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AIDS In America: The True Story of the American AIDS Epidemic
33.4 million People are infected with AIDS world wide. Since 1981 25 million people have died from AIDS, and that number is growing (UNAIDS.org). It is safe to say that AIDS, the virus that president Ronald Reagan blatantly ignored and did nothing about, has metastasized into one of the worst pandemics in human history. The story of AIDS in America is a shameful tale of silence and passiveness at a time when drastic action was needed. President Reagan himself was silent and did not speak of the impending crisis that AIDS threatened; even as 6,000 Americans were infected and dying, Reagan said nothing (Shilts, 1988). Henry Waxman, a Democratic representative from California wrote the following about Reagan’s silence on the issue of AIDS, "It is surprising that the president could remain silent as 6,000 Americans died, that he could fail to acknowledge the epidemic's existence.” Reagan finally did speak about AIDS in 1987 when the virus had infected more then 36,058 Americans and had truly become a global epidemic (Shilts, 1988). Reagan will be remembered not for what he could have done to prevent AIDS from becoming a global catastrophe, but for what he did do-nothing.
1981 began with the Reagan administration seizing the reigns of government and chopping the domestic budget down to size. Valuable money was taken from public health organizations; Reagan’s reasoning was that individual states could deal with their own health problems. In an action that would symbolize the blatant ignorance of the Reagan administration for the next eight years, Reagan cut the funding for the Centers for Disease Control (CDC) by more then half (Shilts, 1988). The only organization that could protect America if a pandemic arose had been personally crippled by the president.
During the surfacing of the AIDS epidemic there was much ignorance and prejudice. Because homosexuals were dying no one seemed to care; there was no glory or fame curing a “gay” disease. But as the French had stated in 1981, viruses cared little for individual sexual preference, and very soon AIDS was killing heterosexuals by the dozens. Babies, as well as intravenous drug users and prisoners, had begun to die from the strange immune deficiency (Shilts, 1988). And then it happened; a hemophiliac from Denver, Colorado got AIDS. The deadly unknown disease was in the blood supply. Doctors from the CDC, namely Dr. Don Francis immediately, urged the blood banks and corporations to stop accepting donations from the various risk groups and anyone showing symptoms of the deadly disease (Shilts, 1988). The CDC also began to push for the testing of all blood for hepatitis B core antibodies. Scientists found that 88% of AIDS patients had been infected with hepatitis B prior to contracting AIDS and although the test would not screen out AIDS infected blood fully, it would drastically minimize the chances of a patient receiving an infected transfusion (Shilts, 1988). The blood industry however refused to listen, arguing that it would cost millions to test donor’s blood, and for what? The CDC didn’t even have evidence that AIDS could be transmitted through the blood; they didn’t even know what was causing the disease. Despite Francis’ pleas the blood industry stood firm; they would wait and see. The FDA, who had the final word on the matter, agreed. The CDC had overstepped its bounds; many at the FDA didn’t even believe that AIDS existed. Dr. Don Francis was fuming as he left the CDC’s auditorium; the blood industry is killing people he thought, simply because they don’t want to spend a few dollars. This waiting and seeing was going to kill people.
As 1982 came to a close the CDC pronounced AIDS an epidemic. The government and the lushly funded NIH (National Institutes of Health) however thought otherwise; next to nothing had been done to prevent the spread of AIDS or even help those infected (Shilts, 1988). If you were infected with AIDS you were on your own. Dr. Don Francis of the CDC was frantically trying to set up his own viral lab, scraping together funds from everywhere. Francis was key in the development of the hepatitis B vaccine and had helped stop Smallpox in India and the Ebola outbreak in Africa in 1976 (Shilts, 1988). Francis knew that AIDS was being spread by an infectious agent, and he was almost sure that it was a retrovirus (a virus that uses the enzyme reverse transcriptase to transcribe its RNA genome to DNA) however; he could not prove this because of the blatant lack of funding. His lab still wasn’t ready and time was running out. “How many people would have to die before the government would do something?” Francis wondered.
