Box Turtle Bulletin

Thirty Years

Today marks the thirtieth anniversary of the Centers for Disease Control’s publication of a mysterious set of illnesses which took the lives of five gay men in Los Angeles. AIDS had been swirling around unnoticed since the 1930s, and doctors in Europe and Africa began to notice that people were falling victim to a host of diseases which are normally curable in the Congo River basin in the late 1970s. But it took the CDC report of a cluster of cases in southern California to signal that the mysterious deaths were somehow related. The rest, as they say, is history, with a whole lot of stigma thrown in.

Karen Ocamb happened to be in the middle of Southern California’s epidemic in the 1980s. She was living in a “glass closet,” as she described it. She was out to select friends. She found herself becoming an AIDS care provider simply because her friends needed her help. She told me via email, “I didn’t come out to family until I had to tell Chris Scott’s mother — the wife of an Air Force General and my godmother who was living at a military retirement community associated with March Air Force Base — that her son was gay, had AIDS, was dying in Intensive Care and she should dash to his side. Chris was closeted, too. I came out to my Aunt Bobbie and then my mother because I didn’t think it was fair that AIDS outed Chris but I could stay in the closet. My Aunt Bobbie said she already knew and my mother basically disowned me.”

Karen has put together what amounts to being a lovely online shrine to the many people she knew over the years along with her memories as an AIDS care advocate and LGBT journalist. You can see her updates by following this tag. She has it all, beginning with an interview with Dr. Robert Gottlieb, who wrote the first CDC report after having noticed the remarkable similarities between four cases of an “apparently new” disease. She continues with some of her own personal memories, activists and allies, early marches, rallying cries, demonstrations, indifference,  bigotry and hope. Karen is currently participating in the AIDS LifeCycle, a seven day ride from San Francisco to Los Angeles.

World AIDS Day 2010

Today is World AIDS Day, a time to reflect, to refocus, and to address the continuing global epidemic of HIV/AIDS. This day always brings remembrances for me, and I thought I’d share some.

But I’ve sat here and written and revised and amended and started over, and I’ve found that I simply cannot share my personal thoughts on this. I’ve been devastated by this disease, but I’ve also been astonishingly lucky. I’ve lost some very dear to me, but considering that I lived within 50 miles of the Castro for all of the 80’s, my loss is nothing, nothing at all, compared to others.

But regardless of the extent, I find that I can’t personalize AIDS on this site. And yet I can’t just write some impersonal analysis, today. HIV/AIDS is personal, intensely personal to gay men of my age.

It has always been a part of our lives, a backdrop to socializing, romance, love and sex; always an issue, always present. It has been the filter through which we have been demonized, the focus of compassion, the impetus for our activism, and the basis of our shellshock. It’s built bonds between gay men and lesbians and parents and churches. It exposed the world to the existence of gay people outside of “the big city”. And it killed many of our best and brightest – some of whom we loved.

I am encouraged about recent studies – and we do discuss them here – and about the statistics regarding longevity and continued effectivity. But AIDS is not statistics, it’s stories, and that’s where I stumble. You’d think after enough time it would become easier, yet there are still things I don’t talk about.

But maybe you can. Perhaps you have stories to share.

Or perhaps you want to reflect on a future, the increasingly likely hopes for both a prevention and a cure. Or to discuss the international consequences of a disease that is ravishing some parts of the world.

If so, here is a space for your recollections and thoughts.

New Research: HIV Circulated Among Humans Since 1908

According to a new study to appear in tomorrow’s issue of the journal Nature, the HIV virus which causes AIDS has been circulating among people for about 100 years. This article in Nature describes research findings which were first presented last June.

This latest genetic analysis on the HIV virus pushes the estimated origin of AIDS in humans back to between 1884 aqnd 1924, with a more focused estimate at 1908. This is decades earlier than the previous estimate of 1930.

Researchers took advantage of the fact that HIV mutates rapidly to reach this conclusion:

…[T]wo strains from a common ancestor quickly become less and less alike in their genetic material over time. That allows scientists to “run the clock backward” by calculating how long it would take for various strains to become as different as they are observed to be. That would indicate when they both sprang from their most recent common ancestor.

