A 1983 ad designed to counter the widespread fear
that AIDS could be caught through casual contact
The first time I heard about AIDS was from a committed radical, an uncompromising defender of civil rights. Tuesday, May 11, 1982. The New York Times had just published a major article on the "New Homosexual Disorder" which back then was called GRID, Gay-Related Immunodeficiency.
"One thousand one hundred and sixty!" my friend said. "That's the median number of sexual partners the guys getting the disease have had. Can you believe that? One thousand one hundred and sixty!"
He was more impressed by the sexual statistics than by the new disease or its fatal consequences.
We spent the next few minutes joking about what, if we'd stopped to think about it, was a very unfunny subject -- which was typical of the reaction of the straight males I knew.
As news of the disease spread, so did the jokes. Most of which were not funny, and many of which betrayed not merely insensitivity but gleeful hostility.
What disease do gay crocodiles get? Gator-aids.
What disease do musicians get? Band-aids.
How does Anita Bryant spell relief? A-I-D-S.
AYDS--referring to the appetite suppressor: With this, the weight stays off.
And three particularly vicious jokes.
What's the medical definition of AIDS? A disease that turns fruits into vegetables.
What does gay stand for? "Got AIDS yet?"
A new acronym for AIDS: WOGS--Wrath of God Syndrome.
In the media AIDS became a popular subject of fun. During his morning radio show on WNBC, Don Imus broadcast a sketch that featured a debate between God and an obviously gay deputy mayor of New York City in which God, hesitating to shake hands, asked the deputy mayor, "You got a surgical glove?" During his HBO performance Eddie Murphy did some AIDS jokes that caused a furor.
"His routine . . . is so sick that I wanted to put my foot through the TV," the New York Daily News quoted another Eddie Murphy, chairman of the Christopher Street Gay Festival, as saying. "[It's] unacceptable. We hope to start picketing his personal appearances, shows, and boycott his movies. . . . People are really angry with him about this AIDS routine. He's got to be stopped."
Humor is dialectical. The antigay AIDS jokes were joined by jokes that made fun of the straight public's fear of AIDS and gays.
The political cartoonist Toles drew a man-on-the-street interview on "What do you think about AIDS?" which researchers at the Centers for Disease Control in Atlanta, one of the main organizations working on the problem, taped to a corridor wall outside their office.
"It affects homosexual men, drug users, Haitians and hemophiliacs," says a woman. "Thank goodness it hasn't spread to human beings yet."
"If it spreads to the general public, it would be a grave medical crisis, demanding an immediate government response," says another man.
"And if it doesn't?" asks the interviewer.
The man answers, "It's God punishing homos."
"I only hope that scientists are able to discover a cure soon," says a man with a mustache. "But not too soon."
The epidemic is not just the disease but the virulent reaction the fear of the disease can release in straights towards gays. And in gays toward straights.
In March of 1980 a young gay man named Nick came down with an odd, tenacious illness, something like mono: fevers, weight loss, fatigue. . . .The doctors in New York, where he lived, couldn't figure out what was wrong, so Nick's lover flew him from city to city across the country, trying to find someone who could help -- without success. By summer they were so desperate that wherever they went they stopped people to ask if anyone had ever heard of anything that caused Nick's symptoms.
When Nick finally died and an autopsy was done, he was diagnosed as having had toxoplasmosis, a disease caused by parasites, Toxoplasma gondii, that invades cells and multiply, eventually stretching the cell's walls and creating a pseudocyst or causing the cell to burst like a ripe milkweed pod, sending the parasites out into the system to invade new cells.
When one of Nick's Fire Island housemates also came down with a mysterious wasting disease, friends of theirs in the gay community suspected a connection. Sexually transmitted diseases were common, especially among those who had many partners: lice, scabies, urethritis, proctitis, prostatitis, herpes, worms, shigella, campylobacter, amebiasis, hepatitis, and those familiar venereal vaudevillians syphilis and gonorrhea. Rare diseases were appearing all the time, even tropical complaints like lymphogranuloma venereum. Nick and his housemate apparently had gotten one of these new -- and serious -- bugs. But disease was the sexual tax paid by men who frequented baths and bars with backrooms, where pickups were easy and hygiene was poor.
