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Wednesday, December 1, 2010

29 Years On, a Timeline of the Early Years of AIDS

By Steve Weinstein -

No one knows where AIDS began, but theories abound. What we do know is that, in 1980, men began dying in New York and Los Angeles from previously obscure diseases. In 1981, the federal Centers for Disease Control recognized the pattern, and, by 1983, a new disease striking gay men was recognized.

Not long thereafter, Haitians, intravenous drug users, those who had received blood transfusions and hemophiliacs became new categories of victims. With the simultaneous discovery of the virus that causes AIDS in Paris and Washington, serious research into treatment began.

The concept of "safe sex" made condoms an essential part of gay life. From AZT, an accidental discovery, to the HAART cocktail, to a vaginal microbicide and the latest breakthrough -- a pill that appears to prevent infection in 90 percent of gay men -- the trail to treatment and prevention of AIDS has been a long trail of tears.

For the gay community, it has been a tale of heartbreaking loss followed by unparalleled activism, organization and fund-raising.

Today, the pandemic continues barely unabated in Africa, among people of color in this country, and among young gay men.

What follows is a timeline of the trajectory of a disease that ranks with the Black Plague, Spanish Influenza and polio as one of the greatest medical tragedies of all time. What began in Africa -- a beginning lost in the mists of time -- spread to the United States.

Prior to 1981


Somewhere in Africa ...

The origins of AIDS remains shrouded in mystery and, despite medical archeologists’ best efforts, will likely remain that way.

What we do know is that certain Central African tribes hunted and ate monkeys, which carried a strain of HIV, simian immunodeficiency virus (SIV) somehow mutated in humans, probably in the late 19th or early 20th century, most likely in Cameroon or the interior of the Belgian (now Democratic Republic of the) Congo.

Colonization Spreads Contact

At the same time, European powers scrambled to divide the continent up among themselves. The continent began to develop cities, ports, industries and roads.

This allowed more movement among people. At the same time, dislocation of families, sexual promiscuity and the advent of monetary exchange meant that women were working as prostitutes -- and the men were taking whatever diseases they picked up back to their native villages.

Later, immunization from various diseases ironically also spread the nascent disease. Doctors strained for resources re-used needles on several patients, some of whom were probably infected.


Earliest Cases

Thanks to international trade, it didn’t take too long for the then-unknown disease to spread into European and American populations.

The oldest known case of AIDS can be traced to David Carr, a British printer in Manchester, England. He suffered bizarre symptoms in 1958, including skin lesions, fatigues, weight loss, night sweats, high fever, cytomegalovirus and Pneumocystis carinii pneumonia (PCP) -- now all recognized as symptoms of AIDS.

We now know for sure he had AIDS because his doctors, puzzled at his disease, preserved blood specimens.

1959 and 1960, two Congloese had symptoms of AIDS. In 1969, the first reported case in the United States was reported in St. Louis. The same year, a Norwegian sailor, his wife and daughter died of AIDS.


Operation Sail

In his landmark book And the Band Played On, the late journalist Randy Shilts advanced a unique theory. Although only conjecture, it is at least as plausible -- or no more implausible -- than others.

Shilts implied that Operation Sail, in which navies from all over the world converged in New York Harbor to celebrate the United States’ bicentennial in 1976, brought Congolese sailors.

These sailors may have (probably did) enlist the services of local prostitutes. They, in turn, may have infected some of their customers, at least one of whom may have had sex with a man.

That men (or men) then had sex with several other men. And so it could have begun here.


The House on Fire Island

In 1980, gay men who shared a house in Fire Island Pines came down with mysterious symptoms and died within weeks. The house became one of -- if not the -- first places in the United States where the disease struck gay men.


Patient Zero

Ga√ętan Dugas was a Canadian airline steward who has become notorious as Patient Zero. Dugas apparently contracted the virus at some point in the late 1970s or very early 1980s.

Dugas was quite promiscuous and frequented bathhouses during his layovers in various cities. At least 40 early cases of AIDS have been traced to him.

