Peter Shalit Wasn’t Aware When He Entered Medical School That a Global War Was Looming—And That It Would Require His Loving Expertise
by Dann Dulin
Peter Shalit entered medical school like any other student, passionate and committed to keeping others healthy. Little did he know that he would soon encounter a gross mutation that would become the Black Plague of the century.
Peter began medical school in 1981, which was the onset of GRID, or gay-related immune deficiency, as HIV/AIDS was called for a spell. During those following tumultuous years of the first decade of the epidemic, Shalit was studying, interning, and completing his residency to become a Doctor of Internal Medicine. He started his independent practice in 1990, which continues today in Seattle, Washington.
The majority of the doctor’s focus has been on the virus (most of his patients are living with HIV or are being treated to prevent HIV), and in addition, his practice is a clinical research site for trials of new HIV treatments and preventive medications. Peter is a professor at the University of Washington where he teaches HIV treatment and prevention.
Simply put, Peter Shalit is an HIV doctor. He’s been on the battlefield his entire professional life. He’s also gay. If you’re of a certain age, you will certainly remember his father, the famed movie and book critic, Gene Shalit. Gene’s trademark was his Afro-like black hair, Village People-esque handlebar moustache, loud bowties, and terse wit. He was a fixture on NBC’s The Today Show for nearly four decades. At ninety-four, Gene lives in the New England countryside, and, according to Peter, hasn’t watched a single movie since he retired nine years ago!
On the personal side, though, Peter admits that his relationships are “complicated,” essentially, he’s in a “thruple.” A “thruple” is three people who are romantically linked. He married Bob, whom he met in 1998. Next door to them lives Peter’s previous partner, Andy, whom he met in 1980 and they lived together until 2004. They all live on the same property and are family.
Peter recently purchased the DVD box set of the sixties TV series, Honey West, starring the sultry and effervescent Anne Francis [A&U, November 2005], who had an extensive and illustrious acting career, as well as being an AIDS activist. As a family, Peter, Bob, and Andy watched the first episode, munching over a bucket of Ezell’s Fried Chicken, available only in Seattle, which Peter calls “the best in the world.”
In Peter’s birth family, he is the oldest of six. Raised in Leonia, New Jersey, and North Tisbury, Massachusetts, he refers to both towns as “magical” and “amazing.” From his esteemed dad, he learned to—“Find your own path”—and did so with the help of the Seattle Counseling Service, when he was in his early twenties. The organization might likely be the world’s oldest LGBT+ mental health agency, since they’ve been around for fifty-one years. Peter’s fervent about a number of charities, but the Seattle Counseling Service is high on his list.
Also high on Dr. Shalit’s list are those living with the virus, whom he considers heroes.
Dann Dulin: The terms HIV and AIDS has been invariably misused and tossed around through the years. For readers who might be unfamiliar, set us straight on these acronyms.
Peter Shalit: HIV is a virus. AIDS is an illness caused by untreated HIV. I prefer to talk about HIV, which is a real biological entity, rather than AIDS, which is an arbitrarily-defined set of illnesses originally assembled for epidemiologic purposes, and whose definition has not changed in years despite vast increases in our knowledge, and which has a huge amount of social and psychological baggage attached to it.
It’s important, truly, how we use these terms. What’s the best advice you ever learned about being in the medical field?
Active listening. I learned this first from my therapist, and then in training as a peer counselor. This was all before I went to med school, but I incorporated it into my personal and professional life. It sure helps me in my work but also in my interactions with friends and family. Being a good listener is rewarding. People appreciate being listened to.
That is so true. Many talk, but unfortunately, few listen. How did you first hear about AIDS?
In 1981 I was a medical student when the first reports of “gay-related” bizarre infections and cancers started appearing. From that point on, of course, being a young gay man it got my full attention. In retrospect, I had spent part of the summer of 1980 in Provincetown, and there were men there who unexpectedly became very ill and had to be flown to the hospital in Boston for care, but no one had put it together yet.
