AIDS Turns 25

The purplish lesions of Kaposi’s sarcoma that marked many early AIDS victims.

(National Institutes of Health)

“Pneumocystis Pneumonia—Los Angeles” read the headline on page 2 of the June 5, 1981, edition of the Center for Disease Control’s Morbidity and Mortality Weekly Report. It was an unassuming title for what proved to be the announcement of the public health crisis of the century.

“In the period October 1980-May 1981,” the article reported, “5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died.” Over a page and a half, the authors—an immunologist, Michael Gottlieb, and two internists, Wayne Shandera and Joel Weisman—presented five case reports. Their measured medical language belied the vague panic rumbling in doctors’ offices and hospitals across L.A. Five men in the prime of life had been ravaged by a fungus so benign that it usually sickens only patients whose immune systems have been suppressed by chemotherapy or post-transplant anti-rejection drugs.

Weisman and Gottlieb declined to speculate why, but an editorial note following their article hazarded a guess: “The fact that these patients were all homosexuals suggests an association between some aspect of a homosexual lifestyle or disease acquired through sexual contact and Pneumocystis pneumonia in this population.” Over the next few years, events would prove that assumption on a world stage. The CDC, unknowingly, had tracked the footprints of a young monster in the five sick Californians. For now the behemoth bided its time, but it would come of age before the year was over. It was a fait accompli when, 25 years ago today in a government newsletter, the beast soon to be called AIDS made news for the first time.

Weisman had first noticed something amiss the previous fall. In October a 30-year-old man had come to his private practice with fungal infections on his fingernails and palate, herpes, rashes, diarrhea, swollen lymph nodes, and a fever. Tests showed a low white cell count. Something was clearly hampering his immune system. After the man’s condition worsened over the winter, Weisman sent him to Gottlieb, at the UCLA medical center. By that point, the patient had lost 30 pounds and had been running a 104-degree fever for three months. Gottlieb was struck by the similarity to one of his own patients, a 31-year-old artist with a yeast infection of the throat and Pneumocystis pneumonia, whose T-cell count was zero. In a strange coincidence, both patients were gay. When Gottlieb and Weisman discussed the case in February, Weisman mentioned another young gay man with the same intransigent list of problems, adding that in the past few months he had seen 20 more young male patients with swollen lymph nodes. The two doctors began outlining a paper on the unusual outbreak.

When a fourth Pneumocystis victim visited his office and a fifth was found to have died in Santa Monica, Gottlieb realized that he had an medical emergency on his hands. He and his coauthors would have to shortcut the usual months-long cycle of submission and review at most scientific journals and alert medical professionals to this problem as soon as possible. Gottlieb’s friend Shandera suggested the CDC’s weekly booklet, read by doctors and hospital staff around the world, which had a lead time of only a few weeks. The trio filed their report in mid-May. James Curran, head of the CDC’s venereal-disease prevention services, signed off on the paper with the comment “Hot Stuff. Hot Stuff.”

Once the article came out, doctors in two other American cities jammed the CDC’s phone lines to report their own cases. In New York it had begun two years earlier with little complaints, almost too insignificant or nebulous to bother a doctor about. Fatigue. Eczema. Weight loss. But the symptoms wouldn’t go away, and new ones erupted with alarming speed. New York has many hospitals, which in this instance proved as much a curse as a blessing. Only one or two patients with the same bizarre complaints might show up at each, making it difficult for doctors to sense the larger picture. But the CDC, which disbursed all orders for pentamidine, the standard treatment for Pneumocystis pneumonia, noticed a big upsurge in the number of requests from New York. In 12 years, the CDC had supplied the drug for only two cases not caused by cancer or transplant-related immunosuppression. Now, in the first four months of 1981, it had received 9 orders, all from New York, and all with no explanation of why the patients had the disease.

Rumors had been rumbling in New York’s gay community for a year about weird bugs going around. A chef died in December 1980 of herpes; a few weeks later a male nurse suffocated to death from Pneumocystis pneumonia. Gay-friendly doctors saw patient after patient with mysteriously enlarged lymph nodes. Then in March 1981 a young bartender died of toxoplasmosis, a parasite that rarely affects adults. By that time, eight incidences of Kaposi’s sarcoma, a usually benign cancer that almost always affected elderly men, had appeared in New York’s medical centers, and four of the patients had already died. In April a 37-year-old clerk was the first San Franciscan diagnosed with KS, and six other gay men in San Francisco had come down with Pneumocystis pneumonia. Physicians in the three cities began to wonder if all the baffling ailments were caused by a single disorder.

On July 4, 1981, the MMWR ran another report, titled “Kaposi’s Sarcoma and Pneumocystis Pneumonia Among Homosexual Men—New York City and California.” Since 1979, the article reported, 20 New York men and six California men had contracted KS. All were gay and between 26 and 51. Eight had already died. In addition, 10 new cases of Pneumocystis pneumonia had emerged in California. “The occurrence of this number of KS cases during a 30-month period among young, homosexual men is considered highly unusual,” the CDC commented in an editorial note. “That 10 new cases of Pneumocystis pneumonia have been identified in homosexual men suggests that the 5 previously reported cases were not an isolated phenomenon.”

A day before the second MMWR report, a short article on page 20 of The New York Times broke to the general public the news of a gay epidemic. “The medical investigators say some indirect evidence actually points away from contagion as a cause,” the Times reported. “Dr. Curran said there was no apparent danger to nonhomosexuals from contagion. ‘The best evidence against contagion,’ he said, ‘is that no cases have been reported to date outside the homosexual community or in women.’” (No cases of KS, maybe, but a hospital in Queens was already home to a miniepidemic of Pneumocystis pneumonia among intravenous drug users.)

