Dr Fax: Introduction to the 1996-2000 archive

This content is archived for reference. For up-to-date materials go to the main site.

September 2, 2016. Related: Dr Fax (AIDS Treatment Project, ATP).

Doctor Fax was a publication produced in the UK from June 1996 to January 2000 by the activist organisation AIDS Treatment Project (ATP). The archive is included on the i-Base website because it was a unique community response and as a historical record.

This was a very exciting and compelling time for HIV research and therefore for our health. Previous treatments – using only one or two drugs – had showed very short term benefits.

In 1996, everything changed. The first reports from using triple combinations were not only dramatically better but appeared to be durable for people who were lucky enough to respond. For the first time, the effectiveness of treatment could be measured by viral load tests – thanks to other scientific discoveries advances.

This new technology lead to dramatic changes in how to monitor and measure responses to treatment because the activity of treatment could be seen in days and weeks rather than months. Previous reliance on CD4 counts as a marker of immune damage or improvement or from clinical symptoms themselves. Both of these things are important but they are not a very sensitive way of knowing whether treatment is working.

Many of the volunteers and staff at ATP were HIV positive and were on treatment. Many had started treatment when HIV was already very advanced were caught just in time. However, many UK doctors and the majority of community support groups, were slow to pick up on the importance of these breakthroughs. This was probably because of the disappointing years with limited treatment success, together with concerns about side effects often due to using high doses of some drugs in people who were already sick. So a caution against combination treatment underestimated the risks of developing drug resistance.

Many patient organisations were focussed on complimentary therapies and on palliative care, and were sometimes hostile to treatment. ATP was therefore launched to broaden access to information about the latest research.

Dr Fax was a strategy to ensure our doctors were up to date. It reported advances from an HIV positive activist perspective – the difference between getting it right or wrong was about not missing the chance for treatment to work, now that treatment had eventually arrived.

DrFax reported the data in technical medical language but also included summary comments on the implications of the results for clinical practice. While one of the medical controversies categorised US doctors as “hitting hard, hitting early” and UK doctors as “hitting late and gently” – ATP interpreted the accumulating evidence to show that neither was right. Our experience supported “hit late then hit hard” – ie to delay until you really need treatment and then use the strongest treatment available.

We already knew that side effects with the first treatments meant they were not perfect. We also knew that living well without symptoms was possible for most people with CD4 counts about 200 cells/mm3. But we also knew that drug resistance was irreversible and quick to develop in anyone using treatment that failed to suppress viral load.

ATP also ran a treatment phoneline three evenings a week so that real people who had responded to treatment could talk to other HIV positive people who were sceptical of it’s effectiveness and worried about side effects.

Dr Fax was edited and compiled by Paul Blanchard who also had a separate full time job, and the medical adviser who supported the publication with comments was Dr Graeme Moyle, later joined by Dr Stefan Mauss and Professor Clive Loveday, who support was critical and appreciated.

Dr Fax was distributed to doctors by fax or post every two weeks. This was driven by the pace at which new research was unfolding a new approach to HIV. It seemed that each study we reported added to the new bank of information about the best way that someone would be treated in the clinic.

When the former editorial and publication team at ATP set up HIV i-Base in April 2000, we relaunched Dr Fax as HIV Treatment Bulletin (HTB). Paul Blanchard continued as editor for the next two years, and then joined the editorial comment group. Graeme Moyle, Stefan Mauss and Clive Loveday also continued as medical consultants on the new advisory board for HTB.

It was with great sadness and an immense loss when Paul Blanchard died in May 2016. This archive is a tribute to his vision and energy and to the impact he had on UK activism.