Aids

AIDS

A New Disease

About the beginning of the decade, physicians discovered the existence of a "new" illness. This disease burst on the world scene in a terrible way as a new "plague" striking mankind. For a while there was general alarm when Americans discovered that the disease was linked to sex, blood, and drugs. It came to be known as AIDS, an acronym that stood for Acquired Immunodeficiency Syndrome. AIDS is caused by infection with the human immunodeficiency virus (HIV), which attacks certain cells in the immune system, leaving it unable to fight off "opportunistic" infectious diseases and certain unusual cancers. The virus also can invade brain cells, leading to psychological disturbances. The disease is always fatal.

Early Cases

The first warnings came when a Los Angeles physician noticed a cluster of symptoms from young men in California who were members of the growing gay community there. The first official announcement was published on 5 June 1981 by the Centers for Disease Control (CDC), the federal epidemiology agency in Atlanta. The CDC researches health problems and works to prevent and control the spread of disease. In its weekly bulletin the CDC described several severe pneumonia cases observed in five patients in three Los Angeles hospitals. All the victims were young gay men, and all had lethal pneumonia called PCP from the pneumocystis carinii organism, which usually only causes illness when there is a serious problem in the immune system. Five cases does not seem like many, but this form of pneumonia was so rare that five cases in a single year made it definable as an epidemic. On the East Coast the incidence of PCP was increasing, and rumors were circulating about the unusual appearance of a rare malignant disease (Kaposi's sarcoma) that had appeared in the gay community in New York.

A New Name for a New Disease

The CDC began its work. A Kaposi's Sarcoma and Opportunistic Infections (KSOI) Task Force was formed under the direction of James Curran, then chief of the venereal disease branch. On 4 July 1981 the CDC informed the medical community of the fatal nature of the new illnesses and "highly unusual" spread of the normally rare Kaposi's sarcoma among young homosexual men. Although Kaposi's sarcoma was usually limited to the elderly, there were two key exceptions. It was endemic (an epidemic disease found in a particular locality) across equatorial Africa and was also found among patients receiving immunosuppressive treatment. Since the first cases in the United States seemed to affect only homosexuals, the Public Health Service named the complex of diseases GRID—gay-related immune deficiency. But when heterosexuals began to become victims also, GRID became Acquired Immunodeficiency Syndrome, or AIDS.

A Slow Call to Arms

After 1982 the AIDS epidemic spread rapidly. Ten new cases were diagnosed each week in 1982, one hundred in 1984. At the end of 1988 the total number of AIDS cases reported to the CDC numbered 86,000. Many physicians realized that they were in the throes of a major medical problem. Public fears fueled by media reports led to a kind of collective hysteria; but public health agencies and the federal government moved very slowly against the disease. There were two primary reasons for the government's reluctance to confront the issue. In the first place, the diseases associated with the AIDS virus were rare enough that there were relatively few trained clinicians and researchers who were familiar with them. The second reason was that the first patients with AIDS were primarily homosexual men. AIDS forced a confrontation between the politics of the gay revolution of the 1970s and the politics of the Reagan revolution of the 1980s. The needs of public health—to stop the AIDS virus—got lost in the sexual politics of the early 1980s. White House officials and many public health sources were made uncomfortable by the link between the spread of AIDS and homosexual behavior. They made vague references to "exchanging bodily fluids," which lost them valuable time in helping the public to understand how AIDS could be transmitted and further fueled public panic as well as a backlash against the gay community. In the early years of the crisis the federal government's research teams saw AIDS as a budget problem and did not provide major funding for AIDS research until the epidemic had spread throughout the country.

REPETITIVE STRESS INJURY (RSI)

What do playing video games, typing on computer keyboards, hammering nails, strumming a guitar, doing pushups, and playing tennis have in common? They can be bad for your health. Many aches and severe pains resulting from these activities became known as a syndrome doctors called "repetitive stress injury** (RSI). Tennis players suffered from "tennis elbow," an elbow strain that came from constantly hitting the backhand incorrectly, and "carpal tunnel syndrome," a wrist problem caused by snapping the racket instead of following through on a swing. Video-game fans found themselves with an especially troublesome carpal tunnel injury nicknamed "Space Invader's Wrist" after the popular game. The pain and swelling in the wrist was caused by rapid repetition of button pressing, paddle twisting, joystick pushing, sphere rolling, or combinations of these actions. An estimated 65 percent of all video-game players suffered at some time.

Most publicity went to injuries from computer use. According to the Bureau of Labor Statistics, RSI accounted for nearly half of all 1988 work-place illnesses in private industry, compared to only 18 percent in 1981. Meatpackers and textile workers still suffered, but the big increase came from data processors and journalists who spent long hours at the keyboard. Hours at the computer continuously stressed the wrists, elbows, and shoulders. Tendons in the arm became inflamed, leading to numbness and pain. Unless the injuries were diagnosed and treated, they could develop into serious lifelong disabilities. The science of ergonomics, or how humans adapt to the work-place, came to the rescue with design alterations to minimize problems. Experts said frequent short breaks from work were crucial, but that the real key was to make technology adapt to humans instead of the other way around.

Sources:

Susan Block, "Tennis Elbow? Runner's Knee? Golf Toe? Easing the Pain Those Fitness Fads have Wrought," Los Angeles Magazine (Nov. 1982): 112+;

Barbara Kantrowitz, "Casualties of the Keyboard: a Push to End Injuries from Computer Use," Newsweek (20 August 1990): 57;

" 'Space Invaders' May Be Hazardous to Your Health," Current Health (November 1982): 10.

