by Ruby Comer
Istik Levy, MD (Part 2)
After my enlightening breakfast with Dr. Levy (see my exposé last month), I continue my discovery of this fascinating country of Israel. My ever-efficient tour guide, Carmela Zion, once again leads several of us journalists on our trek through this ancient land, and her accompanying stories drip with rich insight.
In Nazareth we visit the home of Mary, and then Joseph’s carpentry shop where kid Jesus worked alongside his father. Some of you may not be believers; however, that isn’t the point for me. It’s compelling to approach it from a historical perspective and to be here where so much took place! At the seaport town of Akko, built around 285–246 BC, I’m so overcome by the majestic views that I stretch out my puny arms, face the Mediterranean Sea, and just gave thanks.
Ending our journey in Jerusalem, I ride a camel then Segway through Old Town. It was my first time for both—and what a buzz!
Straddling the camel I feel like Peter O’Toole in Lawrence of Arabia and, on the android contraption, I feel like a kid again. I don’t want to get off. (Training is mandatory before you rent and thanks to Yair Peretz at Zuzu Segway for his patience in teaching this ol’ broad.)
I meet up with Dr. Levy later that evening at The Eucalyptus Restaurant (serving authentic Israeli dishes), not far from the towering Leonardo Plaza Hotel where I camp out for a couple of nights on a high floor and have a sensational view of the city, including the serene splendor of Independence Park, adjacent to the hotel.
The head chef and proprietor of the eatery, Moshe Basson, comes by to greet us, as we nosh on delectable appetizer dips and breads. (This one time I indulge and just poo on my gluten-free diet!)
Ruby Comer: What a cozy, hospitable place you have here, Moshe. [He smiles, takes my hand, and gently kisses it. Holy Lord, shower me with more!] Itsik, you’ve been in the HIV/AIDS field for many years, what have you noted is the greatest change and the greatest challenges you have faced?
Itsik Levy: Just now, the Ebola epidemic and all the fear it engenders reminds me that not such a long time ago the greatest obstacle in treating HIV patients was the fear of those patients which encouraged racism and homophobia. It only increased their isolation. Not only did they have an incurable fatal disease but also social isolation, many from their own families and medical staff, as well. Fortunately, the greatest changes are seen both in the medical-biological field by HAART, which turned the disease into a chronic lifelong condition with an acceptable quality of life. This enabled people to bring back their HEART by reducing the fear. Family and social isolation is much less dominant now than in the past.
What are the major differences in diagnosing and the treatment of HIV in the Arab community of Israel and the Jewish population? [I sip the savory artichoke soup.]
Unfortunately, there are huge disparities between Jews and Arabs concerning HIV diagnosis, treatment, and prognosis. Arabs are being diagnosed much later than Jews. They have a much more suppressed immune system and many opportunistic infections. Also, their linkage to care, medical follow up, and adherence to treatment is far worse than among Jews. [He pauses to take a bite of his chicken, stuffed with figs.] The main reason is that the Islamic culture is much less accepting of homosexuality, drug abuse, and other behaviors which are considered to be immoral. Arab patients are afraid to go for testing, and when diagnosed they are afraid to go to the medical center. We are now doing some work together with the Israeli AIDS task force to encourage Arab MSM to go for testing and to be more adherent to their medical follow up and treatment.
Itsik, has the ultra-orthodox Jewish community posed any problems in your efforts to promote AIDS awareness among Israeli youth?
I must say that the ultra-orthodox Jewish community in this regard minds their own business and have never interfered with our work. Saving life is a first priority of this community and so they were often a helping hand.
I assume there is some HIV/AIDS stigma in Israel. Can you expand on this?
Stigma is driven by fear, as well as other factors. Unfortunately, the stigma is worse among those groups that are most affected by HIV. For example, many MSM will not meet somebody who is known to be HIV-infected. I must say that in recent years more and more gay people with HIV are coming out with their disease in the media and today there are more serodiscordant couples. The situation is much better now than just a couple of years ago.
The worst stigma comes from the Ethiopian community where all patients are working very hard to hide their status. The social price they have to pay if the community learns of their status is too high. For example, there is a socially important ritual of coffee drinking, called buna. Being infected with HIV may cause a man to be banned from this ceremony. He would prefer to die rather than give his secret away. We are trying to do some work in the community with the help of local leaders and “cultural bridges.” These bridges are usually people that were born in Ethiopia but are already many years in Israel. They can understand both western Israeli and Ethiopian cultural and social codes and they work to reduce the stigma.
Among the general population the stigma becomes less and less of a problem. Two examples are the Israeli army, which in the past denied recruitment of individuals with HIV and now accepts them, and among women, who now want to make a child with MSM whereas before they did not want to do it [because of the fear of HIV]. Today more and more women are not intimidated by the fact that their partner is HIV-positive.
What is your opinion of PrEP?
Well, PrEP is not the solution for everything. It’s a very important part of preventive measures, but I’m not sure I want to see my community taking pills every day, which may influence their kidney function, their bones, and maybe increase their risk for HIV drug resistance. On the other hand, maybe I’m too conservative and maybe the same things I just said were also said in the past about contraceptives. Now contraceptives are part of the standard practice. I suppose my ambivalence reflects the ambivalence of many in the medical and MSM societies, which means that only time and more research concerning the efficacy and risks of PrEP will help us to give a more definite answer.
What is your take on where we stand globally today with the pandemic, Doc?
New HIV infections have fallen significantly in many countries. At least half of these countries are in Sub-Saharan Africa. This decline has occurred especially in countries where sustained and strategic programs take into account the specifics of local epidemics, and where the political leadership and the community leadership have joined forces. It’s still too early to be overly optimistic because it could discourage the leadership from investing more in HIV prevention. So lets be happy for what has been done, but it’s not the time for rest.
If you were fourteen years-old again, would you choose to pursue the same career?
Yes. [He softly chomps into his dark chocolate soufflé and I chow down on this oh-my-god-out-of-this-world Basbussa-Semolina cake, served with raw sesame cream and date honey. We exchange satisfied looks. Dr. Levy continues.] As I said earlier, Ruby, I chose to work with HIV patients because I loved the combination of science and humanitarian work. I believe that today, AIDS, like many other infectious diseases, reflects the combination of biology and social circumstance. I hope that now with the Ebola epidemic in our gates we will remember the lessons we learned from the beginning of the AIDS epidemic and not make the same mistakes. [Itsik leans in, his azure eyes beeline toward mine, and he inhales a measured breath.] The world community must invest in the containment of the epidemic.
To read Part 1 of the interview click here.
Ruby Comer is an independent journalist from the Midwest who is happy to call Hollywood her home away from home. Reach her by e-mail at [email protected]