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Opportunistic Infections

AIDS in America is 25 years old today, and so is the stigma that goes with it. Will future generations will look back at June 5th, 2006 as Year One in the fight against Stigma?

Jim Burroway

June 5, 2006
Pneumocystis Pneumonia — Los Angeles

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. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection…

Pneumocystis pneumonia in the United States is almost exclusively limited to severely immunosuppressed patients. The occurrence of pneumocystosis in these 5 previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual. 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…

All of the above observations suggest the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections such as pneumocystosis and candidiasis.1

MRSA: The New Gay Plague?

Twenty five years after AIDS emerged into America's consciousness, the same pattern of stigmatizing the gay community as a diseased threat to society played out again. This time, it was due to erroneous reports of a “flesh-eating superbug” rampaging through the Castro. Read more in “Testing the Premise: Is MRSA the New Gay Plague?”

When this report from the Centers for Disease Control and Prevention appeared on June 5, 1981, the world got its first glimpse into a puzzling new disorder that had begun striking gay men. These young, otherwise healthy men were suddenly dying of diseases that ordinary immune systems would have dispatched without the slightest problem. But something had destroyed their immune systems, allowing these otherwise innocuous infections an opportunity to take root and overwhelm them. Doctors refer to these diseases as opportunistic infections, diseases which take advantage of gaps in the immune system.

The CDC followed up a month later with another report of twenty-six gay men in New York and California who were suffering from Kaposi’s sarcoma (KS).2 Until then, KS was a rare skin cancer that was typically found only among older Mediterranean or Central African men. In its classic form, it spread slowly and was usually treatable. But in these young men, it struck suddenly and spread very quickly, killing eight within twenty-four months.

Taken together, these two reports signaled the start of a brand new epidemic, and this epidemic was inextricably tied with homosexuality from the very beginning. First dubbed Gay-Related Immune Disease (GRID) or “gay cancer”, it later became known as the Acquired Immune Deficiency Syndrome (AIDS). Today marks the twenty-fifth anniversary of “The Gay Plague.”

Pneumocystis carinii pneumonia (PCP), Cryptococcis, candidiasis, KS — these and others became signature opportunistic infections striking gay men. But there were other opportunistic diseases which took hold in society as AIDS began to spread: fear, bigotry, backlash, and the most persistent, stigma. AIDS not only gave opportunistic infections an easy entry into the bodies of those harboring the HIV virus, but it also gave opportunistic anti-gay activists an easy entry into American politics.

The poor homosexuals — they have declared war upon nature, and now nature is exacting an awful retribution. — Patrick Buchanan3

AIDS is God’s judgment on a society that does not live by His rules. — Jerry Falwell4

At first, it was a common assumption that there was something unique about the so-called “homosexual lifestyle” that caused AIDS. This was actually a comforting thought for many; “normal people” wouldn’t have anything to worry about. Even some scientists bought into this assumption as they proposed all sorts of theories to explain what could cause AIDS. These theories included marijuana use,5 alkyl nitrates (or “poppers,” used as a sexual stimulant),6 or repeated exposure to sperm and seman.7 Even hydrocortisone creams came under suspicion.8 All this despite marijuana having been around for decades with no apparent destruction of the immune system, alkyl nitrates and hydrocortisone creams were used by gays and straight alike, and women have been repeatedly exposed to semen for all of human history.

Anti-gay assumptions surrounding AIDS were so strong that some refused to believe that the same illness was showing up among intravenous drug users, hemophiliacs, and other heterosexuals. According to one popular theory, AIDS was caused by repeated exposure to sperm and multiple sexually transmitted diseases.9 As for anyone else, “we cannot, at this time, explain why AIDS is thought to be occurring in Haitians, hemophiliacs and others [emphasis mine].”10

After the discovery of the Human Immunodeficiency Virus (HIV) as the cause of AIDS, fears among the general population exploded. If AIDS really was caused by a virus, then that meant that anybody could become infected. Gay men were then blamed for endangering all of society with this deadly disease, which only reinforced the stigma of AIDS.

The stigma surrounding homosexuality led directly to the stigma surrounding AIDS, and the two stigmas became one and the same. Stigma against people with AIDS doubled back onto the gay community, affecting gay men and lesbians alike — even though lesbians generally weren’t coming down with the disease. Stigma proved to be a blunt opportunistic infection that knows no fine distinctions.

