The AIDS Epidemic and U.S. Government Policy

The outbreak and spread of AIDS (Acquired Immune Deficiency Syndrome) caught the medical community and the world by surprise. This was a new category of disease, in that it was not the same as bacterial or viral agents that killed by multiplying within the body; rather, AIDS killed by stripping the body of its defenses to other pathogens. As Grmek (1993) observed, “AIDS [was] essentially new in the sense that it was inconceivable until the 1970s” (Grmek, p.x). One factor that, at least as far as many believe, may have had to do with the U.S. government’s allegedly slow response to the AIDS crisis had to do with the politicizing of the disease and the populations most affected by it.

AIDS (as caused by the HIV, or human immunodeficiency virus) was first identified in 1981. was first identified in 1981. During the 1980s, by far the greatest number of those afflicted with the virus was sexually active gay men, along with intravenous drug users (Heyward & Curran, p.74, 76-77). Further research showed why these populations were particularly vulnerable: the AIDS virus is actually not very easily transmitted, and the direct exposure from unprotected anal sex was one of the few significantly dangerous activities, along with the use of contaminated needles by recreational drug consumers. These two populations were stigmatized as a result. For quite some time (including long after the scientific facts were known), AIDS was considered a “gay disease,” and in keeping with the sometimes extreme conservatism of the 1980s, was touted by Christian fundamentalists as well as many in the mainstream media as “God’s punishment for homosexuality.”

It is debatable whether these perceptions had any impact on government policy. The Center for Disease Control (CDC) created a task force on HIV in the early 80s, and significant government resources were, in fact, allocated to the problem. The disease had what was essentially a 100% morbidity rate (over 5 years from diagnosis) and no known treatment, let alone a cure. In 1982, the CDC reported that “Death occurred in 41% of all cases” (CDC, p.1) of those that had been diagnosed between mid-1981 and mid-1982. Obviously, many more of those cases died some time later; in fact, very few of those afflicted with the disease during that time period survived, in the absence of any effective treatment. While the public may have thought that AIDS was a “gay and drug users’ disease” and thus, it posed little threat (in fact, in some of the crueler rhetoric spewed at the time, it was viewed to be a boon as it was wiping out “undesirable” populations), the CDC had no such illusions, and viewed the disease as a grave threat to public health overall. Any misconception that this was a “gay” disease was quickly dispelled when many “normal” people contracted the disease via contaminated transfusions.

Adding to the political nature of the AIDS epidemic was the sharply limited demographic of those afflicted. Heyward and Curran (1988) noted that after several years of the disease, “males between the ages of 25 and 45 are the greatest number of patients with the infection” (Heyward & Curran, p.72). Many of the public thought—wrongly—that AIDS was a danger only to that population, and only to those of that group who were gay and/or used drugs. The rapid spread of the disease, however, underscored its potential to infect large populations. Peterman, Drotman, and Curran (1985) noted that “The number of reported cases of AIDS in the US is increasing rapidly. The first 1000 cases were reported over 17 months, the next 2000 were accumulated over 12 months, and an additional 3000 were recorded in only 11 months” (Peterman et al., p.2). The disease was becoming a general health concern rather than just being confined, as the public had thought, to a specific at-risk population. There were public health “side effects,” as well, such as the suspect nature of blood supplies and serious concern over the hazardous nature of sharps and other medical waste.

By the latter part of the 1990s, it was becoming clear that the population at large was at risk. Philips (1997) observed with alarm that females, a population that had been at first very minimally affected by the AIDS epidemic, were now a significant portion of the afflicted population and that “The acquired immunodeficiency syndrome has become the third leading cause of death among women in the 25-to-44-year-old age group, and the disease ranks first as cause of death among African-American women in that group” (Philips, p.1747). This was despite the fact that it was well known that the HIV virus was not easily transmitted and that condoms dramatically reduced the incidence of transmission. There was, in fact, considerable frustration on the part of health officials, in that the deadly nature of the disease combined with its relative difficulty of transmission should have resulted in a low incidence of infection. U.S. authorities at this time, therefore, increased their focus on AIDS awareness and prevention.

