Joseph Sonnabend

Joseph Sonnabend (born 1932 in South Africa) is a distinguished retired physician, scientist and AIDS researcher, notable for pioneering community-based research, the propagation of "safe sex" to prevent infection, and an early and unconventional "multifactorial" model of AIDS. During the 1980s and 1990s he treated many hundreds of HIV positive people.

Background
Joseph Sonnabend was born to a physician mother and a university professor father in South Africa. He trained in infectious diseases at the University of Witwatersrand in Johannesburg and the Royal College of Physicians of Edinburgh. During the 1960s he conducted research at the National Institute for Medical Research in London, where he worked under Alick Isaacs, a pioneer of interferon research.

In the early 1970s Sonnabend moved to New York to be an associate professor at the Mount Sinai School of Medicine. After losing his interferon research grant he worked at Kings County Hospital Center and as Director of Continuing Medical Education at the Bureau of VD Control for the New York City Department of Health. In 1978 he started a private clinic for sexually transmitted infections in Greenwich Village.

Early AIDS work
Dr. Sonnabend was one of the first physicians to notice among his gay male patients the immune deficiency that would later be named AIDS. Independently of government agencies he conducted some of the earliest research on the syndrome, and in 1983 founded one of the first AIDS journals, AIDS Research (renamed AIDS research and human retroviruses in 1986, after Sonnabend's departure).

Multifactorial model of AIDS
Prior to the identification of HIV as the cause of AIDS in 1984, Sonnabend's investigations led him to propose that AIDS among gay men was caused by multiple factors including Epstein-Barr virus and repeated exposure to cytomegalovirus and semen. This suggestion conflicted with the prevailing view that a single agent was responsible.

A key implication of Sonnabend's "multifactorial model" was that frequent unprotected anal sex increased risk of AIDS. This was the inspiration for the world's first attempt to promote safe sex: a booklet written under his direction by two of Sonnabend's patients, Michael Callen and Richard Berkowitz in 1983. At the time, such attempts to change sexual behavior met with vilification from many gay community leaders; later they would be regarded as fundamental in HIV prevention.

Role in founding AIDS organizations
To help fund his research and that of other scientists, Sonnabend collaborated with his friend Dr. Mathilde Krim and others to set up the AIDS Medical Foundation (AMF) in 1983. This organization would later become amfAR, one of the world's leading nonprofit supporters of HIV/AIDS research, prevention and advocacy.

A pioneer of community-based research, Sonnabend also helped to establish the nonprofit Community Research Initiative (CRI, later renamed CRIA, then ACRIA) in New York in 1987. One of CRI's early achievements was a trial that contributed to the approval of inhaled pentamidine for preventing PCP, a common AIDS-related infection. Sonnabend served as Medical Director of CRI/CRIA until 1996.

Another of Sonnabend's projects was the PWA Health Group, which he founded in 1987 with Michael Callen and Thomas Hannan. This nonprofit organization aimed to widen access to promising AIDS therapies not approved in the U.S. The PWA Health Group went on to become an important source of AIDS treatment education and advocacy; it is now part of DAAIR.

Controversies
As a popular physician, Sonnabend was renowned for protecting and promoting patients' rights. He did not shy away from criticizing the scientific establishment when he felt it was failing to put patients' interests first. He often disagreed with mainstream opinion on AIDS.

Views on AIDS treatment and causation
In the late 1980s, Sonnabend became a prominent critic of the use of AZT monotherapy to treat asymptomatic, HIV-positive people, which he thought was based on insufficient clinical evidence. Nevertheless he did prescribe the drug in short courses for people with indications of elevated interferon, which he believed might play an important role in pathogenesis and could be controlled by AZT. In 2006 he expressed his view that high doses of AZT had "killed thousands" during the late 1980s and early 1990s.

Until the late 1990s Sonnabend continued to assert that the issue of AIDS causation "remained open" and that many factors might be involved. This led some researchers and activists to associate him with "AIDS dissidents" who deny that HIV has any role in AIDS — a charge that Sonnabend refuted:

I was kind of surprised to find myself on the outside. I had rather thought that I represented a kind of academic caution that I took for granted to be the norm. I always believed my criticisms were reasonable and not radical.

His unconventional views on the causes and treatment of AIDS led to accusations of malpractice; he says he was shunned by mainstream scientists and refused funding.

Sonnabend later became an advocate for combination antiretroviral therapy, which he prescribed to numerous patients. However he strongly disagreed with early U.S. guidelines that recommended treating people during the initial stages of HIV infection (known as "hit early, hit hard").

The effects of modern medication helped to change Sonnabend's views on AIDS causation, leading him to assert that, "the evidence now strongly supports a role for HIV." Nevertheless, he still disagrees with the scientific consensus, and maintains that people infected with HIV only develop AIDS if exposed to cofactors such as other viruses and bacteria. He suggests that in many people HIV lies dormant without provoking a sufficient immune response to generate a positive antibody test result (seroconversion).

Other controversial views
In the 1980s, Sonnabend criticized activists who he believed were overplaying the threat of a heterosexual AIDS epidemic in America, causing a rift that led to his resignation from AMF.

He has also suggested that much of the funding for fighting AIDS in Africa has been misspent:

There's a place for AIDS drugs and prevention campaigns, but it's not the only answer. We need to roll out clean water and proper sanitation. Do something about nutrition. Put in some basic health infrastructure. Develop effective drugs for malaria and TB, and get them to everyone who needs them.

Assessments of Sonnabend's career
Despite his unconventional and often controversial opinions, mainstream AIDS researchers have in recent years become less critical of Sonnabend, recognizing his devotion as a physician and patients' champion. According to NIAID Director Anthony Fauci:

He is one of the true soldiers in the war against HIV. He is a model for a real translation of care to the patient. In terms of the controversy surrounding his work, I think, in general, at the end of the day, most would agree that his contributions have been positive. He is an outstanding man.

Personal life
For most of his life Sonnabend identified as gay, though in his twenties he fathered two sons. He has retired from medical practice and now lives in London.