When I was told that I’d contracted this virus it didn’t take me long to realize that I”d contracted a diseased society as well. — David Wojnarowicz; artist, writer, filmmaker11

The Tip Of The Iceberg

Gay men in America were blamed for the AIDS epidemic because they were the first to be noticed with the disease. But across the Atlanitc, a very different association was being made.

In 1981, just as American doctors began publishing the first reports in American medical journals, Belgian doctors were troubled by a patient they had been treating.12 A Zairian woman had checked into a Brussels hospital complaining of fever and weakness, where she was diagnosed with tuberculosis. With treatment, she appeared to recover and was released. But six months later, she returned with fever and difficulty with breathing. This time doctors discovered that she was suffering from PCP, the same rare pneumonia that was afflicting gay men in the United States. She was treated and discharged three weeks later. But then she returned in March 1982 with Salmonella typhimurium, another unusual opportunistic infection. She never recovered, dying just four days later. During her autopsy, doctors discovered that not only was she still suffering from PCP, she was infected with Cryptococcis as well. The progression of her disease was remarkably like those of gay men in America.

As word spread about the new disease in America, European doctors began to comb through their records looking for similar cases. Swedish doctors recalled an eight-year-old boy from Zaire.13 Born in August 1974, he was diagnosed with tuberculosis before he was five months old, and suffered repeatedly from pneumonia during early childhood. To obtain better medical care for their son, his parents moved to Sweden in 1978, where he was hospitalized more than twenty times over the next three years for pneumonia, oral candidiasis, diarrhea, and weight loss. Before he turned six, he came down with PCP. By seven, he started to show signs of mental deterioration, followed by additional signs of nerve damage, septic fever, and difficulty with breathing. He died in September 1982. Doctors preserved blood drawn in 1981 and 1982, and when HIV testing later became available he was found to have been HIV-positive. The doctors concluded that “it is likely that this child developed AIDS early in 1975, long before the AIDS epidemic was apparent in the United States.”

Another doctor, noting the strange cases in American and Europe, wrote to the British journal Lancet of a Danish surgeon who had worked in a primitive hospital in rural Zaire between 1972 and 1975.14 She also showed signs of the same disease. While she was still in Zaire, she suffered from diarrhea, fatigue, severe weight loss and swollen lymph glands — all the classic symptoms of AIDS. When she became gravely ill in July 1977 while on vacation in South Africa, she flew home to Denmark and checked into a local hospital. There she was found to be suffering from PCP and oral candidiasis. She was treated and discharged, but she returned in November as her health worsened. She died in December. According to her doctors, she remembered “at least one case of KS while working in northern Zaire, and while working as a surgeon under primitive conditions she must have been heavily exposed to blood and excretions of African patients.”

Other Belgian doctors noted that of all the AIDS cases they treated between 1979 and 1983, 92% were African immigrants who either lived in Belgium or traveled there for medical care. None of these patients were homosexual, drug abusers or taking any medication before becoming ill. These doctors worried that because they were only seeing wealthy Zairians who could afford to go to Belgium, “it is likely that AIDS is endemic now in Central Africa, and that cases seen in Belgium represent only the tip of the iceberg.”15

Cry Africa

The fears of those Belgium doctors were quickly confirmed.

Before AIDS, a very rare form of skin cancer, Kaposi’s sarcoma (KS), was more common in Central Africa than anywhere else, accounting for nearly 9% of all malignant tumors in eastern Zaire.16 While the classic form of KS was very severe, it was slow growing and often treatable. But Dr. Kapita Bila, working in the 2,000-bed Mama Yemo Hospital, Kinshasa’s largest public hospital, noted an explosion of a new aggressive form of KS in the mid-1970’s, remarkably similar to what many AIDS patients in Europe and North America later experienced.17 More than a decade later when the first HIV tests were developed, scientists noted that the single distinguishing feature between African patients suffering from the classic form of KS and the new aggressive form was that those with aggressive KS were all HIV-positive.18

Canadian doctor Arnold Voth also worked at the same hospital between 1974 and 1978, where he and his colleagues saw lots of patients who were probably suffering from AIDS:

Patients presenting with uncontrollable diarrhea and weight loss and going on to die were well-known to clinicians at that time. They became even more well-known in the following ten years.19

