8998 H1N1,AIDS,Gynecology

The XVII International AIDS Conference in Mexico City from August 3 through 8 has, as its stated goal, to conduct a forum that “promotes scientific excellence and inquiry, encourages individual and collective action and dialogues, and fosters accountability.” The conference’s impressive agenda is testimony to how far we have come in dealing with the worldwide problem as well as how much has been forgotten regarding the early causes, and rapid spread, of the illness in America. Specifically, why were the rather obvious dual goals of prevention and education ignored for so long?

By the summer of 1981, an unnamed phenomenon was being widely discussed in medical circles. Three here-to-fore rare illnesses: a pneumonia (Pneumocystis Carinii), a cancer (Kaposi’s Sarcoma) and a fungus (Candida) were atypically being observed in increasing numbers in large American metropolitan centers. A Center for Disease Control (CDC) task force created a new term grouping them as “Opportunistic Infections” meaning conditions that would not normally appear in healthy individuals and which, therefore, needed some “opportunity” to manifest themselves. Sadly, since the problem was so largely based in the homosexual community, it did not ignite concern in government or even among the general public. A conservative wave had come to power in Washington, DC, and it was clear that as long as “normal Americans” were not at risk, there was no reason to prioritize research programs or even education. 

In January of 1982, the CDC had documented one hundred eight cases of the “syndrome” and formed an “Opportunistic Infection and Kaposi’s Sarcoma task force.” It requested $830,000 from the NIH (National Institute of Health) multi-billion dollar budget – a request that was denied. Of primary concern was whether the illness was bacterial or viral. If the former was true, surely an antibiotic could easily be identified to kill the bacteria. In the case of the latter, the virus would have to be “isolated” so that a vaccine could be made from the antibodies the infected person’s immune system makes to fight the virus. The term “isolated” was coined with the discovery of the electron microscope in the mid-twentieth century that allowed researchers to actually “see” tiny viruses. Once the virus is isolated, it was thought, a vaccine could easily be made – like Jonas Salk had done with Polio. As we all know, the Polio virus still exists. The vaccine does not destroy the virus but rather it changes the host who has been immunized so that the virus becomes ineffective and thus irrelevant. 

While scientists on both sides of the Atlantic were racing to identify the virus, the condition was being called “the gay plague.” Fortunately, the gay community thought during the winter of 1982, there were increasing hints that the new illness was not confined to homosexuals. On February 25, 1982, The Wall Street Journal featured an article titled “New, Often Fatal, Illness in Homosexuals Turns up in Women, Heterosexual Males.” A month later, The Los Angeles Timesprinted a similar piece to coincide with the CDC’s announcement that the number of cases had nearly tripled in three months to two hundred eighty-five. The CDC had changed its name for the disease from GRID (Gay Related Infectious Disease) to AIDS (Acquired Immune Deficiency Syndrome), signaling the discovery that the general population’s immune system was somehow being targeted.

Clusters of new sub-groups began to emerge which led to the calloused term “four H’s” for homosexuals, heroin addicts, Haitians and hemophiliacs, presumably in decreasing order of undesirability. 

By 1983, the illness had been observed in sixteen countries and most scientists had come to believe that AIDS was indeed caused by a virus. Jean-Claude Chermann, at The Pasteur Institute in Paris, was the first to suggest that AIDS was not only a virus but a “retro-virus” and, importantly, was not the same virus that causes leukemia as was theorized by Robert Gallo at The National Cancer Institute (NCI). A retro-virus not only attacks and kills its target but it invades the cells thus releasing many clone viruses after it destroys the attacked cells. This soon to be recognized fact, along with the added problem that, with the passage of time, the virus was “mutating” (creating variations of itself) seriously magnified the difficulty of producing a vaccine. 

In November, 1983 representatives from thirty nations attended the first AIDS conference in Geneva, Switzerland, as the number of reported AIDS cases in America rose to over 3,000. Regular annual meetings named “International AIDS Conferences” began in 1985 in Atlanta, Georgia. 