By the end of 1982, health officials and doctors alike knew that AIDS was in the blood supply (The Body.org). Yet they could do little about it. The CDC, and primarily Dr. Don Francis, were confronted with the daunting task of convincing the blood industry to start testing blood immediately. The blood banks would not listen.
A blood test for AIDS was not implemented by the blood industry until 1985, more then five years after the epidemic had begun to kill homosexual men (Shilts, 1988). Various blood banks implemented their own tests and were strongly reprimanded for doing so by the FDA and the blood industry. As more and more people became infected with transfusion AIDS the blood industry continued to “wait and see.” And because of the virus’s extremely long incubation period many would not show symptoms for years, Dale Lawrence of the CDC had found that the latency period of the virus could range from a few months to ten years. At this rate, thousands would be infected without even knowing it (Shilts, 1988). Lawrence shuddered as he thought of what the future held.
In New York City, the hot bed for AIDS little was being done to stem the epidemic or offer support to the individuals infected. In fact, the city government and mayor Ed Koch literally ignored the epidemic, stating that the percentage of AIDS cases had dropped dramatically in the last few months, when in reality hundreds were still being infected and spreading the deadly disease (Shilts, 1988). Doctors and scientists alike were taken aback by the city’s lack of interest in the disease. It made perfect sense to Dr. Don Francis; he had seen it again and again. Because AIDS was a homosexual disease no one paid any attention, the cold hard truth was that no one really cared.
HIV or Human Immunodeficiency Virus is what causes AIDS. Unlike other viruses AIDS is fiendishly clever; it attacks the immune system, the body’s defense against infectious pathogens. Specifically, AIDS targets CD4 cells, white blood cells that are a key component to the immune system (Bugl, 2009). As the virus destroys CD4 lymphocytes, one becomes more and more susceptible to opportunistic infections (Bugl, 2009). During the 1980s doctors began treating an influx of patients with rare, usually non lethal diseases. Common among AIDS patients is Pneumocytis Carinii Pneumonia or PCP. PCP is caused by the Pneumocytis protozoa, an organism that is found almost everywhere and that a healthy immune system kills off (Bugl, 2009). PCP is usually seen in people with weak immune systems such as lymph cancer patients or individuals with autoimmune diseases and is easily cured by using the drug Pentamidine; however doctors were using the drug without success and their patients were suffocating to death, the tiny protozoa filling up the air sacs in their lungs (Shilts, 1988). This baffled doctors. “How could this be happening?” They wondered.
Another rare disease was also becoming quite common, Kaposi’s sarcoma, a rare often non-lethal skin cancer. However this disease was not the benign cancer found in Italy and Africa, this KS was vicious covering the patient in sickly purple lesions and not responding to treatment (Shilts, 1988). In addition to the PCP and KS, doctors saw severe herpes infections as well as oral thrush, weight loss and crippling diarrhea. Then there were the rare parasitic infections; some that had never before been seen in humans (Shilts, 1988). Parasites that usually attacked birds, cats and sheep were infecting the brain, lungs and digestive tracts of humans. It was horrifying for doctors since the parasites did not respond to treatment or treatment simply did not exist (Shilts, 1988). And then there was the most baffling thing of all; the patients seemed not to have any immune system, their CD4 Lymphocytes were nearly gone.
Because AIDS attacks the immune system (specifically T-helper Cells or CD4 Lymphocytes) it is extremely hard to treat. During the early moths of 1983, French doctors at the Institute Pasteur had discovered a new retrovirus in CD4 lymphocytes cultured from the lymph nods of AIDS patients (Shilts, 1988). At first the French thought they had merely found the HTLV virus (Human T-cell Lymphotropic Virus) discovered by Dr. Robert Gallo in the late 1970’s. Gallo had suggested that AIDS was caused by his virus, but the French found that unlike HTLV, this retrovirus was killing off CD4 lymphocytes instead of causing an explosion in growth (Shilts, 1988). They had found a new retrovirus, and it was causing this deadly immune deficiency. As Dr. Luc Montagnier contacted Dr. Willy Rozenbaum about the findings, he was hopeful that the antiviral drug he had developed in the late 1970s would be useful to stall AIDS and help the suffering patients (Shilts, 1988). Montagnier explained all this to the ecstatic Rozenbaum, finally he could do something about this disease, after so much wasted time, after so much wasted life.
