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It Hasn't Gone Away


The scourge came upon us rather quietly. In the late spring of 1981 a new president, Ronald Reagan, was rounding up votes for his tax-cut package. Americans were fascinated by Prince Charles's fairy-tale courtship of Lady Diana Spencer, who was routinely referred to as the next queen of England. Al Pacino was starring in David Mamet's "American Buffalo" at the Circle in the Square. And an enormous ad campaign was touting a new movie from the creators of "Jaws" and "Star Wars," an old-fashioned cliffhanger called "Raiders of the Lost Ark."

It was then, almost exactly 20 years ago, that the first hint of a serious problem was detected. On June 5, 1981, the Centers for Disease Control and Prevention published an article in its Morbidity and Mortality Weekly Report that began as follows:

"In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died."

A month later, on July 3, The New York Times ran an article by Lawrence K. Altman that said:

"Doctors in New York and California have diagnosed among homosexual men 41 cases of a rare and often rapidly fatal form of cancer. Eight of the victims died less than 24 months after the diagnosis was made.

"The cause of the outbreak is unknown, and there is as yet no evidence of contagion. But the doctors who have made the diagnoses, mostly in New York City and the San Francisco Bay Area, are alerting other physicians who treat large numbers of homosexual men to the problem in an effort to help identify more cases and to reduce the delay in offering chemotherapy treatment."

The cancer was Kaposi's sarcoma. AIDS was upon us, and the progression of the disease from that early mystifying period would be swift and horrible. But the reaction to the disease, both in the United States and elsewhere, was tragically slow.

Ronald Reagan's biographer, Lou Cannon, wrote: "Reagan's response to this epidemic was halting and ineffective. In the critical years of 1984 and 1985, according to his White House physician, Brigadier General John Hutton, Reagan thought of AIDS as though 'it was measles and it would go away.' "

By the end of 1988, nearly 90,000 Americans had been diagnosed with AIDS and nearly 50,000 had died. By the mid-90's, the peak of the epidemic in the U.S., more than half a million Americans had been diagnosed with AIDS, and more than half of them had died.

Elsewhere the news has been worse. What is happening in Africa is beyond hideous, maybe even beyond comprehension. According to the World Health Organization, more than 25 million people in sub-Saharan Africa are infected with the human immunodeficiency virus, H.I.V., and AIDS. More than 12 million African children have been orphaned by AIDS. Nearly four million Africans were infected with H.I.V. last year.

Worldwide, more than 36 million people are infected with the AIDS virus, and in some places much, much worse is yet to come.

Twenty years after the first scientific paper on the disease we now call AIDS, the world is still not ready to properly fight the epidemic that has already killed more than 23 million people and will soon surpass the lethal toll of the bubonic plague of the Middle Ages.

The countries that have been hit hardest by the disease do not, in many cases, have the money, the medical resources or the sociopolitical infrastructure necessary to fight the disease. (In much of Africa it is still taboo to even talk about AIDS.) And there is no real plan among the wealthier nations to fight AIDS globally.

In the U.S., where AIDS deaths have been reduced dramatically by the use of protease inhibitors and other drugs, a dangerous sense of complacency seems to have settled in. But there are 40,000 new cases of H.I.V. infection each year, and no one knows, really, how long individuals taking the drugs can survive, or whether the virus will mutate, or become resistant to the drugs.

Twenty years later the epidemic is still with us. There is no cure. There is no vaccine. And in a world as interconnected as ours has become, there is no cause for complacency.

Copyright 2001 The New York Times CompanyPrivacy Information

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