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Ryan Lee
Friday, June 02, 2006
Twenty-five years ago this week, James Curran traveled from his Atlanta office to a hospital in New York City where he “reunited” with a patient whom he had never met, and whom the young scientist would never forget.
“I recall walking into NYU Medical Center and meeting a man who was almost precisely my age, who had come from a suburb of Detroit, as I had, and had attended a Catholic high school, as I had,” said Curran, who was then working as an epidemiologist at the Centers for Disease Control & Prevention.
“We were now back together, if you will, 20 years later, him with what I initially thought was a rare skin cancer that, frankly, I had never heard of until the week before, and me now investigating his case,” Curran said.
The “rare skin cancer” Curran was investigating was related to the appearance of pneumocystis carinii pneumonia in five gay men in Los Angeles, which the CDC first reported June 5, 1981.
The cluster of cases were the initial scientific observations of the disease that would come to be known as AIDS, which Curran said had already invaded the lives of a quarter-million gay men before the first five cases were reported.
“None of us could’ve known that then, but it’s this insidious nature that can take a virus which occurs slowly — the evidence occurs slowly — and allow it to persist so long,” Curran said.
“The fact that there were only a small number of cases initially, and the fact that they were predominately gay men, made it easier for people to deny that this was a large problem, and it even made it easy for the gay community to deny that it was a large problem.”
For many gay men, that sense of denial would soon diminish, as friends, lovers and scores of other young, previously healthy individuals died within a matter of weeks or months.
But as Curran and other researchers frantically searched for the cause of the unknown plague, American society — including government, media and the public — responded to the deaths of tens of thousands of gay men with what critics call systemic disinterest.
“Ronald Reagan had been elected with the support of evangelical Christians and the so-called ‘Moral Majority’ at the time, and that was a group that you would not predict would be interested in sexually transmitted diseases, or in new conditions predominately in gay men,” said Curran, who left the CDC in 1995 to become dean of the Rollins School of Public Health at Emory University.
Curran’s Emory office is just a few yards up Clifton Road in Atlanta from where he used to work with the CDC. There’s also not much distance between where America’s HIV prevention efforts were in the ‘80s and where they are today, Curran said.
“There were struggles with the domestic policy council and others in the Reagan administration just relating to a lot of the issues that AIDS deals with, and I think we see that today in the current administration, with the discomfort, politically, with their political constituents, and dealing with issues likes condoms, and sex education, and things like this,” Curran said.
“I don’t think domestic AIDS has been a high priority of the White House administration. Global AIDS has been the focus, and I think HIV prevention is not something they’re comfortable with, or their constituents are comfortable with,” he said. “HIV prevention works — it works if its hands are not tied by local, national or international political considerations.”
Politicizing prevention?
Some AIDS activists worry that HIV funding “guidance documents” issued by the current White House have accelerated “the erosion of evidence-based approaches.”
“When you look at guidance documents, there’s a lot of language that tells you very much about what the orientation is of the current political regime, and what is being promoted and what is not being promoted,” said Judy Auerbach, vice president for public policy of the American Foundation for AIDS Research. “That message gets out both formally and informally, and I think program planners and practitioners respond to it — they fund what they think they can get funding for, and they’re afraid to do things that they think they will be criticized for.”
Auerbach was part of a recent study issued by the Open Society Institute, a liberal New York-based human rights group, that praised President George W. Bush’s leadership fighting global AIDS, but accused the president of ignoring the domestic epidemic.
Conservative members of Congress have promoted audits of community-based organizations that teach explicit safe sex techniques, and forced abstinence-only proponents onto discussion panels at scientific conferences. They are as responsible for ideology-based interference with HIV prevention as the White House, Auerbach said.
Part of Bush’s domestic AIDS strategy penalizes states like New York and California that proactively funded anti-AIDS efforts by shifting resources to rural and southern states, said Matt Foreman, executive director of the National Gay & Lesbian Task Force.
Foreman also criticized Bush for what he called “the reprehensible shift” from comprehensive sex education to an abstinence-only approach, but added that gay rights organizations — many of which were able to develop a solid infrastructure only via the AIDS crisis — must also again become champions of safer sex and HIV prevention.
“There needs to be a national dialogue sparked to re-engage the LGBT community around HIV, and in order for there to be some kind of broad-based street activism we would need a spark,” Foreman said. “That kind of activism comes in waves, and we’re overdue for the next wave to arrive.”
‘ABCs’ and abstinence-only
David Reznik was among the multitude of gay men who lost friends and lovers during the first 25 years of the AIDS epidemic.