The drug, called HPA-23 had been co developed in the late 1970s by Dr. Luc Montagnier, it was effective in stopping retro-viral infection because it inhibited the enzyme reverse transcriptase that retroviruses use to transcribe their RNA genome into DNA; no it would not cure AIDS but it would at least stall the crippling disease, it was a start thought Montagnier.
As the French announced their discovery of the retrovirus that was causing AIDS, Dr. Robert Gallo’s lab at the NCI (National Cancer Institute) was trying unsuccessfully to culture the CD4 lymphocytes (Shilts, 1988). The problem was they simply couldn’t culture the lymphocytes, they kept dying. It became evident in the following months that the French had discovered the virus first; however Gallo refused to acknowledge this, saying that his lab had been at the forefront of any such research on AIDS (Shilts, 1988). This would start a feud that would ultimately prevent a blood test for AIDS to become available to the public for almost a year. During Gallo’s self absorbed and childlike antics, millions of transfusions were administered and thousands of the recipients were infected with AIDS. Instead of giving the French the credit they deserved for discovering the retrovirus and then working with them for a cure or a vaccine, Gallo selfishly fought them every step of the way and for what? A Nobel Prize (Roberts, 1990). A blood test did finally become available, it was the inferior American version patented by Gallo himself, but it was too late, in the time Gallo had spent feuding with the French, AIDS had infected thousands (Roberts, 1990). Gallo made millions from his patented blood test and even though it was inferior to the French test the U.S. government adopted it whole heartedly. During 1985 so much could have been done to stall the spread of AIDS yet little was, the president of the United States, Ronald Reagan was still pretending that AIDS did not exist, meanwhile thousands of Americans were dying .Many would come to call 1985, “the lost year (Shilts, 1988).”
Another widespread factor that greatly contributed to the early spread of AIDS were the gay bathhouses, the social institutions were breeding grounds for sexually transmitted diseases, with homosexual men having upwards of five sexual contacts a night (Shilts, 1988). The owners of the baths in cities such as San Francisco and New York refused to say that AIDS could even be transmitted through sexual contact, let alone close their institutions. The baths were not closed in San Francisco until late 1984 (Shilts, 1988). By then thousands of gay men were infected and dying, but the bathhouse owners didn’t care, in their eyes, AIDS was just another obstacle that stood in the way of making money, which in the end was all that really mattered. When it came to AIDS, money and politics came before saving lives, not surprisingly this fact is veiled in the history of AIDS in America. The few textbooks that do mention AIDS cover up the lack of government response by providing the reader with blatantly false information. This is not only a distortion of historical facts, but an insult to the tens of thousands of Americans who have died of AIDS. AIDS isn’t a heroic tale of advancements, it is a story of death, the deaths of tens of thousands of innocent Americans, Americans who turned to their government for help and instead were shunned because of their beliefs. The story of AIDS is one of shame and silence, a story that is largely forgotten.
During the first international AIDS conference in 1985, secretary of Health and Human Services Margaret Heckler gave her speech on AIDS: “AIDS will remain our number-one public health priority until it has been conquered, we must conquer AIDS before it affects the heterosexual population” she said, in other words AIDS had to be stopped before it started killing the people who mattered.
In late 1985 Rock Hudson collapsed in a hotel lobby in Paris, he was there to receive injections of HPA-23, one of the anti-retroviral drugs being used by the French to treat AIDS (Shilts, 1988). No drugs existed in America, where according to the Reagan Administration AIDS was “the number-one public health concern”, instead Americans who could afford it would travel to Paris to stay alive. When it became known that Hudson had AIDS, the true media coverage of the epidemic began, in the history of the AIDS epidemic there was AIDS before Rock Hudson and AIDS after him (Shilts, 1988). The deaths of thousands didn’t make headlines, but the death of one movie star would forever change the AIDS epidemic.
