hiv/aids

Dr. George Kent

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Read and listen to longtime HIV/AIDS physician Dr. George Kent as he discusses his 32 years of work at the Santa Clara County PACE Clinic and what he sees as the new challenges ahead for treating patients with HIV.

Dr. George Kent has been caring for people at the Santa Clara County’s AIDS clinic for over 32 years. He started in 1989 when he began splitting his time between working with HIV patients and being a primary care physician with his own clinic.

“I’m not making this up,” the longtime ally said. “I would deliver a baby in the morning, then go to my private practice, and then to the HIV clinic. After work, I would go to the house of someone who was dying of AIDS and help his caregiver and partner with hospice. The circle of life was amazing to me.”

He has seen the disease evolve from one that was untreatable and incurable to what is now a chronic condition.

 As someone who has treated patients since the early days of the epidemic, he remembers how difficult it was. “People my age were dying in the prime of their lives. Many were gay and estranged from their families. There was social stigma. It was a terrible time.”

The Stanford and Case Western Reserve graduate came to the HIV field after a residency at the UCSF-affiliated program in Santa Rosa, followed by training at the CDC as a medical epidemiologist, then returning to San Jose and completing an HIV mini-residency with the AIDS Education and Training Center at UCSF.

Afterwards, he looked around San Jose to see who was caring for HIV patients. One day he went to the Santa Clara Valley Medical Center.

“The clinic was in this little corner in the outpatient department; there were a few exam rooms. A person I met there was Dr. Ira Greene, a dermatologist and wonderful guy. We hit it off. After he got to know me and checked me out a bit, I said, ‘Ira, do you need some help?’ He said, ‘sure, you can join us.’ That was in 1989, and I’ve been there ever since.”

Kent reflected on some of the difficulties in the early days. “We felt a little like a M.A.S.H Unit. At one point we were in a flimsy little trailer in a parking lot. It was hot in the summer and cold in the winter. It made us more cohesive because we really did feel like it was us against the world.”

The PACE Clinic, or Partners in AIDS Care and Education, assembled an interdisciplinary team from the beginning. “You had oncologists, you had infectious disease, you had primary care, and you had dermatology because a lot of these conditions manifested with skin problems.”

Working with HIV was the ultimate medical education for Kent. The virus was a multifaceted issue that impacted family relationships, societal attitudes, and the whole of the LGBTQ+ community when it first hit the United States. There were concerns over confidentiality and end-of-life planning that just did not exist when it came to other terminal illnesses.

“It certainly has made me a better doctor,” Kent said of caring for his patients.

In the PACE Clinic, the staff kept a whiteboard where they recorded the names of the people that died each month. “At the end of the month, we’d have a service. We would all get in a circle and say something about each person that died. We light a candle and have a memorial service, and then we’d have to erase the whiteboard and start over the next month.”

Witnessing the deaths of so many young people took a toll on Kent, and he needed time to cope with the stress and burnout. “I took two months off during the height of it,” he said.

Things started looking up for HIV patients in the early nineties, more than a decade after the first cases were discovered in the United States. With protease inhibitors and other medical therapies, the virus no longer claimed the lives of the majority of people in Kent’s care. “People just came back to life.”

Some of those individuals are still alive today. “I have these 25-year relationships with these patients who were basically at death’s door.”

Although Kent recognizes the magnitude of his work back in the early years of the AIDS crisis, he doesn’t want to glorify it. “We were all there on the front lines, and we felt like we were doing something important and meaningful.”

Today, HIV is no longer a death sentence. It is a chronic condition that can be managed with medications and even prevented with treatments like pre-exposure prophylaxis, or PrEP.  Kent is hopeful some of his patients might see a cure for HIV in their lifetime.

He believes more primary care physicians need to be trained to work with HIV to expand access to treatment and help normalize the condition. By giving patients the option to see their regular doctor, the medical community can make living with HIV part of mainstream medical care. 

“I see HIV as a primary care condition,” Kent said. “I don’t think you have to go to a specialty clinic just because you have HIV.”

Advances in HIV treatment have only been part of the battle; the other is getting people into care and keeping them in care.

Today, healthcare disparities among those affected by HIV complicate the “Getting to Zero” mission, which aims for zero new HIV infections, zero deaths, and zero stigma.

In particular, he highlighted the importance of reaching vulnerable and underserved communities like the homeless and people of color living in the South. Two barriers that keep Black HIV patients from getting the care they need are medical racism and mistrust of doctors.

“We definitely need more outreach into those communities with culturally-competent clinicians who can establish trust, because our biggest challenge right now is accessing these communities.” 