“Almost all of the people I counted as friends in the ’80s and mid-’90s are dead,” said Reznik, a dentist who is among the authorities on HIV and oral health in the nation.
Hoping to have a greater influence in the U.S. response to fighting HIV and AIDS, Reznik and several dental associations lobbied the White House to appoint an oral health expert to the Presidential Advisory Council on HIV/AIDS. In January 2003, Reznik himself was tapped by George W. Bush to serve on PACHA.
Like many AIDS activists, Reznik said he had preconceived notions about PACHA being held hostage by social conservatives who advocated only abstinence-until-marriage as a solution to HIV.
“But I’ve been there three years, and there’s been no abstinence-only discussions,” said Reznik, who is HIV-negative. “In a society that always seems to be so polarized, I’ve found that people from very diverse backgrounds are coming together and doing things to move forward — it’s been a very fulfilling experience.”
Among the “significantly good things” Reznik said the current Bush administration has done to fight AIDS domestically is expand the availability of rapid HIV testing to non-laboratory settings, incorporate HIV tests into routine medical check-ups, attempt to eliminate waiting lists for state-administered AIDS Drug Assistance Programs and call for reauthorization of the Ryan White CARE Act in his last two State of the Union addresses.
“I don’t remember if Ryan White was ever mentioned during the previous administration’s State of the Union speech,” Reznik said.
Bill Clinton mentioned AIDS in five of his eight State of the Union addresses, but never specifically mentioned the Ryan White CARE Act, which provides treatment to those who cannot afford it.
The hallmark of Bush’s anti-AIDS efforts has been the “ABCs” of HIV prevention: Abstinence, Be faithful, and use a Condom, with funding for abstinence education more than doubling during Bush’s tenure.
Contrary to claims that the ABC approach ignores science, Reznik said it is virtually identical to the decades-old approach of delaying the onset of sexual activity via abstinence, reducing the number of sex partners by being faithful, and if neither of those goals is attainable, always using a condom.
“There’s a whole body of evidence-based research that those are the steps that reduce the risk of the transmission of HIV,” said Reznik, who added that abstinence-until-marriage being taught in schools shouldn’t be blamed for rising HIV rates among gay youth.
“Yes, getting good education in school is part of the equation, but I think it’s not fair to blame lack of comprehensive sex education in schools for rising rates among gay men because that takes parents off the hook, it takes friends off the hook, it takes media off the hook and it’s saying everybody should get all their information from school,” he said.
With gay men still representing almost half of the more than 1 million Americans currently living with HIV, gay rights organizations must rekindle their AIDS activism and place it alongside high-profile issues such as marriage, Reznik said.
“I don’t know if we have a great institutional memory, and I think we’ve forgotten about those awful early days,” he said. “There hasn’t been a great communication between the surviving generation — those who lived through AIDS in the ‘80s — and the gay men who are coming of age now.”
Prevention after ‘the cocktail’
Prevention workers at community-based organizations also see a disconnect between today’s young gay men and the previous generation whose lives were altered by the virus.
“There is that feeling out there [among gay youth] that you can go and do anything you want tonight, and then tomorrow just take some medications if you have to, and it’s not a big deal,” said Steve Balfour, interim executive director at AID Atlanta, who is gay and HIV positive. “It is still killing people, it is still causing people to get very sick.”
The majority of AIDS activism during the past 25 years focused on attaining medical treatment for those who were facing death — the first 15 years searching for any kind of treatment that would prolong life, the past 10 years making sure as many Americans as possible have access to the retroviral drug cocktails developed in 1996.
The higher quality of life AIDS drugs have provided to HIV-positive individuals during the past decade is immeasurable, but the perceived availability of such drugs also complicates modern prevention efforts, said Neena Smith-Bankhead, director of education and volunteer services at AID Atlanta.
“With treatment, you have all these messages trying to empower people who are living with HIV, but those same messages are reaching people who are HIV-negative, and their perspective changes,” Smith-Bankhead said.
Changing attitudes among gay generations has caused some HIV organizations to adjust their prevention strategies from simply passing out condoms in gay bars, to using internet sites like Yahoo, MySpace and Manhunt to reach everyone from barebackers, to crystal meth users, to “people who won’t go near a penis without a condom on it.”
“It’s about knowing what activities are risky, knowing where you fall on that continuum of risks and trying to take steps to reduce risks gradually,” said Charles Stephens, coordinator of AID Atlanta’s African-American gay outreach program.