Sounds parallel to Larry Kramer’s play, The Normal Heart, where guys were getting sick in the summer on Fire Island. Tell us about your early days of encountering this strange new virus.
My first interaction with patients living with AIDS was probably 1982. The first one I remember had actually been a friend of mine, and he was in isolation in the hospital at the end of a long hall. I was rotating at that hospital and visited him. He was dying of lymphoma and spent his time in that isolated room… writing goodbye letters to friends.
Heartbreaking. Was your passion kindled by this distressing event that motivated your pursuit onto the battleground?
My residency training began in 1985 and I made it a point to be involved in the care of folks with AIDS, many of whom were my friends or peers. So actually I felt a particular motivation to help as much as I could. I started my practice in 1990 at the peak of the AIDS horror, so a lot of my practice was involved with that condition from the first day I began my own practice.
Share a story of a patient that touched you.
There are many, but here’s one. [Dr. Shalit adjusts his smart-looking bookworm-ish spectacles.] In the early nineties, I took care of a colleague, a doctor just a few years older than me, let’s call him Arthur. We had a bond because we were both doctors, and his family had basically disowned him because of his sexuality and his illness. He came to me as a patient for help and survival, even though as a physician we both knew it was hopeless. [His shoulders slump and Peter emits a laden sigh.] Initially, Arthur was pretty healthy but ultimately his CD4s were gone. He went into hospice. At one point, it seemed as though he was dying of some opportunistic infection and was going to go in a day or two at most. He was barely conscious and on the most oxygen they could give.
[Peter sits back in his chair, clasping his hands behind his head.] In the meantime, I had never taken a single day off since starting practice a couple years earlier, but I had been convinced to take a week’s vacation out of town. Before leaving I visited Arthur one last time to tell him ‘goodbye’ and express my deepest apologies that I would not be in town for his last day(s) on the planet. He said, ‘That’s ok, I’ll wait.’ Sure, I thought. Well I came back from my vacation a week later and he was still alive. I went to visit him in the hospice and he was not conscious, and barely breathing. I sat down next to him and held his hand, told him I was back, and just sat with him. After a few minutes, his breathing stopped. He had waited for me; otherwise he would have died. Once I arrived, he was able to let go. [He takes a hard swallow.] I have lots of stories like that. I could write a book—but I won’t because really I don’t want to remember those horrible times.
Pow! Bam! Hits you right in the gut and throat, Peter. How did you deal with all the deaths you’ve experienced—both professionally and personally?
I developed certain goodbye rituals for patients. I would write ‘deceased’ on the cover of their chart, and put a copy of their obituary inside. Also I have a little box of file cards where I wrote the name and date of death of each patient. I still have that box. To a degree I became numb to all the deaths—if I hadn’t, I would not have been able to bear the pain.
Losing friends was harder but not that much harder than losing patients because I developed such a strong emotional bond with the patients who were dying. Anyway, the line between patients and friends was blurred because some of my friends became my patients, and vice versa. When HIV was untreatable, death was just about inevitable, but I never referred to a deceased person as having lost their battle, because the end was a given. Instead I referred to them as having won, since they did their best with the time they had, and I considered that “winning.”
Nice healthy reframing. Tell about your first HIV test.
I was a medical student in 1981 and in those days they had two gay diseases: “GRID” which made gay men get sick and die, and ‘Diffuse lymphadenopathy syndrome’ which was for gay men who had lots of swollen lymph nodes but weren’t otherwise sick. It seemed that some of the lymphadenopathy guys did go on to get sick with GRID. Now we know those guys had earlier stages of HIV infection. So there was a study of gay men with lymphadenopathy, and a control group of gay male college students without lymphadenopathy, to see how their health fared over time.
Though I lived though the first phase of AIDS, I never have heard of this.
