Treating HIV/AIDS Patients and Their Loved Ones With Compassion and Courage

Peter G. Gulick

When Peter Gulick was in medical school, he was unaware of the virus that would define the trajectory of his career.

The human immunodeficiency virus (HIV) emerged in the early 1980's and became one of the most significant challenges in modern medicine. Gulick found himself in circumstances that called for not only medical acumen, but for compassion, advocacy, and social justice for patients and their loved ones.

Since then, Gulick has become a highly regarded physician, researcher, educator, and friend to the HIV/AIDS community in critical regions across Michigan. More than 30 years later, he continues to build community-engaged efforts that address the HIV/AIDS epidemic with one of society's most vulnerable populations.

"I wanted to treat cancer"

From an early age, Gulick was interested in medicine. "My dad had a little to do with it. I grew up in Youngstown, Ohio, and he had a couple of friends who were primary care doctors, the center of all medicine. I was able to observe some of what they did, I'd follow them around, including in the hospital, and scrub in for their surgeries. My family physician was an osteopath. They took care of the whole patient, something that made sense to me," recalled Gulick.

According to the American Academy of Osteopathy, doctors learn to treat the whole person rather than the symptoms. Osteopathic principles integrate patient treatment of mind, body, and spirit.

He graduated from Mount Union College in Ohio and entered Chicago College of Osteopathic Medicine Midwestern University.

"I wanted to treat cancer," said Gulick. "Oncology patients were so appreciative of the care that they received. I wanted to practice whole patient care, and this was where I felt that I could make a difference. I was on rotations with oncologists and I liked how they approached it—cancer can be a mystery, and you need to give patients tools for treating cancer, but also living after a cancer diagnosis. I liked the way oncology gave you the chance to utilize all those skills."

He had a fellowship in oncology for a year at Roswell Park Memorial Institute in Buffalo, then decided to return to the Cleveland area. By the time Gulick applied for a fellowship to the Cleveland Clinic the oncology positions were filled, so he accepted an offer in infectious disease. He became certified in internal medicine, infectious disease, and oncology by the American Board of Internal Medicine.

NAMES Project AIDS Memorial panel made for "Bob I." of Lansing. Photograph courtesy of MSU Museum.

Gulick arrived at MSU in 1984 and focused on infectious disease, hematology, and oncology rotations and lectures with College of Osteopathic medical students.

But other circumstances were developing in the United States that would have far-reaching effects on the medical profession, as well as social norms.

What is HIV and What is AIDS?

According to the definition listed on the federal government website, human immunodeficiency virus (HIV) is a virus that attacks cells that help the body fight infection. Known as an opportunistic disease, this makes a person more vulnerable to other infections and illnesses.

Acquired immunodeficiency syndrome (AIDS) occurs when a person's immune system is severely damaged from an HIV infection that has gone untreated.

People contract HIV from other people with HIV. This can occur during the exchange of certain bodily fluids via methods most commonly associated with sexual activity, blood transfusions, sharing needles and syringes, pregnancy, delivery, and/or breast-feeding.

Because HIV wears away at the immune system, HIV-positive patients are vulnerable to infections and certain types of cancer, among them: tuberculosis, meningitis, candidiasis (inflammation of the mouth, tongue, and esophagus), lymphoma (initiated in the white blood cells), and Kaposi's sarcoma (affecting blood vessel walls).

The HIV-positive diagnosis during the 1980's was a death sentence with a life expectancy of two years or fewer, with unpleasant symptoms and a deteriorating quality of life. Today, HIV is viewed as a chronic condition, and someone diagnosed in 2020 can anticipate living a normal life span with appropriate medical attention. Screenings, medicine, and education prevention programs have drastically reduced undiagnosed cases and dramatically increased life expectancy.

But the progress has been painful for many of those involved. Peter Gulick was there from the beginning. More than 35 years later, he continues to treat patients, solve problems, and build strong partnerships with community collaborators.

