Early crusader

Hero Next Door: N.Y. DO battled AIDS crisis with education

James Braun, DO, started the Physicians’ Research Network in 1990. It quickly became an unparalleled source for HIV education.


New York City was a grittier and more dangerous metropolis in 1982, when James F. Braun, DO, moved to Greenwich Village, a former artists’ neighborhood in Manhattan that had become the heart of the city’s gay and lesbian community. In the meatpacking district just north of his apartment, Dr. Braun recalls an unused rail line that once hauled in cattle. The streets were lined with slaughterhouses, meatpacking facilities and empty warehouses.

Over the years, Dr. Braun has witnessed lower Manhattan’s transformation. The decrepit rail line became a park and pedestrian walkway that New Yorkers and tourists alike flock to; the meatpacking district’s warehouses became loft apartments, restaurants and boutiques. In Greenwich Village, the city renovated the neighborhood’s landmark Washington Square Park, and high-rise buildings have replaced some of the brownstones.

At the same time, Dr. Braun has seen the rise and later, the metamorphosis, of New York’s HIV/AIDS epidemic. A family physician, he opened his own practice in 1983 and volunteered at community clinics, where he first began treating patients with HIV, which hadn’t yet been discovered. At the time, the illness was called gay-related immune deficiency, or GRID. Young patients were coming to clinics with bewildering problems physicians normally see in older patients, such as oral thrush and herpes zoster. Sicker patients were acquiring rare cancers and going blind from retinitis.

“The early 1980s were pretty scary in New York in particular,” Dr. Braun says. “It wasn’t until the mid-’80s that HIV was nailed down and there were tests available for it. In the meantime, all we could do was try to patch people up and get them back on their feet or treat opportunistic infections the best we could. But by and large, once people became symptomatic it was a rapidly progressive disease.”

Throughout the ’80s, Dr. Braun and his colleagues found themselves becoming specialists in this emerging disease. They received more and more referrals because many physicians weren’t willing to work with HIV patients. Those who were faced significant challenges. Clinical guidelines were scant and constantly changing, and effective drug combinations to treat HIV wouldn’t be available until the mid-’90s. Physicians didn’t have a lot of tools to offer their patients, and they were encountering death far more often than family physicians normally did. The deaths of early AIDS patients were typically slow and painful; the disease often took young patients who otherwise would have been in their prime years.

Supporting, educating HIV physicians

These challenges led to burnout among New York City physicians who treated large numbers of HIV and AIDS patients. In 1990, Dr. Braun started the Physician’s Research Network (PRN) to provide New York City’s HIV/AIDS physicians with a support group of their peers and to educate them on ever-evolving treatment guidelines. The group has met monthly since then. Today, PRN has about 680 members, which include physicians, nurse practitioners and physician assistants. During PRN meetings, the first hour is usually reserved for conversation and networking, and the second and third hours are devoted to presentations and Q&As with two guest speakers.

“I started PRN for primary care physicians out in the field,” Dr. Braun says. “Many were so busy in their office practices that they didn’t really have time for grand rounds in hospitals, and they didn’t have the support a hospital structure could provide. People had more questions than answers in those days. And that’s why peer support was so important.”

PRN member and volunteer Charles John Gonzalez, MD, PhD, recalls those days.

“During the early part of the AIDS epidemic, PRN was both the best and almost the only way of getting clinical information passed along,” says Dr. Gonzalez, who is now the associate medical director for science and policy at the New York State Department of Health’s AIDS Institute.

Over the years, PRN has drawn notable scientists in AIDS research as presenters, and they often worked with PRN’s membership to find subjects for studies that advanced research in the field. For instance, PRN hosted AIDS researcher David Ho, MD, in 1995. An early champion of combination antiretroviral therapy, Dr. Ho asked attendees to help him enroll patients in an upcoming study that would become one of the world’s first on the effects of triple antiretroviral therapy with a protease inhibitor, Dr. Braun says. Known as HAART (highly active antiretroviral therapy), this more potent combination of drugs marked the beginning of HIV’s transformation from a death sentence to a manageable illness. Dr. Ho went on to become Time magazine’s Man of the Year in 1996.

