How Macon’s HIV care went from one doctor’s fight to the pharmacy counter

Few realized it at the time, but in June 1981, the medical world was about to change forever.

A rare lung infection struck five previously healthy young men in Los Angeles, 1,900 miles away from where Dr. Harold Katner was undergoing training in Louisiana.

That distant cluster of cases, 45 years ago, marked the official arrival of the human immunodeficiency virus, or HIV, in the United States. It was the beginning of a wave that would come to define Katner’s medical career in Macon.

Much has changed in the decades since HIV and the disease it causes, AIDS, entered the medical vocabulary. The virus — which was initially concentrated among white, sexually active gay men, as well as intravenous drug users — forced a transformation in how hospitals operate, how drugs are approved and how patients interact with doctors.

Still, Georgia remains among the hot spots in the country for new diagnoses, ranking second in the nation when measured per capita, according to 2023 data compiled by AIDSVu, an online mapping tool managed by Emory University’s Rollins School of Public Health. Only Washington, D.C., recorded more new cases.

Georgia’s North Central Health District, which includes Bibb County, ranked sixth out of the state’s 18 districts in the rate of new HIV diagnoses in 2024, according to the Georgia Department of Public Health.

Katner, who moved to Macon in 1985 to take a position with Mercer University’s School of Medicine, said the numbers seem to have plateaued in the city, though he continues to see new cases. Roughly 2,803 Georgians in the North Central Health District were living with HIV in 2024.

Legislation signed last month by Gov. Brian Kemp could help drive down numbers statewide. The new law will allow trained pharmacists to prescribe and administer HIV prevention meds — PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) — directly to Georgians who ask.

It’s a far cry from the situation Katner encountered when he first arrived in Macon in the mid-1980s. Back then, the fear and stigma attached to the virus were so severe that it left him as the only infectious disease specialist in Middle Georgia treating HIV patients. 

With effective treatment still years away, Katner became more than his patients’ doctor. He held their hands as they died.

Many of his fellow doctors warned him he was taking a chance with his life, even though the virus isn’t spread by casual contact. He found himself shying away from telling acquaintances specifics about the type of work he did.

“I was managing people that were basically lepers in society,” he said.

During those early days, he absorbed an incredible amount of grief. 

“It was extremely depressing to go to work every day — seeing all these complications, losing young people,” he said. “A lot of my patients were getting infected while they were in high school, and they’d be dead in their mid-20s. That was hard to deal with.”

The game-changer came in 1996, Katner said, with the development of the “AIDS cocktail,” a combination of antiretroviral drugs that made an HIV diagnosis no longer a death sentence, but a chronic illness. The problem was that patients had to adhere to a strict, complex drug regimen that involved sometimes up to 20 pills a day.

Veronica Howard, who was pregnant when she was diagnosed with the virus in 1994, remembers that time well. Initially, she was taking about 15 pills a day.

She gave birth to a healthy child, then fell into a depression. She had questions about how she ended up with the virus — who, why, how?

Then, she became ill and was hospitalized with an opportunistic lung infection associated with the virus.

“I remember the doctor telling my mom, ‘If she doesn’t take her medicine, she’s not going to be around to see her kids, and you’re going to be raising them,’” Howard said. “At that time, it was like a lightbulb moment that clicked for me, that ‘Hey, you need to do what you need to do to take care of yourself. You can’t worry about who, why, how.’”

She’s lived with HIV for more than three decades now and has been undetectable for most of that time. Instead of many pills, she now takes one a day — an “amazing” advancement, noted Katner. The medication makes the virus untransmittable in people with HIV. 

Outside of Atlanta, in the Ryan White Program-supported health clinics throughout the state, 91% of the patients under care are virally suppressed, said Katner, who is the HIV/infectious disease adviser to the Georgia Department of Public Health.

Still, the stigma persists, said Howard, who is a peer advocate for others with the ailment. Over the years, the HIV demographics have shifted to include more women and heterosexuals,  disproportionately impacting Black and Latino Americans.

Many patients fear the judgment that might come if they discuss their sexual history with their doctors or friends.

“I see clients on a day-to-day basis that are living with this diagnosis alone,” she said. “I call it, they’re dying in silence because they don’t have the support because of the stigma. They don’t want to tell anyone.”

That’s part of the reason the legislation making HIV prevention drugs more readily available was so important, proponents of the bill said.

Another reason: Pharmacies are accessible to nearly everyone, meaning the drugs will be.

Kenric Ware, a pharmacist and clinical associate professor of pharmacy practice at the Mercer School of Medicine, engaged in the legislative process of the bill from its draft stage to its passing.

He could see there was a need to make prevention drugs more available.

“If you look at the state of Georgia in general, most of the access points are usually in the Atlanta area,” he said. “The farther out you get from Atlanta, obviously with Macon being south of the city, and even farther south, we have more and more challenges with access.”

Though the law takes effect July 1, pharmacists must complete a state-approved training program before they can administer the meds.
Katner said the increased accessibility could be another game-changer. 

He noted there has been much research and many developments in managing the disease. He believes that, in the next few years, patients might be able to go to the doctor for two shots every six months. No more pills.

The doctor who once watched young people die now has patients who are in their 70s and 80s.

This is what he tells them: “If you take medicines, you don’t smoke, you don’t drink too much, you don’t use drugs, I’ll get you to 90 years of age. You’ll die of old age, not old AIDS.”