1981
• Doctors in New York and California begin to notice immune system disorders in otherwise healthy young gay men.
• On June 5, the Centers for Disease Control & Prevention reports the first case of the illness that will come to be called AIDS.
• Number of known AIDS deaths in United States during 1981: 234.
1982
• The CDC links the new disease to blood. The name Gay-Related Immune Deficiency (GRID) is replaced with Acquired Immunodeficiency Syndrome (AIDS). Disease linked to four risk factors: male homosexuality, intravenous drug use, Haitian origin and Hemophilia A.
• Gay Men’s Health Crisis, the first community AIDS service provider in the U.S., established in New York City.
• First AIDS case reported in Africa.
1983
• The CDC warns blood banks of the risk of infection through transfusion; the first AIDS discrimination trial is held in the U.S.
• People living with AIDS, as they want to be called instead of “AIDS sufferers” or “AIDS victims,” take over plenary stage at U.S. conference and issue statement on the rights of PWAs referred to as The Denver Principles.
• National Association of People with AIDS formed.
1984
• Virus isolated by Luc Montagnier of the Pasteur Institute and Robert Gallo of the National Cancer Institute determined to be cause of AIDS; later named the Human Immunodeficiency Virus (HIV).
• The Secretary of Health & Human Services announces that “a vaccine will be ready for testing within two years.”
• San Francisco officials order gay bathhouses shut down; major public controversies over bathhouses rage in New York and other cities.
1985
• First International AIDS Conference held in Atlanta.
• Rock Hudson (right) announces he has AIDS.
• Ryan White, 14, is barred from attending public school in Indiana because of being HIV-positive.
• First HIV test licensed by the U.S. Food & Drug Administration.
1986
• President Ronald Reagan uses the word “AIDS” in public for the first time.
• Surgeon General C. Everett Koop calls for AIDS education of children of all ages and for widespread use of condoms.
• Ricky Ray, a 9-year-old hemophiliac with HIV, is barred from Florida school and his family’s home is burned by arsonists in the following year. Ray died in 1991.
• Fifth anniversary of AIDS. Cumulative known deaths: 16,301.
1987
• ACT UP — the AIDS Coalition to Unleash Power — founded after a speech by Larry Kramer at the Lesbian & Gay Community Services Center in New York.
• Zidovudine (AZT) is approved to fight AIDS itself.
• U.S. adds HIV as a “dangerous contagious disease” to its immigration exclusion list (right).
• Pianist and performer Liberace dies of AIDS.
• AIDS Memorial Quilt founded (above).
1988
• First World AIDS Day held on Dec. 1.
• ACT UP members demonstrate at FDA offices in Washington, D.C., over slow process for drug approval.
1989
•CDC issues guidelines for preventing Pneumocystis carinii pneumonia, a major cause of death for people with AIDS.
• Choreographer Alvin Ailey dies of AIDS.
• Gay artist Robert Mapplethorpe
dies of AIDS.
1990
• Ryan White dies from AIDS at age 18. The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 is approved by Congress, providing federal funds for community services.
• President George H.W. Bush signs the Americans with Disabilities Act, which in part prohibits discrimination against people with HIV.
• Artist Keith Haring dies of AIDS.
• Fashion designer Halston dies of AIDS.
•CDC issues guidelines for preventing Pneumocystis carinii pneumonia, a major cause of death for people with AIDS.
• Choreographer Alvin Ailey dies of AIDS.
• Gay artist Robert Mapplethorpe dies of AIDS.
1991
• NBA superstar Magic Johnson announces that he has tested positive for HIV and will retire from professional basketball.
• Red ribbon introduced as the international symbol of AIDS awareness at the Tony Awards by Broadway Cares/Equity Fights AIDS and Visual AIDS.
• Freddie Mercury, lead singer of the rock band Queen, dies of AIDS.
• Housing Opportunities for People with AIDS (HOPWA) Act of 1991 enacted by the U.S. Congress, to provide housing assistance to people living with AIDS through grants to U.S. states and local communities.
1992
• The International Olympic Committee rules that athletes with HIV can compete. First clinical trial of multiple drug therapy is held.
• AIDS becomes number one cause of death for U.S. men ages 25 to 44.
• HIV-positive speakers Mary Fisher and Bob Hattoy address the Republican and Democratic National Conventions, respectively.
• Tennis star Arthur Ashe announces he has AIDS.
• “Brady Bunch” star Robert Reed dies of AIDS.