1984 saw the beginnings of a sad phenomenon that slowed the research trying to isolate the still unseen virus that causes AIDS. The Pasteur Institute in France and the National Cancer Institute in Washington began competing rather than cooperating – both hoping to win the Nobel Prize in Medicine. The two teams could not even decide on what to call the mystery they were looking for. The French referred to the virus as “LAV” while Doctor Gallo, holding firm to the concept of a link with HTLV-I (the virus that causes leukemia), called it HTLV-III. As any hopes of a trans-Atlantic cooperation disappeared, the number of reported cases was skyrocketing. In April of 1984 there were 4,100 reported cases in America with 1,807 deaths. Two months later the figures had risen to 5,000 cases and 2,300 fatalities while only a few superficial, palliative treatments were available. 

In the spring of 1984 America lost a great opportunity to de-stigmatize AIDS which would have accelerated research and education. Actor Rock Hudson was diagnosed with AIDS. For months he tried in vain to conceal the news while being treated in France – ironically at The American Hospital of Paris. He did manage to fool one important friend, however. At a White House celebration in August, 1984, and in response to First Lady, Nancy Reagan’s question regarding the actor’s gaunt appearance, Hudson claimed he had been food poisoned in Israel while shooting a film. Worse, perhaps, Reverend Jerry Falwell said we all “needed to return to moral sanity” and not to “favor homosexuals” in medical research. The un-protested comment was made during a speech at the Democratic National Convention in San Francisco. 

Finally, and for the first time since one of the most overt act of discrimination in modern history had begun, public protests erupted in California and New York amid confusion of how the virus was contracted. Many believed it was transmitted through casual contact such as kissing or touching and, therefore it was suggested, the “contaminated” individuals should be quarantined. Others took an opposite point of view. Doctor Gallo said that only one out of one hundred people who were exposed to the virus would progress to developing “full blown AIDS”. That theory was discounted when the number of reported cases crossed the 6,000 mark and Ronald Reagan’s first term was drawing to a close without the President having ever addressed the problem during a policy speech. In fact he had never uttered the word “AIDS”. 

Shortly after Ronald Reagan was sworn in for his second term, and as the number of American AIDS cases reached 8,000, the Office of Management and Budget (OMB) actually cut spending for AIDS research from $96 million to $85 million. Equally disappointing was the fact that the CDC did not fund a proposed unit which was suggested to be called “Operations AIDS Control” even though there was increasing documentation of heterosexual transmission of the virus as well as a reported incidence of the disease in the US Army and new awareness of the risks associated with sharing IV needles.

By mid 1986, the “two viruses” (HTLV-III and LAV) were recognized as one and internationally renamed HIV (Human Immunodeficiency Virus). At the same time, it was becoming widely accepted that that there were several strains of the virus and that the easiest way to determine the virus’s effect and damage to the immune system was to measure a type of white blood cell called the CD-4 lymphocyte, also known as the “T Helper Cell” and commonly referred to as the “T-Cell”. By this time, the number of AIDS cases in America had passed 10,000.

The early evolution of AIDS in America chronicles a sad chapter in our history. Questions abound regarding what the progression of AIDS might have been if President Reagan had emphasized education and prevention. Would an early government “Manhattan-type Project” to discover a vaccine before HIV mutated have been possible? If Rock Hudson had confided in Nancy Reagan, might she have convinced the President to consult experts and emphasize safe sex education? Obviously, there are no verifiable answers to these theoretical questions. 

Luckily, however, the world now benefits from Herculean efforts to combat the AIDS crisis such as the Clinton Global Initiative (CGI) and the Bill and Melinda Gates Foundation in cooperation with Warren Buffet. These laudable programs are trying to address the challenges posed by the thirty-three million cases of HIV worldwide. However, while these topics will be discussed and analyzed at the XVII International AIDS Conference, let us remember the innocent, early victims who died frightening, painful and dehumanizing deaths. 

©2008 Richard René Silvin