I volunteered for the study as a control patient since I was a student and didn’t have the lymph nodes. Every few months I would go in and have a physical exam looking for lymph nodes, lots of blood work, and got asked a lot of questions such as, how many sex partners I had had since the last visit, had I traveled and had sex with anyone out of town, etc. Oh, and I got a free hepatitis B vaccine in the study. [He chuckles, stroking his lengthy beard.]
Okay, can’t beat that!
By the way, the study nurse was a wonderful woman named “Victory,” which was a very appropriate name. Anyway a couple of years later, I believe it was 1983, I was still in my third year of medical school, which is a very busy time. I got home late one Friday and there was a message on my answering machine from Victory. This was shortly after HIV had been discovered. The message said that they had an experimental version of a new test for the AIDS virus, and they had tested my blood, and if I wanted to know the result, to please call back. Well it was after five o’clock on Friday by the time I got the message, which meant I could not learn the result until the following Monday. [Peter let’s out an achy groan.]
Oh, god, that’s excruciating….
It was not a good weekend. [With a scoff, he mockingly laughs.] Remember, back before the test, gay men were always wondering if that spot on their skin meant they had KS, or if that cough meant they were going to die of pneumonia in a few weeks? So this was a really big deal to know that there was a test that could stop the wondering. I sure wanted to know the results immediately. It was so stressful waiting. Now we know better how to give HIV test results to an individual.
Indeed. Thankfully. Elaborate on your clinical research site you have in your practice.
Our clinic is a site for trials of new ways to treat or prevent HIV. We don’t design the trials—the study managers recruit clinics like ours to be sites for the trials. But one “discovery” that I’m proud to have been a part of is a local pharmacy that wanted to have a pharmacist-run PrEP clinic. It was a student project and I was the medical advisor. We overcame all the barriers and developed a successful PrEP clinic exclusively staffed by pharmacists, with my clinic serving as medical backup. It provides access to lots of folks who otherwise would have trouble accessing PrEP. We wrote it up in a medical journal, and according to a recent article in the New England Journal of Medicine, our PrEP clinic was an inspiration for California’s new law empowering pharmacists to prescribe two months of PrEP without a doctor’s prescription.
Kudos. How proud that must make you feel. What are you currently working on?
The next studies we are working on are for antivirals that are long lasting, meaning that in the future, it will be possible to treat or prevent HIV without taking a daily pill. Possibilities range from a weekly pill, to a monthly pill, to a two-monthly shot, to a shot every six months, to an implant once a year. This is very exciting and I’m confident it will happen, because there are several such drugs in the pipeline and several companies working on these drugs.
This is exceptional news, Peter. Will there be a cure or a vaccine down the pike?
I am uncertain that either a cure or a vaccine is biologically possible, although many smart people are working on both things, with lots of money supporting the research. I’m skeptical because HIV is a cunning virus, and ever since the 1980’s a cure and a vaccine have “just been over the horizon.” That horizon may actually be a mirage.
I know, I recall hearing about a potential vaccine as far back as the eighties, too!
[Peter nods.] But gee, if HIV could be treated by a shot every six months, that would be the next best thing to a cure. If women could get an annual implant for birth control that also protects them against HIV, well, that would be pretty similar to a vaccine. [He pauses, clearing his throat.] Five years from now I believe these and other long-acting options will be a reality, and no one will have to take daily medicine to treat or prevent HIV.
I’m elated to hear this. What is something that bugs you, which has not been done to prevent the spread of HIV?
What bugs me is that we have done very well at treating and preventing HIV in the more privileged members of our society, and so we know how to do these things well from a medical point of view. But from a societal point of view, people of color, and poor people of any color, have been left behind. This is where the epidemic continues to flourish. It is a societal problem and the efforts of the medical community are not enough to fix this particular problem.
Alas … true enough. What has been the greatest challenge working in the AIDS field?
The greatest challenge is our incredibly frustrating healthcare system. [He releases a loud exhale.] I spend so much of my time fighting to get my patients the treatments they need. It’s a crime. Now when I have to fill out forms appealing the denial of a life-saving treatment for a patient, I also write a few lines on the form to the person at the insurance company who processes it, things like: “How can you sleep at night?” or “How can you look yourself in the mirror?”
