Doctor turned S.F. General into a model AIDS hospital

Dr. Merle Sande, an infectious-disease specialist who helped turn San Francisco General Hospital into a model for AIDS and HIV care in the early years of the health crisis and later devoted himself to building an infrastructure to prevent and treat AIDS in Africa, died Nov. 14 of multiple myeloma at his home in Seattle. He was 68.

Sande had been chief of medical services at San Francisco General for only six months in 1981, when he began to notice that young men with grave and bewildering infections were being admitted with disturbing frequency.

Once Sande and his colleagues realized that the various illnesses were permutations of acquired immune deficiency syndrome, he took steps to ensure that patients received the highest standard of care available and were not stigmatized by unreasonable restrictions. Under his leadership, San Francisco General opened the first hospital ward designed to address the needs of AIDS patients and an outpatient clinic that brought in services from the community.

“At a time in the early 1980s when there was a lot of fear, Merle’s attention was on the quality of the patient experience,” said Dr. Paul A. Volberding, vice chairman of the Department of Medicine at UC San Francisco, who knew Sande for 27 years and co-founded the hospital’s AIDS clinic.

Sande collaborated with colleagues, including Dr. Julie Gerberding, now the director of the Centers for Disease Control and Prevention, to develop the first infection control protocols for AIDS to safeguard the health of medical workers.

The guidelines, which addressed a wide range of issues, including how to handle a needle stick injury from an HIV-infected patient, “remain largely unaltered today,” said Dr. Warner C. Greene, a longtime colleague and leading researcher on AIDS and HIV who teaches medicine, microbiology and immunology at UC San Francisco.

Greene said that Sande’s greatest work took place over the last five years as president of the Academic Alliance for AIDS Care and Prevention.

The alliance brings together top academic AIDS researchers to work with Makerere University in Kampala, Uganda, to improve patient education and physician training and conduct research.

With funding from pharmaceutical giant Pfizer, the group built a state-of-the-art AIDS clinic, which has treated 10,000 patients since it opened in 2004. Sande also helped create a training facility where more than 1,700 doctors and healthcare workers from 26 African countries have learned about advanced AIDS treatments.

A native of Mount Vernon, Wash., Sande earned his bachelor’s degree from Washington State University in 1961 and his medical degree from the University of Washington in 1965. He taught medicine at the University of Virginia in Charlottesville and the University of Texas Health Science Center in San Antonio before joining the UC San Francisco faculty and becoming chief of medical services at San Francisco General, the university’s teaching hospital, in 1980.

When Sande found himself at the center of the AIDS epidemic, he was reminded of another scare 30 years earlier, when he was a boy growing up in the midst of the polio epidemic that left some of his friends paralyzed. “My parents came in every morning to check my neck,” he recalled in a 1996 interview with the San Francisco Chronicle. “We knew it was a virus. We knew we were all vulnerable.”

The fear of AIDS was far worse, but Sande discouraged hysteria. “It didn’t seem to him that AIDS was easily contagious,” Volberding said. “I remember him deciding that we should provide the same care for AIDS patients as anyone else, without barriers and excessive restrictions on the patients’ freedom to be in the hallways and have visitors.”

Sande opposed calls for universal screening and quarantine of AIDS patients and urged medical professionals to promote rational dialogue about how AIDS is transmitted. In an editorial for the influential New England Journal of Medicine in 1986, he wrote that “the picture is clear . . . the AIDS virus is spread sexually, by the injection of contaminated blood,” not by casual contact.

With Volberding and other colleagues, Sande edited “The Medical Management of AIDS,” a widely used textbook, now in its sixth edition. Last month he and Volberding collaborated on another book, “Global HIV/AIDS Medicine,” which was written largely for use in Third World countries.

He also spearheaded an effort to create a top-notch AIDS research center at UC San Francisco, using public and private funds. The result was the Gladstone Institute of Virology and Immunology, which opened in 1993.

In 1996, Sande left his posts in San Francisco to become chair of the Department of Medicine at the University of Utah in Salt Lake City. He resigned that job in 2002 to devote himself to his work for the Academic Alliance for AIDS Care and Prevention in Africa.

In 2005, he returned to his home state to teach medicine at the University of Washington.

He is survived by his wife, Jenny Lo; a sister; four children; and eight grandchildren.

elaine.woo@latimes.com