A Titan for HIV Care

For nearly 40 years, Dr. Ellen Tedaldi has been caring for patients with HIV and AIDs, since before the virus and the disease had names.

It has been her life’s work, nearly all of it in Philadelphia, at Temple University Hospital, caring for the city’s most vulnerable population.

As a child, she had polio, and perhaps that is at the root of her compassion, her desire to be a doctor, her empathy for those who are different, who feel ostracized, who suffer.

A small woman almost swallowed up by her long white coat, Dr. Tedaldi walks briskly down the halls and along the streets around the hospital and Lewis Katz School of Medicine because there’s so much to do. She still works well into the evenings, returning calls to patients, approving and faxing pre-authorizations to insurance companies, writing her patient notes.

Late one afternoon, watching her attack the mountain of paperwork, I asked her what “MACP” after her name stands for. She replied, “Master, American College of Physicians – but really master file clerk.”

In truth, there are more than 160,000 members of the American College of Physicians, and only a couple thousand achieve the title of master. They are selected, according to the ACP website, because of "integrity, positions of honor, impact in practice or in medical research, or other attainments in science or in the art of medicine."

Two other esteemed Temple doctors, Larry Kaplan and Gerard Criner, received the same distinction this year.

As a student, Dr. Tedaldi wanted to do primary care medicine, and in 1984, after completing her residency at a safety-net hospital in Minneapolis, she accepted a job in Internal Medicine at Columbia Presbyterian Hospital in New York.

“That’s where my entire career changed,” she says.

“The hospitals were exploding with patients coming in with HIV,” she said, “only we didn’t have a name for it. There was no testing. No medications. No real understanding of what was happening.”  

“All the patients were coming with opportunistic complications,” she continued. “It seemed like that’s all we were seeing. We saw gay men. We saw IV drug users as well as their sexual partners. We saw a lot of women…. There was no support, nothing, for the patients I was seeing.”

 “This was medicine at its fullest,” she recalled. “From the medical aspects to social aspects to political aspects. This was all encompassing…. I looked up and saw a lot of people didn’t want to do this. There’s a lot of stigma to this. But it never entered my mind…. It was worldwide public health catastrophe. And I wanted in.”

In many respects, the parallels to the beginning of the Coronavirus pandemic are dramatic.

“It was intense,” she said of the early days of HIV. “That’s rather an inadequate term. The severity of illness that patients came in with was extraordinary. We were learning how to treat on the fly. Ancillary services weren’t even on the radar screen. For many patients you were the only person that was interacting with them. Their families didn’t want to know about their illness. They were struggling to manage and they had very little in the way of hope or treatment. I became like a lioness. When insurance companies weren’t covering stuff (she would insist): `No, we have to get this covered. We have to get access. Or else they’re going to die.’ Any time a drug was developed, I was in.”

In the late 1980s, determined that this would be her area of expertise, Dr. Tedaldi accepted a job at Temple in Internal Medicine. When she got here, she realized her focus would again be HIV.

“When I first came down to Philly,” she recalled, “a woman with severe HIV had gone blind. She had Cryptococcosis. I would go to draw blood and sit with her. I’d bring my kids with me. I wanted them to see. It just seemed like the right thing to do. Patients were too sick to come in; you were really the only one they had left.”

“They needed to know I was there for them,” she added. “If I had to put into one word what is the role of the physician: an advocate. That was certainly in the early parts of HIV. You’re too sick to fight. I don’t know if it was the maternal instinct or something, but the instinct was we have to take care of you.”

So much has changed in HIV care, says Dr. Tedaldi, since she started practicing medicine. Treatment has gone from non-existent, to 10 pills a day, down to one. And soon enough she says it will simply be an injection every two months. She shared a story at a Temple Story Slam in 2018 about Rosa (begins at 1:13.00), her first AIDS patient, whom she helped get and survive a flight back to the Dominican Republic so she could die with her family. Dr. Tedaldi ended the story this way: “I think about her every time I offer a newly diagnosed patient with HIV a single tablet option. `Take this and you will live for decades.’ ”

For patients today with HIV who take their medication daily, the viral load becomes undetectable, Dr. Tedaldi says, and the virus cannot be transmitted during sex. Still, she says, despite all the progress, the stigma of HIV still remains high for many of her patients.

“I always ask, `Who knows about your situation?’ They can’t say `HIV’ for at least five years,” she says, “they can’t mention the actual name. There are still many people who keep it very discreetly to themselves. Part of the discussion with them is that’s a big burden to carry yourselves. You’re living with something chronic, but also has a social stigma.

“You see a lot of women,” she added, “often with traumatic backgrounds, and that may be how they got exposed. And just self-esteem issues. Post-traumatic stress is still considerable. Their partners say to them, `Nobody’s going to want you, so you should stay with me.’ ”

Dr. Tedaldi emphasized PREP -- Pre Exposure Prophylaxis. “We now have prevention methods that prevent you from getting HIV,” she said. “For men, you can take a pill as needed around the time you’re going to have sex. For women, you take a daily medication to prevent the acquisition of HIV. If you’re with a partner who has HIV, you can take a drug to prevent getting it.” She adds that there is now injectable PrEP, though insurance still will not pay for it in many cases.

Some of her patients without HIV will say to her, “If my partner’s undetectable, why do I need it?”  Her response borrowed from a colleague: “One more tool you can add to your tool box. One more way to be safe and careful.”

Dr. Tedaldi plays many roles. She cares for patients every day in clinic, many with HIV, but also patients with a wide range of other conditions. She for years went into the community with a van from Prevention Point, an organization helping those with substance use disorder, providing care to people on the streets and supervising medical students. She walked last winter with a student group providing street medicine to the homeless along Broad Street. She has never stopped making home visits and continued on occasion during the Coronavirus pandemic, when patients were in desperate need.

