"I remember a very young woman, she might have been around 24 years old, very sick, and in a  confused state. I asked her 'Do you know where you are?' to try and ground her, instead, she  grabbed my arm suddenly, stared into my eyes, and whispered, 'I have the disease'." 

Cesare Saponieri, MD, New York.  

Cesare Saponieri is a cardiologist in New York who had his early start of residency in internal  medicine in 1994, during the peak of the AIDS epidemic in the USA. "At 25 years old, right  when I had no more hope of staying in the US for the residency program, a hospital in Queens  took me in. It was during the peak of the full-on-blown AIDS epidemic, and as interns, we were  on the forefront most of the time" he tells me, during a summer day in Bari (Apulia, Italy) where  he's staying on vacation. "I have been in NY right now for more than 30 years, especially  because I overworked myself as much as I could until my early fifties, but after the pandemic I  am learning to manage my time differently, recharging when needed". Saponieri's focus is now  on sudden death due to heart failure and other cardiological conditions, making him familiar with  "near-death experiences" in patients resuscitated by CPR. Before he experienced the loss of  terminally ill patients due to AIDS in a fast-paced timeline now that he moved onto cardiology  and that HIV is not perceived as a "death sentence anymore" Saponieri has been experiencing  life and death in a completely transformative way.  

​"Working so close to death every day changes something inside of you, for the better or worse.  The solidarity and strength that patients who had AIDS had to gather among themselves to  survive, even for a few months, was a breakthrough. When the State was not there, volunteers,  associations -such as ACT UP New York- and queer collectives would step in. That is all they  needed, someone that cared." The stigma was the greatest barrier between society and people  living with the illness. Patients would get evicted if they were found out to be living with HIV, or  mobbed by their landlord until they were obliged to move. Workplaces would make people  resign or directly fire someone, not only because of the hysteria surrounding the at-the-time  unclear ways of transmission but also because it was portrayed as a punishment illness. The first  groups to show up in emergency rooms were the members of the LGBTQ+ community,  specifically homosexual men, who at the time were highly discriminated against by the way  society was describing and experiencing the virus, calling AIDS 'gay cancer' between 1981 and  1982.
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"After the wave of young men showing the signs of Kaposi Sarcoma was being handled, mostly  through at-home palliative care, chemotherapy, and treatments, dementia came. Very young  patients came confused, staring into the distance, unable to recall basic information, like their  names or the year they were living in."  

​"The most heart-wrenching thing was," Saponieri says "that the patients looked like us. They  were the age you are now. They were listening to the same music you listened to, went to the  same schools you went to, they had lives, families, and jobs when all unexpectedly everything  crumbled down: high rates of infection were mowing friends' groups, neighborhoods, and  communities, one sudden death after the other." The days filled with dread and uncertainty made  lots of healthcare workers quit because of the effects of post-traumatic stress disorder, and the  turnover rate in hospital wards dedicated to HIV and AIDS was significantly higher than in other  units.  

"When I was interning, most doctors did not even want to touch a patient with HIV. They  refused to treat them or would even be scared to talk to them. The Kaposi Sarcoma was a  recognizable sign, and this would scare MDs and nurses away even before a test came back  positive, contributing to ostracizing patients and making the gap between the diagnosis and  treatment even greater." Those were the times of azidothymidine (AZT) as a first try in HIV  treatment, a compound that was rushed by the FDA to be prescribed to patients in record time  starting in 1987 (Time, 2017). Before AZT, there weren't any other standardized treatments to  cope with AIDS and doctors would only attempt to treat separately the complications of AIDS,  the most common pneumonia and skin cancer among others. Even considering the controversial  trials to get AZT approved, which was originally used in cancer treatment, the hope of having the  first drug to fight HIV and AIDS was shining light for thousands of people. Now thanks to  antiretroviral therapy (ART), the quality of life drastically improved and the chances of  transmitting HIV are significantly lower, close to zero if the therapy is followed correctly. "The  stigma we have to fight is inside of us, as well as outside" concludes Dr. Saponieri "We have to  stick together as a community, and take care of each other, be the change." 

​Dr. Cesare Saponieri is a cardiologist in Brooklyn (New York). Before cardiology, he  specialized in internal medicine during the years of the AIDS epidemic in New York. He is now  working on sudden death due to heart failure and other cardiological conditions.  

Sharon Zeller is a master's student of media management at USI-University of Italian-speaking  Switzerland, focusing her research on digital resources in the field of HIV. She has been an  intern at the National organization Until There's A Cure since 2021.