Images provided by The New-York Historical Society
The early history of the AIDS epidemic in New York City—from the first rumors in 1981 of a “gay plague” through the ensuing period of intense activism (ACT-UP), clinical research, and political struggle—will be the subject of a major new exhibition at the New-York Historical Society (170 Central Park West, New York, NY 10024), AIDS in New York: The First Five Years, on view from June 7 through September 15, 2013.
At the beginning of the 1980s, various reports began to emerge in California and New York of a small number of men who had been diagnosed with rare forms of cancer and/or pneumonia. The cancer, Kaposi’s Sarcoma, normally only affected elderly men of Mediterranean or Jewish heritage and young adult African men. The pneumonia, Pneumocystis Pneumonia Carinii (PCP), is generally only found in individuals with seriously compromised immune systems. However, the men were young and had previously been in relatively good health. The only other characteristic that connected them was that they were all gay.
It now seems clear (and has been proven) that HIV, the human immunodeficiency virus itself, has been around for decades, conceivably even for centuries. We may also never know when HIV first crossed over from its original animal hosts. But when one is thinking of “AIDS” — Acquired Immunodeficiency Syndrome — as a medical construct, a classification created by medical and public health authorities, it becomes easy to pinpoint the specific day on which AIDS first came into view: June 5, 1981.
On that day, of course, no one had ever heard of HIV or of AIDS (which was first known by several other names particularly GRID – Gay-Related Immune Deficiency). Previously, throughout the 1970s, small numbers of people had been dying from HIV-related causes, one at a time, here and there. But such deaths were rare enough and random enough for no real pattern to emerge. And so, it was not until mid-1981 that the epidemic first reached proportions large enough for it to be picked up by the public health monitoring and surveillance system.
It thus came to be that on June 5, 1981 the Center for Disease Control and Protection publication Morbidity and Mortality Weekly Report (MMWR) included a nondescript article entitled simply “Pneumocystis Pneumonia — Los Angeles.” Based on cases from Drs. Michael Gottlieb and Joel Weisman, this is the so-called “Document Zero” of the AIDS epidemic, the one from which all others proceed.
“In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia (PCP) at 3 different hospitals in Los Angeles,” began the article.
“Pneumocystis pneumonia in the United States is almost exclusively limited to severely immunosuppressed patients,” continued the article, in the first signal of things to come. “The fact that these patients were all homosexuals suggests an association between some aspect of a homosexual lifestyle or disease acquired through sexual contact and Pneumocystis pneumonia in this population . . . . [raising] the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections.”
The article then went on to recount the five case histories, which encapsulate an early history of the sudden, ferocious impact of AIDS. A “previously healthy 33-year old man” developed PCP and oral candidiasis, dying May 3, 1981. Another 30-year-old man was diagnosed with PCP after “a 5-month history of fever each day and of elevated liver function tests“; yet another had esophageal and oral candidiasis. And a 29-year-old man, who three years earlier had battled Hodgkin’s disease, died in March 1981. The last, at age 36, had cytomegalovirus (CMV) infection and a “4-month history of fever, dyspnea, and cough.”
What might have been seen as an obscure, easily forgotten medical footnote became more troubling a month later when the July 3, 1981 issue of MMWR reported yet another trend: “During the past 30 months, Kaposi’s sarcoma (KS), an uncommonly reported malignancy in the United States, has been diagnosed in 26 homosexual men.” The article also indicated the diagnosis of 10 additional cases of pneumonia among gay men in Los Angeles and the San Francisco Bay Area. And so it noted, dryly, that “physicians should be alert for Kaposi’s sarcoma, PC pneumonia, and other opportunistic infections associated with immunosuppression in homosexual men.”
The issue burst into the forefront of the new when The New York TImes, on July 3, 1981, published the first report of the illness in an article entititled “RARE CANCER SEEN IN 41 HOMOSEXUALS“, written by Dr. Lawrence K. Altman, which opened with “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.” Buried on the inside of the first section of The Times on page A20, the article none the same, was the shot heard around the world and the opening of what has become one of the more storied medical fights in the annals of medical history. Continue reading