Anna Wald, M.D., MPH

My career was not by design, but was heavily influenced by the era of early urban HIV epidemic disproportionally affecting marginalized communities, my interest in reproductive health and my desire to address health disparities. I tend to make choices based on whom I am working with rather than what I am working on and that has been a good mantra for me.

In 1981, the same fall I started medical school at Mount Sinai Medical School in New York City, the December issue of The New England Journal of Medicine featured the first manuscripts describing Pneumocystis pneumonia, Kaposi sarcoma, and non-healing herpes simplex infections in men who have sex with men (MSM). By the time we started third-year clinical clerkships, we would admit young men who often died from the still mysterious illness during their initial hospitalization.  At that time, the route of transmission was still unclear, and the disease was thought to be limited to MSM. Subsequently, I moved to Boston to start residency in internal medicine at Boston City Hospital.  This was just around the time that the AIDS epidemic had started to affect people who used injection drugs.  Thus, much of my clinical training was focused on caring for people with advanced HIV and opportunistic infections.  At that time, we had a test for HIV but no therapies as AZT was not approved until 1987, and life-changing protease inhibitors and other drugs did not become available until almost a decade later.

I was in the Primary Care track during residency and I chose to work in the newly established AIDS clinic as part of my continuity clinic experience.  Outpatient infectious disease practice was very limited in the 1980’s – and in many institutions, it was the hematologists and oncologists, rather than the infectious disease physicians that established outpatient HIV treatment centers.  At Boston City Hospital, Dr. Howard Liebman, an oncologist, launched the clinic and some of my patients participated in the trial of AZT vs DDI, one of the initial AIDS Clinical Trial Group (ACTG) studies.  My other interest was women’s health and I volunteered during emergency room rotations to see women who needed pelvic exams for evaluation of genital complaints, which sparked my interest in sexually transmitted infections.

When I moved to Seattle in 1989, my plan was to work in a neighborhood health center – but in the Pacific Northwest these were mostly staffed by family practitioners rather than internists. I reached out to the University of Washington’s Dr. Lawrence Corey who headed the ACTG and Dr. Ann Collier who directed the local ACTU and, based on my clinical HIV expertise, they offered me a position as a clinician enrolling participants in the trials of novel antivirals. I also continued to provide clinical care at Madison clinic (the largest AIDS clinic in Seattle) and started to take courses toward a Master’s in Public Health degree.  After 2 years of working at the ACTU, I applied to the Infectious Disease fellowship, and Larry Corey invited me to work with him on a new grant on asymptomatic herpes simplex virus infections.  This has led to other studies in clinical virology as well as clinical trials of novel therapeutics and vaccines.

Unlike the dominant paradigm in the 60’s that infectious diseases would become irrelevant to human health, recent decades have made it clear that our specialty will never lack for patients. We will always have challenges posed by new pathogens – either old ones that resist our therapies or ones that are newly emergent or newly recognized.  I anticipate that we will see a new generation of vaccines and immunotherapies for infectious disease that will provide additional tools for treatment of our patients, and which will attract young physicians to the field.

I enjoy the large variety of activities, from seeing patients, to looking at gram stains in the micro lab, to writing manuscripts. However, mentoring fellows and early stage faculty is the most rewarding.  I have been lucky to have amazing trainees and being able to help them push themselves to grow intellectually and professionally is very satisfying; having had a K24 mentor award from the National Institute of Allergy and Infectious Diseases (NIAID) was incredibly helpful as it provided protected time both to develop mentoring skills and to practice them. This is one of the best aspects of my current position as Head of the ID division at University of Washington.  Most of it is listening to ideas and aspirations and reflecting it back to the mentees. Their creativity and energy are inspiring.

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