To assist physicians outside the New York City area, Dr. Braun began publishing The PRN Notebook, a printed newsletter, in 1995. The PRN Notebook summarized each meeting’s presentations and provided other clinical updates. Dr. Braun mailed the notebook free of charge to any clinician who asked for it. Eventually, The PRN Notebook went online. Dr. Braun now posts edited videos from the meetings to the notebook. Physicians can earn continuing medical education credits by watching the videos via PRN’s partnership with the New York State Department of Health’s AIDS Institute.

And in New York, physicians attending PRN meetings often gleaned information that they could use to assist their patients.

“I deal with a lot of secondary complications of hepatitis,” says Susan Marshall, MD, an HIV specialist and nephrologist in Manhattan. “PRN helped me get a foot in the hematology and liver worlds. I heard about the newest trials out there, which directly helped a few of my patients. I got them into trials I would not know about it if I didn’t go to these meetings.”

Two of Dr. Marshall’s patients found medicine via trials that cured their hepatitis with minimal side effects, Dr. Marshall says.

Clinical investigator Martin H. Markowitz, MD, marvels at how ahead of the curve the PRN meetings were in terms of content.

“Jim was one of the earliest believers in identifying acute HIV, which is a very new HIV infection,” says Dr. Markowitz, who is the clinical director of the Aaron Diamond AIDS Research Center in New York City. “We started treating acute HIV infection in 1995, and it took until about 2010 for the guidelines published by the government to recommend treating acute infections. We were 15 years ahead of the curve. Jim would help me promote my program and help us recruit patients.

“And it’s turned out that acute infection is critical in the transmission of HIV infection. Jim was one of the first people to recognize the importance of that, and through PRN arranged many programs where this issue was discussed well before it became a routine topic.”

PRN often transmitted vital information to clinicians in a more timely manner than the Centers for Disease Control and Prevention or academic institutions, Dr. Braun says. Just after 9/11, in the midst of the nation’s anthrax and bioterrorism scare, the CDC advised medical professionals to get vaccinated for smallpox. But the smallpox vaccine is actually a live virus called vaccinia. Although it doesn’t harm healthy patients, vaccinia can make those with immune deficiencies very sick.

“The question that emerged was, ‘What about our first-line responders who have HIV practices and who are seeing people who are immune deficient?’ ” Dr. Braun says. ” ‘Will they have to leave work for two weeks and then return after they’re no longer infectious?’ Nobody knew the answer to that question. I had talked with people at the CDC and the National Institutes of Health. The CDC was actually calling me and asking me to help them figure out how to advise people.”

Israel had been the first country to vaccinate its military for smallpox, and Dr. Braun got in touch with the country’s surgeon general, Yehuda Danon, who spoke at a PRN meeting a few months later. Because people who were vaccinated later became immune to vaccinia, the Israeli government created a stockpile of immune globulin from them that it then had on hand for patients who might get exposed, Danon explained. Danon told the audience that they would be infectious for a short time and to make decisions based on their patient population. Ergo, physicians with HIV practices should either avoid the vaccine or take time off after getting it.

“We have a tradition at PRN of finding either the most knowledgeable and most interesting people or the best educators from wherever they are and bringing them to New York,” Dr. Braun says.

Evolution of HIV

Next year, PRN will celebrate 25 years of continuous monthly meetings. Dr. Braun plans to hold the group’s first-ever fundraiser. PRN is supported by educational grants from pharmaceutical companies, but Dr. Braun says he is careful to accept only unrestricted grants so donors never play a role in choosing PRN’s guest speakers or content.

This illustration created for The PRN Notebook helps clinicians visualize liver tissue coinfected with HIV and Hepatitis C.

At the fundraiser, Dr. Braun plans to hold an awards ceremony. Among other awards, he says he’d like to establish one to encourage young people to create artistic images based on medicine. For many years, PRN worked with a microbiologist and illustrator, Lou Henderson, PhD, now deceased, who produced vivid images of viruses for The PRN Notebook. The images are still on PRN’s website, and the group has also made posters from them.

Dr. Braun marvels at how much HIV and AIDS treatment has evolved over the past 20 years.

“Since 1996, it’s pretty amazing how the epidemic has changed,” he says. “Young people today don’t seem all that concerned about it, whereas people who were around in the late ’80s and early ’90s remember the incredible horror of people dying right and left.”