How has COVID-19 affected your practice?
It’s affected our practice profoundly. Due to physical separation guidelines, we (like other outpatient practices) have temporarily stopped seeing patients in person. We are doing online “telehealth” visits for the time being. Per CDC recommendations, we are postponing the usual six-month follow ups for our patients living with HIV if they have been stable and adherent. PrEP is another issue. Many gay men have changed their sexual behavior in response to the pandemic and there is less need for PrEP. We are counseling all of our sexually active patients that the safest partner is yourself or a member of your household; however, I have been told that apps like Grindr and Scruff are still very active, which is risky in terms of our efforts to stop the spread of coronavirus. We are still seeing men acquire sexually transmitted infections despite the lockdown. The pandemic has also affected HIV research since most trials have been suspended or are being curtailed or modified due to the lockdown in our area. And it has affected the finances of our practice, since our revenues from patient care are way down. We have applied for assistance through government programs. We are not alone in having this issue; many independent medical practices are having difficulty right now and some may close for good.
How similar are the two viruses?
HIV and SARS-CoV2 are completely different viruses. There are a few similarities though. Both have RNA as their genetic material, and both have a protease function as part of the process to produce new viruses….HIV meds do not work against SARS-CoV2. HIV protease inhibitors have been tried against SARS-CoV2 and have not shown success, but protease inhibitors that work against the SARS-CoV2 virus are being developed as therapy for COVID-19.
Does COVID-19 pose an extra threat to HIV-positive people? How?
One might guess that COVID-19 poses an extra threat to PLWH because in general, folks with other chronic medical conditions tend to do worse with COVID-19 infection. However, preliminary experience from Spain, which has a high rate of COVID-19 disease and many people living with HIV, is that folks with HIV do the same or maybe even a little better than folks without HIV. This is true even for those who are not on treatment, have a high viral load and a low CD4, etc. So if you have HIV, it may actually be your superpower against COVID-19. I await further confirmation of this preliminary observation. The important risk factors for COVID-19 complications though are lung disease (including smoking), diabetes, high blood pressure, and heart disease, which are conditions that commonly affect PLWH.
The pandemic itself may be a threat to PLWH in the sense that routine medical care has been disrupted, and there may be disruptions in supplies of medication. All PLWH are advised to have at least a month’s extra supply of their HIV medication, and many insurance companies are permitting advance refills and ninety-day rather than thirty-day supplies, fortunately.
What lessons can we learn from the AIDS epidemic that we can apply to COVID-19?
Oh, gee, the two epidemics are very different in the sense that the nature of the virus is different. SARS-CoV2 kills much faster, transmission is more via social proximity rather than intimate contact. But the similarities are that both are “new” viruses to the human population, and can spread in a “stealth” way in which the sickest people are only the tip of the iceberg in terms of the population of affected people. I think one lesson we have learned from the AIDS epidemic is that ignoring an epidemic allows it to spread and get out of control. Unfortunately we did not learn this lesson well enough and so the same thing has happened with SARS-CoV2. But we are finally employing effective methods to stop transmission of SARS-CoV2. Also, the AIDS epidemic contributed greatly to our knowledge of virology and antiviral therapy, and that has given scientists many tools to help combat the current COVID-19 pandemic.
You have been on the frontline of this pandemic from inception. You could have chosen another field to practice. Do you have any regrets?
No regrets. It’s been the greatest gift to be able to see the 180º transformation of an inevitably-fatal disease to become a chronic manageable one, and incredibly rewarding to see folks have wonderful fulfilling lives that were only made possible because we now have treatment for this virus.
Since I have a similar sexual history as many of my patients who have HIV, “There but for the grace of god” I escaped infection. Maybe for a genetic reason, but ….[he pauses, glances off, and in an almost transcendent state, Dr. Shalit says]….sometimes I think the cosmic reason was to allow me to play the role I’ve played.