In 1987 at the third international conference on Acquired Immune Deficiency Syndrome, President Ronald Reagan gave his first speech on AIDS. Surprisingly however he did not talk about widespread public education, instead he rambled on about mandatory testing, something that all public health officials strongly disagreed with. Surgeon General C.Everett Koop appointed by Reagan, strongly criticized the President’s lack of response to the epidemic, in his report on AIDS he stated that mandatory testing was out of the question, instead the focus should be placed on public education campaigns that began in elementary school (Shilts, 1988). The ultra-conservative Koop was one of the first public health officials to treat AIDS solely as a public health concern, leaving out any political aspects. For this he was shunned by the Reagan administration and accused of “coddling” homosexuals (Shilts, 1988). At the end of 1987, the United States of America was the only industrialized nation that did not have a government sponsored AIDS education program.
The widespread refusal to recognize AIDS as a public health issue by the Reagan Administration resulted in one of the worst medical crisis of our time. Reagan’s refusal to say anything about AIDS or give money for AIDS research led directly to the death of millions of Americans. The most amazing part is that the president of the United States could stand by and watch as thousands of Americans died, that he could simply do nothing is appalling. Reagan’s defense spending peaked at $456.5 billion dollars, only $16.7 million was allocated to the CDC for AIDS (Shilts, 1988). In the end it came down to politics, AIDS was a homosexual disease, and after all who really cared if the gays died?
AIDS in the 21st Century
Currently AIDS is one of the biggest public health concerns worldwide. In 2008 33.4 million people were infected with AIDS and that number is only growing (UNAIDS.org). The search is still on for a cure or a vaccine but so far people infected with AIDS are going to die. Major advancements in anti-retroviral therapy have drastically increased the life expectancy of people infected with AIDS. However the viruses’ ability to mutate so easily, forces doctors to use a “cocktail” of drugs for treatment. It takes flu viruses a year to mutate significantly; it takes HIV only a day (Bugl, 2009). Why was AIDS allowed to spread unchecked during the 1980s while the federal government sat by and watched? Why was nothing done to stop the disease before it metastasized into an epidemic? Reagan was the president who let AIDS ravage America, first by refusing to allocate funds to fight the epidemic and then by providing no political leadership during the epidemic. Ronald Wilson Reagan, the 40th president of the United States of America let politics come before public health, in the end Reagan cared more about political agenda then saving the lives of the American people.
In 2010, despite tremendous advancements, the fight on AIDS is still failing. Nearly 40 million people are infected with HIV worldwide; more then 22.4 million of these are living in Sub-Saharan Africa (UNAIDS.org). Most are in immediate need of life saving anti-retroviral drugs, which only about 40 % will actually receive (UNAIDS.org). Sponsors have begun to donate their money elsewhere because AIDS is not a curable disease, this means trouble for South Africa especially. People show up everyday at AIDS clinics and hospitals, begging for anti-retroviral drugs. Most clinics and hospitals are so packed that they have a waiting list, and these people are turned away (Mcneil, 2010). Some patients smuggle drugs to their relatives who are ailing from the disease, the problem with this is that patients can then develop a drug resistant strain of the virus, which then can be spread (Mcneil, 2010). In the year 2000 AIDS accounted for more then 30.6% of mortality in South Africa alone, three times more then any other factor (Coovadia, 2009). Globally the fight on AIDS is failing, with the current economic crisis money is scarce and AIDS programs are already under funded. The Obama Administration has voted to shift funding from AIDS to mother-child illnesses that can be cured such as Malaria (Mcneil, 2010). AIDS is once again becoming second class, people take the virus as a joke. No American thinks they can be infected with AIDS, “AIDS is a poor disease; people in Africa get it, not Americans”. This ignorance will surely have its price; the CDC estimates that 468,578 people are living with HIV in America (as of 2007), a 20,000 person increase from the preceding year (Centers for Disease Control, 2009).
Don Francis thought about the AIDS epidemic as he packed the remains of his office into a brown cardboard box. He thought of all the people who would die, and all the people who could have lived. It was ironic almost that he had been able to conquer Smallpox in India and Ebola in Africa, yet fail to stop the AIDS epidemic in the most advanced nation in the world. As he was leaving the building, he ran into Jim Curran the director for AIDS research at the CDC, “It didn’t have to be this way” said Francis “we could have stopped it.”