The new work used genetic data from the two old HIV samples plus more than 100 modern samples to create a family tree going back to these samples’ last common ancestor. Researchers got various answers under various approaches for when that ancestor virus appeared, but the 1884-to-1924 bracket is probably the most reliable, Worobey said.

In addition to the modern samples of HIV used in the analysis, researchers also worked with a 1960 sample taken from a woman in what is now present-day Kinshasa in the Democratic Republic of the Congo. This 1960 sample is the second-oldest known surviving HIV genetic material. The oldest is from a 1959 blood sample taken from an unknown man in Kinshasa.

Michael Worobey of the University of Arizona noted that the new estimate correlates with the rise of cities in Africa, which he described as “ideal for a virus like HIV” because of the greater opportunities for people to pass the virus on to others. Worobey is also optimistic about the virus’ eventual demise:

“I think the picture that has emerged here, where changes the human population experienced may have opened the door to the spread of HIV, is a good reminder that we can make changes now that could help reverse the epidemic. If HIV has one weak spot, it is that it is a relatively poorly transmitted virus. From better testing and prevention, to wider use of the antiretroviral drug therapy, there are a number of ways to reduce transmission and force this virus back into extinction,” he said.

You can learn more about the history of HIV/AIDS in our 2006 report, Opportunistic Infections — a report which still needs to be updated to reflect this latest research.

HIV Infected Humans Much Earlier Than Thought

HIV-1, the prevalent strain of Human Immunodeficiency Virus infecting people around the world was first thought to have entered the human bloodstream at around 1931. Now a second human tissue sample stored at a hospital in Kinshasa in 1960 has pushed the date back more than two decades:

Marlea Gemme… analyzed HIV-1 genetic material obtained from lymph tissue collected in 1960 from the University of Kinshasa pathology department in the Democratic Republic of the Congo–only the second HIV sequence predating 1976 deciphered to date. Thus far, she has sequenced about 1000 DNA bases, which she has compared with the previously reported sequence of HIV-1 extracted from a frozen blood sample from 1959. Since it entered into humans, HIV-1 has been evolving into different substrains–but the 1960 and 1959 sequences were much more divergent than expected, Gemmel reported at the meeting. “It reflects a long past of diversification before 1960,” she said.

By comparing the two sequences with more recent ones, Gemmel was able to show that HIV-1 first entered humans about 1908, not 1931, as earlier analyses with just the 1959 sample found. Her analysis also indicates that the virus existed in low levels in humans until the middle of the 20th century. “That matches the rise of population centers,” Gemmel explained, suggesting that urbanization around that time paved the way for the AIDS epidemic.

There is increasing evidence that AIDS has existed in some very remote parts of Africa for several decades before exploding in Kinshasa and other large cities in the 1970s and in Europe and America in the early 1980s. You can read more about the history of AIDS in our report, Opportunistic Infection, which we will now have to update to include these latest findings.

Today In History: HIV Virus Discovered

Twenty-five years ago today, on May 20, 1983, an article appeared in the journal Science in which a team led by Luc Montagnier of France’s Pasteur Institute announced that they had discovered the virus which causes AIDS. The suspected virus was isolated in a patient who had died of the disease. Nearly a year later, American researcher Robert Gallo would make a similar claim, sparking a three year debate over who actually discovered the virus.

Nevertheless the discovery of the virus sparked a sense of premature optimism. US health secretary Margaret Heckler famously declared in 1984 that “We hope to have a vaccine ready for testing in about two years.” Two decades later, that vaccine remains out of reach.

The introduction of the “AIDS cocktail” in 1995 has transformed the experience of AIDS from being a terminal condition to being a very serious chronic one. Where receiving an AIDS diagnosis was once tantamount to being handed a death sentence, today people are living full and productive lives with HIV/AIDS. And yet, the more than two-decades-old stigma associated with HIV/AIDS continues.

