While the world was busy celebrating the eradication of smallpox in 1980, a new virus was just about to invade America—a virus that would come to define the public health landscape for the next few decades. The first HIV cases were reported in the U.S. in 1981 and peaked in 1993. As of 2014, around 37 million people were living with HIV globally, with over half of them concentrated in sub-Saharan Africa.
Acquired immune deficiency syndrome (AIDS) has an incubation period of six to eight weeks, followed by flu-like symptoms such as fever, muscular aches, fatigue, and sometimes diarrhea. These symptoms then subside, often not reemerging for up to 10 years. All the while, the virus continues to multiply and destroy the cells of the immune system. Eventually, rare infections would start to appear during the beginning of the epidemic, claiming the lives of their victims within two to three years if left untreated. Modern medicine has developed a potent cocktail of drugs that manages symptoms and reduces opportunistic infections. Antiretroviral therapies such as AZT, first approved by the FDA in 1987, are particularly effective at lowering the viral load.
HIV spreads through bodily fluids during sexual contact as well as via blood transfusions, infected needles, and congenitally from mother to child. Active AIDS is formally defined as having fewer than 200 CD4 T-cells per micro-liter of blood (compared to the normal count of 800 to 1200). Because these cells regulate antibodies in the immune system, having fewer of them reduces the body’s ability to fend off opportunistic infections. Eventually, people would die of rare and exotic diseases; pneumocystis pneumonia was one of the most common initial conditions, Kaposi’s sarcoma became known as “gay cancer,” and tuberculosis has been on the rise after years of steady decline.
The initial public health response was neither coherent nor effective. Although the Centers for Disease Control and Prevention (CDC) had warned of the dangers of blood contamination in the early 1980s, screening was not performed by the Red Cross until Luc Montagnier of the Pasteur Institute isolated the virus and developed an effective blood diagnostic test in 1984. By then, half of all hemophiliacs (who needed concentrated pooled serum from blood banks to prevent bleeding) were HIV-positive.
Since HIV overwhelmingly affected gay men and drug users, the Reagan administration turned a blind eye for many years and slashed healthcare budgets just as new cases were on the rise. Many of the early victims made matters worse by refusing to get screened for fear of being ostracized or losing their jobs. As an extreme example, the Canadian airline steward Gaëtan Dugas—widely known as Patient Zero—claimed that he had 250 sexual partners per year and carried on with unprotected sex even after finding out that he was HIV-positive.
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