In Santa Clara County, medical teams serve homeless encampments and bilingual Latinx community outreach workers manage care for Latino HIV patients. “The outreach workers will go to someone’s house. If we have a patient that missed their appointments, or didn’t refill their medication, they’ll go to their house. They’ll meet them where they work.”

Translators of every known language are available at the PACE Clinic, which offers additional services like counseling, psychiatry, nutrition guidance, and a treatment adherence program.

“We have world-class institutions here in Santa Clara County with the expertise that you don’t see hardly anywhere else in the world, much less, our country or our state.”

Kent grew up admiring his father’s impact on people as an obstetrician. Working at the PACE Clinic has helped him to fulfill the societal benefit of the medical career he always wanted. 

Working in Family Medicine at Stanford Health Care and the PACE Clinic has proven beneficial to him and his patients.

“If one of my Stanford HIV patients loses their insurance, then I can see them at PACE Clinic. I love that because then I don’t have to lose them. So, I have one foot in both worlds—enabling that continuity of care that I think is really helpful. I feel very fortunate.”

Marty Fenstersheib

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You might have heard about Dr. Marty Fenstersheib, Santa Clara County’s testing and vaccine officer who came out of retirement in 2020 to help in the fight against COVID-19. However, you may not know he worked for the county since 1984 and was instrumental in the fight against HIV/AIDS.

Born in Pittsburg, Pennsylvania, Dr. Marty Fenstersheib received his B.S. at Tulane University, M.D. at Universidad Autonoma de Guadalajara, and M.P.H at U.C. Berkeley. He is Board Certified in Pediatrics and Preventive Medicine. He always craved big challenges. He left his first job in private practice because he found it too easy. He entered U.C. Berkeley’s Public Health program and, as a fluent Spanish speaker, was soon working in a Spanish-language clinic in San Francisco’s
Mission District.

In 1984, he joined Santa Clara County’s Public Health Department as director of the immunization program. This was in the early days of the epidemic. “I actually was the first person in the health department that gave results to people that they were HIV positive. The test came out in 1985 and nobody knew what to do, so no one wanted to give the results. So, I did,” Fenstersheib said. “It soon became known that if you got the test and I came in the room—it wasn’t good news. After
that, there was nothing else to tell them.”

Fenstersheib achieved national prominence when he pioneered a then-revolutionary AIDS treatment that meshed medical care with education to keep infected patients from spreading the virus. He helped open a County clinic to provide education, referrals, and support. The approach was profiled in the Journal of the American Medical Association.

The HIV Early Intervention Clinical Program he started in 1987 became the model for the State of California. More than two dozen similar clinics were subsequently established and funded across the state. When Congress significantly expanded
the federal funding for AIDS care in 1990 with the passage of the Ryan White CARE Act, Fenstersheib’s program became the national model for AIDS treatment clinics.

Throughout the epidemic, Fenstersheib continued to serve as a hands-on clinician, caring for HIV patients for more than 27 years, even after becoming the County’s Public Health Officer and later, after adding the role of the Public Health Department Director.

The epidemic had a profound impact on Fenstersheib personally. His partner was diagnosed as HIV positive in 1984 and died in 1992. In addition, Fenstersheib has sung with the San Francisco Gay Men’s Chorus since 1983, and he reflects on the loss of more than 300 members of the chorus who have died of AIDS since the epidemic began.

Fenstersheib retired from the county in Sept. 2013. In 2020, due to his knowledge of public health and infectious diseases, he was hired back to be the COVID-19 testing and vaccine officer at the county’s Emergency Operation Center.

Bob Clayton

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James Robert Clayton, known to everyone as Bob, was born in 1934. He was working for the Social Services Agency in 1981 when a man seeking help walked into his office suffering from a new and unknown malady. The man was one of the first county residents with AIDS. For the rest of his life, Clayton would be at the forefront of the Santa Clara County effort to deal with the disease and care for its patients.

In 1985, Clayton opened his home as the first AIDS residence in the county. In March of that year he helped form a weekly support group for AIDS patients that initially called itself “Freedom from Fear.” By January 1986, that group had incorporated as a nonprofit and become the Aris Project.

In 1994, Clayton received national recognition when he was presented with the Family AIDS Network’s National AIDS Caregiver Award. His nomination announcement noted that “Bob cries easily, never afraid to share his grief with other caregivers. Yet, he talks about the pain he carries each day as a ‘small price to pay’ for the rewards he has found reaching out to other people in need. Bob talks about each of the people he has been a caregiver for as a proud parent talks about their child- with love and unconditional acceptance.”

