After nearly 30 years as a leader in New Mexico's network of caring for people with HIV and AIDS, Dr. Trevor Hawkins is leaving the state to take a job with one of the world's leading manufacturers of drugs to treat the disease. While the move doesn't come without some sadness, Hawkins is excited about helping to increase access to lifesaving treatments on a global scale.
Hawkins saw his first Santa Fe patient with AIDS in 1986 at his general practice and continued to treat many to follow. Initially, the cases were always fatal. But over time—and not without the help of drug research he conducted in the City Different—treating those with the virus is now more like chronic medicine for maladies such as diabetes and high blood pressure.
"Those early years were the years when we had an average of one death a week from an AIDS-related cause. I always had a couple of patients in the hospital, sometimes three or four at any given time. And it was a lot of hospice work. A lot of death and dying. When Hawkins came to visit you at home, you could guarantee that you had a month left. I was like Dr. Death knocking on the door," he tells SFR.
"Those were the tough, tough times. The focus was more on treating opportunistic infection, fungi in weird places such as the bone marrow; people with no immune system saw exotic opportunistic infections and that was the bulk of the work because we didn't have a way of managing the virus. Then from 1996 on has been an increasing sort of success in terms of developing new drugs and new therapies and we have been a part of that in terms of our research here."
Drugs to treat HIV have come so far that an infected person can be treated to the point where the virus is undetectable and therefore intransmittable.
English-born Hawkins founded the Southwest CARE center in Santa Fe in 1996. He's continued to research treatment and participate in health policy planning while still maintaining his post as chief medical officer at the clinic that provides medical care, education, prevention and support services to people affected by HIV and AIDS in Northern New Mexico. It also serves those with Hepatitis C and other related conditions and has recently expanded to include a women's health operation and other family practice.
But now, Hawkins is taking his leave. He'll begin work as the the senior medical director for medical affairs at Gilead Sciences, Inc. in Foster City, Calif. in mid-September.
Much of Hawkins' recent research is about preventing the spread of HIV with what's known as "pre-exposure prophylaxis," the use of antiretroviral therapy in combination with safer sex practices to stop infection from taking place.
While massive progress in treatment means people today live much longer than their counterparts who became ill when it took off in the 1980s, new infections remain a challenge both in the United States and abroad.
In New Mexico, the state Epidemiology Bureau's most recent report, from 2014, indicates that the frequency of new diagnoses among those ages 13-24 increased by about 60 percent since the last study and at the same time new diagnosis also more than doubled for those over the age of 55. Previous analysis has shown that on a national scale young, Hispanic gay men make up a disproportionate share of new cases. But that doesn't mean straight, old white women aren't showing up with new diagnosis, too.
While condom use has been proven to reduce the risk of contracting HIV, Hawkins says sexually active young people just haven't demonstrated a willingness to use condoms. Taking preventative medication, he says, might be a more effective strategy.
Using the same medicines that make up the modern treatment cocktail, the pre-exposure approach stands to offer something that's currently not accessible to many. In places where women aren't empowered to demand condom use, for example, it could make a huge impact.
"One of the things that got me interested in this is a wonderful OB/GYN doctor from Zambia who talked about how great [pre-exposure prophylaxis] is," he says. "For the first time the women she takes care of would have a way of protecting themselves in against one of the great risk factors for infection in Africa, being married."
While of course he has reservations about leaving the clinical and research setting to work for Big Pharma, Hawkins says the company that he calls the "leading provider of HIV and Hepatitis C drugs on the planet" has a science-based business ethic that includes selling the drugs at cost at times and helping other nations manufacture generic versions. His new role will include helping provide data and background for those countries, he says.
"I think I can make a difference within that system," he says.
He's confident, he says, that he's leaving the Santa Fe clinic "in better hands," with Dr. Anne Foster, former director of New Mexico's Medicaid program, taking over as interim chief medical officer and Dr. Joel Gallant assuming oversight of Southwest CARE Center's specialized medical services and research program.