His work helped change people’s attitude toward older people living with the virus that causes AIDS.Stephen Karpiak, whose research into the lives of New Yorkers aging with H.I.V. revealed a scarcity of support networks and high rates of depression, leading to changes in the care of older people living with the virus, died on Oct. 16 at a hospital in Manhattan. He was 74. His brother, Michael, said the cause was kidney damage that resulted from an infection.AIDS had a devastating impact on gay men in the 1980s, especially in New York. The advent of antiretroviral drugs in the 1990s marked the beginning of a hopeful shift, and a decade later, after an era of despair, gay life reclaimed its vibrancy in the city. But Dr. Karpiak at the time was starting to conduct research about older adults living with H.I.V. and he was troubled by what he was learning.The landmark study launched by Dr. Karpiak interviewed 1,000 New Yorkers over 50 about their quality of life and mental health; it eventually also included San Francisco, Oakland and Chicago. The data was stark.Dr. Karpiak learned that his subjects struggled with fragile support networks and inadequate health care, and that 70 percent of those infected by H.I.V. lived alone; this social isolation resulted in substantially higher rates of depression. His study, “Research on Older Adults With H.I.V.,” was published in 2006, and he dedicated the rest of his career to building on it.“There was a core message that you would detect in the focus group data: ‘You abandoned us,’” Dr. Karpiak said in a 2020 interview. “They say, ‘Gee, you saved our lives, but at what cost? You gave us extended life, but at the cost of impoverishment, continued rejection, ageism, and stigma.’”“We gave them a pill,” he added, “then said goodbye to them.”Dr. Karpiak, who witnessed the AIDS crisis as a gay man in New York in the 1980s, became an impassioned advocate for those aging with the disease and railed against ageism.“They encounter programs where the emphasis on prevention of H.I.V. in high-risk youth and young-adult populations often dominates,” he wrote in a 2019 article for Positively Aware magazine. “We live in a society where youth receive the highest premium. Aging is seen as a disease rather than an inevitable process of living.”Dr. Karpiak championed his cause at the AIDS Community Research Initiative of America, where he worked as a lead researcher for years.He built caregiving networks for older people with H.I.V., trained health care providers in treatment strategies and became a skilled fund-raiser who dealt with supporters like Donna Karan and Calvin Klein. His research was also backed by large grants from pharmaceutical giants like Gilead. ​​Dr. Karpiak sought to reach his research subjects directly. As executive director of the Pride Senior Network, which he joined in 1999, he ran and edited The Networker, a free quarterly newspaper aimed at older gay New Yorkers that was distributed in bars and doctors’ offices. Its inaugural issue, in 2000, featured a manifesto about age discrimination by the novelist Patricia Nell Warren.In 2010, he participated in a conference on H.I.V. and aging at the White House, and he also helped start National H.I.V./AIDS and Aging Awareness Day.Dr. Karpiak was an advocate as well as a researcher and served as executive director of the Pride Senior Network in New York. He is pictured in 2000 with the network’s founding director, Ellen Ensig-Brodsky; on the screen is the organization’s newspaper.Diane Bondareff/Associated Press“As Stephen grew older as a gay man himself, because he was a scientist, he couldn’t help but notice disparities around him,” said Tonya Taylor, an assistant professor at SUNY Downstate Health Sciences University in Brooklyn who was mentored by Dr. Karpiak, and studies women aging with H.I.V. “He gave visibility to this topic and brought it out from the darkness.”Stephen Edward Karpiak Jr. was born on Aug, 13, 1947, in Hartford, Conn. His father was a fire captain. His mother, Olga (Yanenko) Karpiak, was a judicial secretary.He graduated from the College of the Holy Cross with a degree in psychology in 1969 and earned his doctorate in experimental psychology at Fordham University in 1972. He joined Columbia University’s medical school as a researcher studying seizures and behavioral disorders.In his 30s, Dr. Karpiak lived in the West Village and was immersed in the city’s gay nightlife. He partied until dawn at clubs like the Saint and the leather bar Ramrod, and he fell in love with a schoolteacher, who became his partner. When the AIDS crisis began, he started receiving messages on his answering machine from friends desperately seeking his medical advice. He also began attending funerals constantly.“Losing all those people was never far from his mind,” said his brother, who is his only immediate survivor. “And it tied deeply into his personal life. He lost his lover, who was his soul mate.”His partner’s death stirred something in him.“When he finally saw those who survived, he saw they weren’t surviving well,” he added. “So Stephen thought, ‘How can I do something about this?’ He couldn’t do anything when it was happening in the 1980s, but then he got his chance.”Dr. Karpiak left Columbia University in the mid-1990s and moved to Phoenix to run a clinic for people living with H.I.V. He also managed an agency there that provided housing for homeless men living with the virus.Dr. Karpiak returned to New York in 1999 to lead the Pride Senior Network. One day at a health fair he gave out a simple questionnaire that asked: If you are older and were to suddenly fall ill, do you have someone who would care for you? After studying the responses, he undertook his research.Dr. Karpiak joined the faculty of New York University’s College of Nursing in his 60s and later worked for G.M.H.C. (formerly Gay Men’s Health Crisis), where he founded its National Resource Center on H.I.V. and Aging.When the coronavirus pandemic gripped New York, Dr. Karpiak grew concerned about how older people living with H.I.V. would be affected by lockdown. Sequestered in his Hell’s Kitchen apartment, he took part in web conferences with medical experts to address the topic. He always encouraged his research subjects to tune in, so they could hear that someone was looking out for them.“The Covid-19 pandemic showed us that we are an ageist society,” Dr. Karpiak said in 2020. “We hear misinformation constantly: ‘This virus only affects old people,’ so most people, ‘don’t need to worry about it so much.’”“I have heard many older adults say, ‘The worst thing in the world is to feel abandoned,’” he continued. “Even more unsettling is hearing from them, ‘There is something worse than AIDS, like loneliness.’”

He pioneered a new branch of emergency medicine — when emergency rooms are nowhere to be found — and helped compile the definitive textbook on health care in the wild.Dr. Paul Auerbach, an emergency care physician who pioneered the field of wilderness medicine in the 1980s and then taught ways to heal people injured by the unpredictable, died on June 23 at his home in Los Altos, Calif. He was 70.His wife, Sherry Auerbach, said the cause was brain cancer.Out in the wild, knowing how to treat a venomous snake bite or a gangrenous infection can mean the difference between life and death. In the 1970s, however, the specialized field of health care known as wilderness medicine was still in its infancy. Then Dr. Auerbach showed up.A medical student at Duke University at the time, he went to work in 1975 as an intern with the Indian Health Service on a Native American reservation in Montana, and the experience was revelatory.“We saw all kinds of cases that I would have never seen at Duke or frankly anywhere else except on the reservation,” Dr. Auerbach said in a recent interview given to Stanford University, where he taught for many years. “Snakebites. Drowning. Lightning strike.”“And I just thoroughly enjoyed it,” he continued. “Taking care of people with very limited resources.”Back at Duke he tried to learn more about outdoor medicine, but he struggled to find resource material.“I kept going back to literature to read, but there was no literature,” he said. “If I wanted to read about snake bites, I was all over the place. If I wanted to read about heat illness, I was all over the place. So I thought, ‘Huh, maybe I’ll do a book on wilderness medicine.’”Dr. Auerbach started researching material for the book in 1978, when he began his medical residency at U.C.L.A., finding the time to do so despite grueling 12-hour hospital shifts. He collected information about how to treat burn wounds, hypothermia, frostbite and lighting injuries. He interviewed hikers, skiers and divers. And he assigned chapters to doctors who were passionate about the outdoors.The resulting book, “Management of Wilderness and Environmental Emergencies,” which he edited with a fellow student, Edward Geehr, was published in 1983 and is widely considered the definitive textbook in the field. Updated by Dr. Auerbach over 30 years, it is in its seventh edition and now titled “Auerbach’s Wilderness Medicine,” with sections like “Protection From Blood-Feeding Arthropods” and “Aerospace Medicine: The Vertical Frontier.”“Paul literally conceived of this subspecialty of medicine,” said Dr. Andra Blomkalns, chair of emergency medicine at Stanford. “At the time, there wasn’t a recognition that things happen when you’re out doing things. He developed this notion of, ‘Things happen to people all the time.’ Which is now a big part of our identity in emergency medicine.”In the early 1980s, hearing from doctors and nurses with similar interests in outdoor medicine, Dr. Auerbach founded the Wilderness Medical Society with Dr. Geehr and Dr. Ken Kizer. The group is now the largest membership organization in its field and has hosted events like a trek to a Mount Everest base camp and a trip to a station in the Utah desert that simulates life on Mars.Dr. Auerbach joined Stanford as chief of its emergency medicine division in 1991. He left the university four years later to work in the private health care sector before returning to the university in 2005 and remaining there until his retirement last year.He became an elder statesman in his field. He spoke at conferences around the world, in one case describing how the erectile-dysfunction pill Viagra can be used to treat high altitude pulmonary edema because it reduces artery pressure.In his wilderness medicine classes at Stanford, Dr. Auerbach taught his students, foremost, to respect the outdoors“When house staff and residents and young doctors say, ‘How do I learn wilderness medicine?’ My very first answer to them always is, ‘Learn the wilderness first,” he said in the Stanford interview. “Because you can’t help anybody if you’re just scrambling to keep yourself alive.”Dr. Auerbach and a young patient in 2010 after he had traveled to Haiti as a medical volunteer in the wake of a devastating earthquake there.Chuck Liddy/The News & ObserverIn 2010, when an earthquake devastated Haiti, Dr. Auerbach traveled to the country with a team of emergency medical workers, and despite his years of experience, he found the trip harrowing. A few years later, when an earthquake hit Nepal, he went there to assist with emergency care and later helped establish a hospital there.Dr. Auerbach said it was imperative never to get too comfortable when dealing with the whims of nature. “You have to be afraid when you go into work,” he said. “You have to stay humble.”Paul Stuart Auerbach was born on Jan. 4, 1951, in Plainfield, N.J. His father, Victor, was a patents manager for Union Carbide. His mother, Leona (Fishkin) Auerbach, was a teacher. Paul was a wrestling star in high school and grew up spending summers on the Jersey Shore.He graduated from Duke in 1973 with a bachelor’s degree in religion and then enrolled in Duke’s medical school. He met Sherry Steindorf at U.C.L.A., and they were married in 1982. (In the 1980s he worked part-time as a swimsuit model for the swimwear company Laguna.) Dr. Auerbach studied at Stanford’s business school shortly before joining the university’s medical faculty in 1991.In addition to his wife, he is survived by two sons, Brian and Daniel; a daughter, Lauren Auerbach Dixon; his mother; a brother, Burt; and a sister, Jan Sherman.As he grew older, Dr. Auerbach became increasingly devoted to expanding the field of wilderness medicine. In revising his textbook, he added sections about handling environmental disasters, and, with Jay Lemery, he wrote “Enviromedics: The Impact of Climate Change on Human Health,” published in 2017.Last year, shortly before he received his cancer diagnosis, the coronavirus pandemic began to take hold, and Dr. Auerbach decided to act.“The minute it all first happened, he started working on disaster response,” his wife said. “Hospitals were running out of PPE. He was calling this person and that person to learn as much as he could. He wanted to find out how to design better masks and better ventilators. He never stopped.”

#masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutNew Variants TrackerAdvertisementContinue reading the main storySupported byContinue reading the main storyThose We’ve LostMonica Alexis, Nurse’s Aide With a Calling, Dies at 83Ms. Alexis worked in hospitals in New York and Pennsylvania, helping her patients with “the most important things.” She died of complications of Covid-19.Monica Alexis, born in Trinidad, came to the United States and became a nurse’s aide with a commitment to helping patients.Credit…via Alexis familyMarch 8, 2021, 12:27 p.m. ETThis obituary is part of a series about people who have died in the coronavirus pandemic. Read about others here.Growing up in Trinidad in the 1940s, Monica Alexis was known in her family for a precocious sense of compassion.Her older brother suffered from severe diabetes and she bandaged his swollen feet nightly. After a cousin became a doctor, she decided she wanted to pursue a career in health care one day.When Ms. Alexis was in her 20s, a friend told her that she knew of Caribbean women who were finding steady work as health care aides at hospitals in New York City, and that the pay was much better than in the Trinidad. By the 1970s, Ms. Alexis had settled in Astoria, Queens, and she was helping patients as a nurse’s assistant at NewYork-Presbyterian Hospital in Manhattan. After that, she worked at Reading Hospital in Pennsylvania for nearly two decades.As a nurse’s aide, Ms. Alexis was responsible for the everyday tasks that allow hospitals to focus on saving lives. She brought meals to patients and made their beds. Standing 5-foot-2, she hoisted people twice her size to bathe them. When engaged in sensitive duties like removing catheters from elderly men, she reassured them with sass: “Why are you shy? Don’t be silly. I have three sons. You don’t have anything I haven’t seen before.”As years passed, hospital colleagues often encouraged Ms. Alexis to become a registered nurse, but she wasn’t interested.“She wanted to stay a nurse’s assistant,” her daughter, Melissa Alexis, said. “She felt that becoming a registered nurse would take her away from what she wanted to do for her patients. The stuff you don’t think about. The little things. But they are the most important things.”The Coronavirus Outbreak