It wasn’t until Dr. Voth returned to Canada in 1983 and read the medical reports about AIDS that he realized that this was what he saw in Zaire almost a decade earlier. Other doctors in Kinshasa combed through their medical records and discovered similar cases during the same timeframe.20 When this disease appeared in Uganda, the severe wasting and diarrhea led people there to give this new mysterious disease the sardonic name “Slim.”21

More evidence emerged to reveal that AIDS had been silently killing people long before the 1970’s. The best evidence came from a blood sample taken in Kinshasa clear back in 1959 during a malaria study. When that preserved sample was tested in 1986, it tested positive for the HIV virus.22 Other stored blood samples from Central Africans taken in 1960’s and 1970’s tested positive as well. According to one expert:

If the prevalence detected in those collections is at all representative, several hundred or several thousand HIV infections may already have existed in Kinshasa in 1959 and 1970, several tens of thousands by 1980, and tens or hundreds of HIV infections in (the Zairian province of) Equateur by 1976…23

Scientists now know that the HIV virus originated in the Congo River basin of equatorial Africa, and that the epidemic had been going on as far back as the late 1950’s.24 There is even some evidence to suggest that the HIV virus itself has been around since between 1915 and 1941, when it evolved from a very similar virus (SIV, or Simian Immunodeficiency Virus) present in chimpanzees. It is unknown when HIV first appeared in humans.25

Most of the opportunistic infections common among African AIDS patients were similar to other common diseases Africans had been suffering for decades.26 These opportunistic infections simply went unnoticed in a land with few overworked doctors and laboratory facilities, massive social disruptions, poverty, and poor communications. In 1960’s, the ratio of doctors to the Belgian population may have been one for many tens or even hundreds of thousands.27 Overwhelmed doctors didn’t have the luxury of time for writing up unusual cases for medical journals like their European and American counterparts. It would have been easy for unusual diseases and even extensive outbreaks to go unreported. It wasn’t until wealthy Africans began seeking treatment in Europe that the true scope of the epidemic became known to the wider world.

Stigma With A Capital “S”

When the doctor reported the case of the Danish surgeon to the British journal Lancet, he closed his letter with this suggestion:

During my stay in Zaire in 1976 I was impressed by the epidemiological and virological flying teams from the USA and Europe who quickly identified the Ebola virus. Perhaps such teams should search for another African virus, albeit slow killing, and explore the possible connection between endemic and epidemic AIDS/KS in Africa and America.28

Unfortunately, the American attitude towards AIDS would always be very different from the European one. While the medical community was very interested in what was going on in Africa (American researchers finally made the trip to Zaire in 1984), many Americans dismissed the possibility of an African connection because it only meant one thing: If African men and women were succumbing to heterosexually-acquired AIDS, then everyone was at risk. The stigma attached to AIDS insisted that such a thing was impossible. Stories appeared in the conservative press dismissing the African AIDS epidemic as a fraud; this one as late as 1993:

To a remarkable extent AIDS has remained confined to homosexuals and drug addicts. The African AIDS epidemic now looks very fishy … Die in an auto accident in Kampala, it’s said, and you may be counted as an AIDS statistic.29

Americans with AIDS were not only battling the many opportunistic infections that came their way, they also were in a constant struggle against a persistent opportunistic infection that was taking hold all across society. Stigma became so great that it has taken on a life of its own, worthy of being regarded as its own syndrome — Stigma with a capital “S”. Despite AIDS being a primarily heterosexual disease worldwide, Stigma was firmly implanted in the American body politic from where it refused to budge.30

Stigma provides the strongest explanation for why the official response was so different toward AIDS. When 29 people died of Legionnaire’s disease at a Philadelphia hotel in 1976, the Centers for Disease Control and Prevention immediately threw its entire weight into the problem and identified the source of the disease within months.31 There was little talk of money or appropriations; Congress and the Ford administration simply footed the bill. But this time when CDC investigators were prepared to throw everything they had against AIDS, they ran into a Reagan administration that was on a cost-cutting binge, instituting a near freeze on all public health funding on the belief that health care would be better handled at the local level.

