Salem Press

The Eighties in America
AIDS Epidemic

Definition: Appearance and spread of an infectious immunodeficiency syndrome

The appearance of rare opportunistic infections among populations of gay men and intravenous drug abusers led to the discovery of a previously unrecognized agent, now called HIV. By the end of the decade, thousands of Americans had been infected, and the disease itself, AIDS, had begun to spread throughout the world.

While the presence of a disease subsequently known as acquired immunodeficiency syndrome (AIDS) was initially recognized in 1981, the disease's etiological agent, the human immunodeficiency virus (HIV), had entered the human population several times during the previous decades. Computer-generated data measuring the rate of mutation of a simian virus to one in humans has supported the theory that penetration into the human population may have occurred as early as the 1930's.

Medical historian Jonathan Engel has suggested as that between 1950 and 1972, infection may have occurred at least nineteen times. The oldest confirmed infections took place in 1959. Antibodies against HIV were found in blood collected in 1959 from a Bantu man in Leopoldville, Belgian Congo, who succumbed to an immunodeficiency disease. That same year, another man died in Manchester, England, exhibiting the same immunodeficiency defects. Retrospective analysis of his stored blood confirmed infection by HIV.

Beginning of the Pandemic
Recognition of an immunodeficiency syndrome was first reported in the June 5, 1981, issue of Morbidity Mortality Weekly Report. The story, originating from the Centers for Disease Control (CDC) in Atlanta, described an unusual and rare parasitic lung infection, Pneumocyctis carinii pneumonia (PCP), in five homosexual men in Los Angeles. The outbreak came to the attention of the CDC, because the only known treatment, a drug called pentamadine isothionate, was available only from that agency.

Later that summer, the CDC reported that an unusual epidemic among gay men was more widespread than had earlier been thought: More than 140 previously healthy young men had been diagnosed with either PCP or a rare form of cancer called Kaposi's sarcoma (KS). Generally only observed previously among Italian or Jewish men of Mediterranean origin, KS was unheard-of in the age population now being observed. Furthermore, the newly detected form of KS was much more aggressive were previously known instances. Because the disease had only been reported up until then in homosexuals, it was initially referred to as gay-related immunodeficiency disorder (GRID).

Although the initial belief was that transmission of the disease, cause still unknown, was somehow related to homosexual behaviors, it soon became apparent that other means of transmission were also likely—most notably through contaminated blood. By the end of 1982, at which time more than six hundred cases had been reported, it was clear that intravenous (IV) drug abusers were at risk; cases were also observed in several hemophiliacs, whose only possible exposure had been through their use of Factor VIII (blood-clotting) products obtained from donated blood. The name of the illness was also changed, reflecting its more widespread nature, to acquired immunodeficiency syndrome, or AIDS. The range of opportunistic infections associated with the immune disorder was also widened to include illnesses such as fungal and other rare parasitic infections.

If there was any fortunate aspect associated with the outbreak at the time, it involved a growing understanding of the unknown etiological agent's method of transmission. While it clearly could be transmitted through sexual behaviors, as well as in contaminated blood, it was not transmitted through the air. Victims were classified by the CDC as falling into four specific categories, including homosexual or bisexual males (75 percent of known victims), IV drug abusers (13 percent), and hemophiliacs or transfusion recipients (around 0.3 percent). Since a number of Haitians who did not then appear to fall within the other categories had been diagnosed with the disorder, Haitians were included among the risk groups.

Isolation of the Etiological Agent
Speculation within the general public, and even among some medical professionals, as to the cause of AIDS initially focused on homosexual behaviors, such as the use of amyl nitrate to enhance sexual pleasure or even the practice of anonymous sex with multiple partners. Among some evangelicals, the belief was that the disease represented a punishment from God. Since semen itself was felt to have some immunosuppressive properties, "sperm overload" was suggested as a possible cause. The demographics of the disease, however, did not fit. Increasing numbers of cases were observed among hemophiliacs, women, and even infants and young children, twenty-six of whom had been diagnosed with AIDS by late 1982. Furthermore, the specific cause of the immunodeficiency had become apparent, a loss of a class of lymphocytes called T cells, named for their site of maturation in the thymus. Researchers began to narrow their focus in the search for a cause, believing that it likely was a virus.

Suspicion by 1983 began to focus on a group of viruses known as human T-lymphotropic viruses (HTLVs), which had the ability to infect lymphocytes. HTLV-1 and HTLV-2, the two initial suspects, were in a group known as retroviruses. Retroviruses are viruses containing ribonucleic acid (RNA) that also carry an enzyme called reverse transcriptase, a protein that copies their RNA into deoxyribonucleic acid (DNA) following infection. Ultimately, two laboratories laid claim to isolation of the etiological agent associated with AIDS, one in Paris, the other in Bethesda, Maryland.

Among the leading researchers in this field was Robert Gallo at the National Institutes of Health. Gallo was already well known for his development of a method to grow lymphocytes in culture. In retrospect, the timing of this procedure turned out to be critical to the hunt for the cause of AIDS, since the ability to grow HIV in the laboratory and to develop an effective method for testing blood supplies was the result of Gallo's work.

In April, 1984, Gallo announced the isolation and identification of a virus that he felt was the cause of AIDS and that he named HTLV-3. However, the issue of priority quickly introduced politics into the science. In January, 1983, Luc Montagnier at the Pasteur Institute had also isolated a virus that he felt was the etiological agent of AIDS and that he called the lymphadenopathy associated virus (LAV). The two viruses were later shown to be identical. The issue of priority was never completely settled, though the evidence is that Montagnier was probably first, while Gallo is credited with developing the blood test for the virus's detection. To eliminate the confusion over names, the virus was given the name HIV. In 1985, a second, similar, virus was isolated in West Africa; the original virus was named HIV-1, while the newer isolate became HIV-2.