AIDS Nonsense From the Far Left

We often debunk the junk science emanating from conservatives. Rarely do we mention junk science from the left. It’s not because it doesn’t exist; it’s just rarely anti-gay, so it often escapes our attention.

The Canadian bills itself as “Canada’s new socially progressive and cross-cultural national newspaper.” But from its web site, it’s unclear how often the paper is published, but a scan of its headlines show a strange fascination with conspiracies, especially if they get to use the word “eugenics”:

• Finance Minister Jim Flaherty’s eugenics message on Ontario’s Budget: Cut taxes to the rich, and ignore social justice for the poor and others.
• U.S. journalists suggest Hillary Clinton and Barack Obama are political decoys for the Bush administration’s North American Union agenda
• First Nations Insight: War is caused from the marginalization of the feminine perspectives of women in social and political structures
• Iraq War is a Eugenics orchestrated genocide masquerading as an anti-terrorist operation

For one whose looking for weird stuff to debunk, there’s treasure to be had here. Like this one by AIDS conspiracy theorist Alan Cantwell:

HIV-AIDS was created with the use of Gay men as targets for Eugenic experiments suggests U.S. doctor
There is no doubt that AIDS erupted in the U.S. shortly after government-sponsored hepatitis B vaccine experiments (1978-1981) using gay men as guinea pigs. …

The widely accepted theory is that HIV/AIDS originated in a monkey or chimpanzee virus that “jumped species” in Africa. However, it is clear that the first AIDS cases were recorded in gay men in Manhattan in 1979, a few years before the epidemic was first noticed in Africa in 1982. It is now claimed that the human herpes-8 virus (also called the KS virus), discovered in 1994, also originated when a primate herpes virus jumped species in Africa. How two African species-jumping viruses ended up exclusively in gay men in Manhattan beginning in the late 1970s has never been satisfactorily explained.

Those two paragraphs alone have a lot of whoppers which are easily refuted. Let’s break it down:

The first AIDS cases were recorded in gay men in Manhattan in 1979. Not quite. The first known case of AIDS was found in a 1959 blood sample drawn from an unknown man in Leopoldville, Belgian Congo (today’s Kinshasa, Democratic Republic of Congo, formerly Zaire). This was long before the hepatitis B vaccine experiments that Cantwell is so sure started it all.

The epidemic was first noticed in Africa in 1982. By having this sentence follow the previous one, Cantwell seems to suggest that the African epidemic followed the American one. But just because the African epidemic wasn’t noticed until 1982 doesn’t men that’s when it started. In fact, as early as 1983, researchers had identified an epidemic already well underway. In fact, it was well established in some parts of Zaire in 1976.

How two African species-jumping viruses ended up exclusively in gay men in Manhattan beginning in the late 1970s has never been satisfactorily explained. Here, Cantwell’s referring to the Herpes-8 virus, which we now know causes a form of cancer known as Kaposi’s sarcoma (KS). This disease was a very common opportunistic infection among those whose immune system was compromised. Being a transplant patients has been one historic risk factor due to anti-rejection medications which work by lowering the immune system. KS was also common among many ethnic groups in the Mediterranean, Middle East and Africans living in Africa.

The virus which causes KS may have been discovered in 1994 but the disease was first described in the medical literature by Dr. Moritz Kaposi back in 1872. Because KS has been quite common in Africa, there have been thousands upon thousands of medical reports on the disease throughout the past century. For evidence, all you have to do is go to the National Institutes of Health’s PubMed database, type in “Kaposi’s sarcoma” and press “GO.” As of this writing, you’ll find references for 10,850 articles in professional journals going back to 1948. That’s quite an achievement since PubMed rarely indexes articles published before 1950.

This is pretty elementary stuff that any dermatologist would know. It takes a lot of ignorant — willful ignorance even — for a retired dermatologist like Alan Cantwell to pretend these facts don’t exist. But like all such conspiracy theorists, he has to either ignore fundamental facts or bend them beyond all recognition for his crackpot theories to survive (like some other theorists we know). Cantwell’s theories are so nutty, he had to start his own publishing house just to get his books into print. Nobody else would touch them. But it just goes to show that the practice of abusing science isn’t confined to one end of the political spectrum.  It’s everywhere.