Like any tax, people didn't relish paying it, would avoid it if they could, but if caught recognized it was something they were foolish to think they could escape. Anyway, science was making progress against many of the sexually transmitted diseases. In fact, there would soon be drugs for hepatitis and herpes. Whatever had hit Nick and his housemate -- if it turned out to be anything more than a coincidence -- would soon be identified and brought under control.
For those doing a sexual high-wire act, medicine was a safety net.
About the same time -- late 1979 and early 1980 -- Dr. Joel Weisman, a former New Yorker with a private practice in the Los Angeles area, began noticing an increase in the number of patients with a mono-type disease. Weisman had a reputation for being sympathetic to the problems, emotional as well as physical, of gay men, and so lots of gays came to him. He is quiet, methodical, not an alarmist. But this syndrome struck him as odd and potentially dangerous: The patients got fevers and swollen glands and took much longer than usual to get better.
Weisman generally diagnosed the illness as cytomegalovirus, a herpes virus that is common in the United States among slum kids, especially preschoolers, and gay men. The virus is excreted in saliva, urine, semen, feces, and possibly breast milk. It is transmitted through what one text calls "close and prolonged contact" and through transfusion of whole blood.
Like toxoplasmosis -- the disease Nick was diagnosed as having -- CMV usually is so mild it can go unnoticed; and, like toxoplasmosis, it can be particularly severe, even fatal, in someone whose immune system is not working properly. CMV also tends to suppress the immune system -- the sicker you are, the sicker you get -- creating a whirlpool that can suck you down the drain.
A lot of the men with the CMV symptoms were gay.
In late 1980, one of Weisman's patients, also a gay man, wasn't responding to treatment. For three months he'd been getting weaker. He lost thirty pounds. He ran fevers of around 104 degrees. His lymph glands were swollen. And he developed a yeastlike fungus, called candida or thrush, that caked his mouth, the back of his throat, all the way down his esophagus.
Like toxoplasmosis and CMV, candida usually is not a problem for adults; like toxoplasmosis and CMV, it can be severe in someone whose immune system is not working properly.
In December of that year another physician in the Los Angeles area, Dr. Michael Gottlieb, was studying a patient at UCLA who was suffering from candida. Gottlieb and his colleagues ran some blood tests and found that the man's immune system was in shambles. Eventually the patient was diagnosed as having pneumocytis carinii pneumonia.
Like toxoplasmosis, cytomegalovirus, and candida, pneumocystis is often found in infants and people whose immune systems are not functioning properly.
And like Nick, Nick's housemate, and Weisman's patient, Gottlieb's patient was gay.
In March of 1981 Weisman's patient had been admitted to UCLA. Tests showed he had the same immune system abnormalities as Gottlieb's patient. He, too, was diagnosed as having pneumocystis. Within a couple of weeks another of Weisman's patients was hospitalized at UCLA. He'd been suffering from mysterious fatigue and fevers, had been exposed to cytomegalovirus, and had pneumocystis. His immune system was abnormally depressed. And he was gay.
Gottlieb ran a fourth case of a gay man who'd been exposed to cytomegalovirus and had just died of pneumocystis.
Then, a fifth case: same pattern. Fatigue, fever, cytomegalovirus, pneumocystis, gay.
There was tremendous resistance, in both the gay and the medical communities, to entertaining the possibility that this might be a new disease.
"People had the naive belief that no new killer infectious disease would ever come along," Weisman said. "Then there was Legionnaire's disease, toxic shock, and now this. I've been in practice for fourteen years. My whole generation of physicians up until this time had not had to deal with a disease that could kill the doctor in treatment of the patient. That's why this generation of physicians reacted so terribly. This was a disease of the gay community. And you know those gays do all those bad things. They brought it on themselves." That sort of reaction. "Even some gay scientists who had very bad self-images looked upon it this way." As for straight scientists, Weisman said, "I remember calling a person [in infectious diseases] to describe what was occurring. He said -- and this was a theme very early on -- 'I don't know what you're making such a big deal of it for. If it kills a few of them off, it will make society a better place.'"
The gay community resisted the idea of a new contagious disease as much as the doctors did. They didn't want to be stigmatized. Sexual lepers. Anyway such a notion seemed preposterous. How could a disease pick out just gays? That had to be medical homophobia.
In the spring of 1981, the five Los Angeles cases of pneumocystis were reported to the Centers for Disease Control in Atlanta, Georgia, a complex of buildings near Emory University that from the outside looks like a middle-size city's department of motor vehicles. Inside it has the bare, somewhat temporary, low-budget look that government laboratories always had on the 1950s television show "Science Fiction Theater." Its function, however, is anything but low budget.
