Breaking the stigma of AIDS part of Raffanti’s long legacyJul. 7, 2022, 9:39 AM
by Bill Snyder
On June 29 Stephen Raffanti, MD, MPH, hung up his scrubs at the Vanderbilt Comprehensive Care Clinic for the last time. It was a bittersweet moment for the man who helped lead Nashville out of the darkest days of the AIDS epidemic 30 years ago.
“I’ll miss you,” Raffanti told colleagues who gathered to honor him. “I will miss my patients. I won’t miss worrying about (them).”
Raffanti had just completed a fellowship in infectious diseases at the University of Miami in 1990 when he was recruited by Vanderbilt to help coordinate health care services for the rapidly growing number of Middle Tennesseans infected by the human immunodeficiency virus (HIV), which causes AIDS.
Appointed director of AIDS Services for the Metro Public Health Department, Raffanti established the Infectious Diseases Clinic at Metro General Hospital and expanded HIV services in the Lentz Public Health Clinic, while also seeing patients at Vanderbilt University Medical Center as a faculty member in the Department of Medicine.
Many patients, especially those in rural areas, could not find a doctor willing to see them. At the time there was no effective treatment for AIDS. Patients often ended up in the hospital or skilled nursing facility, where they died.
Adding to the trauma was the stigma and discrimination against AIDS patients, many of whom were gay men. “It’s one thing to die,” Raffanti said. “It’s another to die hated by your community and isolated. I sometimes think the cruelty was harder to take than the deaths.”
William Schaffner, MD, who helped recruit Raffanti while serving as chief of the Division of Infectious Diseases, said the young infectious disease specialist had three critical characteristics that VUMC valued.
In addition to his clinical expertise, “he was so empathetic,” Schaffner said. “He accepted (his patients) completely as human beings.” Raffanti also had an agile sense of diplomacy, which enabled him to bring disparate parts of the community together to work on a common goal.
“Steve is an incredible visionary,” said Beverly Byram, MSN, FNP, who started working with Raffanti in 1991 and continued until her retirement in 2018. “These (patients) had nothing. They were a plague. His vision was giving them the best care. He was always grounded in the best of humanity.”
To that end, Raffanti became involved with United Way’s Community AIDS Partnership and met with local business leaders including Neil Diehl, then CEO of Ingram Barge Lines.
In 1993, Mayor Phil Bredesen appointed Raffanti to a newly formed AIDS Task Force representing all sectors of the Nashville community. It recommended the creation of a place that would provide all-encompassing, out-patient care to HIV patients from throughout Middle Tennessee. That place became the Comprehensive Care Center.
With support from the United Way and other major hospitals, and with Raffanti serving as medical director, the CCC opened its doors on Feb. 1, 1994, in a facility on 24th Avenue South provided rent-free by Hospital Corporation of America and Nashville’s Baptist Hospital.
Soon after, Tennessee’s Medicaid program, TennCare, expanded health coverage to thousands of AIDS patients who were otherwise uninsurable.
The result was a flood of patients — 600 in the first six months — but also a flood of deaths. In the first 12 months, 359 patients died — one death nearly every day.
The tide turned in 1996 with the introduction of the first antiretroviral drugs for HIV. “People went from death’s door back to work,” Raffanti recalled. As therapy improved, AIDS was transformed from a uniformly fatal illness into a chronic, manageable disease.
In 2010, the CCC became part of VUMC, changed its name to the Vanderbilt Comprehensive Care Clinic (VCCC), and moved to Vanderbilt Health One Hundred Oaks. With more than 4,000 active patients, it remains one of the nation’s largest outpatient HIV/AIDS treatment facilities.
In connection with the Southeast AIDS Education and Training Center, the VCCC helps train health care providers and develops new models of HIV/AIDS care.
Raffanti, now professor emeritus of Medicine, is retiring with his wife to their cabin in rural Middle Tennessee. Succeeding him as VCCC’s medical director is Sean Kelly, MD, assistant professor of Medicine.
Raffanti’s clinical excellence and commitment to HIV/AIDS education “will have long-lasting benefit to persons living with HIV,” said longtime colleague Tim Sterling, MD, holder of the David E. Rogers Professorship in Medicine.
Beyond that is Raffanti’s “enormous and endless capacity for … acceptance and respect,” Schaffner added. “In order to have kindness, you must have respect. All of us who worked with him were infused with that spirit, and we were made the better for it.”