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Joseph Sonnabend opened his medical practice in the Greenwich Village neighborhood of New York City in 1977, on the cusp of what would become one of the most consequential battles of modern medicine. At the time, what is now known as AIDS — acquired immunodeficiency syndrome — had not yet been identified, and scientists were years away from isolating HIV as its cause.
“Fate,” Dr. Sonnabend once said in an interview with BuzzFeed, “put me at the beginning of this epidemic.” He was a gay physician who treated predominantly gay men at a time when they were often regarded as outcasts. Receiving his patients after they looked in vain for compassionate care elsewhere, he became one of the first physicians to recognize the emergence of AIDS and went on to play a critical, if at times controversial, role in slowing its spread.
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“He was very devoted to the clientele” at a time when “there was still a lot of prejudice, bias, hostility to people who were gay,” Robert C. Gallo, an American virologist who is credited as a co-discoverer of HIV (human immunodeficiency virus), said in an interview.
Dr. Sonnabend died Jan. 24 at a hospital in London, where he had lived since 2005. He was 88. The cause was complications of a heart attack he had suffered three weeks earlier, said David Kirschenbaum, a friend and co-executor of his estate.
Born in South Africa and trained in England, Dr. Sonnabend brought to his medical practice a background in infectious diseases that helped him understand before many others the nature of the illness that in its earlier years was stigmatized as a “gay cancer” or the “gay plague.”
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“I was seeing kinds of morbidity amongst sexually active young gay men that could not be adequately accounted for,” he recalled in 2000 when he received an honor from Amfar, a research organization that he helped found in 1983 as the AIDS Medical Foundation. These illnesses included Kaposi’s sarcoma, a rare cancer that produces purple skin lesions, and a form of pneumonia that generally occurs only in people with severely compromised immune systems.
“The other doctors who were treating AIDS didn’t have the research experience or the instincts,” he told POZ, a publication that caters to people affected by HIV/AIDS, in 1998. “And the academic researchers — the top immunologists, virologists and so on — who had the expertise, didn’t have the patients. I had both the background and the patients. And that was an amazing discovery. I mean, it was as if I had jewels.”
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“I had patients who liked me, who were willing to give me blood, who would participate in anything,” he continued. “The one thing I didn’t have was a freezer. I couldn’t afford a freezer, so I kept the blood in a refrigerator that had a little freezing compartment.”
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Like many researchers at the time, Dr. Sonnabend struggled to understand the new syndrome and its cause, initially linking AIDS to repeated hits to the immune system from multiple sexually transmitted diseases and other infections. By the mid-1980s, scientists including Gallo and the French virologists Françoise Barré-Sinoussi and Luc A. Montagnier demonstrated that AIDS was caused by a virus, HIV.
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In those early days and later, including when he challenged prevailing views about the antiviral drug AZT, Dr. Sonnabend at times found himself at odds with the medical establishment, which he said dismissed him as “just a VD doctor” (“VD” refers to venereal, or sexually transmitted, disease).
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“I desperately wanted to help,” he said, “but I was basically told to mind my own business and just take care of my patients.” He helped form what became Amfar to pursue community-based clinical trials.
As chairman of the scientific committee at the AIDS Medical Foundation, Dr. Sonnabend also served as a medical consultant for a publication that was widely read within the gay community: “How to Have Sex in an Epidemic: One Approach.”
The booklet, written by activists Richard Berkowitz and Michael Callen, was first printed in 1983, just as scientists closed in on the discovery of HIV as the cause of AIDS. Under Dr. Sonnabend’s guidance, the authors challenged sexually active gay men not necessarily to limit their number of partners, but rather to change their sexual practices — including by using condoms — to protect themselves and others from the spread of disease.
“We brought the ire of the gay community down on us for even daring to suggest that behavior spreads germs,” Dr. Sonnabend told POZ, recalling the reaction to the explicit booklet, which they distributed in places such as gay bars. “We became hated people.”
They produced the booklet, Dr. Sonnabend reflected in POZ 30 years after the volume was released, because “the three of us shared a belief in the importance of sexual expression as a vital human need. It was particularly important, that at a time when it could be associated with the possibility of such dreadful consequences, sex itself be defended as one of life’s joys.”
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Callen died of AIDS in 1993. Berkowitz, now 65, and living with AIDS for years, was depicted in the 2008 documentary “Sex Positive.” He credited Dr. Sonnabend, who was his physician, with saving his life on multiple occasions and with instilling in him the message — which he and Callen sought to share through their booklet — that “it’s never too late” to discard old habits and begin having safer sex.
Joseph Adolph Sonnabend was born in Johannesburg on Jan. 6, 1933, and grew up in Bulawayo, in what is now Zimbabwe. His mother was a physician, and his father was a sociologist. Both parents were Jewish immigrants from Europe.
Dr. Sonnabend studied medicine at the University of the Witwatersrand in Johannesburg, where he graduated in 1956. He later trained in microbiology and immunology in England, where he worked with Alick Isaacs, who helped discover the antiviral protein interferon. Dr. Sonnabend later examined overproduced interferon as it might relate to the development of HIV/AIDS, a contribution that Gallo described as “real and lasting.”
In 1969, Dr. Sonnabend became a professor at Mount Sinai Medical School in New York. He joined the city health department, advocating programs to reduce sexually transmitted disease among gay men, and volunteered at a clinic for gay men in Greenwich Village before opening his own practice.
“It was in a small apartment, crowded from floor to ceiling with magazines, posters, medical supplies and furniture that wasn’t worthy of a low-rent garage sale,” Sean Strub, the founder of POZ, wrote in a profile of Dr. Sonnabend.
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His role in the demonstrations at the 1968 Democratic National Convention in Chicago sealed his place in the annals of the counterculture. He had been diagnosed two weeks ago with lymphoma, said his wife, Kirsten Liegmann.
“Patients in the waiting room sometimes rearranged the order of seeing Joe, based on our collective assessment of who needed to see him first,” Strub recalled. “Those of us with insurance remind him to send out bills; those without often helped in his office, cooked him dinner or volunteered with the organizations Joe started. Over the years, his patients have redecorated, filed, cleaned and helped in the management of his practice.”
Dr. Sonnabend was married once and had two children from other relationships, according to Kirschenbaum, but complete information on his survivors was not available.
When he received the honor from Amfar, Dr. Sonnabend remarked that he had felt “the burden of history.”
“My involvement has been as a laboratory scientist, as a physician, as a clinical researcher, as a community activist, and as a sexually active gay man,” he said. “And all these involvements have been intertwined over time, and it has been burdensome.”
“I’ve witnessed so much failure,” he said.
But there were also profound, meaningful successes.
Strub, who has AIDS, described himself as “one of the dying” people Dr. Sonnabend had kept alive. “Not through some magic combination of pills he urged me to take,” Strub wrote, “but through an intangible conveyance of hope, respect [and] trust.”
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