Today, seventy million people are infected with a virus that 30 years ago no one had heard of. To mark World Aids Day on December 1, Michael Hanlon considers the impact of HIV/Aids on science and society.
In June 1981, the Centers for Disease Control in Atlanta, Georgia issued a landmark report about five young gay men in Los Angeles who had died from a mysterious condition that had destroyed their immune systems. Within two years, Aids (Acquired Immune Deficiency Syndrome) was changing the world. Any disease with the capacity to infect and kill millions will have a profound effect, but this modern ‘plague’ was different. It was an odd, horrible disease; a collection of separate illnesses. Chest infections, typically Pneumocystis pneumonia (PCP) were a common indicator, as was Kaposi’s Sarcoma, a rare form of skin cancer. But most sufferers were swamped by a tide of common, usually trivial bacterial, viral and fungal infections that overwhelmed their weakened bodies.
The advent of Aids would forever alter the way we think and talk about sex and sexuality; it would bring previously taboo subjects out into the open. It involved issues of race and celebrity, wealth and poverty, highlighting as never before the inequalities between the rich West and the developing world.
This was a disease that was co-opted by gay-rights activists, liberals and bigots alike. Who can forget the infamous comment by James Anderton, then Chief Constable of Manchester Police that gay men were ‘swirling in a cesspool of their own making’? Or celebrities such as Elizabeth Taylor, Elton John and Madonna who championed the cause and the victims?
Aids arrived just as Western Society was on the verge of a decadent sexual free-for-all. The sexual revolution of the Sixties and Seventies had gone mainstream. Drug use was at an all-time high, sex tourism (an important factor in the spread of the causative agent HIV) was a major growth industry. And across Europe and North America an exuberant gay scene had emerged to replace the furtive life homosexuals had endured only a decade previously.
Aids put a stop to so much of that and the 1980s took on a darker, more puritanical edge. In Britain it forced a prudish Tory administration to sanction one of the most sexually explicit health education campaigns in history (although not explicit enough for its critics).
Aids became, inevitably, the subject of controversy, myth, misinformation, prejudice, political correctness and scientific confusion. Initially, it was believed that only gay men, intravenous drug users, haemophiliacs and others given contaminated blood transfusions were at risk; then Africans – men, women and children – started dying in their tens of thousands and then millions. When Aids was considered to be a ‘gay’ disease some homosexuals claimed they were being stigmatised; later, there was equal outrage when it became clear that health campaigns – informed by an ‘inclusivity’ agenda – were not targeting the most likely victims who were indeed, in the West at least, gay men.
Some believed, erroneously, that you could catch Aids from a coffee cup or a lavatory seat, or by shaking hands with an infected person. When Princess Diana shook hands publicly with an AIDS victim in 1989 it was seen of huge significance. For a long time, too, it was believed that anal sex was key to transmission of the human immunodeficiency virus (HIV). That was not the case. No one then imagined that one of the surest routes of HIV infection would prove to be from a pregnant woman to her child during birth.
When it became evident that condoms limited the spread of HIV even this seemingly straightforward advice became mired in controversy, with the Catholic Church opposed on dogmatic grounds and
American evangelicals insisting that only sexual abstinence would halt it progress. A positive diagnosis was considered to be a certain death sentence and in the 1980s it was widely predicted that millions in the West, straight and gay alike, would die. Then the Aids deniers started to emerge: scientists and commentators who persisted in a belief that Aids does not exist or was not caused by HIV. This line was championed in several newspapers and for a while, tragically, became official government policy in South Africa. On that continent, too, cruel new myths emerged: the idea that HIV could be cured by sex with a virgin had horrifying consequences.
But reason for the most part prevailed and the world reacted with commendable speed to the crisis. A new agency, UNAIDS, was created in 1995. Millions, then billions, of dollars were spent on the search for vaccines and drugs. Some muttered that this was diverting resources away from less media-friendly but equally grim plagues, the diarrhoeas and mundane parasites that claims the lives of tens of millions in developing world. And no doubt it did. But the discovery of HIV/Aids coincided with – and drove – the development of new technologies such as gene-sequencing and monoclonal antibodies that have far-reaching benefits for humankind. The result was the microbiological equivalent of a thermonuclear strike unleashed against one of the most sophisticated viruses ever encountered.
HIV, an RNA retro virus, has been photographed, its genome sequenced and the mechanism by which it cripples, then destroys the immune system (by attacking CD4 T-cells) elucidated in the minutest detail. We also know that HIV emerged (probably) in the central African jungles in the early 20th century and became a global pandemic in the 1980s. Carriers can remain ignorant of their infection and healthy for years – greatly increasing the chance of transmission – before Aids develops. There is still no cure or vaccine but, provided you are lucky enough to live in a place where the new combinations of antiretroviral drugs (the buzz-term is HAART, highly-active antiretroviral therapy) are available and your health system can afford to pay for them, being HIV-positive is no longer a death sentence.
But we are not out of the woods. Aids has killed 30 million people (including 20,000 Britons with around 100,000 currently HIV positive and infection rates rising) and will kill millions more, mostly in Africa. Around one in 150 people worldwide are currently infected with HIV. A post-AIDS generation in the West is increasingly blasé, even defiant, about the need to take the sexual precautions that became widespread a quarter of a century ago, because of the availability of effective drugs.
We know so much yet some mysteries remain. How did a virus that first infected heterosexual forest-dwelling Africans decades ago make the leap from the Congo to the bathhouses of California without medical science noticing its existence? The disease is very much an ‘African’ plague, yet, the first documented Aids victim on that continent was a white Cape Town air steward. Why did the African pandemic take so long to emerge and why the concentration in the south of that continent and not the equally impoverished north and west? Why did Aids in the West remain a disease of homosexual men and intravenous drug users, yet in Africa it is predominantly a straight disease which affects women in greater numbers than men?
Aids has been a disaster for humanity but the tide is turning. Infection rates in southern Africa peaked maybe a decade ago and there has been a steady decline in the number of people dying of a disease that, thanks to those new drugs (which are getting cheaper all the time), is manageable, if not curable. Hopefully, by the time the world marks Aids Day a decade hence, this strange, spiteful disease will have faded to a background hum of just another public health issue that humankind has learnt to live with, if not entirely conquer.