 2020. Despite crucial strides, efforts to cure HIV infection are also not on the immediate horizon. In fact, 2020 witnessed the failure of another promising vaccine candidate.
So on this day, let’s applaud all scientists have done and will do to treat infectious diseases like AIDS. I wear red today to remind myself that I am an infectious disease physician because of the AIDS pandemic I witnessed nearly three decades ago when I started my medical career. The red ribbon also reminds me never to forget those who have fought the good fight to ensure HIV could be turned from a death sentence into just another chronic condition.
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