1981, 1982: GRID to AIDS

Kaposi’s Sarcoma lesions  

June 5, 1981

On that date, the U.S. Centers for Disease Control and Prevention in its Morbidity and Mortality Weekly Report newsletter reported unusual clusters of Pneumocystis pneumonia (PCP) in five homosexual men in Los Angeles.

By March 1981, several men in New York and Los Angeles were also coming down with Kaposi’s Sarcoma, a rare form of cancer formerly only known primarily among elderly men of Italian or Eastern European Jewish extraction.

On May 18, 1981, the New York Native published an article by Dr. Lawrence Mass that called rumors of a "gay cancer" unfounded. It was the first newspaper report of AIDS.

On July 3, 1981, the New York Times published a story. Entitled "Rare Cancer Seen in 41 Homosexuals," it is acknowledged as the first article to detail the extent of the disease and has been immortalized in plays (Larry Kramer’s The Normal Heart) and films (Longtime Companion). The article was also the first to infer sexual transmission as a possible cause -- a surmise that would be fiercely devoted in the next few years.



By 1982, it was becoming evident that (homosexual) sex was at least partly responsible for transmission. The disease was tentatively named "gay-related immune deficiency," or GRID. Colloquially, in New York, some ironically called it "Saint’s Disease," because it was affecting so many members of that all-male disco.

Authorities soon realized, however, that it was hitting other groups, such as Haitian immigrants, hemophiliacs, and heterosexual intravenous drug users.

In August 1982, it began to be called by the more general name auto-immune deficiency syndrome, or AIDS.



In July, gay community leaders, federal bureaucrats and officials of the Centers for Disease Control met in Washington, D.C. The result: an agreement to call the new disease AIDS:
• Acquired: unlike lupus and other illnesses, AIDS comes from someone else. It is not an auto-immune disease.
• Immune Defiency: AIDS attacks the body’s immune system, rendering it helpless.
• Syndrome: AIDS per se, does not cause illness and death. Rather, it’s the opportunistic infections that the weakening of the body’s immune system allows into the body.

The last point is the most salient. With the advent of AIDS, diseases once confined to sheep herders, miners and spelunkers, the aged, and other groups became common among gay men (and eventually, others).

One of the things researchers learned from AIDS was how prevalent the germs causing these diseases are. We just never knew because a normal-functioning immune system throws them off. It’s like H.G. Wells’ theory in War of the Worlds, only working on people right here on earth: Centuries of immunity build-up to infections became moot.

The other central facet of AIDS was wasting. The body, unable to replenish itself or respond to nourishment, breaks down. In Africa, AIDS becomes known as "the wasting disease."



Gay men couldn’t -- didn’t want to -- believe that sex was the cause of this terrible illness. After 10 years of post-Stonewall liberation, it seemed like a horrible nightmare: The very act that gave them their identity was causing them to sicken and die.

Other factors were searched. One of the most obvious suspects was amyl nitrate. There was, after all, a cause and effect: The men in L.A. and New York who were getting sick were heavy users of poppers.

The use of poppers, while certainly not great for the immune system, has been disregarded by most experts as an efficient cause of AIDS. But the theory remains controversial, as certain researchers, who contain to maintain a "multifactorial causation" of AIDS. In the face of prevailing wisdom, such doubters have become known as AIDS denialists.


Blood Transfusion

In California, a baby became sick with AIDS-like symptoms. The baby had received a blood transfusion. Soon thereafter, people -- heterosexual, monogamous or non-sexual, living far from the epicenters of the epidemic -- were coming down with AIDS.

They all had had blood transfusions.

Hemophiliacs, because of their need for frequent transfusions, became especially susceptible. Hemophiliacs began to become shunned. Like gay men, they were considered "carriers," whether or not they displayed symptoms.

In response, the next year American Red Cross and other groups banned donations from anyone who had gay sex within the past several years. The ban spread to other countries -- a ban that continues today, despite gay groups’ and others’ high-level protests.