One of the highlights of his life came in 1996 when he carried the Olympic torch in San Jose as it made its way to Atlanta.

At the time of his death in 2003, Clayton was serving as interim director of ARIS.

Helen Miramontes

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Helen Miramontes’ nursing career began in 1972 in Kaiser Santa Clara’s critical care unit. It later continued at Valley Medical Center where she worked for 20 years, ultimately as a nurse supervisor.

Her involvement with AIDS policy and services came about because of her family. In the 1980’s, one of her sons was openly gay and suffering from alcoholism. “In the beginning, she sort of got into it because she needed to know what this is about because (my parents) thought I was going to get sick,” said her son David Miramontes during an interview with Ken Yeager in October 2018.

David’s twin brother, Jonathan, was also gay but still in the closet at that time. He would ultimately die of AIDS in 2006.

The epidemic was not the first time that Helen had gotten involved in a cause. “My mother was involved in the civil rights movement, the Vietnam War movement, and the migrant farm worker movement in the 60s. I remember being next to her with my siblings, all six of us, listening to Cesar Chavez,” said David Miramontes. “She always said that social work helped her really get started doing AIDS work.”

She developed one of the first train-the-trainer programs that addressed the need for cultural competency in HIV/AIDS care. The course provided nurses straight-forward information, focusing on the role of stigma, ignorance, misconceptions, and intolerance in undermining treatment and research toward a cure. She explained the course’s direct approach by saying, “You don’t change attitudes with slides and didactic lectures.”

As she became nursing’s “go-to” person about HIV/AIDS, she also served on a host of committees and boards, including Santa Clara County’s AIDS Task Force. As chair of the Task Force I got to know her and saw firsthand the dedication and passion she brought to her work.

In 1993, Miramontes became an Associate Clinical Professor in UCSF School of Nursing’s Department of Community Health Systems. She taught and mentored faculty and students and was involved in the UCSF AIDS Research Institute. She continued her public service on numerous local, national, and international boards. In 1995, she was appointed to President Clinton’s Advisory Council on HIV/AIDS, serving on both the research subcommittee and executive subcommittee on international issues.

Miramontes retired from UCSF in 2000 as Full Clinical Professor and relocated to be closer to her children in the Las Vegas area. Her activism continued there. During this time, she also cared for her son Jonathan. She died in May 2016, six days shy of her 85th birthday. Her name, and Jonathan’s, have been inscribed on the Circle of Names at the AIDS Memorial Grove in San Francisco’s Golden Gate Park.

Bob Reed

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Bob Reed moved to the South Bay from Idaho in 1982, the year before Santa Clara County’s first HIV infections and AIDS deaths were recorded. He first read about the infection that became known as AIDS in 1981. Even though he was a nurse, Reed continued to have unprotected sex and embrace an “eat, drink, and be merry lifestyle,” as he describes it, for the first half of the 1980s.

By 1986, he knew he had HIV. That was confirmed with a terse phone call from his doctor after he got tested. He recalls the doctor saying only “you’re HIV positive” and then following that with “You’re a nurse so you know what that means. Call me if you need anything,” and then hanging up. The entire call lasted less than two minutes.

Reed recalls even then, five years into the epidemic and the year after Rock Hudson’s death, there was still a tremendous amount of ignorance about HIV and AIDS in the county.

His doctor told him he would be dead within six months. His apartment manager worried that he might infect other tenants just by living in the same building. In a hospital lobby, he helped himself to a bowl of popcorn put out for patients but was then reprimanded for contaminating it and making it unsafe for others.

Like many HIV/AIDS patients, Reed internalized a tremendous amount of self-loathing and felt at the time that he deserved a certain amount of this mistreatment.

A turning point came when he began receiving services from the County’s Early Intervention Program. Under the leadership of Marty Fenstersheib, it was one of the few dedicated HIV/AIDS clinics in the nation at that time. It did not do a significant amount of advertising. He learned about it the way most patients did, through word of mouth. He described its services as “life-saving.”

Ultimately, Reed would spend three years working as a nurse at the clinic. His personal experience as someone living with HIV made him especially effective. This was particularly true in the years before the AIDS cocktail became widely available, when an HIV diagnosis was considered akin to a death sentence. Reed provided an example for so many others in those years just by living his life and doing his job.

In 2004, Reed became a member of the County’s HIV/AIDS Planning Council for Prevention and Care, now known as the Santa Clara County HIV Commission. He has been elected co-chair of the commission on two separate occasions.

