Yesterday, December 1, was World AIDS Day. Since 1988, this day has been set to bring attention to one of the world’s greatest health crises. Since the scourge was first identified in 1981, epidemiologists estimate that more than 25 million people across the globe have died of AIDS. The agent that causes AIDS – HIV (human immunodeficiency virus) – was first isolated in 1984. But, AIDS surely was around long before 1981; wreaking havoc on the immune systems of unsuspecting people. There’s anecdotal evidence that people were dying of AIDS in Africa and Europe in the 1960’s and in the U.S. by the 1970s. Not all of the victims were gay/bisexual men, drug users, prostitutes or various other members of society’s miscreants.
In his 1987 book And the Band Played On, author Randy Shilts describes the early uncertain days of the AIDS epidemic; noting how even the gay male community was reluctant to admit there was a problem; and providing incredibly detailed scientific research. He’d based it on a series of articles he’d written about the ailment for the “San Francisco Chronicle.” The same year AIDS was identified Shilts had become the newspaper’s first openly gay employee. While the novel was hailed as groundbreaking and a masterpiece of investigative reporting, Shilts took a big risk with both it and his series of articles for two reasons: 1) he brought attention to a health issue many at the time thought wasn’t worth covering, and 2) he revealed personal details of his own sexual proclivities.
Shilts (who died of AIDS in 1994) faced the same level of ostracism within the gay/lesbian community as writer and gay rights activist Larry Kramer did in 1978 when he published his book “Faggots,” a scathing criticism of New York City’s seemingly sex- and drug-obsessed gay male populace. In the story the main character laments, ‘Why do faggots have to fuck so fucking much?!’ At the start of the AIDS epidemic, Kramer condemned gay men for “fucking themselves to death.” Such honesty doesn’t correspond nicely with political correctness. Neither do I.
AIDS is not really a disease unto itself. As the acronym implies, it’s a syndrome in which the body’s immune system is adversely impacted and it’s acquired. Once that happens, individuals can fall victim to almost any ailment. AIDS is associated primarily with 2 diseases: Kaposi’s sarcoma (KS), a rare form of skin cancer, and pneumocystis carinii pneumonia (PCP), a rare form of double pneumonia.
Among cancers, KS is relatively benign. Historically it usually strikes older men of Mediterranean extraction; perhaps, because they spent years fishing in the open sea without any of the now-recommended skin protection. But, they often live long lives anyway and usually die of something else.
In 1910, a scientist named Antonio Carini Orsi discovered the PCP virus in the lungs of Brazilian guinea pigs. In 1918, European doctors found it in the lungs of the common sewer rat. Not until after World War II, however, did scientists realize it could live in humans; when European orphanages and Nazi concentration camps (where health conditions were deplorable) were evacuated. In the 1950s, as organ transplants became possible, doctors realized they had to suppress the body’s immune system to prevent rejection – and discovered that PCP would then settle into the patient. Once they started up the immune system, the PCP would disappear.
By the late 1960s, however, doctors in some of Africa’s largest metropolitan areas, such as Kampala, Uganda and Nairobi, Kenya, were startled to learn of a particularly vicious strain of KS coming from the continent’s heartland. It didn’t make sense, since the region’s residents didn’t fit the traditional profile. At the same time, doctors in many large European cities began to treat cases of both KS and PCP. There was a tenuous connection: many of the European victims had either visited or lived in Africa. They were military personnel, diplomats, missionaries and others involved in the health care industry; all helping various African nations to build their new-found independence after centuries of European imperialism.
Beginning in the late 1970s, doctors in such U.S. cities as New York and San Francisco were alarmed at increasing incidents of KS and PCP among otherwise healthy gay men. Then, other doctors began to notice similar KS and PCP developments among intravenous drug users and prostitutes. But, since those groups were generally considered the dregs of society, the mainstream medical community didn’t take their health concerns seriously.
In June of 1980, California state health officials met in San Francisco for their annual conference. Dr. Mathilde Krim, an official with the San Francisco Health Department, expressed concerns about the relentlessly high rates of venereal disease infection, including Hepatitis B, among the city’s gay men. Just 5 years earlier, scientists had confirmed that Hepatitis B could be sexually transmitted; the same year they identified Hepatitis C (initially called non-A, non-B). In 1977, San Francisco established the “Cohort Study,” a program designed to track rates of Hepatitis B infection in gay men. Administrators aggressively asked participants detailed questions about their sexual activities and drew blood and tissue samples. A decade later, when the first test for HIV appeared, many of those blood and tissue samples tested positive for that virus. That’s why the U.S. bans any man who’s had sex with another man since 1977 from donating blood or becoming an organ donor. On the bright side, results of the Cohort Study led to the development of the Hepatitis B vaccine in 1983.
At the 1980 California state health conference, though, Krim warned that there was “too much infection,” later adding, “If something new gets loose here, we’re going to have hell to pay.”
That was a long time ago. It’s 2012, not 1982. We now know how HIV is – and is not – transmitted. We know it’s not God’s condemnation of the homosexual lifestyle, and Ronald Reagan wasn’t responsible for its spread. AIDS circulated rapidly among gay men not because of the type of sex they had, but because of the number of partners they had. Beginning in the late 1960s, gay men took the sexual revolution and ran with it – further and faster than any other group of people.