The importance of education at the “street level” had been recognized for some time. It was acknowledged by authorities that it was unrealistic to expect intravenous drug users to curtail their drug use, even in the face of the mortal danger of AIDS. Therefore, a concerted effort was made to supply these people with clean, uncontaminated needles and to educate them on the need to use only such needles. There was also a distribution of bleach to sterilize used needles. Watters (1987) reported that “In terms of cost effectiveness, the MidCity program had significant impact…in a short period of time” (Watters, p.1). The money spent was minimal, with the results significant, but it should be noted that this campaign took place in San Francisco, one of the most liberal and tolerant communities in the world, and one that had already seen a huge devastation in its gay population. Such a use of public funds, however minimal, saw significant push-back from the public in other cities.

That the AIDS virus disproportionately affected (and affects) certain socioeconomic groups made the resources allocated to its prevention and cure a political football in the 1980s and 1990s. Conservative religious groups continued to tout AIDS as “God’s punishment” and questioned the wisdom of using scarce public resources to treat society’s “deviants.” Since the U.S. had no public healthcare insurance system, many of those living in urban poverty and diagnosed with AIDS went untreated and thus experienced high mortality. Singer (1994) noted this effect: “The social identity of HIV/AIDS has been shaped…by the prevailing configuration of social relations across class, race, gender, and sexual orientation” (Singer, p.931). AIDS was no longer just a “gay disease”; it was also a poor person’s disease. Another example of this effect was shown in a later study by Spaulding et al. (2009), who noted that prison populations were another high at-risk group: “Seroprevalence was high early in the epidemic; 16.2% of men and 25.1% of women tested for HIV in 1989 at the New York City jail…were found to be HIV-positive (Spaulding et al., p.7558). The authors also noted that increased awareness of the proper methods of AIDS treatment and prevention had by the time of the study significantly reduced this number.

It appears that any public perceptions of a supposed lack of effort on the part of U.S. medical authorities to deal with the AIDS epidemic are not based on fact. The initial seemingly slow response on the part of the CDC and other agencies was due not to any kind of indifference but rather, to the fact that no one quite knew what they were dealing with. The HIV virus proved amazingly difficult to eradicate. In the early years of the epidemic, anyone with HIV was pretty much doomed, so naturally, efforts focused on education and prevention at first. This was misconstrued by many as showing a lack of concern for those who were already suffering from the disease. The outcries of conservative and religious groups certainly helped to reinforce this misconception. U.S. authorities, in fact, always viewed the AIDS epidemic as a serious threat.

References

Centers for Disease Control (CDC. (1982). Update on acquired immune deficiency syndrome (AIDS)--United States. MMWR. Morbidity and mortality weekly report, 31(37), 507.

Heyward, W. L., & Curran, J. W. (1988). The epidemiology of AIDS in the US. Scientific American, 259(4), 72-81.

Grmek, M. D. (1993). History of AIDS: emergence and origin of a modern pandemic. Princeton, NJ: Princeton University Press.

Peterman, T. A., Drotman, D. P., & Curran, J. W. (1985). Epidemiology of the acquired immunodeficiency syndrome (AIDS). Epidemiologic Reviews, 7, 1-21.

Phillips, P. (1997). No plateau for HIV/AIDS epidemic in US women. JAMA: the Journal of the American Medical Association, 277(22), 1747-1749.

Singer, M. (1994). AIDS and the health crisis of the US urban poor; the perspective of critical medical anthropology. Social Science & Medicine, 39(7), 931-948.

Spaulding, A. C., Seals, R. M., Page, M. J., Brzozowski, A. K., Rhodes, W., & Hammett, T. M. (2009). HIV/AIDS among inmates of and releasees from US correctional facilities, 2006: declining share of epidemic but persistent public health opportunity. PLoS One, 4(11), e7558.

Watters, J. K. (1987, June). Preventing human immunodeficiency virus contagion among intravenous drug users: the impact of street-based education on risk-behavior. [Unpublished] 1987. Presented at the III International Conference on AIDS. Washington, DC: June 2 1987.