San Francisco Chronicle - Friday, February 16, 2001
Gregory Lewis, Chronicle Staff Writer

He was treated, he recalled, but "it was so impersonal, so harsh," that it changed his life. "No one took time to explain anything, and particularly being a teacher who took time with concepts and explaining to people, ultimately that was the thing that started making me think about going to medical school." He attended the University of San Francisco Medical School.

It's a lucky thing for his 2,000 patients that Scott, 56, was treated so coldly that day. His 25-year-old Oakland-based practice is as unique to modern- day medicine as door-to-door milk deliveries.

He sees patients in his homelike office at 28th and Summit streets, but he still makes house calls because "some patients are too sick to leave their homes."

He treats the 400 AIDS and HIV-positive patients in his practice with tender loving care. And twice a year he takes clothing and supplies to a children's AIDS orphanage in Zimbabwe. He spends time trying to persuade other doctors, especially African American physicians, to treat those with AIDS.

"Dr. Scott and I have a doctor-patient relationship," said George Kyles, a 51-year-old Hayward man who is HIV-positive. "We have a Christian relationship.

We have a relationship that I don't lie to him. I tell him everything. People die because they lie to the doctor."

Scott insists he's no counselor, but he is known to chase down patients with HIV, the virus that causes AIDS, to encourage them to get regular health care and to eat properly. He'll contact family members and even the patient's pastor to remind him to keep an appointment.

That's what led Kyles to Scott. Kyles, who is starting an AIDS ministry at Love Center in East Oakland, said a church member with HIV "was at death's door" and had virtually given up taking his medication. "Dr. Scott got in touch with our pastor, who talked to him."

The patient is alive today, Kyles said, thanks to Scott's efforts to get friends to intercede.

DISPROPORTIONATE IMPACT

African Americans make up 18 percent of Alameda County's population but have made up 41 percent of all AIDS cases since 1980. In 1998, Alameda County supervisors declared that there was a state of emergency in the African American population caused by AIDS, becoming the first county in the nation to address the disproportionate impact on the African American community.

Both in the county and in the nation, AIDS is the leading cause of death for African Americans ages 25 to 44.

Scott has helped found organizations, such as AIDS Project of the East Bay, that educate and inform clients of the resources available, which includes help with rent, food and other necessities.

"He's community-oriented," said friend Terence Hayes, 45, who has AIDS but is not a patient of Scott's. "He's always looking to help, and not just people with AIDS. He's active in a lot of things. But he has a real interest in the church. My mom felt so comfortable with him after meeting him at church (that) she chose him as her primary doctor."

One of Scott's most significant accomplishments was getting his church, Allen Temple Baptist Church, involved in battling the AIDS crisis.

As head of the church's AIDS ministry, Scott has convinced the congregation to not only adopt the orphanage in Zimbabwe but also to build housing for 15 HIV-positive men and women in the East Bay. The apartment building under construction at 78th Avenue and International Boulevard is scheduled to open later this year.

His pastor, the Rev. J. Alfred Smith Sr., says Scott "is not only a brilliant and excellent physician, but he also has a heart of gold. He stands in the tradition of Albert Schweitzer and some other pioneers as it relates to his commitment to eradicating AIDS, not only here at home but also in Africa." Scott's commitment was such that he raised the issue of AIDS at a time when the subject was taboo in the African American community.

He had three HIV-positive patients who belong to three of Oakland's largest black churches, Scott recalled. But, when he asked them, " 'Who have you told?" Each one of them said, 'You and I are the only ones who know. I haven't told momma, daddy, brother or sister.'

"I've always thought you've got to share this with somebody. And they'd say, 'Whatever you do, don't tell my pastor.' I'm a doctor, not a counselor. They need me, but they also need a counselor."

So Scott invited the three pastors, one of whom was Smith, to lunch. He told them: "This thing is here. There is a member of your congregation who has AIDS. I can't be a doctor and a pastor, too. Maybe it's something you said or haven't said that's made them fearful."

After that meeting, Smith and Allen Temple responded.

"Pastor Smith preached an open church with a redeeming gospel," Scott said. "The other churches have not been as forthcoming. But we (at Allen Temple) started seeing people die, and now the relatives don't feel their children are condemned."

