In mid-1981, research epidemiologists identified clusters of Pneumocystis pneumonia and Kaposi’s sarcoma, both indicators of immunosuppression, among gay men in Los Angeles and New York City. The cause proved to be a sexually transmitted retrovirus attacking T-lymphocytes. Of African origin, the virus was already well established in the New World in 1981. It produced a lethal worldwide pandemic that continues to rage in the twenty-first century despite massive national and international efforts at containment.
The Morbidity and Mortality Weekly Report (MMWR) issued by the U.S. Centers for Disease Control (CDC) in Atlanta, Georgia, on June 5, 1981, described an outbreak of Pneumocystis carinii pneumonia
On July 3, an update appeared in MMWR with the warning, “Physicians should be alert for Kaposi’s sarcoma, PC pneumonia, and other opportunistic infections associated with immunosuppression in homosexual men.” On August 28, with 108 cases confirmed, the CDC established a task force on “Kaposi’s sarcoma and opportunistic infections,” the term by which the condition was known until September of 1982, when it was replaced with “acquired immunodeficiency syndrome” (AIDS). By that time, 593 cases had been reported, of whom 243 had died, and several cases had occurred among recent Haitian immigrants and intravenous drug users.
AIDS-infected lymphocytes such as those shown here are too weak to combat viruses and other agents of disease.
The early progress of the disease in the United States can be traced in MMWR reports. In June, 1982, 413 cases had been reported, of whom 155 had died; by June, 1986, 16,458 cases had been reported, of whom 8,361 had died. The exponential rate of increase, consistent with a transmissible pathogen rather than an environmental cause, is evident. In 1986, CDC epidemiologists projected that if unchecked, the epidemic could claim as many as 179,000 lives by 2000. The actual figure for the United States alone stood at 550,394 in 2005.
On April 23, 1984, Dr. Robert Gallo, a virologist at the National Cancer Institute, announced that he had found the cause of AIDS, human T-cell lymphotropic virus type III (HTLV-III; now known as human immunodeficiency virus, or HIV), and was working on developing diagnostic tests and a vaccine. The same virus was reported a month earlier by Dr. Luc Montagnier of the Pasteur Institute, who was eventually credited with priority of discovery. Associating a specific pathogen with AIDS rapidly led to tests for HIV infection and screening of donated blood, but hopes for a vaccine proved premature. Convinced that a virus was involved, Dr. Curran and others at the CDC had already been pushing for rigorous screening of blood donors and education campaigns among vulnerable populations but were met with little cooperation from the medical community, many of whom maintained that AIDS was a generalized reaction to continued exposure to numerous pathogens among promiscuous homosexuals and intravenous drug users. Public disapproval of the most affected groups and suspicion of CDC recommendations deriving from the 1976 swine flu immunization debacle both played a role in delaying measures to prevent the spread of AIDS.
The case of Ryan White, a teenage hemophiliac diagnosed with AIDS in 1985, attracted national attention to the minority of cases not acquired through socially condemned behavior. After the local school in Indiana expelled Ryan as a danger to his classmates, singer-songwriter Michael Jackson paid to relocate the White family to a more accepting community and took part in publicizing the case. Associated activism led to the passage of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990,
The CDC sent medical teams to Haiti and central Africa to trace the sources of the epidemic. Of the many models for the origin of the current epidemic, the most plausible postulates that it began in the Belgian Congo (later Zaire, and now the Democratic Republic of the Congo) in the late 1950’s. Isolated cases that may have been AIDS occurred earlier, and some investigators, reviewing mysterious epidemics in the historical record, theorize that AIDS epidemics are a recurring phenomenon. In the 1960’s, the newly independent country of Zaire imported skilled workers from many countries, including Haiti and Cuba; upon their return home, some carried the disease. In Cuba, prompt draconian quarantine measures curbed AIDS, but in Haiti it became a pervasive urban problem perpetuated mainly through heterosexual contact. At the same time, migrant mining workers spread AIDS to Southern Africa, where poverty, social unrest, and a paucity of medical resources allowed the disease to escalate to levels unknown in the developed world. A number of Asian countries are also badly affected.
Beginning with azidothymidine (AZT),
In terms of the number of people affected and the long-term social consequences, the AIDS epidemic dwarfs any political, social, or environmental process between the end of World War II and the new millennium. In the United States, the number of deaths exceeds fatalities in any single war. In the worst-affected African countries, where a third of the adult population is infected, there are literally not enough healthy people to maintain the economy while caring for the ill and the children. In developed countries, providing drugs and ongoing care to AIDS sufferers burdens the health care system.
Early responses to the AIDS epidemic in the United States illustrate both the strengths and the weaknesses of public health systems in a democratic country with a largely private health care delivery system. Mechanisms for identifying and tracking the epidemic worked admirably. Whether they would perform as well if faced with a similar situation today is questionable, given several decades of drastic cuts in public health funding. The United States also led the way in research into the causes of the disease and the development of effective therapeutic agents for treating people once infected.
Epidemiologists had identified and publicized the basic methods for preventing AIDS transmission by the beginning of 1983, even before the causal agent was known. Changing people’s behavior through education and voluntary compliance proved to be an uphill battle, as promiscuous male homosexuals and intravenous drug users were accustomed to avoiding contact with any public agency. Already living with grave health risks, they resisted making lifestyle changes. Especially among teenagers, publicizing and facilitating safe practices through explicit literature, or by distributing condoms and clean needles, carried a risk of encouraging experimentation by people who otherwise would have avoided dangerous practices altogether. Conservative churches consequently opposed the most radical AIDS prevention agendas. At the other end of the spectrum, gay political action groups, whose influence grew as the epidemic progressed, effectively prevented involuntary measures such as mandatory testing or criminalizing unsafe sex by an HIV-positive individual. The resulting compromise, inevitable in a pluralistic democratic society, is inefficient compared to the two alternatives.
AIDS has become a fact of life in the early twenty-first century. Although death rates in the United States dropped from the mid-1990’s onward owing to the availability of better therapies, rates of new infection appeared to be rising. AIDS began to spread rapidly in urban areas in China and India. A vaccine against the scourge had yet to be developed. If nothing else, the global AIDS epidemic made it clear that there are challenges against which science and modern medicine, unaided by major social transformation, are feeble allies at best.
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Baker, Janet. A.I.D.S.: Everything You Must Know About Acquired Immune Deficiency Syndrome, the Killer Epidemic of the 80’s. Saratoga, Calif.: R & E, 1983. Primarily a sourcebook documenting the growth of scope and knowledge during the first two years of the epidemic. -
Feldman, Douglas A., and Julia Wang Miller, eds. The AIDS Crisis: A Documentary History. Westport, Conn.: Greenwood Press, 1998. Includes source documents on the discovery of the virus and social issues involved in prevention efforts. -
Gallo, Robert C. Virus Hunting: AIDS, Cancer, and the Human Retrovirus: The Story of a Scientific Discovery. New York: Basic Books, 1991. Firsthand account of the process by which HIV was isolated and characterized. -
Sherman, Irwin. The Power of Plagues. Washington, D.C.: ASM Press, 2006. The chapter on AIDS includes a clear, nontechnical description of how a retrovirus functions and comparisons with major historic plagues.
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