Hat tip: Stefano

Today in History: AIDS in Black Africans

As we’ve mentioned before, by the time 1983 came around the panic surrounding the emerging HIV/AIDS crisis had already reached epic proportions, with anti-gay groups and individuals pinning everlasting blame on the gay community. When they had bothered to notice, some would acknowledge that Haitians, drug addicts and hemophiliacs were also at risk for AIDS. But it was the gay community which bore the brunt of the responsibility for the new “plague.” In 1983, Pat Buchanan would thunder:

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

Ignorance among many Americans was running a fevered pitch, but things were very different in Europe. Belgian and French doctors had noticing something for quite some time: they had been treating wealthy African immigrants from their former colonies who were suffering from diseases which were remarkably similar to those reported by AIDS patients in America. Finally, twenty-five years ago today, on March 19, 1983, the rest of the world would learn what they have been noticing with the publication of this brief letter in the respected journal The Lancet:

Acquired Immune Deficiency Syndrome in Black Africans

SIR,-Acquired immune deficiency syndrome (AIDS) has been described in homosexual or bisexual men, in drug addicts, in haemophiliacs, and in Haitian immigrants. To our knowledge there is no report of AIDS and opportunistic infections in previously healthy Black Africans with no history of homosexuality or drug abuse.

Tables I and II show the clinical and immunological data on five Black patients seen in Brussels and who were from Central Africa (Zaire and Chad). Three of them had been living in Belgium, for between 8 months and 3 years. All were of good socioeconomic status. They presented with prodromes of fever, weight loss, and generalised lymphadenopathy, and extensive investigations did not reveal any neoplasia. Patients A and E died; the three survivors are still ill.

These patients fulfilled all the criteria of AIDS. …

This preliminary report suggests that Black Africans, immigrants or not, may be another group predisposed to AIDS.

Indeed, the world would soon learn the horror that had been stalking the Congo river region for decades. This small letter to the editor would later prove to be the canary in the coalmine. It is the first published indication of a pandemic which had already taken countless lives in Zaire and Chad, and would very soon engulf much of an entire continent.

Source:Clumeck, N.; Mascart-Lemone, F.; de Maubeuge, J.; Brenez, D.; Marcelis, L. Letter to the editor: “Acquired Immune Deficiency Syndrome in Black Africans.” Lancet 1, no. 8325 (March 19, 1983): 624.

See also:
Opportunistic Infections

Today in History: A Fog Begins to Lift

Ten years ago, the February 5, 1998 edition of the journal Nature published a short report by a team led by Tuofu Zhu of Rockefeller University. That team examined the genome of an HIV-positive blood sample taken in 1959 from an unidentified man in Leopoldville in the Belgian Congo (today’s Kinshasa, Democratic Republic of Congo, formerly Zaire). By looking at how the virus has mutated over the past 40 years, and by projecting the mutation of that particular virus (dubbed ZR59) back further, they were able to estimate when the various HIV virus groups evolved from a common ancestor. Zhu and colleagues concluded:

Our results … indicate that the major-group viruses that dominate the global AIDS pandemic at present shared a common ancestor in the 1940s or the early 1950s. Given their ‘starburst’ phylogeny, HIV-1 was probably introduced into humans shortly before that time frame, about a decade or two earlier than previously estimated. …The factors that propelled the initial spread of HIV-1 in central Africa remain unknown: the role of large-scale vaccination campaigns, perhaps with multiple uses of non-sterilized needles, should be carefully examined, although social changes such as easier access to transportation, increasing population density and more frequent sexual contacts may have been more important.