Accordingly, PRN’s content has changed, too. Physicians now focus more on management and prevention, Dr. Braun says.

“We don’t deal so much any longer with opportunistic infections and AIDS-related cancer, though nobody knows what’s going to happen as people continue to age,” he says.

While Dr. Braun has been a leader in educating physicians on treating HIV, he has also treated many patients, notes Dr. Markowitz.

“PRN has been a leading disseminator of information on a disease state that’s constantly changing, and Dr. Braun has been at the forefront in helping people get educated,” he says. “He has also been one of the leading HIV physicians in the community.”

Outside of PRN, Dr. Braun ran a private family medicine practice in Manhattan for about 20 years. He now works for Callen-Lorde Community Health Center, a large lesbian, gay, bisexual and transgender clinic in Manhattan’s Chelsea neighborhood. He has become increasingly interested in performing minor surgical procedures, which he attributes in part to his osteopathic medical education. Dr. Braun graduated from the Kansas City (Missouri) University of Medicine and Biosciences College of Osteopathic Medicine in 1979.

“The broad training I had as an osteopathic physician has served me well throughout my career,” he says. “I was able to do things in my office that many MDs didn’t learn how to do in residency, such as debriding wounds and removing skin lesions. I had great rotations in my family practice residency with surgical units and emergency rooms.”

“During the early part of the AIDS epidemic, PRN was both the best and almost the only way of getting clinical information passed along.”
Dr. Gonzalez

In particular, Dr. Braun has begun performing high-resolution anoscopies and biopsies to screen patients for anal cancer. He then treats high-grade precancerous lesions with infrared coagulation.

Anal cancer screening is a growing field in HIV care, Dr. Braun notes. While clinicians don’t yet know whether treating precancerous lesions in the anal canal will prevent cancer, studies are underway to answer that question. Meanwhile, the treatment protocol follows the model for preventing cervical cancer. Both anal cancer and cervical cancer are caused by human papillomavirus, and HIV patients get the cancers at much higher rates than other patients.

More family physicians should be aware of anoscopy as a way to potentially prevent cancer in their patients, Dr. Braun says.

“Anybody in primary care could easily learn how to do anoscopies if they want to incorporate them into their practice,” he notes.

Dr. Braun also suggests that all primary care physicians learn how to conduct a culturally sensitive sexual history to discern a patient’s risk for HIV and other sexually transmitted diseases.

“Part and parcel of basic health screening is to make sure people know if they are HIV-infected by doing routine screening, which is recommended by the CDC,” he says. “It can be done very easily at the point of service through a rapid test. Anyone who can run a rapid strep test in the primary care office can also run a rapid HIV test. And now, he or she can also run a rapid Hepatitis C test as well.”

Anyone born between 1945 and 1965 should be screened at least once for Hepatitis C, Dr. Braun says, noting that treatments for the disease have greatly advanced.

“It’s a tragedy when patients aren’t diagnosed until they have end-stage liver disease because the disease is now more easily treatable than ever before, with high cure rates and avoidance of liver transplantation,” he says, stressing that DOs are poised to set an example.

“Because the osteopathic profession trains so many primary care physicians, it should really set the standard for primary care involvement in screening for HIV and Hepatitis C,” he says.


  1. Marah J Lee

    There were many DO’s on the front lines in NYC treating HIV/AIDS patients. I began my internship and residency at St. Vincent’s Hospital in Manhattan in 1989. We had the largest patient population in the city with AIDS and I am sad to say, most of those patients were diagnosed and died in the hospital. Thankfully, HIV is now a treatable disease, and the few patients who survived their hospitalization may still be alive. Since my residency, I moved to South Florida. I continue to treat over 600 patients with HIV as a solo practitioner. In addition, I am clinical professor for NSU College of Osteopathic Medicine, hoping to instill what I have learned about HIV patients in the future of medicine.

  2. Barbara Greenwald, Executive Director, NY State Osteopathic Medical Society

    Dr. Braun will be speaking about how DOs can help end the AIDS epidemic at the 2015 annual CME convention of the New York State Osteopathic Medical Society (NYSOMS). For more information, go to NYSOMS’ Web site: http://www.nysoms.org

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