DR. SHALIT’S VITALS
What was it like growing up in your father’s shadow?
It didn’t feel like a shadow. [He pauses.] The best part was that he had free passes to the NYC movie theatres, so my buddy Chris—who later became a movie director—and I would spend all day Saturday from ten in the morning onward seeing movie after movie. Also, I am not very much like my dad so I didn’t feel competitive or overshadowed.
Who was your first celebrity crush?
Elton John. I knew he was gay before he did. Just look at the cover photo of him on his first album …
Did you have posters hanging on your walls of Elton when you were a teen?
I was a nerdy brooding closeted gay teen and Elton was a nerdy brooding closeted pop singer. I recognized that and immediately fell in love. I pasted pictures of him all over my bedroom walls when I was in high school. In 1971 my dad interviewed him on TV. Afterwards, off-camera, he told Elton about my obsession. My dad didn’t call it a crush, as I hadn’t come out to him yet. Elton autographed a photo of himself for me and wrote a personal note on it about that “Your dad told me about you…Apologies for ruining the paint job.”
What film could you watch over and over?
Blade Runner or Blue Velvet. It’s a toss-up between those two, and I’ve watched them many times.
What’s your favorite childhood sitcom?
Sitcoms were like cotton candy. No substance to them. Didn’t interest me … and the laugh tracks were annoying, too. I watched Star Trek starting with the first episode, first night it aired, first year. In college two different stations showed Star Trek reruns so I watched two episodes every night, in black and white on a little TV. Later I was able to see them in color and basically started over. I have seen those seventy-nine original episodes so many times now I know most of the lines by heart. Star Trek TOS may look superficially like science fiction, but it’s really social commentary with a digestible coating of sci-fi to make it go down easier.
What do you miss about yesteryear?
The sixties and seventies classic rock era! Every week there was new amazing songs on the radio. Tell you what…those are still the best songs made in the twentieth century or the twenty-first century. Or… maybe… ever.
What band was your favorite growing up?
The 5th Dimension! Highly underrated and still not in the Rock and Roll Hall of Fame. That’s a crime.
Tell something that most people probably don’t know about you.
I’m a plant nerd. I grow and breed tropical plants. I also edit a botanical journal.
What appeals to you about wearing a long beard?
A beard is the most obvious secondary sex characteristic that makes a man a man.
For women it’s breasts; for men it’s a beard. When I was a teenager and my beard started growing in, it was like this amazing masculine miracle transformation happening to my body! I couldn’t understand why I was supposed to scrape it off every day. Still don’t.
My beard is very tightly connected to my male identity. To quote the song, “Lola”: “I’m not the world’s most masculine man / but I know what I am and I’m glad I’m a man”
My beard reminds me of that. It’s something a man has.
My high school wouldn’t let me graduate without shaving. [Peter’s java-brown eyes lift upward, as he shakes his head.] So the day before my high school graduation was the last day of my life I have shaved. It was never a matter of fashion … the opposite actually. I experienced a lot of shunning and rejection in the gay community when I was younger due to having a beard. I mean, I went bald in my twenties and had a big beard, and that was just not the look for a young gay man in the seventies and eighties.
I would have gotten a lot more attention from men if I had shaved, but I didn’t take it personally. I just thought it was weird that “clean-shaven” was supposed to be an attractive characteristic for a man. I always managed to find boyfriends or partners anyway, and usually they were bearded themselves. That was before the “bear” movement. Bless them for making it ok to be a hairy bearded gay man.
For years I kept the beard trimmed relatively short. It was kind of necessary professionally. Ultimately, I wanted not only to have a beard, but also to have a long beard. So I let it grow out. I love being able to grab it with my fist. I love when people ask me if they can touch it. But mostly it pleases me and I don’t do it for any other reason. And since I’m my own boss, I don’t have anyone telling me how I should be groomed.
Dann Dulin is a Senior Editor for A&U.