That single serendipidous 1959 blood sample from a man whose name and fate is lost to history provided an important part of our understanding of where the virus came from. Simon Wain-Hobson wrote a commentary in the same issue of Nature explaining its implicaitons:

What else is the position of ZR59 among HIVs telling us? First, it probably means that the global epidemic was indeed founded by a single HIV although, in this respect, it is no different from the annual ‘flu strain. Second, the centre of the radiation and ZR59 are a considerable stretch from any simian counterpart, suggesting that HIV had a human history before it went global. Third, the Big Bang seems to have occurred around, or just after, the Second World War. Emerging microbial infections often result from adaptation to changing ecological niches and habits. And, of course, the post-war era saw the collapse of European colonialism and attendant changes in urban and technological traits. As usual, when data are limited we’re in the realm of speculation, meaning that the story is not over. …

In 1959, the Nobel prize for physiology or medicine was awarded to Severo Ochoa and Arthur Kornberg for their work on nucleicacid polymerases, while the world rocked around to Elvis and Chuck Berry. There was fog in the English Channel.

And in 1959, a blood sample was drawn from an unknown HIV-positive man in the Belgian Congo. What he must have gone through afterwards…

Sources: Zhu, Tuofu; Korber, Bette E.; Mahmias, Andre J.; Hooper, Edward; Sharp, Paul M.; Ho, David D. ” An African HIV-1 sequence from 1959 and implications for the origin of the epidemic.” Nature 391, no. 6667 (February 5, 1998): 594-597. Abstract available here.

Wain-Hobson, Simon. “Immunodeficiency viruses, 1959 and all that.” Nature 391, no. 6667 (February 5, 1998): 531-532.

Today in History: AIDS in Africa

In early 1988, the AIDS hysteria was in full swing. The air was filled with the rhetoric of the innocent “general population” besieged by disease-ridden homosexual men. Just two months earlier, Pat Buchannan wrote an op-ed in the New York Post saying,

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.

The scientific community however wasn’t seeing it that way. For more than five years, several articles had been appearing in medical journals pointing to central Africa as the source for the new disease. Another similar article appeared in the February 4, 1988 edition of the New England Journal of Medicine by lead author Dr. Nzila Nzilambi of Mama Yemo Hospital in Kinshasa, Zaire.

Mama Yemo Hospital saw a large number deaths in the middle 1970’s due to baffling diseases which strongly resembled what would later become known as AIDS. Dr. Nzilambi’s early personal interest in AIDS led him and a group of American and European researchers to investigate the possible origins of AIDS:

The Equateur province of Zaire occupies the northwestern part of the country and has a population of approximately four million people. The river Zaire is an important geographic landmark and provides a major trade route between the cities of Kinshasa and Kisingani.

In 1976, there was an epidemic of Ebola hemorrhagic fever in a remote part of the Equateur province, centered at the mission hospital of Yambuku, near the village of Yandongi. In the course of epidemiologic investigations of this epidemic, many hundreds of serum samples were collected from residents of the surrounding area. This same are was selected for the present study to allow follow-up of persons examined in 1976. There has been no evidence of Ebola virus activity in this region since the 1976 epidemic.

… Five of the 659 serum samples collected in 1976 had antibody to HIV according to both enzyme-linked immunosorbent assay and Western blot analysis. One of the positive samples yielded HIV on culture. At follow-up in 1985, two of the persons who had tested positive for anti-HIV in 1976 were still alive and healthy: Subject 1, a 59-year-old woman, and Subject 2, a 57-year-old-man. Both had remained positive for anti-HIV. The ratio of helper to suppressor T cells was normal in Subject 1 but abnormally low in Subject 2.

A ten years span after infection with the HIV virus and the appearance of AIDS symptoms is quite common. It appears that Subject 1 follows this pattern and may have been very recently infected in 1976. Subject 2 however is beginning to exhibit damage to his immune system ten years after his blood was drawn. The authors continue:

Subject 3, was was 36 years old when blood was collected in 1976, died in 1978 after a prolonged illness characterized by weight loss, fever, cough, and diarrhea. She had lived in Kinshasa from 1972 to 1976, where she was unmarried and was considered a “free woman.” … Subject 4, who was the wife of Subject 2, was 43 years old when sampled for blood in 1976; she died in 1981 after a long illness associated with fever, weight loss, skin rash, and oral lesions. Subject 5, who was 7 years old in 1976, died of pneumonia and weight loss at the age of 16. With the exception of Subject 3, none of these seropositive persons had traveled outside the region of their respective home villages.