Haitian Immigrants

Kaposi’s sarcoma began to appear among Haitian immigrants. Haitians became yet another stigmatized group. In the black humor of the time, a popular joke went, "What’s the hardest part about getting AIDS? Telling your mother you’re Haitian."

There was nothing funny about the spread of the epidemic, however. Exactly how and why AIDS spread so quickly into this particular population.

One theory (which is still controversial, although also widely accepted) is that a gay men (or gay men) visited Haiti and had sex with a local men or men, either as an assignation or a paid sex worker. The man or men may have been "gay for pay" -- not improbable considering the country’s desperate level of poverty. That man or men then infected women, who in turn spread the disease to other Haitian men.

The Haitian connection, whatever the cause, didn’t prove lasting as one of the salient groups carrying the virus. But it did point to a terrifying aspect of the disease: its ease moving from gay men into the general population through sexual contact.

Debbie Reynolds was the only Hollywood star who would associate herself with the disease.  

Raising Funds

In Greenwich Village, a small group of men met in writer Larry Kramer’s apartment. Frustrated at the lack of government response, the men agreed to form an ad hoc organization to care for those succumbing to sickness and advocate for medicine to fight it.

The organization the six men founded would become known as Gay Men’s Health Crisis. GMHC, which has since expanded far beyond its original mandate of caring for gay men, operates out of the Chelsea neighborhood of New York City.

It remains one of (if not the) largest private AIDS service organizations in the world and quickly became the model for similar organizations that sprang up around in cities throughout the United States, and then the world.

Across the country, in San Francisco, the first AIDS benefit took place, featuring Margaret Whiting, Sylvester (who would later die of AIDS), George Kirby and Morgana King. The headliner was Debbie Reynolds, who, at the time, was the only well-known celebrity who wanted to be associated with the disease.



In January, a group of scientists at the Pasteur Institute isolated a retrovirus that killed T cells taken from an AIDS patient.

The virus would eventually become known as the "human immunodeficiency virus" and be universally recognized as the cause of AIDS. HIV attacks healthy cells, attaches itself to them and replicates its DNA onto them. It spreads quickly. It is one of the most efficient and most rapidly mutating viruses ever discovered.

The discovery of HIV itself was mired in controversy between doctors in Paris and Washington, D.C. The issue was finally resolved in a Solomon-like decision that gave co-recognition -- a decision that remains controversial to this day.

But the discovery of HIV meant that AIDS now had a recognizable cause.


Safe(r) Sex

Michael Callen was a singer-songwriter in New York City. Richard Berkowitz was an S&M hustler there. The two men together formulated a theory on the way that gay men should be having sex to protect themselves.

They co-wrote a book, How to Have Sex in an Epidemic: One Approach. The central thesis is one that has now become second nature to gay men: the use of condoms.

Prior to this, condoms were snickered at as a way for randy teens to prevent pregnancy or for soldiers and sailors on leave to prevent getting venereal diseases such as syphilis.

But condoms became the totem for gay men protecting themselves and their partners. Sales skyrocketed. Bowls of condoms began appearing in banks, in government offices, even in churches.

The era of safe sex had begun, and it is one we are still very much living in.


Silence from the President

For activists then and now, one of the most infuriating aspects of the early years of the AIDS epidemic is what, in their eyes, was a complete blackout by the Reagan Administration.

Ronald Reagan took office in 1980, and so it was under his watch that the epidemic took root. Many maintain that, had the federal government had a much more active role in fighting the disease, it would not have become the catastrophic pandemic that still rages.

In January 1983, Margaret Heckler, a former congresswoman from Massachusetts, took over as the secretary of Health and Human Services. Heckler had had no previous public-health experience, and clearly the impact of the crisis overwhelmed her.

She famously -- and incorrectly -- announced that the nation’s blood supply was safe. She fought with activists and did not fight for more funding for the desperately under-funded Centers for Disease Control, ground zero in the fight against AIDS.

