A Quarter Century of AIDS Following the Birth of Death

When doctors in California reported the first AIDS cases in 1981, they had no idea why their young homosexual patients were dying. While researchers were looking for the virus, it travelled around the globe.

By Stefan Schmitt

From 1967 to 1979, the medication Pentamidin was prescribed only twice -- in the entire United States. But in 1981 five patients suddenly required it urgently, all of them in hospitals in the West Coast metropolis of Los Angeles. All five were suffering from a rare form of pneumonia, triggered by Pneumocystis carinii. These protozoa attack only patients with severely compromised immune systems.

And this was not the only place where Pentamidin was suddenly in high demand. Gay men in the US states of New York and California were showing up with extremely rare forms of cancer.

On June 5, 1981, a two-page article appeared in Morbidity and Mortality Weekly Report, a periodical of the US health agency, Centers for Disease Control (CDC). In this first scientific essay on the new illness, doctors Michael Gottlieb and Wayne Sandera described the cases of five gay men from L.A. –- one of whom already had died.

And Pentamidin did not help the others, either. All signs pointed to the spread of a new, mysterious illness. The CDC set up a research group to determine risk factors and to follow the phenomenon nationwide.

For one and a half years, doctors gathered clues that seemed to fit into the pattern of unexplained immune deficiencies: By the end of 1982 the CDC list included 593 cases: More than one third of the patients were already dead by the time the list was collated.

The first reports from outside the USA were beginning to surface -– three quarters of those affected were homosexual men. Then, by 1982, hemophiliacs started showing symptoms that fit into a vague pattern. Three gay men and one hemophiliac from the cities of Frankfurt, Munich and Berlin were mentioned in the statistics of the Robert Koch Institute. By 1986, all were dead.

Initially, the name of the illness -- "Acquired Immunodeficiency Syndrome" (AIDS) –- was simply a helpless description of symptoms. Doctors saw the destruction of natural defenses in supposedly healthy people, whose weakened bodies no longer could fight opportunistic infections or tumors.

In March of 1983, two scientific teams –- one led by the US researcher Robert Gallo and the other by French researcher Luc Montagnier –- independently and simultaneously presented the cause of this immune-system failure in the research magazine Science: It was a virus. In 1986, following years of arguing, the infectious agent was named HIV, Human Immunodeficiency Virus. It is a retrovirus that can insert its own DNA into the genetic make-up of host cells. To this day, there is no medication that can cure this disease.

Later investigations would show that people had died of AIDS even before the illness was discovered. Germany documented its first case in 1978. It is generally accepted that the pathogen made the leap from apes to humans in West Africa. Only recently were scientists able to trace the virus to one group of chimpanzees in Cameroon.

Tracing the development of AIDS awareness, one finds an unprecedented combination of shrill hysteria, media explanations and ideological proclamations about the new illness. At first, AIDS was brushed aside as a problem for gays and drug addicts. But then health scandals –- such as the contamination of German blood reserves with HIV in 1985 –- served as a reminder to those who thought themselves safe: There is no absolute protection from the virus.

Finally, prominent victims such as the actor Rock Hudson, who died in the fall of 1985, turned the issue of AIDS into a topic of general concern.

''We stand nakedly in front of a very serious pandemic as mortal as any pandemic there ever has been. I don't know of any greater killer than AIDS, not to speak of its psychological, social and economic maiming.''

WHO General Secretary Halfdan Mahler, 1986

In the 1980s, AIDS self-help groups and initiatives sprang up in many western countries. Germany already had its first AIDS-Help group in 1983, in Berlin. The evaluation of the new illness is often drastic. "Some countries are threatened with genocide, the extermination of entire nations," HIV co-discoverer Robert Gallo said in 1987. Former Cardinal of the Roman Catholic Curia Joseph Ratzinger, today Pope Benedict XVI, says: "One must not speak of a punishment from God. It is nature's revenge."

According to a handout that former German Federal Minister of Health Rita Süssmuth sent to German households in 1987, only 5 to 20 percent of those infected with HIV come down with full-blown AIDS. Later, the minister had to correct this statement. The controversial Bavarian Minister of the Interior Peter Gauweiler introduced a required AIDS test for civil service applicants and political refugees –- and also tried in vain to introduce a general obligatory AIDS test.

The Tagesschau television magazine showed images from the Cologne Carnival, in which traditional dancing figures, the Funkenmariechen and Funkenmajore, would only kiss through a surgical mask.

"Maybe the Lord brought down the plague because illicit sex is against the Ten Commandments."

US President Ronald Reagan, 1989

In February 1992 the Italian textile manufacturer Benetton published an advertising billboard featuring the dying AIDS patient David Kirby surrounded by his family. Prominent AIDS victims like the German tennis player Michael Westphal (1991), the singer from the British pop group Queen, Freddie Mercury (1991), and the US-American tennis professional Arthur Ashe (1993) drew public attention -- and attracted increased financial donations. In 1991, a red ribbon was adopted as the international symbol for the fight against AIDS.

In 1987, Retrovir (AZT) was the first medication recognized as slowing the progress of the disease. During the 1990s additional medications –- so-called Protease Inhibitors and Reverse Transcriptase Inhibitors –- came on the scene. They interfered with the replication of the virus within the host body. Combination therapies led to a dramatic increase in chances for survival with the disease.

In 2004, the UN's World Health Organization (WHO) launched its "3 by 5" initiative, with the goal of providing medication to 3 million infected individuals by 2005.

AIDS experts warn that many young people in industrial nations today believe that this new combination therapy is a cure for AIDS –- a potentially deadly mistake. There is still no anti-viral compound that can either protect against HIV infection or cure it, despite ongoing research.

"The USA spends €7.30  per person each year for AIDS research, while Germany is only spending 9 cents," complains Norbert Brockmeyer, President of the German AIDS Society and a dermatologist at the Ruhr-University Bochum.

We need to be realistic. If we are here to try and end the epidemic and fight the epidemic, we will not succeed by putting our heads in the sand and pretending these people do not exist or do not need help."

UN General Secretary Kofi Annan, 2006

For those infected with AIDS in Western industrial states –- a small proportion of all those affected –- life expectancy has increased markedly in the quarter century since 1981. But in the developing world, the UN's "3 by 5" goal has failed. By the end of 2005, only 1.3 million people had access to medication, according to the UNAIDS World Aids Report of 2006.

Among the complaints lodged by experts is that while the number of treatment centers in India has increased dramatically, hundreds of thousands of people still have no access to medication. In Russia, though the administration has provided more funds for the fight against AIDS, this has not translated into more treatment. In South Africa, AIDS treatment makes little progress because the government gives only half-hearted support, and largely denies the illness.

On the other hand, development aid workers criticize Western governments and pharmaceutical firms for being obsessed with the HIV virus only because it threatens citizens of wealthy nations. Compared with immunodeficiency disease, other infectious illnesses are seriously underrepresented in both public awareness and scientific research.

The Robert Koch Institute reports that 1.5 to 2.7 million people die each year of malaria alone. Typhus affects 16 million people annually; tuberculosis affects 8 million (with 2 million deaths) per year. In contrast, about 38.6 million people worldwide are HIV-positive, and 2.8 million die each year of AIDS.

With material from AP, dpa, Reuters

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