White House officials insisted that the already stretched CDC had all the money they needed to combat AIDS. The dedicated CDC researchers who were assigned to the AIDS task force worked heroically, but without adequate funding and support there was little they could accomplish. It was difficult enough just keeping up with all the new case reports pouring in. Two years after the first report was published, the CDC still didn’t have the budget to hire statisticians to make sense of the data. Without that, they couldn’t definitively say which sexual behaviors were responsible for spreading AIDS. There were no funds for basic lab work on tissue and blood specimens. One frustrated researcher even had a request for a textbook on retroviruses turned down.32

As long as Stigma continued to infect society, there would be little political support for spending taxpayer dollars on AIDS. Proposals for AIDS funding faced opposition not only from the key officials in the Reagan administration for fiscal reasons, they also stoked outrage from social conservatives who proclaimed such funding immoral:

“What I see is a commitment to spend our tax dollars on research to allow these diseased homosexuals to go back to their perverted practices without any standards of accountability.” — Ronald Goodwin, vice president of Moral Majority.33

Stigma provided the opportunity for hundreds, then thousands of Americans to fall to the disease. Whenever AIDS was discussed in the public sphere, it was the gay community that repeatedly came under fire for endangering the entire nation:

If homosexuals are not stopped, they will in time infect the entire nation, and America will be destroyed. — Rev. Greg Dixon, Moral Majority spokesman.34

Everyone detected with AIDS should be tattooed in the upper forearm, to protect common-needle users, and on the buttocks, to prevent the victimization of other homosexuals. — William F. Buckley, Jr.35

I think we should do what the Bible says and cut their throats. — Rev. Walter Alexander, First Baptist Church, Reno36

Rep. William Dannemeyer (R-Ca) was one of the most strident anti-gay voices in Congress. He hired Paul Cameron as his AIDS adviser, who was an early advocate of quarantining AIDS patients.37 Rep. Dannemeyer repeatedly demanded that Surgeon General C. Everett Koop begin mandatory testing of all gay men for AIDS and their names entered into a national database. Dr. Koop refused, believing that it would drive the disease underground and keep people from seeking treatment. At one point, Rep. Dannemeyer telephoned the Surgeon General and demanded to know why he refused to begin mandatory testing and reporting. Dr. Koop recounted that phone call, in which he told Rep. Dannemeyer:

“I told you, that’s not within the power of the Surgeon General, but for reasons I’ve also explained over and over, I wouldn’t do it if I could. But suppose just for the sake of argument, I could and did. Suppose I called you next week and said I now knew who every seropositive [HIV-positive] person was in the whole United States. What would you do?”

After a long pause, Dannemeyer, as I recall, replied, “Wipe them off the face of the earth!”38

Guilt and Innocence

While Stigma linked homosexuality to AIDS in the minds of most Americans, it soon became obvious that it wasn’t just gay men getting sick, and this led some to try to distinguish between the “guilty” and the “innocent.” Senator David Pryor (D-AK) noted that people with AIDS “are not necessarily homosexuals and once again they are not from San Francisco or just New York. They are children whose only sin is to be born.”39 Yet no matter how the lines were drawn, gays were always guilty, and everyone else was innocent. One observer noted:

According to the term’s users — the media, public health officials, politicians — the “general population” is virtuously going about its business, which is not pleasure-seeking (as drugs and gay life are uniformly imagined to be), so AIDS hits its members as an assault from diseased hedonists upon hard-working innocents.40

Stigma allowed the lines between the “guilty” and “innocent” to blur in some very illogical ways. Conservative columnist Patrick Buchanan accorded intravenous drug abusers and “unsuspecting” prostitutes the status of innocent victims:

There is one, only one, cause of the AIDS crisis — the willful refusal of homosexuals to cease indulging in the immoral, unnatural, unsanitary, unhealthy, and suicidal practice of anal intercourse, which is the primary means by which the AIDS virus is being spread throughout the “gay” community, and, thence, into the needles of IV drug abusers, the transfusions of hemophiliacs, and the bloodstreams of unsuspecting health workers, prostitutes, lovers, wives and children.41

Yet “innocence” afforded very little immunity to Stigma. People with AIDS were evicted from their homes, fired by their employees and shunned by their families.42 Three young boys with AIDS were refused admission to the De Soto County School District in Florida, their barber refused to cut their hair and their church suggested they stay away from Sunday services. After a federal judge ordered the school district to enroll the children, they endured intimidating phone calls and two bomb threats before their home was destroyed by arson. They moved to a motel, but were evicted after the owners learned of the boys’ status. They had no choice but to move away.43

While thousands of people had been dying horrible deaths from AIDS in Africa for decades, there was only one group of people to blame for the origin of AIDS as far as many Americans were concerned:

It seems pretty clear if homosexuals hadn’t come out of the closet and started sodomizing one another all over the world, none of this would have gotten started in the first place. It’s safe to say AIDS is the first and greatest by-product of the Gay Liberation Movement. — Paul Cameron44

It finally took the quiet dignity of a fresh-faced teenager from Indiana to put a face on AIDS that was innocent enough for public sympathy. The federal program which today provides AIDS medication to low-income patients came about as a result of the Ryan White CARE Act of 1990.45 This legislation, the first to provide for the care and treatment of people with AIDS, was enacted more than nine full years after the epidemic was first noticed.