History

One of the earliest reports regarding AIDS came from the U.S. Center for Disease Control (CDC) in June 1981, from Morbidity and Mortality Weekly Report, documenting five gay men in Los Angeles who each developed a rare lung infection, along with other unusual infections. At the same time, reports were made about a rare, aggressive cancer occurring in gay men in California and New York.

"We saw a couple of cases at the Cleveland Clinic intensive care unit in 1983, when I had a fellowship in infectious disease, that involved reduced lymphocytes resulting in opportunistic infections," said Gulick. He was still training but interacted with the attending physicians who met with lab people and sought information from physicians responding to the unusual medical conditions.

In 1984 the federal Health and Human Services Administration announced that Dr. Robert Gallo and his colleagues at the National Cancer Institute had located the cause of AIDS, a retrovirus they labeled HTLV-III. The retrovirus was described with several names before it was named HIV in 1986. During that same time, a national organization called AIDS Action was formed to advocate on behalf of people and communities affected by the epidemic, through education, AIDS-related policy, and legislation.

Media coverage was also heightened because of actor Rock Hudson's announcement that he had AIDS, along with the subsequent reveal that he was gay. In addition, New York and Los Angeles local officials took steps to shut down gay bathhouses and other venues frequented for "high-risk sexual activity" related to HIV/AIDS. AIDS was considered an epidemic and was sometimes referred to as a "gay plague" because of the toll it was taking on men in the LGBT community.

"I'll take care of you."

Featured panel from the AIDS Memorial Quilt by the NAMES Project, displayed during a 2017 exhibit by the MSU Museum. (Click for a larger view)

While not intended, Gulick's education and interests in infectious disease and oncology were well-suited to address the growing HIV/AIDS crisis.

He quickly discovered that treating AIDS patients was much more than addressing the disease.

"I had no experience with gay or homosexual patients—not in medical school, not in practice. I had no experience with the lifestyle. When I came to Lansing, there was panic about how it was transmitted," he recalled.

"Nobody else wanted to do it; nobody wanted to provide care. I was thrown into it and began taking care of these patients. Most of them were in the hospital; they were being treated with antibiotics and they weren't getting better. (At that time) they were male and Caucasian."

Gulick was faced with tough circumstances, and the memories he carries are painful reminders of the early days of the epidemic. AIDS patients were being shunned and shamed. Family members would avoid them; the same went for colleagues and casual friends. People were afraid of the disease and were often critical of people that contracted HIV.

"Patients didn't trust me because I wasn't gay. They wouldn't look me in the eye. They would cower or withdraw if I touched them, like wounded animals. I kept saying ‘I'll take care of you,' and I wanted them to know that I meant it," he said. "I had to get down in front of them and say, ‘Look, you are a human being. I will take care of you like you are my son. I don't care that you have HIV, you're human.' The trust took a while. That shocked me because I didn't grow up in an environment like that."

"There was no family support, there was no ancillary help because people were afraid to go into their surroundings. I went to see a patient and their meal was sitting outside the room because people were afraid to take the food in. There were yellow paper strips of tape at the door, just like a hazard scene or a crime scene," said Gulick.

"I was still doing oncology at the same time. They had family support, everything. Nobody blamed them for getting cancer, and their support network was usually pretty strong. With HIV, the only support was their partner. They stood by their partner through thick and thin – they did everything to take care of him."

Just as Gulick would address one issue, another would pop up to take its place, each uglier than the next.

"It was really frustrating for us, we could treat the infection, but the immune system was so damaged that we couldn't get to the source. You don't have any control over anything without an immune system. If we can't get your immune system recovered, it's only a matter of time," said Gulick.

"I was having a hard time getting other physicians to treat the other conditions from these patients with compromised immune systems. I would go to the doctors' lounge to eat and I'd sit by myself, nobody would even eat with me. They didn't want me to refer cases," Gulick said. "I got a lot of flak because I took care of them."