Members of the CDC were dipping into their own pockets, fudging expense reports ... doing whatever they could to get money to travel the country, talk to physicians and patients and try to figure out what was happening.

President Reagan would not utter the word AIDS for two more years, until fellow actor Rock Hudson died.

Today, Reagan remains an icon to American conservatives. For many gay men ... not so much.


Klaus Nomi

The first celebrity to die of AIDS was Klaus Nomi. A fixture in New York’s East Village avant-garde arts scene, the German countertenor backed up David Bowie on Saturday Night Live and performed at all the major Downtown Manhattan clubs.

Nomi became sick with KS and died Aug. 6, 1983. The documentary The Nomi Song has brought a renewed interest in his varied performing career, which careened from punk rock to grand opera.


’1,112 and Counting’

"If this article doesn’t scare the shit out of you, we’re in real trouble. If this article doesn’t rouse you to anger, fury, rage, and action, gay men may have no future on this earth. Our continued existence depends on just how angry you can get."

Thus began the most famous essay of the early AIDS crisis. Larry Kramer wrote "1,112 and Counting" for the New York Native, a local gay weekly newspaper.

It appeared on the front page enclosed by a black border. Many gay men dismissed the article. After all, Kramer had written Faggots, a bitterly satiric novel published a few years before that made merciless fun of the New York "A List" and their endless search for non-binding sexual thrills.

Nevertheless, the article provided a virtual template for much of the writing about AIDS that would come. And Kramer himself would go on to found the most effective street AIDS activist group, ACT-UP.



Looked at objectively, there would seem to be every reason for mosquitoes to carry a blood-born virus like HIV. So it’s not surprising that rumors began to spread.

The possibility that a seemingly harmless mosquito bite could infect a person with the AIDS virus spread panic in the general population. Fire Island Pines and Cherry Grove, two primarily gay summer resorts known for the high number of mosquitoes, went through a period of hysteria.

In fact, mosquitoes do not have the mechanism to carry the virus. Unlike malaria or encephalitis, there is simply not enough HIV in any patient. For this and other reasons, mosquitoes do not carry HIV.

AIDS Hysteria

On June 20, 1983, New York Magazine published a cover story by Michael Daly on "AIDS Anxiety." The magazine was known as one of the trendiest on the market, and the long article pointed out the near-hysteria that was engulfing New Yorkers.

The article noted: "Three women have also fallen ill for no known reason. Other victims include 25 city youngsters who apparently had infected mothers, eleven women who had sexual relations with members of a risk group, and ten people who received transfusions of blood that may have been tainted."


Funeral Homes

One of the cruelest byproducts of early AIDS hysteria was the refusal of funeral homes in New York and elsewhere to bury victims of the disease.

Family members and loved ones, already distraught, had to cope with somehow disposing of a corpse that no one wanted.

While alive, people with AIDS were driven from their homes by partners, roommates and landlords. Doctors and nurses refused to use needles on them, lest they be pricked and become infected.

And even in death, those suffering from AIDS were not at peace.

By 1984, gay men were moving (albeit slowly) toward a safe-sex mode of behavior. The nation was beginning to wake up to the hows and whys of the disease. "Normal" people like the young Indiana boy Ryan White put a human face on the epidemic. Modes of infection -- and prevention -- became better known. And in 1984, scientists at Burroughs-Wellcome, a large pharmaceutical firm, began to realize that one of their cancer fighters could reverse the genetic pattern that HIV was replicating in healthy cells. AZT wouldn’t become generally used for a few more years, but rumors spread and gay men used whatever connections they could for dosages.

It was the end of the beginning of the epidemic.

EDGE Editor-in-Chief Steve Weinstein has been a regular correspondent for the International Herald Tribune, the Advocate, the Village Voice and Out. He has been covering the AIDS crisis since the early ’80s, when he began his career. He is the author of "The Q Guide to Fire Island" (Alyson, 2007). 

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