…

The results of our study showed that HIV infection was already present in an isolated area of the Equateur province of Zaire in 1976…

… The clinical descriptions of the modes of death in the three fatal seropositive cases were compatible with a diagnosis of AIDS. These findings illustrate that HIV infection and AIDS could have existed and remained stable in a rural area of Africa for a long period.

Researchers had been writing about AIDS in Africa for several years when this study came out. For example, one study two years earlier found an isolated case of HIV infection from a lone stored blood sample from Leopoldville (Kinshasa’s colonial name) taken in 1959. But none of these studies were able to prove where AIDS came from. That would have to wait until later.

But this one did provide solid evidence that HIV was already present in an isolated region of Zaire in 1976, long before it was noticed in America or Europe. And if the 7-year-old boy was infected from his mother at birth, then that would push the date in this community even further back into the late 1960’s.

Source: Nzilambi, Nzila; De Cock, Kevin M.; Forthal, Donald N.; et al. “The prevalence of infection with human immunodeficiency virus over a 10-year period in rural Zaire.” New England Journal of Medicine 318, no. 5 (February 4, 1988): 276-279. Abstract available here.

Today in History: The Gay Men’s Health Crisis

On January 12, 1982, eighty gay men gathered in writer Larry Kramer’s New York apartment to discuss the mysterious “gay cancer” that had been claiming the lives of their friends and lovers. Forced by bureaucratic apathy on the part of city officials, local health authorities, and even Mayor Ed Koch, the Gay Men’s Health Crisis (GMHC) was born.

GMHC would go on to raise money to provide services and assistance for people with HIV/AIDS, including assistance from a large army of volunteers to meet day-to-day needs like cooking, housecleaning, dog-walking, and transportation to medical appointments, as well as help in navigating the apathetic bureaucratic maze. GMHC also distributed material to help educate the general public on the need for safer sex. In these areas, GMHC worked hard to meet the needs which had been, at best, ignored by local and national health authorities and charities (most shockingly, including most faith-based charities). GMHC also battled the overt stigmatization and hostility which grew among well-known public figures, nationally as well as locally.

GMHC quickly established itself as a well-regarded authority for HIV/AIDS education and service. By 1984, the Centers for Disease Control called on GMHC’s help in planning public conferences on AIDS. As the epidemic continued to grow, GMHC expanded its reach by assisting heterosexual men and women, hemophiliacs, intravenous drug users, and children. Today, the GMHC continues its work as one of the nation’s leading non-profit, volunteer-supported AIDS service and educational organizations.

The Judgment of Future Historians

Stall, Ronald D.; Mills, Thomas C. Editorial: “A Quarter Century of AIDS.” American Journal of Public Health 96, no. 6 (June 2006): 959-961.

This month’s edition of the American Journal of Public Health is dedicated to the twenty-fifth anniversary of the CDC’s first report of AIDS. In one of the lead editorials, Drs. Ronald Stall and Thomas Mills provide a brisk overview of the public response to the epidemic, and emphasize the special difficulties that come with combating a heavily stigmatized disease.

“A Disease of Denial”

Noting that AIDS struck first and the hardest at the most marginalized groups in society — gay men, drug users, foreigners, racial minorities and others of lower socioeconomic status — AIDS has been a disease of denial at the individual, group and national level. When the disease is seen as affecting “those people” it’s easier to deny some of the realities of what it actually takes to combat the epidemic:

Because so many controversial issues directly shape the AIDS epidemic, governments will continue to be tempted to respond by funding unproven programs that convey the impression of restoring traditional cultural values rather than fielding scientifically proven prevention approaches that directly target issues of sexual safety or drug use.

Citing six major meta-analysis studies, the authors contend that we have definitive proof that AIDS prevention programs which directly target safe sexual practices and drug use yield significantly positive results. The difficulty is in finding ways to put these programs into practice given the cultural and political climate today.