So why did Gulick continue to become more and more involved? "I heard the jokes and the names about gays, and then I would watch this interaction between partners. There was so much love. I came to really respect the culture, and the way they cared for each other, loved each other, and stood by each other. I can't even describe it—it was really incredible," he said.

"Fight the disease, and not the people who contracted the virus."

Dr. Gulick was treating patients at the former Lansing General Hospital, now part of the McLaren Greater Lansing health care system. At the same time, he was keeping abreast of emerging information, calling other health professionals for additional information, educating patients and loved ones, providing information for the medical community, and responding to dozens of other details.

"I kept saying that we needed to fight the disease, and not the people who contracted the virus," said Gulick.

He helped organizers pull together the Lansing Area Aids Network, a group that began offering emotional support and educational services for those whose lives were affected by the AIDS epidemic. "It was an effective way to mobilize support and disseminate information. We needed help, and the patients needed help. Their insurances were being canceled, they needed social services, mental health services, and sometimes patients were so sick they needed the most basic help."

Despite the overwhelming circumstances, two events were about to unfold that would impact the way that Dr. Gulick could advance support for local HIV/AIDS patients.

Ryan White CARE Act of 1990

Ryan White was diagnosed shortly after his 1971 birth with severe hemophilia A and diagnosed with AIDS in 1984 after a contaminated blood treatment. When his Indiana school blocked him from attendance because of his disease, he and his mother appealed the decision, and in the process, they became national spokespersons for AIDS research, education, and patient advocacy. They were also the face of AIDS outside of the gay community. Federal legislation produced the Ryan White CARE Act shortly after his death in 1990, and it became the largest provider of services for people living with HIV/AIDS in the U.S.

Around that time, Lansing General Hospital stopped treatment for HIV/AIDS patients. Gulick worked with MSU to bring the patients to the campus system, and that ended after 18 months. So Gulick reached out to Dean Sienko, medical director of the Ingham County Health Department (ICHD) at that time. They collaborated on an application for Ryan White program funding. The grant provided patient lab work and prescriptions, filling a critical gap in services until case managers or social workers could secure insurance, mental health services, substance abuse counseling, and other assistance. The ICHD also provides some services not covered by other sources.

The disease hit close to home with an announcement in November 1991 from NBA player Earvin "Magic" Johnson, a Lansing native and MSU basketball star. Johnson told the world that he learned he was HIV-positive after a routine physical administered by a life insurance company.

"I was already spending a great deal of time on education, now here was someone who again elevated the discussion," said Gulick. "I was working hard to build a network at the local and state level so that we could have more community structure and be able to recruit and coordinate more services."

Ryan White Clinics in Lansing, Saginaw, Harrison, and Flint

In addition to surgeons and specialists, nurses were also hesitant to interact with HIV/AIDS patients. Carol Salisbury, a nurse practitioner at the Ingham County Health Department, began working with Gulick at the Lansing hospital, taught at MSU, and moved to the ICHD with the Ryan White funding. Gulick encouraged Salisbury to earn the nurse practitioner degree.

"Carol provided a lot of support; she went up the hill with me in those early times, before we even had any medicines. As she became more involved, she freed me up to accept more speaking requests and interact with more people to widen community education," said Gulick.

"One huge piece of this work is building trust and consistency with the patients, their families, and the community," said Salisbury. "Dr. Gulick can do all of it, address their medical issues, preventative measures for their loved ones, the support networks, all of it. I have learned to consider so many factors; I've learned so much."

Even though he has talked her out of retiring for the time being, Salisbury has reduced her hours and points to the progress that has been made. "When we started, it was a position and a half. We now have 14 people—nurses, case managers, and social workers at ICHD who work with the HIV-positive patients. Some of those patients do not reside here, they don't always seek care in their own area. Again, it's the stigma."