A New Divide: Orphans vs. “Deathstyle”

By the early nineties, the picture had changed dramatically. Improvements in medicine and prevention strategies led to a 45% drop nationwide in the number of new AIDS diagnosis from its peak in 1993.46 In New York, Los Angeles and San Francisco, long considered the epicenters of the crisis, the drops were even more dramatic. New cases fell by more than 60% in New York47 and Los Angeles,48 while in San Francisco that drop was more than 80%.49

In 1995, highly active anti-retroviral therapy (HAART, also known as the “AIDS cocktail”) became available, and this reduced the annual number of deaths by nearly 70% nationwide over the next two years. As AIDS moved from being a fatal disease to being a very serious and chronic but often manageable one, fears surrounding AIDS receded along with it. But Stigma remains.

Where the 1980’s was marked with a distinction between the “guilty” and the “innocent,” a new divide has emerged in American’s attitudes toward people with AIDS. Africa has now given American religious and political leaders an acceptable way to confront the AIDS crisis. Like the stories of famines in central Africa of the 1980’s and 1990’s, African AIDS has all the elements that tug on the heartstrings of Americans: images of destroyed families, leaving thousands of orphans left to fend for themselves. Because AIDS in Africa isn’t associated with homosexuality or drug use, American leaders can now attack the problems associated with HIV and AIDS while avoiding the social issues surrounding homosexuality.

During the 2003 State of the Union address, President George W. Bush announced a massive $15 billion effort to combat AIDS overseas over the next five years, representing one of the largest single AIDS initiatives in U.S. history. In his speech, the President spoke of a doctor in Uganda who told his patients that he couldn’t help him because there was no money to pay for the expensive medication. President Bush concluded, “In an age of miraculous medicines, no person should ever have to hear these words.”50

Comparison of the Number of People with AIDS and ADAP fundingYet many Americans with AIDS hear exactly those words today. As of February 2006, nine states had waiting lists for low-income people seeking medication through the Ryan White CARE Act. At one point, North Carolina had 891 patients on its waiting list. Other states have severely tightened eligibility requirements, leaving more people unable to get the medicines they need to stay alive.51 As people with AIDS live longer and the rate of new infections remain level, federal funding of the AIDS Drugs Assistance Program (ADAP) under the Ryan White CARE Act has remained essentially flat.52

Conservative religious groups have driven much of AIDS public policy at home and around the world, and their response to the epidemic in Africa has been remarkable. Orange County, California’s massive Saddleback Church established the goal of partnering each of its 2,800 small groups with a village in Africa.53 World Vision ministries and Franklin Graham’s Samaritan’s Purse established massive worldwide programs for AIDS care and prevention.54 Thomas Nelson Publisher, one of the nation’s largest Bible publishing houses, responded with a book targeted at American evangelical congregations entitled The aWAKE Project: Uniting Against the African AIDS Crisis.55 Bruce Wilkinson, author of the best-selling book The Prayer of Jabez, moved to Johannesburg, South Africa and founded Dream for Africa, with the goal of establishing housing for 10,000 AIDS orphans.56 Throughout history, religious organizations have been at the fore in providing medical care for the less fortunate, and Christianity’s response to the crisis in Africa stands as a shining testament to its commitment to take care of “the least of these” (Matthew 25:4057).

But when it comes to AIDS domestically, things are different. Many moderate and liberal religious organizations such as the National Episcopal AIDS Coalition, various interfaith groups and local churches (especially those that are inclusive toward gays and lesbians) have served people with AIDS for decades. In San Francisco, Catholic Charities provides housing for people with HIV and AIDS.58