She teaches in the medical school and for years has given a presentation during new student orientation on the art of interviewing patients. Each year she invites a different patient and interviews him or her on the auditorium stage.

In 2021 she invited Richard, who recounted his long, difficult journey with HIV:  his own denial after getting his diagnosis, his rejection by family, his decision to refuse treatment and flee to Ethiopia, his acceptance there of his virus and finally his decision to come home and seek treatment.

Richard explained to the students that if a patient is filled with self-loathing daily that is destroying his soul, no medicine from any doctor will save him. What he needs most from a doctor is humanity and compassion and trust. That must come before any pills will work.

And this is what Dr. Tedaldi had been for him.

"She's been phenomenal,” he told them. “Sometimes I call for an appointment and she's booked for months in advance and she will squeeze me in. And I appreciate that. When I get to her, she reclines in a chair and says, `What's up?’ And we catch up on things that I've been doing in my life. She says, ‘You’re back again. I got to fix you up and send you out.’ She has always been open and loving and genuine. She has never raised a brow of judgment.”

Students, so moved by Richard’s story, gave him a standing ovation.

Dr. Tedaldi told the students that Richard and his story comprised elements of every theme they'll see here as physicians at Temple: “debilitating illness, childhood issues, family issues, resource issues, stigma issues...”

“What it's going to come down to is a conversation with your patient,” she said. “At the end of the day it’s closing the door and having a conversation. I’m not going to solve addiction or poverty but I’m going to be a support. What does the patient want from me? A lot of it is being supportive and responsive to what’s going on. Always try to get more of the story. The more you’re able to engage with patients, the more you’ll get the information you need to treat them effectively. You have no idea what so many of them have been through. I see them as survivors. And my job is to help them.”

What is evident is that for all the challenges in medicine today, Dr. Tedaldi has never lost her love of patient interaction. The joy of the patient encounter remains.

After shadowing Dr. Tedaldi over the years, a few moments stick out:

A patient who had been in the hospital for a couple months, walked in to her clinic. “Oh my gosh,” she said, “risen from the ashes! How are you feeling?

“Really well,” he says, nodding.

“Fill me in,” she says.

He tells her he’s getting around, playing with his daughters. “They’re 11 and 5,” he says.

“Yes!” she says, smiling broadly. “Appetite?

“It’s coming back.”

He works in car repair and is back to work.

She is amazed at how good he looks. “Are you sure it’s (says his name) sitting in front of me? Maybe it’s your twin?”

She pivots: “Can we get your lovely spouse in here?”

“I’m really trying,” he said. His wife also has HIV and other health issues but doesn’t come to Tedaldi or any doctor.

She looked in his mouth on physical exam. “We need to separate you from some of those teeth,” she said.

“That’s what happens when you’re a bad boy,” he said. “I was in so many fights.”

He seemed like the sweetest man now.

 “This woman is wonderful,” he says of Dr. Tedaldi. “I wouldn’t have anybody else.”

He’s been with her since his HIV diagnosis in 2012. She leaves the room. He adds: “I have had bad experiences with doctors. It seems like a lot of doctors don’t actually care about the patient. She’s never been that way. She’s kind. Warm. She just makes you want to let her know everything.”

*

A 42-year old woman came in for an office visit and kisses Dr. Tedaldi on the cheek. She recounts that when she was hospitalized at first with HIV, she hadn’t told anyone about her HIV or her hospitalization. “Dr Tedaldi was my only visitor,” she said.  “My family didn’t know nothing about me for three or four years. And she would visit me all the time. She’s just awesome.

“When I come see her now,” the woman continued, “I make notes and bring them. (She had the list in her hand. “Bing, bing, bing, she’ll go through them. I battled depression and she really helped me through that. I always tease, I say `If you go, I’m coming with you.’ She’s like a mother.”

“I’m not going anywhere,” Dr. Tedaldi said.

 She says that quite often to her patients.

*

As an appointment ends, the patient gets up and says, “Whatever the doctor tells you to do, you do – some of it!” They both laugh. “I can’t lie to you or myself,” he says.

*

The man was so anxious. His blood pressure was way too high. The transport van was late, and he’d been afraid he would miss his appointment. “This happens all the time,” Dr. Tedaldi said to me. The patient told her the van was so late he was about to cancel. “No! No! No!” she said. “I’ll always see you whenever you get here.”

She looked at his HIV numbers. 

“But wow. You’re doing wonderful. And your sugar is doing much better. Yippee.”

Yippee!” he says, smiling.

Dr. Tedaldi wanted to recognize and give credit to her entire team. “We are the Temple comprehensive HIV program,” she said. “A group of dedicated physicians, nurse practitioners, case managers, patient navigators and pharmacists, a village.”

Physicians

Jennifer Aldrich, MD, Professor of Clinical Medicine 

Rebecca Kim, MD, MPH 
Assistant Professor of Clinical Medicine 

Nurse Practitioners

Sheila Henry, CRNP, Nurse Practitioner 

Jennifer Malloy, CRNP, Nurse Practitioner 

Kelly Lattanzi, CRNP, Nurse Practitioner 

Pharmacists

David Koren, PharmD, MPH, BCPS, AAHIVP, Clinical Pharmacist 

Mark Cinquegrani, PharmD, Clinical Pharmacist

Patient navigators/staff

Milagros Perez 

Andre Rodrigues 

Gabe Rivera 

Case managers

Michelle Billups 

Samantha Daniels 

Melissa Marchany-Marrero