Since the Lansing clinic, Gulick has worked to establish a Ryan White program at Health Delivery, Inc., in Saginaw, followed by the Central Michigan Department of Community Health in tiny Harrison, Michigan. It's the only rural HIV clinic in the state, located in Clare County in the northern middle of the lower Peninsula. The newest effort for Gulick was Sunshine Family Care Clinic in Flint, which opened in December 2019.

"As word got around about Dr. Gulick, he was invited to present information at all kinds of different groups. There were so many questions, and there was a need for understanding, Dr. Gulick just kept accepting invitations to talk and explain HIV and AIDS. That was extra because he was seeing patients and keeping up with the new drugs and treatment protocols. He had to spend time with colleagues and experts to keep up with the new discoveries for treatments or prevention education," said Salisbury.

Mary Boudreau, a nurse practitioner who has worked with Dr. Gulick for 25 years, has been with the Harrison program since it was established nine years ago. "There are patients who drive quite a way to be seen. It started out that people didn't think HIV was in this little rural county, didn't think testing needed to be done. There is stigma, and social impacts for the patients and their families, for sure. We saw a few patients at first, and more and more kept coming," she said.

"I lost my first friend to HIV/AIDS," said Boudreau. "For me, I knew that I wanted to do this work. It wasn't Dr. Gulick's initial plan, but he has been essential to so much of what we understand about HIV. He is such a leader working with all of us—the medical students, nurses, everyone. He wants to know our opinion, and he never treats anyone like a second-class citizen."

Education

The American Academy of HIV Medicine was established in 2002 to educate HIV physicians and provide credentialing programs that promoted standards of care for HIV. Gulick developed the education model for the Academy, served on the Board, and was again instrumental in peer-to-peer connections as well as community advocacy. Even though Gulick carries a caseload of more than 800 HIV-positive patients, he still dedicates a significant portion of his time to education.

There are the MSU medical students, as well as medical professionals across the state who belong to the Michigan State Medical Society who need training and the latest developments in HIV research. Then there are churches, civic groups, LGBTQ activists, government officials, and so many others who benefit from education and understanding.

"High schools have maybe been the hardest; there was so much pushback. They didn't want to hear from me; they wanted to review every slide I was going to show and every word I was going to say. Even when I was allowed in a few of the schools, they still only let me talk to seniors," said Gulick.

"One speaker who sometimes accompanied me was a woman who contracted HIV from her husband. He was a truck driver and had multiple relationships with both men and women. He was diagnosed with AIDS, and her HIV was caught early. She went without drugs for a few years, but when they became available, we got her right on. When he was dying, she sat by his bed and held his hand. She said that nobody else was there for him, and she thought it was the right thing to do. She is living in the Upper Peninsula now, and still helping with HIV education. I've had people tell me what an impact she has had on their awareness. Some of those high school seniors have said the HIV education made such a difference in their life," said Gulick.

MSU HIV Registry

In 2012, Dr. Gulick led an MSU team of infectious disease specialists and basic science researchers to create an HIV/AIDS registry, designed as one of the first in the U.S. to include patients from rural areas as well as urban and suburban populations.

The aim was to collect biological data from patients, along with socio-economic characteristics. That confidential information is available for research that translates into the improved health of patients. According to Gulick, there are currently several NIH grants looking at trying to eventually find a cure for HIV.

"It is the heart of clinical translational research," said Gulick.

Legacy

When asked about retirement—or even slowing down his demanding schedule—Gulick says, "when they find a cure I will retire."

"People will never know some of the things he's done, or how much he's done," said Salisbury.

"He has quietly taken care of so many people, never drawn attention to what he is doing; he's just kept doing more and more," said Boudreau. "That's where the real heroes are."

For Gulick, he sums it up with six brief words: "All human beings deserve medical care."

Sources

1. Health Resources and Services Administration's (HRSA) Ryan White HIV/AIDS Program https://hab.hrsa.gov/about-ryan-white-hivaids-program/about-ryan-white-hivaids-program