But with few exceptions, conservative Christian organizations tend to hold a very different attitude toward HIV and AIDS at home. A search of James Dobson’s Focus On the Family web site reveals that discussions about AIDS falls into three broad categories: encouragement of the Bush Administration’s world AIDS initiative, denouncing AIDS prevention strategies that stray from an abstinence-only message, and the conflation of AIDS with the “homosexual lifestyle.” Most postings fall roughly in the second two categories. The same is true with Tony Perkins’ Family Research Council web site. At Donald Wildmon’s American Family Association web site, postings about AIDS fall almost exclusively in the last two categories, as do postings at D. James Kennedy’s Center to Reclaim America web site, while Lou Sheldon’s Traditional Values Coalition web site mentions AIDS almost exclusively in conjunction with condemnations of the “homosexual lifestyle.”59 It’s no wonder that in a recent national probability-sampled survey, people who were religious were twice as likely to erroneously believe that two HIV-negative men can catch AIDS through homosexual intercourse.60

Over the past fifteen years, we’ve seen a growth the proportion of HIV and AIDS among African-Americans, men and women infected through heterosexual contact, and residents of Southeastern states.61 Despite the expanding scope of the epidemic, many anti-gay extremists would have us believe that being gay is a guaranteed death sentence.62 A few have even gone so far as to call homosexuality a “deathstyle,”63 like this columnist that appeared in the The Washington Times’ op-ed page just eighteen months ago:

What the (gay) activists really want is the stamp of acceptance on homosexuality, as a means of spreading that lifestyle, which has become a deathstyle in the AIDS era.” — Thomas Sowell64

A New Beginning?

June 5, 1981 does not mark the beginning of AIDS. Molecular evidence suggests that the HIV virus is closer to seventy-five years old, and AIDS had been quietly killing thousands for decades before those five young men died in Los Angeles. But June 5, 1981 does mark a watershed event. It’s a fulcrum point in history, separating our measurement of time between “Before AIDS” and “After AIDS”, much as western history is divided between “Before Christ” and “Anno Domini.”65 June 5, 1981 is New Year’s Day for Year One of AIDS. It marks the moment in history that changed everything for gay men (and lesbians, who have been dragged along for the ride by Stigma) — and for everyone else in the US and around the world.

We know how to prevent many of the opportunistic infections that can take hold of someone who harbors the HIV virus. But there is one opportunistic infection that has not been dealt with. Stigma still stalks all those who are living with HIV and AIDS.

Those whose mission it is to take care of “the least of these” have a special responsibility in the war on Stigma, yet startlingly few have even recognized the problem. But remember Saddleback Church, which set the goal of partnering 2,800 small groups with a village in Africa? When Kay Warren, wife of Saddleback Pastor Rick Warren, was flying back from Africa to see the devastation first hand, she suddenly realized that this was the same pandemic that was affecting people in her own backyard. That’s when she decided to establish a group to work with AIDS charities in Orange County.66

Results are mixed so far; Stigma has done a lot to poison the waters. Kay Warren’s late realization about AIDS in America may look bizarre to those who have been caring for people with AIDS for decades. Many longtime AIDS volunteers look askance at these latecomers, asking where they’ve been all these years. Some worry that it’s just another strategy to try to convert gay people into straight. There are twenty-five years of mistrust to overcome, and church members are now getting a close-up look at the role Stigma has played in the epidemic. One church member observes, “I think the biggest problem will be the stigma. People in the church have been uneducated about this.” Whether they will show the patience and forbearing it will require to overcome suspicions remain to be seen.

Those few researchers back in the 1980’s couldn’t make much of a dent against AIDS as long as society’s leaders remained noncommittal. The same can be said about Stigma. Until many more political and religious leaders recognize the crippling impact Stigma has had, and until they are willing to dedicate their own time and resources to battle this infection, we won’t see much headway. After Year One, it took fifteen years before we could begin to see a reduction in number of deaths due to opportunistic infections characteristic of AIDS. It may take another fifteen years or more before we begin to see similar results against Stigma.

And yet, whether our religious and political leaders are prepared to recognize it or not, that is the task before us today as we observe this important milestone. In memory of all who have died, and for the sake of the dignity of all who live, we have a sacred obligation to make June 5, 2006 Year One in the fight against Stigma.