The CDC was organized in the 1940s to deal with outbreaks of malaria among American soldiers. It was so successful -- and fear of some future biological warfare was so rampant -- that its mandate was broadened in the 1950s. By the 1980s, when it was reorganized, it had become the epidemiologic equivalent of Wall Street, a federally funded research facility that monitors disease patterns, a center where the country's epidemic highs and lows are charted and where scientific plungers invest in illnesses with good prospects.
The Los Angeles pneumocystis cases were investigated and written up for the June 5, 1981 issue of the MMWR. the Morbidity and Mortality Weekly Report, the CDC's bulletin: approximately eight hundred words dryly describing the patients' histories, symptoms, treatment and fate: two had died.
As usual, the report was circulated through the CDC's various departments. Dr. James Curran, then chief of the Venereal Disease Research Department, read it. The next week, at a seminar on sexually transmitted diseases in San Diego, Curran and another CDC doctor heard about similar cases on pneumocystis in San Francisco.
By the time Curran got back from the conference, the CDC had learned about similar patterns in New York City, some of whom were also suffering from a rare cancer called Kaposi's sarcoma.
Like toxoplasmosis, cytomegalovirus, candida, and pneumocystis, Kaposi's sarcoma usually is not a problem for young people whose immune systems are functioning properly.
But the Karposi's cases in New York were young men. Some also had pneumocystis. Some had candida. Many had evidence of cytomegalovirus.
All were gay.
By midsummer, Curran and his colleagues had learned of twenty-six Kaposi's cases, twenty in New York City and six in California. Six also had pneumonia, which in four was confirmed as pneumocystis. Twelve of the Kaposi's patients had been tested for evidence of cytomegalovirusl all twelve had it.
The report in the July 3, 1981 issue of the MMWR admitted that "the occurrence of this number of KS cases during a 30-month period among young, homosexual men is considered highly unusual. No previous association between KS and sexual preference has been reported."
The MMWR report warned: "Physicians should be alert for Kaposi's sarcoma, PC [pneumocystis carinii] pneumonia, and other opportunistic infections associated with immunosuppression in homosexual men."
The big question was: Is this syndrome contagious?
In the July 3 issue of The New York Times, which was one of the first newspapers to pick up the story, Curran was quoted as saying: "The best evidence against contagion is that no cases have been reported to date outside the homosexual community."
The hope was that the syndrome was environmental.
"Perhaps certain homosexuals in certain urban centers have been breathing, eating, drinking, or wearing unusual things, behaving in unusual ways, or frequenting unusual locations," said the New York Native, a gay newspaper.
In the New York Native, Dr. Alvin Friedman-Kien, a professor of dermatology and microbiology at New York University Medical Center, the man who had contacted the CDC about the New York KS cases and who is considered by many to be the forgotten hero of AIDS research, explained that the relatively benign form of KS found in the United States had a malign cousin in Uganda. The gay baths and backrooms, with their poor hygiene, mimicked the unhealthy conditions of equatorial Africa, in which the fatal form of KS flourished. They were, in a way no one had previously suspected, a sexual third world.
This was not just a new disease. New diseases are not uncommon -- like O'nyong-nyong fever, which first appeared in humans in 1959; Lassa fever, which made its debut in 1969; and Legionnaire's disease. This syndrome was a different kind of disease, an illness that attacked the body's ability to defend itself.
And it was spreading. Fast.
There were now more than 180 cases. The syndrome had been detected in at least one woman and among junkies -- politely called drug- or IV-needle abusers by doctors who wanted to prove their fairness. They saw themselves as referees outside the struggle in which The Others, the sick, were engaged.
Still, most of the patients -- at that time about 90 percent -- were gay men.
Articles began appearing in the popular press.
Puzzling new syndrome . . . Mysterious Ailment Plagues Drug Abusers, Homosexual Males . . . New Disease . . . Baffles Scientists . . . A mysterious new syndrome that turns usually harmless viruses and bacteria into killers has become a public health hazard . . . Dramatic Spread . . . Out of Control . . . Diseases That Plague Gays . . .