AIDS didn’t spread in the U.S. and other developed countries as rapidly as in Africa and Asia for two main reasons. In the developed world, there’s a generally higher standard of living; people have greater access to health care and information. But, also women in developed countries are more empowered with education and economic security. Unlike women in developing nations, women here know they don’t always have to jump in bed with a man; they don’t always have to resort to prostitution just to survive. They can say no to those things and not be considered an outcast. Women here also aren’t nearly as sexually promiscuous as men. They’ve always considered the consequences of reckless sexual behavior; mainly an unwanted pregnancy. But, if you have two men who are attracted to other men, there’s no cat-and-mouse game; no ‘he acts, she reacts’ type of situation.
HIV most certainly isn’t a new virus. It’s probably lurked in the blood stream of humanity for centuries, if not millennia, waiting for something like the drug and sex revolutions of the mid-twentieth century. In that respect, the AIDS death toll in the U.S. alone surely exceeds 700,000 and probably the 1 million mark. Throughout the 1980s, many health care professionals – some long since retired – began recalling odd illnesses among people who didn’t fit the early AIDS profile: gay men, drug users and prostitutes. Scientists are now certain that a man who died in what is now Kinshasa, Congo in 1959 succumbed to AIDS. Doctors treating him at the time were so baffled by his illness they preserved samples of his blood, which later tested positive for HIV. That same year a British sailor died of what was later confirmed to be AIDS. His doctors also were confounded by his illness and preserved samples of his tissue, which tested positive for HIV in 1986. Then, there’s the strange case of a teenager known only as “Robert R” who died in his native St. Louis in May 1969, following a 6-month bout with a series of debilitating illnesses. Intrigued by Robert’s curious symptoms, a Washington University researcher froze some of his autopsy samples – which later tested positive for HIV.
A cure for AIDS would be a triumph of medicine and science; perhaps the greatest since the elimination of small pox. It’s one of the many proverbial “Holy Grails” sought by medical researchers. But – to some extent – I hope that day never arrives. If it does, I’m afraid we’ll see a rebirth of the sex and drug revolutions. Some people – realizing they could just take a pill or a series of shots if they become infected with HIV – will go wild and starting fucking around like rabbits on Viagra. Then, within a decade or two – if that long – we’ll see a new, more virulent strain of HIV appear on the microbial horizon. And, it won’t be so easily cured. And, all that time, money and energy that went into AIDS research will be dumped into the sewer like a used condom. That’s not something I wish for – it’s something I fear will happen.
Between 1981 and 2011, estimates put the AIDS death toll in the United States at less than 700,000. But, since 1981, how many people have died of cancer? Leukemia? Diabetes? Heart disease? Suicide? Each of those has taken several times more lives than AIDS. Even among gay/bisexual men, HIV is not the number 1 health crisis. It may be the top concern – as gay and bisexual men comprise nearly half of all people with HIV in the U.S. But, heart disease and various cancers are taking the lives of more gay and bisexual men than AIDS; yet if you look at the literature and the propaganda, you’d think it was the only thing they’d have to worry about. To make matters worse, HIV infection rates are rising among young gay and bisexual men – or “MSM” (men who have sex with other men), as if though the terminology makes a hell of a lot of difference. Regardless, it doesn’t make sense. This generation of young adults grew up reading and hearing about AIDS, safe sex and drug abuse. I can understand 30 years ago when people had no real idea what was happening. But, as a society, we’re not so ignorant – or we shouldn’t be.
HIV is difficult to get. It’s infectious, but not contagious. You don’t catch it from sitting next to an infected person in a movie theatre, or touching an elevator button. It doesn’t float through the air like a flu virus. It’s a blood-borne pathogen, and you really have to do something serious with an infected person – either by choice or unwillingly – to get it. So, why do some people screw around aimlessly and then cry when they get sick? It’s the same with folks who drink alcohol heavily for 20, 30 years and develop cirrhosis. It’s the same with people who deal drugs and get arrested. Why do they think they’re victims? It’s tough to have sympathy for someone who recklessly, almost deliberately, puts themselves in danger and then, comes out injured – or dead. It’s one thing if a firefighter charges into a burning building to save someone and dies in the process. It’s another if someone races down a highway at 100 mph on a motorcycle without wearing a helmet and crashes. Yes, you’d probably help the bike rider. But, are you really surprised he or she crashed?
I’m not being judgmental, but I can be critical. I’ve had unsafe sex with both men and women. I’ve been fortunate, since I’ve never come down with anything. One of my best friends died of AIDS in 1993, and another good friend has been battling HIV for more than 20 years. Neither ever blamed anyone else for their circumstances. About 10 years ago yet another HIV-positive friend of mine dismissed the severity of his affliction; claiming that, one day, AIDS will be a chronically-managed ailment, akin to diabetes and blood pressure. I looked at him like the idiot he was and resented the comparison. An AIDS death is not pretty, or even “chronically-managed.” It’s painful and ugly. Watching my friend die in 1993 made me leery of it and realize it’s not just an inconvenience. There’s nothing manageable about that.
So, as the 25th annual World AIDS Day passes, I wonder how the ailment will progress in the near future. I wonder how our global society will progress with it. Yes, I’m certain science will discover a cure for AIDS – but, in some ways, I think that could be a bad thing.