Cautious though he might have been with the press, behind the scenes Curran was busily tracking down every possible lead to discover what infected these men. The CDC had responded the way government agencies do in times of crisis, by assembling a task force. The Kaposi Sarcoma and Opportunistic Infections Task Force, led by Curran, coordinated information about the cases from across the country. The very nature of the scourge complicated their job. Most epidemics manifest themselves in a characteristic list of specific symptoms, repeated over and over in victim after victim. But this devil used other diseases to do its dirty work, hiding its identity behind their excruciating calling cards.

At a more philosophical level, the whole situation represented a slap in the face to the world’s doctors and scientists. The huge medical advances of the twentieth century—the discovery of antibiotics and vaccines against smallpox, polio, and a host of other plagues that had terrified generations—convinced many that mankind could prevail over contagion forever. In a surge of confidence, the government in 1970 had even rechristened its Communicable Disease Center, established in 1946 to fight the malaria and typhus then still common in the United States, the Centers for Disease Control. But now this new killer emerged, reminding us that every era in history has had its defining plague—leprosy in Christ’s time, the black death in medieval Europe, syphilis in the Age of Exploration, then malaria, typhoid, smallpox, polio—and we are not exempt.

Curran’s team of doctors, sociologists, and parasitologists brainstormed about what was behind the epidemic. Could it be something in the patients’ environment? (A few suspected the nitrate inhalants popular in gay clubs; others, hemorrhoid cream.) Might these patients simply be suffering from an overload of venereal disease? Or was an independent infectious agent at work? By the end of 1981, the CDC had registered more than 200 cases in 15 states. Given that many of the patients had slept with one another or a common partner, the task force concluded that the disease must be transmitted through sexual contact. At the beginning of the year, no one had known that this epidemic existed. Now the CDC had a pretty good guess about how it spread.

The next month the CDC learned of the first appearance of the new disease in a hemophiliac who had received blood infusions. Eight more hemophiliacs would contract it that year, and their cases, along with the heroin addicts’, convinced the medical establishment that blood could transmit the disorder. The “gay cancer” or “gay-related immune deficiency,” or GRID, as the news media called it, was no longer restricted to homosexuals. To reflect this information, the CDC gave the condition a new name in the summer of 1982: Acquired Immune Deficiency Syndrome. Doctors still doubted that a transfusion could cause AIDS in a non-hemophiliac, though, and no one had proven it could be spread through heterosexual sex.

Some even wondered if it was sexually transmitted at all. As a minority that had fought hard—and was still fighting—for its rights, the gay community prized its sexual freedom. Its members had been called perverts their entire lives; to many, the theory that sex was causing AIDS seemed like one more puritanical taunt. At the same time, outside the CDC the federal government paid little attention to the problem. President Ronald Reagan did not utter the word AIDS in public until 1985, by which point nearly 16,000 Americans were infected.

In 1983, though, the public’s attitude toward the disease made an about-face when a straight 53-year old man was diagnosed with AIDS. He was neither an addict nor a hemophiliac. His only possible exposure had been in a transfusion in 1980 during heart surgery. In June the wife of a hemophiliac showed the symptoms. Her sole risk factor was sex with her husband. Up to that point it had been easy to assume that only certain people—gays, heroin addicts, hemophiliacs—could catch AIDS, so many felt it didn’t warrant too much attention. But now America rocketed from indifference to hysteria. Could you get it from a toilet seat? A mosquito? Shaking hands? Even as doctors tried to reassure the public, communities rose to ban AIDS sufferers from teaching, joining sports teams, or attending public schools.

That same year, French virologists identified the human immunodeficiency virus, or HIV, the virus that causes AIDS; two years later, French and American scientists developed screening tests. But the question remained: where did this virus come from? And why was it striking now? Those questions have yet to be answered. Tests on stored blood have confirmed the earliest known HIV infection in the Congo in 1959, and reviews of medical literature uncovered potential cases in England and Canada in 1958 and in America as far back as 1940. HIV is closely related to a virus in chimpanzees, and most likely the simian pathogen combined with a human virus to create a strain capable of infecting people. One theory suggests that the simian virus jumped to African hunters while they were skinning primate prey. A more controversial theory holds that the virus developed in and was spread by polio vaccines given in Africa between 1957 and 1960. The vaccines had been created by processing the polio virus through a culture of simian cells. The culture might have carried the simian virus, allowing HIV to spawn and be injected into countless Africans.

The disease may have begun its virulent spread among gays during the bicentennial celebration in 1976, when people from all over the world converged on New York to party. By December 1980, 55 U.S. men had viruses connected to HIV, and the numbers grew exponentially worse as the years progressed. By the end of 1982, 750 Americans had been diagnosed with AIDS; virtually none of them survived the decade. By 1983 the CDC had recorded 3,000 cases in the United States; by 1990 the number had grown to 156,000. Today there are an estimated 40 million people infected worldwide. If there is any good news in those numbers, it is that we have grown more capable of dealing with the calamity. Drug regimens created in the last decade have extended the lives of those who have tested positive, and increased condom use has slowed the appearance of new cases somewhat, at least in the West. Laws enacted in America in the 1980s and ’90s protect people with AIDS from discrimination in jobs, housing, and health care.

But dealing with a calamity is not tantamount to vanquishing it. The end of this article should be a paragraph about triumphant doctors discovering a miracle serum that reverses the effects of AIDS even in those on their deathbeds. Or a vaccine that prevents anyone from ever suffering from it again. Someday, maybe, that is how this story will end. The monster has reigned far too long.

—Christine Gibson is a former editor at American Heritage magazine.