reprinted from Issue 17, Fall 2013 of Frontiers of Medicine (PDF)
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EEric P. Goosby, MD, had spent his entire career caring for people with HIV/AIDS – from treating patients at San Francisco General Hospital (SFGH) in the epidemic’s early days, to establishing HIV/AIDS delivery systems across the country. But he was stunned by what he saw in a Zambian hospital about 15 years ago.
Sixty patients, all dying of AIDS, were crammed into an open ward. “There were three people in each bed, two on the floor underneath the bed,” recalls Goosby. “Ten people suddenly had grand mal seizures at the same time. I had never seen anything like that. That’s when I flipped into an international focus.”
Goosby served as CEO and chief medical officer of Pangaea Global AIDS Foundation from 2001 to 2009, when President Obama nominated him to become Ambassador-at- Large and United States Global AIDS Coordinator. In his role, Goosby oversees implementation of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), as well as the U.S. government’s engagement with the Global Fund to Fight AIDS, Tuberculosis and Malaria – coordinating nearly $6.5 billion annually in HIV/AIDS efforts.
These two programs, established about a decade ago, have helped turn the tide of the disease worldwide. Organizations like Pangaea had piloted programs demonstrating that HIV could be treated effectively in resource-poor settings. PEPFAR and the Global Fund brought those success stories to scale, creating thousands of clinics in sub-Saharan Africa. “Instead of two clinics in Rwanda, we do 170 clinics and 40 hospitals,” says Goosby. “It may not be perfectly convenient, but people can walk to a facility that can diagnose HIV and initiate treatment – not just in big cities, but also in the rural setting.”
PEPFAR has tested more than 46 million people for HIV, put more than 5 million on antiretroviral therapy, cared for 5 million orphans and vulnerable children, and in 2012 alone prevented 230,000 babies from contracting HIV from their mothers. PEPFAR is now broadening the clinics’ focus to also prevent other diseases, such as hypertension and diabetes, and is supporting an initiative to train more health care workers.
“Eric has done truly amazing things since his training here at UCSF,” says Paul Volberding, MD, director of the AIDS Research Institute at UCSF. “As the PEPFAR director and ambassador he has expanded care to millions, helped lead an education initiative in Africa and supported implementation research within PEPFAR to allow even more people lifesaving access to care.”
Goosby appreciates the many role models he had as a UCSF medical student and resident. “There was a cultural expectation that you honestly admit your shortcomings around knowledge, and that you seek and get help to understand it better,” he says. “That holds the integrity of the profession together, when you’re out in Zambia with absolutely nobody looking over your shoulder. … I think UCSF has been one of the best at instilling that self-policing, intellectually honest approach to patient care.”
He was also among the first graduates of UCSF’s general internal medicine residency program, and says that learning a broad spectrum of skills – such as dermatology and simple surgical procedures – has been invaluable for practicing medicine in countries with virtually no specialists.
In 1987, Goosby became the associate medical director of the SFGH AIDS clinic, eventually caring for 500 patients who died of the disease. Although his team pioneered many of SFGH’s groundbreaking discoveries, including the development of antiretroviral treatments, the devastating losses took a toll. “I was aware of a post-traumatic stress phenomenon that all of us were feeling,” he says.
In 1991, he became the first medical director of the Ryan White CARE Act, bringing the “San Francisco model” of HIV care – medical treatment plus wraparound services to address other issues such as mental illness, addiction and housing needs – to 18 cities.
During the Clinton Administration, Goosby helped establish the National AIDS Policy Office in the White House, and oversaw the development of antiretroviral guidelines that continue to be used worldwide.
“I wanted to not read or write about public health – I wanted to do it,” says Goosby. “Very early in my career, I saw that my talent was in creating something. I found much more joy in the start-up – engaging problems that historically have been felt to be not solvable, with a scaled response.
We’ve shown, at every stage, that you can take care of a bad disease that is uniformly fatal, and do it better.”
Goosby is married to Nancy Truelove; together they have two grown children, Eric and Zoe.