Reed says overall Santa Clara County is an “exemplary” place to live for the LGBTQ community, and the County’s response to the HIV/AIDS crisis was one of the best in the nation. “I’ve lived here since ’82, and I’ve stayed here because there are no villains.

Ira Greene

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In 1981, Dr. Ira Greene was already a well-respected and beloved doctor. As the Chief of Dermatology at Santa Clara Valley Medical Center (VMC), he began seeing an increasing number of patients with Kaposi’s sarcoma (KS). At the time, he didn’t know that he was treating an illness that would soon grow into an epidemic.

Greene attended medical school at the University of North Carolina, and after initial training as an internist in Arizona, he made his way to Stanford for a residency in dermatology. He eventually became a clinical professor there, in addition to his role at VMC.

The KS cases Greene saw in the early 1980s caught his attention because they began appearing in relatively young men. Until that time, KS was an extremely rare condition that mostly afflicted elderly patients. Because Greene had experience in internal medicine, he also took note of the strange mix of skin lesions, swollen glands, lethargy, pneumonia, and other symptoms affecting these patients.

That laundry list of symptoms soon became associated with the syndrome doctors would come to call AIDS. Greene’s knowledge and background as a gay health care professional made him a logical choice for leading the effort to combat the emerging disease. Alongside Dr. David Stevens, Greene established a specialty treatment center at VMC that eventually became known as the Partners in AIDS Care and Education (PACE) Clinic. However, it was his empathy and connection to his patients that truly made him the right person for the job.

By 1988, Greene became associate director of Santa Clara County’s AIDS program. Even though that leadership role took much of his time, Greene never stopped seeing people with AIDS one-on-one as a primary care physician. His compassion during these often bleak years was steadfast. He did all that he could for his patients, often securing experimental treatments in a last-ditch effort to save the dying.

Friends who knew Greene saw the emotional toll that this work exacted. He developed many close personal ties to patients who ultimately succumbed to the epidemic. Still, he continued to make visits to AIDS patients through the 1990s.

“When you work with dying people, you learn a lot about yourself. You are forced to confront your own feelings about death. You feel very mortal,” Greene said in an interview with the San Jose Mercury News in the late 1980s.

Tragically, Greene died in 1998 when his Palo Alto home caught fire. It was a shocking loss for the community.

Karl Vidt

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Karl Vidt moved to Santa Clara County in 1969. When the AIDS epidemic began in the early 1980s, he did not pay much attention to it, believing it was “something affecting people in San Francisco.”

Vidt became much more aware of the disease and the toll it was taking in 1985 when he joined the board of the Metropolitan Community Church, one of the first denominations in the South Bay to provide a welcoming and inclusive atmosphere for the LGBTQ community. Coincidentally, the church became the original home of the Aris Project the same year that Vidt joined its board.

Despite his work with the church, Vidt did not get tested until 1989 when he learned that he was HIV positive. He remembers being “just numb” after getting the news. He says that the tester who told him he was positive, Sandy Gudino, was kind and spent more than an hour with him answering questions and giving him information.

Vidt told few people about his diagnosis. “I just picked up and went on.” However, by 1991 he had gotten sick and was taking regular medications. In the fall of 1992, he came down with Pneumocystis carinii, the strain of pneumonia that had been closely associated with the AIDS epidemic since the early 80s.

In 1993, he developed an infection in his eyes that eventually led to his blindness in December 1996. Throughout the early 90s, Vidt survived with virtually no T-cells whatsoever. Luckily, by the mid-90s his T-cell count began to grow with the introduction of new medications. This led to an overall improvement in his health. He got his first guide dog in 1999, which significantly improved his self-sufficiency and mobility. He was able to play an active role in the community again and continued working at Metropolitan Community Church as the half-time church
administrator.

Vidt also threw himself into the thick of the fight against HIV/AIDS in the South Bay. He joined the Santa Clara County HIV Planning Council for Prevention and Care in 2002. He spent multiple years as chair of its Care and Treatment Committee. He also served a stint as the chair of its Planning and Resources Committee. In addition to his HIV Planning Council service, Vidt also served on the City of San Jose’s Disability Advisory Commission and spent four years as chair of the Santa Clara County World AIDS Day Committee.

Vidt says all of the volunteer service is just his way of contributing to the health care system that he believes has taken such good care of him since his diagnosis. “There was a time when I thought my parents would have to take care of me. Who would have guessed that now I am taking care of my mom,” he said.

In 2008, Vidt received the Leslie David Burgess Lifetime Achievement Award in recognition of his service to HIV/AIDS prevention and care, along with being a shining example for others with HIV/AIDS.