It's a real breakthrough, Scott said. "The church is supposed to be a trusted place."

At Allen Temple, Smith preaches about AIDS without demonizing or placing blame. Speakers are invited to come discuss the disease.

"It's a major effort," Scott said. "There are many large black churches where it has never been mentioned."

Allen Temple progressed to the point where it decided to adopt the Zimbabwe orphanage, which shelters kids, some with AIDS and others whose parents have died of the disease.

Scott visits twice a year with money, care packages for the children and supplies from Allen Temple. The trip also fills a passion he has for collecting Shona art.

BLACK DENIAL IN AFRICA, U.S.

But even across an ocean, Scott sees similarities of how people deal -- or don't deal -- with the AIDS crisis and how it affected black Americans and black Africans.

South Africa has been affected significantly and, as is the case in Alameda County, people at risk often don't get tested, and even when they do, they fail to seek treatment.

"Testing there is extremely expensive, and medication is not available because of costs," Scott noted.

Meanwhile, in the United States, free testing is available and medication is often covered by insurance -- but still people don't avail themselves of those opportunities, he said.

To emphasize the point, Scott calls Nhla Nhla Moyo, a 22-year-old South African who works in Scott's office, over to talk about his country.

Cultural factors contribute to those attitudes, Moyo explained, saying that men, as a rule, cannot be questioned about their role as head of the family and therefore may have multiple sex partners.

"Nobody wants to get tested," Moyo said said. "They also don't want to admit a (family member) died of AIDS. But men don't want to use condoms. And nobody wants a woman boss."

But while the situation Moyo described may sound sexist, Scott said it is not that different than dealing with AIDS in black American communities.

For instance, Scott told of an Oakland woman who was HIV-positive. She hadn't had any blood transfusions or extramarital affairs, she said. But it was when Scott quizzed her about the activities of her husband, who had served time in prison, that she became defensive. He couldn't possibly have engaged in sexual activities behind bars, she said.

Scott's verbal probing is necessary, he said, to determine how his patient contracted the disease. Although many doctors shy away from asking their clients about their sex lives, he finds it hard to believe that some physicians can fail to ask such questions of all who come to see them, regardless of race, age or sexual orientation.

"A study was done of patients over 65 who died at Harlem Hospital in the last five years," said Scott, who goes to every conference and reads nearly every piece of research on HIV he can find. "Seven percent were HIV-positive and had never been tested."

He shakes his head in disappointment, thinking that even with all the access in this country, he might as well be in Africa for all the good it's doing. Scott says the AIDS epidemic in black urban areas such as Oakland has exploded because of numerous factors, including the fact that getting the virus is no longer an immediate death sentence.

What contributes, too, he says is a cavalier attitude about life -- with some people believing that because black people have shorter life spans than whites they might as well live in the moment.

Denial also plays a part. Some people still don't believe they are at risk, despite the growing number of heterosexual men and women contracting the virus.

"There are still doctors who think gays and druggies who engage in sex are the only ones to get this disease," Scott said.

"I reach a broad range of people and persuade people at-risk to get tested and treated, and I try to persuade my colleagues to get involved. There aren't enough African American doctors."

Not all of Scott's patients are black.

A 64-year-old gay college professor, who was diagnosed in 1987, found Scott 10 years ago, after the young doctor he had sought out had quit practicing because too many of his patients died.

The professor said Scott's name kept coming up among his surviving HIV- positive friends. So in need of a doctor, he went to see him. The professor, who asked that his name not be used because he doesn't like to discuss private elements of his life, has been pleased.

"I don't know if he's unique," the professor said. "But one thing that has impressed me is, if a peculiar lab report comes back, he keeps track. On a weekend, on a Sunday, he works though the folders of his patients. I have received calls from him on the weekend alerting me to something.

"Just getting to a doctor on the telephone can be a big problem," the professor continued. ''But not with him. He gives you his personal attention."

That personal connection is not without its toll on Scott, although he keeps it from overwhelming him. Seated in his office, he sadly leafs through a legal pad that contains the names of every one of his patients who has died of AIDS through the years. He doesn't know how many there are.

"I don't count," he says, recalling how many of his colleagues have burned out because they lost so many patients to the disease. "That might depress me."

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