Parallel pandemics: An emergency doctor reflects

It was the spring of 2020 when the first wave of COVID-19 cases arrived at VCU’s emergency department. The new virus spread as rapidly as the misinformation around it. Health care workers donned layers of protective gear. Patients took their final breaths alone in the ICU. For Joel Moll, M.D., a physician and vice chair of education in the Department of Emergency Medicine, it all felt strikingly familiar.  

“The fear was palpable,” Moll said. “We were on the frontlines, and people were so afraid. When patients started dying alone from COVID, it immediately brought back those thoughts and feelings of what I experienced at the start of the AIDS epidemic.”

'This is what I signed up to do’ 

Moll was in high school when reports of HIV/AIDS began flooding the news in the 1980s. As a teenager privately coming to terms with his own sexuality, he absorbed the stigma associated with the illness caused by the human immunodeficiency virus, which affected mostly young, otherwise healthy gay men and caused more than 100,000 deaths from 1981 through 1990.  

“At the time that I was thinking to myself, ‘I think I may be gay,’ it was the same time this new ‘gay plague’ came out,” Moll said, recalling the rhetoric around HIV/AIDS at the time. “If you came out then, it was like, why would you want to be gay, when you can get AIDS and die?”   

When Moll was applying for residencies in the early 1990s, recruitment materials from hospitals in metropolitan areas emphasized that separate teams treated patients with AIDS. The implication, he said, was to reassure applicants that HIV/AIDS care wouldn’t comprise a large portion of their training.  

“Whether that was a true educational concern or bigotry, I don’t know, but people didn’t want to take care of AIDS patients. They said that’s not why they went into medicine,” Moll said. “I always have felt, and I felt this way with COVID too, that this is what I signed up to do. It’s part of what I took the Hippocratic oath for.”  

AIDS became the leading cause of death for Americans aged 25-44 in 1994, the year Moll graduated from medical school and began his emergency medicine residency. During his training, he made a point to physically touch each of his patients who was HIV-positive, because “nobody would touch them, and human touch is so important, especially in establishing relationships.” The medical community knew by then that the virus was not transmissible through skin-to-skin contact, he said, but anxiety remained high among health care providers caring for patients with AIDS.

A lot has changed since then. No longer a death sentence, HIV is now usually a treatable, chronic disease, and HIV-related death rates among people 13 years and older fell by nearly half from 2010 to 2017. In 2012, the FDA approved the use of the first pre-exposure prophylaxis, or PrEP, a medication that reduces the risk of contracting HIV from sex by about 99% when taken as prescribed.

While prevention and treatment have come a long way, disparities and stigmas still surround HIV/AIDS. People of color are at greater risk of infection, and according to the CDC, 76% of people living with HIV in the U.S. have an annual household income of less than $20,000. And despite the effectiveness of PrEP, a 2018 study examining the slow uptake of the drug reports that PrEP stigma, which is “inextricably linked to HIV stigma,” disproportionately impedes access to the treatment among already disadvantaged populations.

Visibility and advocacy

Moll didn’t publicly come out as gay until he finished training and settled into an attending position. For years he feared his identity would jeopardize his career, and he knew his family “would worry I was going to immediately die of AIDS.” During the height of the crisis, pointed comments from colleagues and community members validated his decision to remain closeted.  

“People would say that patients with AIDS deserved to die because of their lifestyle,” Moll said. “The judgment of whether or not someone deserved a fatal disease based on who they are, that was always hard to listen to, knowing that I also was that way.”  

Coming out still felt professionally risky into the early 2000s. But once he finished training and became more established and stable in his career, Moll said he realized being out and visible was “an absolute necessity.”   

As a physician, sharing his identity with patients has been especially powerful. He vividly remembers meeting a young man who traveled to Richmond for a sexual assault evaluation because he didn’t want his small-town doctor to find out he was gay. Moll let him know he wasn’t alone, and the heartfelt thank-you note from that patient still sits on his desk.

As an educator, Moll strives to be the type of mentor for students and trainees that he didn’t have. Only three years after arriving at VCU in 2015, he received the Leonard Tow Humanism in Medicine Award, a School of Medicine honor that highlights the principles of integrity, compassion, respect and empathy in academic medicine.

“He is an extraordinary role model for the residents when it comes to providing compassionate, patient-centric care,” Harinder Dhindsa, M.D., chair of the Department of Emergency Medicine, said of Moll when he received the award in 2018. “Furthermore, his academic interest in providing appropriate care and educating health care professionals on the particulars of caring for members of the LGBTQIA+ community is national in scope.”  

Moll was also instrumental in creating the OUTlist, an online directory of LGBTQIA+ students, faculty and staff at the School of Medicine to promote visibility, advocacy and inclusion on campus. From a school-wide OUTlist to the introduction of PrEP to the federal legalization of same-sex marriage in 2015, Moll said he never could have imagined the social, medical and political progress of the past decade.  

“I didn’t have it horrible; I've had a lot of privilege,” Moll said. “But I want people to have it better than me.”