1993
• Arthur Ashe dies from AIDS.
• President Clinton establishes White House Office of National AIDS Policy, commonly known as the office of the “AIDS czar.”
• “Angels in America,” a play about AIDS by Tony Kushner, wins the Tony Award and Pulitzer Prize.
• Ballet dancer Rudolf Nureyev dies of AIDS.
1994
• AIDS becomes leading cause of death for all Americans ages 25 to 44; remains so through 1995.
• Elizabeth Glaser, co-founder of the Pediatric AIDS Foundation, dies of AIDS.
• Pedro Zamora (right),
a HIV-positive gay man, appears on the cast of MTVs popular show, “The Real World.” Zamora dies later that year at age 22.
• Randy Shilts, author of “And the Band Played On,” dies of AIDS at age 42.
1995
• First protease inhibitor, saquinavir, approved in record time by the U.S. FDA, ushering in new era of highly active antiretroviral therapy (HAART).
• First guidelines for the prevention of opportunistic infections in persons infected with HIV issued by CDC.
• First National HIV Testing Day created by the National Association of People with AIDS.
• Olympic Gold Medal diver Greg Louganis announces that he is living with HIV.
• Rap star Easy E (Eric Wright) dies of AIDS.
1996
• At 11th AIDS Conference in Vancouver, new protease inhibitors and combination therapies bring renewed optimism.
• U.S. FDA approves viral load test, a new test that measures the level of HIV in the body.
• The number of new AIDS cases diagnosed in the U.S. declines for first time in history of epidemic, though experience varies by sex, race and ethnicity.
• HIV no longer leading cause of death for all Americans ages 25-44; remains leading cause of death for African Americans in this age group.
1997
• AIDS-related deaths in the U.S. decline by more than 40 percent compared to the prior year, largely due to HAART.
• President Clinton announces goal of finding an effective vaccine in 10 years.
1998
• Minority AIDS Initiative created in U.S. after African-American leaders declare a “state of emergency” and Congressional Black Caucus calls on the Department of Health & Human Services to do the same.
• U.S Department of Health & Human Services issues first national guidelines for the use of antiretroviral therapy in adults.
• First large-scale human trials (Phase III) for an HIV vaccine begin.
• The U.S. Supreme Court in Bragdon vs. Abbot rules that the Americans with Disabilities Act covers those in earlier stages of HIV disease, not just AIDS.
1999
• Study finds that numbers of new HIV infections are rising among young gay men.
2000
• At the 13th AIDS Conference in Durban, South Africa, 5,000 doctors and scientists sign the “Durban Declaration” stating that HIV causes AIDS, in response to South African President Thabo Mbeki’s statements to the contrary.
• CDC reports that, among men who have sex with men in the U.S., African-American and Latino AIDS cases exceed those among whites.
2001
• United Nations General Assembly convenes first-ever special session on AIDS.
• First National Black HIV/AIDS Awareness Day in the United States.
• The World Trade Organization, meeting in Doha, Qatar, announces “DOHA Agreement” to allow developing countries to buy or manufacture generic medications to meet public health crises.
2002
• HIV is leading cause of death worldwide, among those aged 15-59.
• UNAIDS Reports that women comprise about half of all adults living with HIV and AIDS worldwide.
• Approval of OraQuick Rapid HIV-1 Antibody Test, by FDA; first rapid test to use finger prick.
• Cumulative deaths in United States through 2002: 501,669.
2003
• President Bush announces PEPFAR, the President’s Emergency Plan for AIDS Relief, during the State of the Union Address; PEPFAR is a five-year, $15 billion initiative to address HIV/AIDS, tuberculosis, and malaria primarily in hard-hit countries.
• First National Latino AIDS Awareness Day in the United States.
2004
• Leaders of the Group of Eight nations call for creation of “Global HIV Vaccine Enterprise,” a consortium to accelerate research efforts to find an HIV vaccine.
• OraQuick Rapid HIV-1 Antibody Test approved for use with oral fluid by U.S. FDA.
2005
• First National Asian & Pacific Islander HIV/AIDS Awareness Day in the United States.
• In an historic and unprecedented joint news conference, the World Health Organization, UNAIDS, the United States government and the Global Fund to Fight AIDS, Tuberculosis & Malaria announce results of joint efforts to increase the availability of antiretroviral drugs in developing countries.
2006
• 25th anniversary of the outbreak of AIDS.
Sources: Staff reports, Kaiser Family Foundation (www.kff.org), AIDS Education Global Information System (www.aegis.com)
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