Those at Risk

Although the syndrome was first observed to be affecting homosexual and bisexual men, soon Haitians, intravenous drug users, and recipients of blood transfusions, including hemophiliacs, were recognized as being at increased risk. Homosexual and heterosexual sexual partners of victims of the disease could also contract it. Strong evidence from the medical community indicated that HIV was transmitted only through three primary routes: vaginal or anal sexual intercourse with an infected individual; exposure to infected blood or blood products through blood transfusions or in intravenous drug abusers exposed to HIV-infected blood through shared needles; and from an infected mother to her child before or during birth.

The Social Dimension of AIDS

Rejection, fear, and stigmatization of the victims complicated the nation's ability to deal with the deadly disease. Since the earliest victims identified as AIDS sufferers were homosexual males and intravenous drug users whose practices countered many mainstream definitions of morality, the disease was associated in some minds with sin and punishment. "The poor homosexuals—they have declared war upon nature, and now nature is exacting an awful retribution," wrote conservative newspaper columnist Pat Buchanan. Misinformation was common. A New York Times/CBS poll revealed in 1985 that about half of all Americans wrongly believed AIDS could be transmitted through casual contact, such as sharing a drinking glass. The fatal nature of the disease also terrified and panicked people. Schoolchildren with AIDS were rejected, and attempts were made to either keep them out of school or isolate them from their classmates. In Queens, New York, parents kept as many as twelve thousand children out of classes after a girl with AIDS received permission from the city to enroll in school. Ryan White, a schoolboy who contracted AIDS from a blood transfusion, became a household name after he was driven from his school and town in Indiana. In Florida the family of three little hemophiliac boys—also infected with HIV through blood transfusions—had their house burned down by fearful arsonists.

Issues

The announcement in July 1985 that film actor Rock Hudson had AIDS (he died on 2 October 1985) dramatically increased public awareness of the crisis. But many problems remained unsolved. Questions of screening and isolating patients led to controversies. Protecting the donated blood supply, for example, became difficult since potential donors feared stigmatization and discrimination if they were identified as HIV-positive. Efforts to protect public health led to discrimination against foreign visitors or potential immigrants. Those testing positive for AIDS were not permitted to enter the country. Some victims of the disease found it difficult to get adequate health insurance coverage because of the high yearly expense of treating patients. The slow process of the Food and Drug Administration (FDA) for approval of new AIDS drugs caused AIDS activists to demand that the government speed up the process by postponing some of the required testing. The activists argued that even though earlier approval could lead to unknown side effects, it was more important to provide potentially life-saving drugs to patients who had no other choices.

Treatment

By 1989 there was still no vaccine to protect against HIV infection, nor were there many major therapeutic agents to greatly prolong and ease the lives of victims. AZT (azidothymidine) was one drug licensed by the FDA for AIDS patients. It interfered with virus replication, prolonging life for many years in some patients and delaying the onset of full-blown AIDS in people with no symptoms. But it had harmful and toxic side effects. The nature of the highly variable virus was a primary obstacle to the development of a vaccine. The virus existed in many different strains, and mutated rapidly into others, even within an individual's body. AIDS was difficult to treat because unlike most known disease agents, HIV infected the immune system cells, the same cells that should be leading the attack against invading pathogens. If the virus was killed, the already threatened immune system was endangered.

Prevention

Since no vaccines or lifesaving effective therapies were available, prevention by means of education to reduce the risk of contracting the disease was the only real means to fight it. In March 1983 the major blood banks attempted to reduce the risk of transmitting the disease via transfusion of contaminated blood by asking individuals at risk for the disease not to donate blood. They also expanded their screening procedures to exclude donors at risk for AIDS. By 1985 tests to screen donated blood for HIV antibodies were available to eliminate blood containing the antibody from the donor pool. In 1988 the U.S. Public Health Service issued a candid brochure about HIV infection and AIDS based on the surgeon general's report. Every household in America received it in the mail. "Safe sex," meaning sex using AIDS-preventive measures, became a common phrase even as controversies arose over providing condoms for high-school-age children instead of encouraging sexual abstinence. The question of providing clean needles to drug addicts to prevent the spread of AIDS from infected drug users when needles were used repeatedly also created controversy. Public health officials were concerned to discover that many of the groups at highest risk of contracting AIDS, such as drug users and inner-city populations, were the ones least likely to be affected by the prevention campaigns.

Predictions for the Future

By the end of the decade AIDS was still spreading in the United States and the rest of the world. It continued on its mysterious, debilitating, and fatal course, made even worse by its social stigma. Despite prodigious efforts to create new weapons against AIDS, it still baffled scientists and the medical community. Some infected with HIV were without symptoms, and some AIDS victims lived throughout the decade with the disease, raising hopes that information could be found from their ability to fight off the disease that could help others. By 1989 scientists felt that while they might not be able to cure the disease, they might find some additional therapies that could keep the AIDS virus in check without the toxic side effects of AZT. Perhaps the real answer would lie in some national strategy to create an effective prevention campaign through education that involved all Americans. But millions of people around the world still became gravely ill. Ironically, AIDS became the main cause of death for persons under age fifty, even though in contrast to other deadly epidemics such as influenza or plague, the routes of transmission of AIDS were in large part controllable.

Sources:

Mirko D. Grmek, History of AIDS. Emergence and Origin of a Modern Pandemic (Princeton: Princeton University Press, 1990);

C. Everett Koop, Koop: The Memoirs of Americas Family Doctor (New York: Random House, 1991), pp. 194-239;

Randy Shilts, And the Band Played On: Politics, People, and the AIDS Epidemic (New York: St. Martin's Press, 1987).