“How Will History Judge Our Actions?”

The twenty-fifth anniversary of the first report of AIDS offers an important moment to reflect on our response to this epidemic. Drs. Stall and Mills contend that because future historians will know that we weren’t ignorant of the dangers of the disease or how it is transmitted, “we cannot escape responsibility for our failure to use effective, scientifically proven strategies to control the AIDS epidemic.”

They will probably be impressed with the rapid progress made in scientific understandings of the pathogenesis and treatment of AIDS, yet appalled by the instances when the ancient curses of racism and homophobia prevented us from fully responding to AIDS epidemics unfolding in our midst, as is the case now with African American MSM [men who have sex with men].

…They will also likely regard as tragic those instances when we allowed scarce resources to be used to support ideologically driven “prevention” that only served a particular political agenda.

My Thoughts

We can avoid the harsh judgment of future historians, but that’s probably poor motivation for implementing the programs that we know will be effective in preventing the spread of AIDS. Instead, we should be motivated because we see those who are vulnerable as our neighbors, not as “those people.” Until we recognize the humanity of all those who are vulnerable and at risk, prevention measures will continue to be driven by ideology and not science — or compassion.

You can further explore the role that anti-gay prejudice has played in the AIDS epidemic in our special report Opportunistic Infections.

The Age of AIDS, The Age of Family

AIDS is twenty-five years old today.

It was on June 5, 1981 that the CDC first reported a puzzling new disease that we would come to know as AIDS. The intervening twenty-five years has been searing experience for the gay community. Discovering that one had AIDS was to receive an automatic death sentence, and over those twenty-five years an estimated half a million Americans died in the worst epidemic of modern times.

As deadly as AIDS was before the advent of Highly Active Anti-Retroviral Therapy (HAART), the Age of AIDS was not the Age of Death. Instead, it is the age of struggle and determination, of coming together and caring for one another, and ultimately of triumph. Today, modern medicine means that for most people, AIDS is not the automatic death sentence it once was. With HAART, most of the estimated one million Americans who harbor the HIV virus live normal lives. But HAART is not a cure. For that, there is still more struggle and determination to go.

But more than anything else, the Age of AIDS is the Age of Family. “Family” has a very strong resonance in the gay community — in a way that few outside of the community know about. When someone wants to ask whether someone is gay or not, the question most often asked is “Is she family?”

That’s not a mere euphemism. “Family” is an honorific that the gay community has earned through twenty-five years of hard work and determination. As those with AIDS were cast out of their own homes and natural families, they turned to those who stepped in and filled the rightful role of family in their lives. The gay community has reinvented the family, not in imitation of what others think a family should look like, but in response to the life-and-death need for all of us to be “our brother’s keeper.”

Jonathan Rauch, writing in Sunday’s New York Times, offers this very experience to explain why marriage is so important to the gay community:

But there was also an epidemic of care giving. Lovers, friends and AIDS “buddies” were spooning food, emptying bedpans, holding wracked bodies through the night. They were assuming the burdens of marriage at its hardest. They were also showing that no relative, government program or charity is as dependable or consoling as a dedicated partner.

Yet gay partners were strangers to each other in the law’s eyes. They were ineligible for spousal health insurance that they desperately needed; they were often barred from hospital rooms, locked out of homes they had shared for years, even shut out of the country if they were foreign citizens. Their love went unmentioned at funerals; their bequests were challenged and ignored. Heterosexual couples solved all those problems with a $30 marriage license. Gay couples couldn’t solve them at any price.

The Age of AIDS has awakened a sense of family for all of us, and with that the determination to protect our family with all the power we can muster.

This twenty-fifth anniversary is a day for remembering those who have died. It is also a day for celebrating those who have survived. And it is a day to remember that the struggle isn’t over. AIDS entered our consciousness twenty-five years ago, and so did the stigma that went along with it. You can read about the role this stigma has played in this epidemic in our latest report, Opportunistic Infections.