1. Centers for Disease Control and Prevention. “Pneumocystis pneumonia – Los Angeles” Morbidity and Mortality Weekly Report 30, no. 21 (June 5, 1981): 250-252. Available online at [BACK]

2. Centers for Disease Control and Prevention. “Kaposi’s sarcoma Pneumocystis pneumonia among homosexual men – New York City and California” Morbidity and Mortality Weekly Report 30, no. 25 (July 3, 1981): 305-308. Available online at (PDF: 184 KB/2 pages). [BACK]

3. Buchanan, Patrick. New York Post May 24, 1983. As quoted in Gould, Alan (ed.). What Did They Say About Gays? (Toronto: ECW Press, 1995): 159. [BACK]

4. Falwell, Jerry. Liberty Report, 1980s. As quoted in Gould, Alan (ed.). What Did They Say About Gays? (Toronto: ECW Press, 1995): 148. [BACK]

5. Nahas, Gabriel G. Letter to the editor. New England Journal of Medicine 306, no. 15 (April 15, 1982): 932. [BACK]

6. Wood, Ronald W. Letter to the editor. New England Journal of Medicine 306, no. 15 (April 15, 1982): 932-933. [BACK]

7. Mavligit, Gioria M.; Talpaz, Moshe; Hsia, Flora T.; Wong, Wendy; Lichtiger, Benjamin; Mansell, Peter W.A.; Mumford, David M. “Chronic immune stimulation by sperm alloantigens: Support for the hypothesis that spermatozoa induce immune dysregulation in homosexual males.” Journal of the American Medical Association 251, no. 2 (January 13, 1984): 237-241. Abstract available online at [BACK]

8. Newmann, Hans H. Letter to the editor: “Use of steroid creams as a possible cause of immunosupression in homosexuals.”New England Journal of Medicine 306, no. 15 (April 15, 1982): 935. [BACK]

9. Navarro, Carols; Hagstrom, Jack W.C. Letter to the editor. New England Journal of Medicine 306, no. 15 (April 15, 1982): 933. [BACK]

10. Sonnabend, Joseph; Witkin, Steven S.; Purtilo, David T. “Acquired immunodeficiency syndrome, opportunistic infections, and malignancies in male homosexuals.” Journal of the American Medical Association 249, no. 17 (May 6, 1983): 2370-2374. Abstract available online at [BACK]

11. Sember, Robert. Editorial: “Untitled (One day this kid…), by David Wojnarowicz“ American Journal of Public Health 91, no. 6 (June 2001): 859-860. [BACK]

12. Offenstadt, G.; Pinta P.; Hericord, P.; Jagueux, M.; Jean, F.; Amstutz, P.; Valade, S.; Lesavre, P. Letter to the editor: “Multiple opportunistic infection due to AIDS in a previously healthy black woman from Zaire.” New England Journal of Medicine 308, no. 13 (March 31, 1983): 775. [BACK]

13. Nemith, Antal; Bygdeman, Solgun; Sandström, Eric; Biberfeld,Gunnel. “Early case of Acquired Immunodeficiency Syndrome in a child from Zaire.” Sexually Transmitted Diseases 13, no. 2 (April 1986): 111-113. Abstract available online at [BACK]

14. Bygbjerg, I.C. Letter to the editor: “AIDS in a Danish surgeon (Zaire, 1976).” Lancet no. 8339, vol. 1 (April 23, 1983): 925. [BACK]

15. Clumeck, Nathan; Sonnet, Jean; Taelman, Henri; Cran, Sophie; Henrivaux, Philippe; Desmyter, Jan. “Acquired immune deficiency syndrome in Belgium and its relation to Central Africa.” Annals of the New York Academy of Science 437 (Acquired Immune Deficiency Syndrome, Selikoff, Irving J.; Teirstein, Alvin S.; Hirschman, Shalom Z. (eds.), 1984): 264-269. Abstract available online at [BACK]

16. Bayley, Anne C. “Aggressive Kaposi’s sarcoma in Zambia, 1983.” Lancet no. 8390, pt .1 (June 15, 1984): 1318-1320. Abstract available online at [BACK]

17. Iliffe, John. The African AIDS Epidemic (Athens, Ohio: Ohio University Press, 2006): 12. [BACK]

18. Bayley, A.C.; Downing, R.G.; Cheinsong-Popov, R.; Tedder, R.S.; Dalgleish, A.G.; Weiss, R.A. “HTLV-III serology distinguishes atypical and endemic Kaposi’s sarcoma in Africa.” Lancet no. 8425, pt. 1 (February 16, 1985): 359-361. Abstract available online at [BACK]

19. Hooper, Edward. The River: A Journey to the Source of HIV and AIDS (Boston: Little, Brown and Co., 1999): 97-98. [BACK]

20. Iliffe, John. The African AIDS Epidemic (Athens, Ohio: Ohio University Press, 2006): 12. [BACK]

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