In this environment, it was also rare for medical students to set their sights on AIDS. Most doctors were terrified about contamination. Dr. Anthony Fauci, today the nation’s highest AIDS official, darkly speculated that transmission might occur otherwise than through bodily fluids. As a result, some doctors wrapped themselves in spacesuitlike protective gear for examining AIDS patients. Others refused to give medical attention altogether. A 1987 survey of doctors in training at New York City hospitals found that a quarter believed it was ethically acceptable to refuse treatment to an AIDS patient. It didn’t get much better over the next few years. As recently as 1990, when a million Americans were living with the virus and 100,000 were already dead, half of all general practitioners said they wouldn’t treat people suffering from the disease, given the chance.
That left the job to a small group of extremely young doctors, mostly women and social-justice types or gay men and lesbians. Says Ronald Bayer, a Columbia professor of public health who has compiled an oral history of AIDS physicians, AIDS Doctors: Voices From the Epidemic, “Here was a moment when only the avant-garde did AIDS, and they were excoriated by their colleagues.”
Among them, an “atmosphere of cowboy medicine” developed, Dr. Abigail Zuger, at the time a resident at Bellevue, said in Bayer’s book. Dr. Joseph Sonnabend—one of the most influential experts on the epidemic, co-founder of the groups that became amfar and the AIDS Community Research Initiative of America as well as a number of other national organizations—personally smuggled pharmaceuticals through Customs that the FDA had banned. “I can’t even begin to tell you what it was like,” he says. “The unbelievable was normal—it’s hard to conceive. It was like a state of siege, there was that sort of energy and hysteria.”
Torres fulfilled his obligations to the National Health Service Corps by taking a posting at the Wards Island Men’s Shelter, which St. Vincent’s ran under contract to the city. While there, the young doctor published studies in prestigious medical journals, mainly focusing on AIDS among marginalized New Yorkers. He conducted the nation’s first HIV-prevalence survey among homeless men, for instance, revealing the startling fact that 62 percent carried the virus—an early indicator that AIDS had jumped the boundaries of the gay community. Partly on the basis of that study, which made headlines in the New York Times in 1989, he was offered the top AIDS job at St. Vincent’s in 1990.
In truth, he had no competition. “Nobody wanted the job,” Torres tells me. At the time, the hospital’s AIDS office was in a storage room on the ground floor of the O’Toole Building, across Seventh Avenue from the hospital, according to Mike Barr, then a staff member. By all accounts, Torres attacked the challenge with unequaled imagination. St. Vincent’s had never been a significant research hospital, but Torres quickly saw a different way to develop the clinic. He began enrolling his patients in cutting-edge pharmaceutical trials, which not only gained them access to promising treatments but also produced an independent income stream for his clinic, at a time when drug companies were paying a lot for access to patients.
At its peak, the clinic had 40 studies running, worth perhaps hundreds of millions of dollars a year. “We had so much money that, quite frankly, it was hard to spend it fast enough,” says Mary Catherine George, the research administrator at the clinic. But spend it they did. The staff grew to include twenty nurse practitioners and fourteen full-time physicians, including psychiatrists and oncologists. They were investigating everything from ways to keep patients from getting pneumonias to the efficacy of the so-called D-drugs, ddI and ddC. St. Vincent’s joined vaccine trials, drug-“cocktail” trials, and studies of salvage therapies for people with multiple drug resistance. Torres became one of the world’s experts on the ways HIV medications alter body shapes of patients and the dual problems of HIV and TB infections, especially among transsexuals and the homeless, who remained his passion.
In fact, it was his work among New York’s most-forgotten communities that set Torres apart from other AIDS doctors. He forged outreach programs to illegal immigrants, intravenous-drug users, transgender patients, and even male prostitutes. This often put him at odds with hospital directors and the Archdiocese. Noel George, who was Torres’s senior research nurse for many of those years, says, “The hospital kept blocking research because they didn’t want condoms mentioned in the consent form.” When Torres wanted to conduct a study of treating people after inadvertent exposures, the hospital refused, arguing that it seemed to be promoting unsafe sex. “I was pushing the envelope,” Torres admits. “They were very uncomfortable about some of the things we were doing.”