On June 5, 1981, the U.S. Centers for Disease Control and Prevention published an article in its authoritative journal Morbidity and Mortality Weekly report that experts now consider the first signal that an unprecedented worldwide epidemic had begun.
“In the period of October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carini pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died,” the MMWR article stated.
“Pneumocystis pneumonia in the United States is almost exclusively limited to severely immunosuppressed patients,” said the article. “The occurrence of pneumocytosis in these 5 previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual.”
It would take another few years before scientists named the condition detected in the men discussed in that MMWR article as Acquired Immune Deficiency Syndrome or AIDS. The name AIDS followed an earlier term used by some researchers and the media – Gay Related Immune Disorder or GRID.
In reflecting on the tumultuous developments surrounding AIDS over the past 30 years, leaders of AIDS advocacy organizations and LGBT activists in the U.S. who lived through the early years of the epidemic say that, to some extent, the MMWR article of June 1981 still has considerable resonance for gay men.
They acknowledge that so much has changed for the better over the past 30 years, including breakthroughs in biomedical research resulting in highly effective drugs that transformed AIDS from a death sentence into a manageable, chronic illness like diabetes.
But AIDS activists also point out that HIV and AIDS continue to disproportionately impact gay men or men who have sex with men (MSM) in the United States and other countries.
And although the perception of AIDS as a “gay disease” has largely receded from the minds of most Americans, AIDS activists say they find themselves in the ironic position of having to remind Congress and state and local governments that more resources and funding are needed for HIV prevention programs targeting gay and bisexual men.
“MSM is the only group for whom, according to the CDC, new infections are still increasing,” said Ronald Johnson, vice president for policy and advocacy for AIDS United, a national group formerly known as AIDS Action.
“So there continues to be a concern that there is not enough targeted prevention resources to MSM, particularly MSM of color and young MSM of all races and ethnicities,” Johnson said.
According to the CDC, while MSM account for about 2 percent of the U.S. population, more than half of all new HIV infections in the U.S. each year (53 percent) occur among MSM. CDC data also show that MSM make up nearly half of all people living with HIV in the U.S. – 48 percent.
CDC figures show that white MSM “account for the largest number of annual new HIV infections of any group in the U.S., followed closely by black MSM,” according to a CDC fact sheet released last month.
“There are more new HIV infections among young black MSM (aged 13-29) than among any other age and racial group of MSM,” the fact sheet says.
The Obama administration, with input from AIDS advocacy organizations, released a National HIV/AIDS Strategy document in July 2010 that, among other things, calls for an aggressive effort to develop better HIV prevention programs targeting MSM.
Johnson and Carl Schmid, deputy executive director of the AIDS Institute, a national advocacy group, praised the administration for developing the strategy document, which they say covers most of the bases needed for addressing HIV prevention programs for MSM.
But the two said the proposals in the strategy document have yet to be fully implemented. They note that delays in its implementation are due, in part, to the U.S. economic situation that has prevented needed increases in federal AIDS funds and severe cutbacks in state and local funding for AIDS-related programs.
Phill Wilson, president and CEO of the Black AIDS Institute, said in a commentary last week in the Washington Informer, a black community newspaper, that he fears the horrors of the AIDS epidemic of the 1980s, when friends and family members watched loved ones die due to a lack of effective medical treatment, could return to some degree in the next few years.
According to Wilson, if the federal government fails to boost funding for the federal-state AIDS Drug Assistance Program (ADAP), low income people who rely on the program to provide them the medications they need keep the AIDS virus in check could become casualties just as their predecessors became casualties years earlier. But this time, he said, an inability to gain access to medicine due to funding shortfalls would be responsible for their fate at a time when effective medicine is readily available.
He called such an outcome “immoral.”
The ADAP program was created under the Ryan White AIDS Care Act to provide life-sustaining drugs for low-income people with HIV and AIDS who are under insured or don’t have any health insurance to help pay for the drugs.
ADAP funding cuts by states and a large increase in the number of people applying for ADAP assistance has resulted in nearly 8,000 people being placed on state waiting lists for the AIDS drugs they need to remain healthy.
The health insurance reform law that President Obama proposed and Congress passed two years ago was expected to relieve the ADAP funding pressure on states when it takes effect in 2014. However, some states that oppose the law have filed lawsuits seeking to prevent its provision requiring all citizens to buy some form of health insurance from going into effect, making its outcome uncertain.
Nearly all AIDS advocacy groups support the law, saying it would strengthen medical care for large numbers of people with HIV/AIDS.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, an arm of the U.S. National Institutes of Health, has been the leading federal government official monitoring the AIDS epidemic and directing AIDS-related research since the disease burst on the scene in 1981.
In a speech commemorating the 30th anniversary of AIDS at NIH headquarters in Rockville, Md., on Tuesday, Fauci said he’s optimistic that an AIDS vaccine can be developed in the near future.
“We have scientific evidence that a safe and effective HIV vaccine is possible,” he said in a statement released on May 18.
“In 2009, a clinical trial in Thailand involving 16,000 people demonstrated for the first time that a vaccine could safely prevent HIV infection in a modest proportion of study participants,” he said. “Many of the best minds in HIV vaccine science are examining blood samples and data from the Thai trial to learn how the vaccine candidate prevented HIV infections and to consider how it could be modified to be more effective.”
Fauci said NIAID is also optimistic about development within the next few years of effective vaginal and rectal microbicides that can be used to prevent the transmission of HIV during sexual contact.
Fauci and other researchers have also pointed to studies showing the effectiveness to a certain degree of prescribing HIV drugs for use by non-infected people believed to be at high risk for HIV infection, such as men who have sex with men.
Known as pre-exposure prophylaxis, or PrEP, the use of this prevention measure is said to have the drawback of being less effective if people fail to take the drug as required. Some also have expressed concern that people using this prevention method are subject to potential side effects of the drugs and may be discouraged from using condoms, which experts say is one of the most effective methods of HIV prevention.
Events and developments in the early years of AIDS
• 1981: The CDC reports in its June 1981 edition of MMWR and subsequent editions that year that an estimated 170 gay men had succumbed to Pneumocystis carini pneumonia and Kaposi’s sarcoma, a rare skin cancer, over the preceding two years. The CDC studies of these cases cited a serious malfunctioning of the body’s immune system in those who contracted the conditions.
• 1982: Gay Related Immune Disorder, or GRID, became the first name to describe what is now known as AIDS. Cases reached epidemic proportions in the U.S., moving beyond clusters of gay men in New York, San Francisco and Los Angeles and into groups with no obvious risk factors.
• 1983: Gay leaders, independent medical researchers and health and social services agency officials testify before a congressional committee that the federal response to AIDS was highly inadequate. They issue a plea for the federal government and the Reagan administration to increase federal funding and federal initiatives to fight AIDS.
• 1985: In late July, actor Rock Hudson stunned the nation when he issued a statement saying he had AIDS and was receiving treatment in Paris that he said he couldn’t get in the U.S. He died three months later at age 59. His announcement and death drew massive mainstream media attention to AIDS. His death prompted his close friend, actress Elizabeth Taylor, to help found the American Foundation for AIDS Research to raise funds for AIDS causes.
• 1988: The NAMES Project AIDS Memorial Quilt makes its second trip to Washington in the spring, where it’s displayed on the Ellipse near the White House. Later that year, about 1,100 AIDS activists staged a protest at the headquarters of the U.S. Food and Drug Administration in suburban Maryland outside D.C., denouncing the FDA for taking too long to approve new drugs for people with AIDS. Police arrested at least 176 of the protesters after they blocked access to the FDA building’s main entrance.