In the summer of 1981, an immunologist from Los Angeles and a dermatologist from New York reported some unusual findings in the Centers for Disease Control's Morbidity and Mortality Weekly Report. Their articles, published a month apart, hinted at a puzzling new syndrome affecting homosexual male patients that began showing up around 1979. These two doctors, as well as others in several large American cities with significant gay populations, observed the genesis of a new disease, Acquired Immune Deficiency Syndrome.
Twenty years ago AIDS was called "The Gay Plague," gay cancer, or GRID (gay-related immune disorder). Sadly, because AIDS was first detected in homosexual males, it was largely dismissed because gay men circa 1980 were viewed as dispensable. The medical community considered this a homosexual disease, neither fashionable nor prestigious, and consequently unworthy of serious attention. Our government at that time, topped by a staggeringly inept former B-movie actor named Ronald Reagan, was uninterested in anything beyond increased defense spending and domestic budget slashing. Reagan, in fact, did not utter a single public acknowledgment of AIDS until 1987. Not surprisingly, the news media ignored AIDS in the beginning, preferring instead to report less complex stories about such things as neglected toddlers who tumble down wells.
What follows are some highlights and fumbles from the past twenty years.
1981. The San Francisco Chronicle reports "a mysterious outbreak of a sometimes fatal pneumonia among gay men has occurred in San Francisco and in several other major cities." The Centers for Disease Control (CDC) notes an alarming rate of a rare cancer (Kaposi's Sarcoma) in otherwise healthy gay men.
1982. The CDC links the new disease to blood and sexual transmission, calling it Acquired Immune Deficiency Syndrome, or AIDS. The Gay Men's Health Crisis is founded in New York City. Amidst crisis in San Francisco, members of the Sisters of Perpetual Indulgence (a non-profit organization of men who perform charitable acts dressed in Catholic nun habits) join with a team of medical professionals to create Play Fair, the first safer sex pamphlet to use plain, sex-positive language -- paid for, in part by sex party benefits and the sale of ashes from a burned down bathhouse. Over 1,600 cases of AIDS have been diagnosed in the United States and over 600 people are already dead -- in contrast, that death toll is far higher than the combined fatalities from Legionnaire's disease and toxic shock syndrome, two maladies that received enormous media attention.
1983. Newsweek and Time magazines run cover stories on AIDS. Newsweek notes "the lethal disease, first reported in the homosexual communities of New York, Los Angeles and San Francisco, has spread to 35 states and 16 foreign countries including France, Germany and Denmark. And although gay men still account for 72 percent of cases, AIDS seems to be moving into the population at large." The article erroneously implies that HIV originated in America's gay community, a conclusion for which there has never been so much as a sliver of evidence. The head of the U.S. Public Health Service claims AIDS is no threat to the "public" because only 1,450 people are infected, all of them gay and bisexual men and IV drug users. Meanwhile, scientists at Pasteur Institute in France discover HIV in blood.
1984. Dr. Robert Gallo, a U.S. researcher claims he discovered the virus that causes AIDS; however, this is about a year after the French discovery. It will be 1991 before Gallo admits the French scientists sent him the blood sample from which he derived HIV and developed a blood test to detect its presence.
1985. The United States Food and Drug Administration (FDA) approves the first HIV antibody test. Film and television star Rock Hudson emerges as the best-known victim of AIDS. The actor's dramatic public decline brings AIDS to the attention of the American public and makes it a household word. Hudson, a closeted homosexual most of his adult life, becomes an inadvertent pioneer by simply acknowledging that he has the disease.
1986. Again, Newsweek runs a cover story on AIDS calling it "one of the most difficult challenges ever faced by modern medicine," and finally acknowledges the presence of HIV and AIDS in Africa, where it's called the "slim disease." The article also makes a startling revelation: several hundred thousand are believed dead from AIDS and most African countries have played down the epidemic fearing that news stories about the disease might lead the rest of the world to suspect the disease has an African origin. Back in America, a group of pissed off New Yorkers form ACT UP, an all-volunteer, grassroots organization that commands the attention of presidents, pharmaceutical companies, scientists and the public through a series of confrontational protests and acts of civil disobedience.
1987. Barely two years after the development of the HIV antibody test, conflicting opinions about testing reach a shrill pitch. Vice President George Bush calls for mandatory HIV testing. Surgeon General C. Everett Koop urges any woman considering pregnancy to be tested. Some gays feel that viral ignorance is bliss. AZT, a failed cancer drug developed by Glaxo-Wellcome becomes the first anti-HIV drug approved by the FDA -- recommended dose: one 100mg capsule every four hours around the clock. Meanwhile, tenacious San Francisco journalist Randy Shilts publishes And the Band Played On: Politics, People and the AIDS Epidemic, a groundbreaking, relentless, investigative volume about the virus and its neglect by government, science and some gay organizations. Shilts himself would die of AIDS complications is 1994.
