How Horrors of the HIV Epidemic Helped a Health Center Address Covid-19

It was the early 1980s in Palm Springs, Calif., and George Sonsel had lost 35 friends who were in the primes of their lives over the previous few years. Doctors said they died from opportunistic infections that affected the gastrointestinal system and pneumonia. Many called the disease GRID, short for Gay-Related Intestinal Disorder, before the CDC called it AIDS in the fall of 1982.

A licensed therapist, Sonsel and a handful of other professionals, including a certified public accountant, registered nurse, marketer, and infectious disease specialist, decided to help ease the burden wrought by the epidemic by surreptitiously making themselves available to patients — many of whom were dealing with issues beyond the disease’s physical afflictions.

One day, Sonsel got a call from a physician about a man in his early 20s whose prognosis was very poor.

“The doctor asked me to talk him, and told me that he wanted to speak with his family,” Sonsel recounted. “The doctor told me he couldn’t treat him, that he came in too late.”

Sonsel asked the young man for his parents’ phone number. It turned out that they lived within a couple of hours drive of the hospital.

“I told him I would try to make the connection and he was just thrilled. He asked if I could make it happen, that they could come visit him, and I said I would make the call, but couldn’t predict what would happen,” Sonsel said.

So he called. A woman answered. When he said he was calling on behalf of the sick young man, the woman said, calmly, that she didn’t know anyone with that name. Confused, Sonsel tried the number again.

“The same woman answered and said, ‘We don’t have a son,’ and hung up. I went back into the room and tried to ease it as best as I could that, you know, I didn’t think they would be able to make it. He died shortly after… that was a key reason for the origination of the organization,” said Sonsel regarding the informal group he co-founded that would eventually become Desert AIDS Project and today, DAP Health.

As he and his fellow volunteers would see, the young man’s horrific experience was just one of many that occurred in Palm Springs during that time.

“People would come here to die. They didn’t have any money,” Sonsel said. A common occurrence would be for people with advanced cases to book a room and obscure their plan to stay gratis beyond the time they paid for. Some compassionate hoteliers would call Sonsel and his friends to help find food, shelter, and care for people in such a situation. They would answer the call, even as some interventions would carry on for days, often to the severe detriment of the volunteers’ own personal practices and businesses.

“Doctors would call us and basically ask, ‘Can you be this guy’s friend?’” Sonsel said.

Despite the awful impact of the virus, Sonsel and his fellow volunteers were initially surprised to find that there was resistance from the community towards the creation of an HIV-focused initiative, due to fears that such an organization would associate the town with the epidemic and thus deter tourists — the economic lifeblood of Palm Springs then and now — from visiting. Now closely identified with gay culture, back then Palm Springs only had about a dozen gay hotels and a few gay bars.

“They wanted to keep it [HIV/AIDS epidemic] under wraps and we thought, ‘No, you can’t do that, this is a medical disease and you have to approach it that way,” Sonsel said, while acknowledging that he understood where his tourism industry neighbors were coming from.

At that time, this decision to help, and thus be associated with the malady, came with great risk to each person involved. “Almost immediately you could expect to be shunned, gay, straight, it didn’t matter. It would expedite the process of losing everything, and a lot of people did. But a lot of people said ‘I want to take this opportunity to make my life count’,” Sonsel said.

In 1987, two Gallup polls found that about half of Americans believed that “it was people’s own fault if they got AIDS” and that “most people with AIDS had only themselves to blame.” While almost 78% believed people with AIDS should be “treated with compassion,” more than 20% believed they should be “isolated from the rest of society.”

Though Sonsel and his group had ample experiential data to confirm the need for a more organized initiative, both in terms of lost friends and the psychological toll their work was taking on them, it was a local interagency survey in 1984 that provided them with the ammunition needed to attain buy-in from the local business community. It showed that a rapidly growing number of people were showing up in emergency rooms and doctors’ offices in town.

That same year, Desert AIDS Project was formally born and granted nonprofit status. The mission back then was to continue to provide the kinds of supportive, mostly non-medical services that they had been providing until that point, such as connecting people with home health care and social support groups. They operated at a loss; the goal was simply to care for as many HIV patients as possible.

Today, Desert AIDS Project, now known as DAP Health, is a Federally Qualified Health Center, has a 44,000-square-foot facility, and serves more than 7,000 patients with a full suite of medical care including primary dental, behavioral health, and chiropractic care as well as access to social services including food and housing assistance. It also has affordable housing units located on its campus. But while much has changed, the volunteer tradition still exists, with over 400 volunteers giving over 60,000 hours of their time every year.

Unfortunately, Palm Springs is still home to an elevated rate of HIV infection, with a rate 400% greater than the national average. While DAP continues to offer specialized care on that front, it was also uniquely ready to fight the Covid-19 pandemic, given its institutional history of fighting viral outbreaks, in terms of testing (it was one of the first clinics to offer HIV/AIDS testing after FDA approval of an antibody test in 1985), caring for chronic conditions, and social services.

“We had a Covid clinic back in March because the doctors here trained in infectious diseases knew that it would play out in much the same way as HIV,” said Jack Bunting, a public relations specialist at DAP. Staff drew on their experiences with HIV to make sure they offered resources beyond traditional medical care.

“We set up a very expansive Covid-19 hotline with medical personnel and trained clinicians to give advice to folks, go over symptoms, and sometimes have them come in for testing,” Bunting said. “We wanted citizens to be able to take control over their health and health care and be able to call and get advice from people who are trained how to empathize.”

In addition to these services, DAP, like many FQHC’s, offers Covid-19 testing and will offer vaccinations once they receive them. Created to help address an acute health inequity, Bunting said DAP is especially sensitive to such issues today during the pandemic.

“This pandemic has amplified pre-existing health inequities, and that’s what we’re here to fight,” Bunting said. “This is just like the HIV epidemic, except they can’t ignore it now because it’s affecting everyone.”

DAP Health was the recipient of a Direct Relief Covid-19 Emergency Grant of $50,000 and a $245,000 Pfizer Innovation Award in Community Health to address infectious disease in underserved communities.