Widening Epidemic
Though the initial features of the growing epidemic were focused primarily in the United States, it became clear by 1984 that the outbreak was taking place in much of the world. What had been known as "slim disease" in Africa was identified as AIDS and was identified in hundreds of patients there. By 1985, the disease had been found in more than fifty countries. More than seven thousand persons with AIDS were diagnosed in the United States, though likely many more were actually HIV-positive.

The impact of the disease on Americans was made particularly poignant by coverage of two high-profile cases. In 1984, a thirteen-year-old Indiana student named Ryan White acquired AIDS from a blood transfusion used to treat his hemophilia. Fear of transmission resulted in his being removed from the school system and forced him to be schooled at home. The issue was brought to court, which resulted in a ruling that he be allowed to return to school. Despite a five-year fight to educate the public on how AIDS can, and cannot, be transmitted, he was frequently harassed by other students and their parents and eventually moved to another town where he was accepted. In his last years, White frequently spoke to other students, explaining his illness and philosophy of life. White died in 1990. In his honor, the Ryan White Comprehensive AIDS Resources Emergency Act was passed by Congress in 1990, to provide health care for persons with AIDS who had no insurance coverage.

The second high-profile case was that of movie star Rock Hudson, who was diagnosed with AIDS in 1984, although the information was not released until the following year. Though it was an open secret in the movie community, the public was unaware that Hudson was gay. Despite a courageous fight, Hudson died in October, 1985. Another prominent person with AIDS was Liberace. A well-known entertainer, Liberace died from AIDS in 1987.

The response to the AIDS epidemic by the administration of President Ronald Reagan was largely neglect during the early years of the outbreak. Despite the fact AIDS had clearly expanded far beyond its origin in the homosexual community, conservatives largely ignored the problem or simply blamed a "choice" of lifestyle. The gay communities in larger cities did respond, attempting to close the bathhouses that often served in spreading the disease, as well as attempting to educate the gay community on how the disease could be avoided. The effort was successful, and new infections began to level off within the community. By the end of the decade, several events served to bring the problem of AIDS to the general public. In 1986, the National Council of Churches established an ecumenical task force, which shortly met with the U.S. surgeon general, C. Everett Koop. The group later produced a pamphlet that attempted to educate the public about the disease. Beginning in December, 1988, the first annual World AIDS Day was held, with the goal being to bring the issue to the attention of the world at large.

The first effective treatment for AIDS appeared in 1987. Azidothymidine (AZT), originally developed as an anti-cancer drug, was shown to be effective in inhibiting the replication of the virus. Although HIV would develop resistance to the drug, it did provide a means to extend the life of affected individuals.

Impact
When AIDS surfaced in Western countries in the early 1980's, it was treated primarily as limited to those exhibiting certain social behaviors. Scientists, medical professionals, activists, and other advocates struggled throughout the decade to educate the populace as to the epidemic's severity, HIV's ability to spread to anyone, and the specific, limited number of methods of transmission. By the end of the decade, AIDS was widely recognized as a problem of global significance requiring global resources to combat.

Indeed, AIDS went on to become a worldwide pandemic that would create particular havoc in developing nations. Lack of proper medical facilities in these countries, poor education in presenting the means to avoid the disease, and the difficulty of altering long-held sexual mores all contributed to the problem. As a result, the middle class in much of central and southern Africa was devastated, creating a generation of orphans, and taxing the economy of these countries. Much the same scenario developed in portions of Asia as well. Debate continues as to whether the scope of this tragedy could have been limited by a swifter, more decisive response on the part of of the U.S. government and President Reagan, who refused to address the crisis in public until May, 1987.

Further Reading
Diamond, Jared. "The Mysterious Origin of AIDS." Natural History 101, no. 9 (September, 1992): 25-29. One of the earlier presentations about the likely origin of HIV as a simian virus. The author includes speculation as to how the virus may have jumped species.

Engel, Jonathan. The Epidemic: A Global History of AIDS. New York: HarperCollins, 2006. The author, a medical historian, provides a history of the outbreak, from its first recognition in the early 1980's to the situation as of 2006. An extensive bibliography is included.

Gallo, Robert. Virus Hunting. New York: Basic Books, 1991. Autobiography of one of the scientists considered to have discovered HIV. Includes his own (albeit arguably biased) description of the discovery.

Gallo, Robert, and Luc Montagnier. "AIDS in 1988." Scientific American 259, no. 4 (October, 1988): 40-48. Description of the recognition of HIV and its association with the disease, by the two scientists most closely linked with the discovery.

Montagnier, Luc. Virus. New York: W. W. Norton, 2000. Autobiography of the the other scientist with a claim to having discovered HIV.

Shilts, Randy, and William Greider. And the Band Played On: Politics, People, and the AIDS Epidemic. New York: St. Martin's Press/Stonewall Inn Editions, 2000. Updated description of the outbreak of the AIDS epidemic and how the lack of recognition by agencies contributed to its spread. Shilts was a newspaper reporter who later succumbed to the illness.

Stine, Gerald. AIDS Update, 2007. San Francisco: Benjamin Cummings, 2007. Yearly update on research into the AIDS virus, as well as information about biological events that follow infection. Discussion about the progress of treatment is also included.

Richard Adler

See Also
ACT UP; AIDS Memorial Quilt; Cancer research; Fetal medicine; Genetics research; Health care in the United States; Homosexuality and gay rights; Hudson, Rock; Medicine; White, Ryan.