1988. Nearly 107,000 cases of AIDS have been diagnosed in the United States and over 62,000 deaths have been recorded. Conservative voices in the Reagan administration fail to prevent a booklet, Understanding AIDS, designed by Surgeon General C. Everett Koop from being mailed to 107 million American households. The threat of a pop quiz might have actually motivated more Americans to read it.
1989. Safe sex information inundates the population from AIDS and social service organizations, the medical community and HIV activists and educators. Unfortunately, the "guidelines" are mostly scattershot and often conflicting, based on personal conjecture, faulty interpretations of high and low risks activities, and biased sources. America, always better at hysterical arm flapping than sane, reasonable assessments, fails again to acknowledge the significance of sex in our lives, choosing instead to turn safer sex education into yet another opportunity to pass judgment, cultivate guilt, and shame anyone unable to achieve a "zero-risk" sexual lifestyle. In promoting safe sex over risk reduction, American guidelines are arguably the most conservative in the world by this time.
1990. Former president Ronald Reagan, who ignored AIDS while occupying the White House, appears in a public service announcement for the Pediatric AIDS Foundation, saying, "We can all grow and learn in our lives and I've learned all kinds of people can get AIDS, even children." He reminds us "you can't get AIDS from hugging someone." Reagan is later diagnosed with Alzheimer's disease, something else you can't get from hugging. Ryan White, a hemophiliac infected with HIV through tainted blood products, dies at 18 from AIDS complications. An effective teenage activist, White ultimately has more impact on Congress regarding AIDS funding than former president Reagan.
1991. Basketball superstar Magic Johnson discovers he's infected with HIV after a routine insurance company blood test. Johnson asserts that his infection is due to rampant, casual heterosexual encounters and retires from basketball, becoming a prominent spokesman for AIDS causes, but failing to galvanize the African American community. Meanwhile, Kimberly Bergalis, a 22-year-old Florida woman announces that she has AIDS and claims to have been infected (along with four others) by her dentist, Dr. David Acer. Bergalis calls for mandatory testing of all healthcare providers prior to her death. But to this day, no one can say just how Acer infected his patients with HIV and it remains a mystery most AIDS experts acknowledge may never be solved.
1992. 335,000 AIDS cases diagnosed in the U.S. and over 198,000 dead. The death certificate of actor Robert Reed, patriarch of TV's "The Brady Bunch," lists HIV among "significant conditions contributing to death."
1993. The so-called "female condom," marketed under the name Reality, wins approval from the Food and Drug Administration even though they refused to allow testing for anal intercourse because sodomy remains illegal in some states. The new condom, an alternative to regular male condoms, fails to catch on with women, although rebellious gay men experiment with it during buttsex. Elsewhere, the U.S. government's official definition of AIDS changes to include a two-part classification based on your T-cell count and history of AIDS-defining disease.
1994. At the United Nations World AIDS Day Conference, U.S. Surgeon General Joycelyn Elders responds to a question about whether masturbation might be taught as a way to prevent AIDS. She says, "masturbation is something that is a part of human sexuality, and is a part of something that perhaps should be taught." One week later, President Bill Clinton fires Joycelyn Elders for "values contrary to the administration."
1995. Olympic diver and gold medallist Greg Louganis reveals he has AIDS and that he tested positive for HIV in 1988, six months before competing in the Summer Olympics. During preliminaries of the springboard competition, Louganis hit his head on the diving board while performing a complicated dive and began bleeding. Old video of the incident floods the airwaves as the media attempt to imply that bleeding from a small forehead cut into a huge, chlorinated pool constitutes a possible route of transmission. "It just doesn't occur that way," said Dr. Steven Miles, assistant professor of medicine at the UCLA Care Center, which does AIDS research and education. Elizabeth Dole, president of the American Red Cross and wife of Bob Dole (then the front-runner for the 1996 Republican presidential nomination) halts publication of a highly anticipated HIV/AIDS training manual for 1600 Red Cross chapters nationwide when her "special team" of advisors from outside the organization convinces her its contents are too explicit and controversial (and very likely life-saving, too).
1996. Time magazine's Man of the Year is AIDS researcher Dr. David Ho, scientific director of the Aaron Diamond AIDS Research Center in New York. Time suggests that Ho's "cocktail" of antiviral drugs -- costing as much as $20,000 a year -- "might, just might, lead to a cure." Meanwhile, California and Arizona voters pass propositions allowing medical use of marijuana for individuals with chronic illness and pain.
