1982: what does AIDS mean?

As currently understood, the recently characterized syndrome of acquired immune-deficiency (AIDS) is at once the first epidemic of immune-deficiency and the deadliest sexually transmitted disease in recorded medical history. Having already claimed more lives than the combined tolls of toxic-shock syndrome and the Philadelphia outbreak of Legionnaire's disease, it is also, according to federal health officers, the most important new public health problem in the United States.

"New," emphasizes Dr. James Curran, coordinator of the Task Force on Kaposi's Sarcoma and Opportunistic Infections for the U.S. Centers for Disease Control (CDC) in Atlanta. "This obviously doesn't have the proportions of such longstanding public health problems as hepatitis. At least not yet."

Thus far, a poorly understood disorder of cellular immunity is believed to be responsible for the more than 634 cases of Kaposi's sarcoma (KS), pneumocystis carinii pneumonia and a rapidly growing number of cases of other unusual, often fatal, opportunistic infections and other cancers that have been reported to CDC during the last two years. Lately, these reports have been accumulating at an escalating rate of 2-3 new cases each day. Approximately 75% of the victims have been characterized as homosexually active ("homosexual or bisexual") men in their twenties, thirties, and forties. But CDC figures now include a growing proportion of heterosexual men and women.

Most of the non-gay victims have histories of intravenous drug addiction. But other victim subpopulations include native and immigrant Haitians and several hemophiliacs. Although cases have been identified in 25 states and 10 foreign countries, nearly half of all reports have originated from New York City.

In many instances, there are treatments for the infections and malignancies, but there is no known cure for the immunological abnormalities that appear to underlie them. Conversely, researchers don't seem to be much closer to detecting the cause(s) of this disaster than they were a year ago. While most observers believe a sexually and parenterally transmissible agent to be a critical factor in the epidemic, they have not yet identified a virus, drug, or other "smoking gun" that could explain all cases.

What does AIDS mean? For a growing number of health care providers and medical researchers, AIDS is having to sell itself more as an "unprecedented" opportunity to study the entanglements of immunity with infectious and malignant disease processes than as a human and public health tragedy. For victims of the syndrome, it has meant incomprehensible physical and spiritual suffering, intensified by cultural stigma and extending the probability of death. For their significant others, it means the experience of grief, intensified by bitter and unfocused recrimination. For those at risk, it means fear, extending in some instances to panic. For the America of moral theologians, it means the wages of sin. And for what Wilhem Reich called the sexual revolution, AIDS, like the herpes epidemic, could mean an unprecedented counterrevolution of preventative medical approaches and control of sexually transmitted diseases. For better of for worse, it could also facilitate what John Money has called the "reconciliation of sexosophy and sexology the two halves of one whole."

Excepted from SIECUS Report, Volume 11, Number 2, November 1982.

Lawrence Mass, M.D.