About that time the CDC had fallen on hard times. A few months after the third MMWR report on this mysterious gay-related syndrome appeared, Senator Sam Nunn announced, through an aide, that he was "concerned about preserving the integrity of the CDC's programs" -- which would have to be scuttled if proposed administration budget cuts were carried out.
In December, a CDC official warned that the centers might be forced to lay off as many as 780 employees; the staff of the Infectious Disease Branch, the division that fights epidemics, might be cut nearly in half.
The CDC budget ended up being cut less than many had expected. Its allocation for fiscal year 1982 for the mysterious syndrome that was hitting the gay community was $2 million, part of a total federal outlay of a little over $5.5 million. In 1976 the appropriation to fight the swine flu, an epidemic that turned out to be a will-o'-the-wisp, was $135 million. But swine flu, the government had thought, threatened everyone; and this disease seemingly threatened only society's misfits: gays and junkies, groups that didn't have visible voting blocks.
Throughout 1982 it became increasingly plain that the disease, whatever it was, was not exclusively a gay syndrome. Other groups began getting it: Haitians, prostitutes, and women who had sex with bisexual men.
At a meeting in Washington of scientists someone raised the awkward issue that the syndrome needed a new name. It was not just a gay plague or gay cancer or -- the name that had caught on -- gay related immunodeficiency (GRID). Especially not GRID. Names have power. Aside from identifying the disease too closely with gays, which upset the hemophiliacs and transfusion victims, GRID evoked too many memories of powerless power systems, of gratings that looked like prison bars, of traffic jams.
But what could the syndrome be called? Curran thinks it was Don Armstrong, chief of infectious diseases at New York's Memorial Sloan-Kettering Cancer Center, who finally said, "Well, just call it AIDS."
Acquired immune-deficiency syndrome.
AIDS. "It was reasonably descriptive," Curran said, "without being pejorative."
By the time the name made its appearance in the MMWR in the fall of 1982, about a year after the CDC had first been alerted to the existence of AIDS, other diseases had joined the list of AIDS complaints: lymphadenopathy (swollen lymph nodes), lupus (a disease whose name comes from the Latin for wolf, because one of its symptoms is skin that looks gnawed), other cancers including Hodgkin's lymphoma, Burkitt's lymphoma (which may be associated with Epstein-Barr virus, the cause of mono), and anemia.
The disease, like a vampire, could manifest itself in many forms; and, like a vampire, it seemed impossible to track down. It was out at night, stalking the backrooms of bars and lonely docks, its power lying in its attraction, its seductiveness, in the prey's willingness to surrender. Most of its victims were relatively young; it seemed to draw strength from the strong, leaving them drained. The disease had an almost mythic presence. But it was simply following the classic pattern of a disease that has been introduced to a previously unexposed population, like the Spanish influenza of 1918, which in one year killed 400,000 Americans with an average age of thirty-three. New diseases tend to hit healthy young adults hardest. But, although AIDS followed a traditional pattern, its effect was radical, unprecedented.
One CDC researcher called the AIDS risk groups the 4-H Club: homos, heroine addicts, Haitians and hookers.
AIDS wasn't a disease that hit "respectable" people. It was almost as though the germs themselves -- if the disease was caused by germs -- were layabouts, marginal microorganisms from the wrong side of the tracks. Not aristocratic like the disorder that causes hemophilia, the bane of generations of European royalty.
Then it turned out hemophiliacs were coming down with this Gay Plague. And patients who'd had blood transfusions, some of whom were children. Suddenly the straight world got concerned.
A rumor started in Texas that AIDS could be transmitted to the blood donor. In less than a week donations at one of the largest blood banks in the country, the New York Blood Center, dropped by 25 percent.
"What happened was a minor panic," said Dr. Alan Waldman, a researcher at the blood center. "It was blown completely out of proportion -- to some extent by the media and particularly by Geraldo Rivera, a New York broadcaster, who reported [for ABC News's "20/20"] that the nation's blood supply was in danger. The distinction blurred between responsible blood donation centers and off-the-street pay-for-the-pint commercial operations."
Although experts estimated the chance of blood contamination to be 1 in 100,000, people are convinced they're going to win lotteries on longer odds than that. No one wanted to give or get transfusions.
By the fall of 1982, around the time of the blood donation crisis, the number of AIDS cases had risen to 593. Two hundred and forty-three of the people with AIDS -- 41 percent -- had died.
One of the CDC epidemiologists said, "We had never seen this problem in nature before."