1997. The Centers for Disease Control reports that an HIV+ man "most likely" passed the virus to his female partner through deep kissing after brushing and flossing his teeth until his gums bled. It remains the first and only case of transmission attributed to deep kissing. HIV drugs, slickly promoted in ads featuring buff, beautiful men and women biking, yachting and mountain climbing, revolutionize HIV care. Princess Diana, one of the first public figures to urge compassion for people living with AIDS and refute the myth of easy contagion, dies in an automobile crash. After a speaker drops out, Tony Valenzuela, gay porn star/escort/writer, is tapped to give a speech about his sex life at the National Gay and Lesbian Task Force's Creating Change Conference. His speech, in which he confesses to personally preferring and loving anal sex without condoms, ignites enormous controversy in the gay press and brings the concept of "barebacking" -- unprotected anal intercourse -- to the forefront.
1998. According to CDC statistics, 52% of gay/bisexual men diagnosed with HIV/AIDS in the U.S. are men of color. African American and Hispanic women accounted for 76% of new AIDS cases among women. Biotechnology company VaxGen begins phase III efficacy trials of the first human AIDS vaccine (AIDSvax). AIDS dissidents (folks who deny the scientific explanation that HIV causes AIDS) pop up globally, including Alive & Well AIDS Alternatives founder Christine Maggiore, several anarchist ACT UP groups, the Foo Fighters rock band, and South African Deputy-President Thabo Mbeki.
1999. The New England Journal of Medicine cautions that hepatitis C and HIV co-infection is on the rise -- there is no known cure or vaccine for hepatitis C. The side effects of antiviral therapy (also known as HAART), like body-fat distribution changes, mitochondrial toxicity, lactic acidosis, elevations in blood lipids, cholesterol and triglycerides, raise concerns about long-term treatment. Study after study suggests that nonoxynol-9, a spermicide added to condoms and lubricants in the 1980s to kill HIV, may actually sabotage safe sex by irritating the skin, creating rashes or ulcers that facilitate transmission of the virus.
2000. According to the World Health Organization, two-thirds of the world's nations still do not have clean blood supplies. Tired and frustrated by years of adherence to combination therapy, some "pozzies" beg for STIs, or Structured Treatment Interruptions. A study sponsored by UNAIDS reveals (again!) that the commonly used spermicide nonoxynol-9 -- touted in prevention lectures for over a decade -- can actually lead to increased HIV transmission by causing irritation of the genital membranes; its use is no longer recommended by UNAIDS or the CDC and numerous AIDS service organizations, but the FDA refuses to halt the production, sale or marketing of condoms or lubricants containing nonoxynol-9 despite the research. The largest International AIDS Conference unfolds in Durban, South Africa featuring a speech from that country's president Thabo Mbeki, (himself publicly skeptical of the theory that HIV causes AIDS) who proclaims the "world's biggest killer and the greatest cause of ill health and suffering across the globe, including South Africa, is extreme poverty." At the same conference, over 5,000 HIV-involved scientists and clinicians, from more than 70 nations, issue a signed statement called "The Durban Declaration" which restates a widely accepted theory: HIV causes AIDS. Later, American scientist Dr. David Ho (credited with developing antiviral combination therapy) receives a standing ovation when he points to a slide of HIV during a lecture at the conference and says, "This, ladies and gentlemen, is the cause of AIDS. Failure to address the modern plague of HIV/AIDS would be an act of criminal irresponsibility which will be judged harshly by history."
2001. AIDS researchers question the "hit early; hit hard" approach to HIV treatment and new federal guidelines recommend that antiretroviral therapy not begin until an individual's T-cell count drops below 350 (instead of 500, and seemingly indifferent to viral load). Results of CDC studies in six large cities indicate roughly one-third of young gay or bisexual black men are infected with HIV. Health officials report AIDS is the number one cause of death for African Americans between the ages of 25 and 44, and African-American seniors make up over half of the HIV cases among people over the age of 55. Meanwhile, at the National Conference on African-Americans and AIDS, Columbus, Ohio publishing executive James L. King told several hundred health care professionals, "I sleep with men, but I am not bisexual, and I am certainly not gay," adding, "I assure you that none of the brothers on the down low like me are paying the least bit of attention to anything you have to say."
Worldwide, 36 million people are infected with HIV; 24 million of those infected live in Africa. In the United States, over 300,000 AIDS deaths have been recorded since the 1980s and new HIV infections have held steady at roughly 40,000 a year for the past decade. America's response to AIDS over the past twenty years has been a bizarre jumble of contradictions, hysteria and denial. Sure, we've come a long way since 1,200 treating physicians and researchers -- mostly white guys in suits -- met in Atlanta for the first AIDS conference in 1985 to discuss how the world could meet the challenge of AIDS. Yet, HIV, the infectious agent responsible, remains largely misunderstood by citizens of the United States, a shocking proportion of whom either believe you can contract this virus by sharing a glass with an infected person or that a "cocktail" is the cure. Ultimately, it is our unwillingness to speak candidly about sex and injection drug use that has created a profound medical problem and ongoing threat to the public health.