Battling a Deadly New Epidemic

By Claudia Wallis

Some experts feel AIDS will strike beyond the gay community

Six months ago, Jack's future seemed boundless. The son of a Midwestern minister, he was bright enough to have won a scholarship to an Ivy League school and to have graduated with a degree in Russian. A natural athlete, Jack had played both college football and basketball and, at 31, maintained his 6-ft. 2-in., 190-lb. frame in perfect trim. Possessed of a ringing baritone, he was poised for a career in opera. Then, early last year, the glands in his neck became swollen and remained so for months on end. By summer, two small dark spots had appeared on his legs. At the urging of a friend, Jack, a homosexual, went to a doctor. The swollen glands were a sign that his immune system was depressed; the penny-size leg spots were Kaposi's sarcoma (KS), the so-called gay cancer. During the next half-year, Jack (not his real name) began chemotherapy and struggled against a series of infections. In the process, he lost 30 Ibs., all of his hair, most of his hearing and, because of chronic irritation to his throat, his voice. He is still hanging on.

Jack is one of 913 people across the U.S. battling against the deadly new syndrome known as AIDS (Acquired Immune Deficiency Syndrome); 228 others have already succumbed. First fully described in 1980, the disease destroys the immune system, leaving its victims prey to all manner of viruses and bacteria. Cancer, particularly KS, is a major threat, as is pneumocystis carinii pneumonia, a singularly lethal ailment. The survival rate after two years of AIDS: less than 20%. Last week, at New York University Medical Center in Manhattan, 300 doctors gathered to exchange notes on the phenomenon. The bad news: "We are at the horizon of a new epidemic, rather than at the peak," says Dr. James Curran, director of the AIDS task force at the Centers for Disease Control (CDC) in Atlanta. Half the known cases of AIDS have been diagnosed in the past six months, and the number of new cases has been doubling every eight to twelve months. Says Curran: "We are no longer acting like a quick solution is just around the corner. This epidemic will be with us the rest of our lives."

The big question in AIDS is who will be affected next. So far, the disease has mostly stricken homosexual men (72% of all cases), intravenous drug abusers (17%), Haitian immigrants (4%) and hemophiliacs (1%). But a majority of the experts believe that what was once known as the "gay plague" will enter the general population. Because of their frequent contact with AIDS patients and blood, "hospital workers will be next," predicts Dr. Roger Enlow, a leading AIDS researcher. As head of New York City's brand-new office of gay and lesbian health concerns, Enlow monitors new cases of AIDS and refers them to various support groups.

To determine the future progress of the epidemic, the CDC has launched an intensive investigation into the 6% of the victims (69 men, women and children) who do not appear to fit into any of the at-risk categories. About a third of these people "will remain unknown," says Curran; they died before CDC investigators could question them. But five are women whose husbands or lovers are drug addicts, suggesting that AIDS may be transmitted through heterosexual relations. Should that prove to be true, female partners of bisexual men are also at risk. Indeed, says Curran, one such woman has now developed the persistently swollen glands that often presage AIDS.

Children of drug addicts and bisexuals seem to be another vulnerable group. Among the unclassifiable 6% are several children born to addicted parents. Pediatric Immunologist Arthur Ammann of the University of California at San Francisco has presented the most compelling evidence of parental transmission of AIDS: a 30-year-old, drug-addicted prostitute whose four daughters all developed symptoms of the immune disorder. The fact that each baby had a different father and that the mother has no sign of a hereditary disease suggests that the cause was not genetic. "Our only option is an infectious cause," says Ammann, who notes that the mother now shows early symptoms of AIDS. Ammann suspects the disease can be transmitted through the placenta.

The most widely feared route into the general public is through blood transfusions. The specter of contaminated U.S. blood banks was first raised early last year when AIDS began to be diagnosed in hemophiliacs. The nation's 20,000 hemophiliacs are uniquely vulnerable to blood-borne diseases because they depend on vast quantities of a blood byproduct to control their bleeding. A year's supply of the substance, known as anti-hemophiliac factor concentrate (AHF), comes from the blood of 25,000 to 75,000 donors. In the past year the CDC has also received alarming reports of about eight cases of suspected AIDS in nonhemophiliac blood recipients. Four cases had received donor blood after open-heart surgery; a fifth was a hysterectomy patient. In a sixth case, that of a baby in San Francisco who had required several transfusions, some of the donated blood came from a man later diagnosed as having AIDS.

Reports of these cases led the U.S. Public Health Service to take action earlier this month. In a move encouraged by the American Red Cross and the National Hemophilia Foundation, the PHS urged that "as a temporary measure," members of high-risk groups for AIDS "refrain from donating blood." Blood centers around the country are now informing donors of this recommendation and discreetly inquiring about their sexual and drug habits.

The new regulations, and much of the scare in general, are built on the notion that AIDS is caused by a transmissible agent. In fact, despite three years of research, there is no direct evidence that such a bug exists. CDC researchers have searched for a new virus with electron microscopes. They have injected laboratory animals with samples of virtually every body fluid and tissue from AIDS patients, including semen and blood. Not one animal has come down with the disease. Reports last month that a University of California monkey colony had contracted an AIDS-like disease brought hope to many that an animal model had finally been found. In fact, the monkeys had been contracting similar symptoms since 1969; there may be no connection with AIDS.

Although Curran and the CDC maintain that a new agent is the most likely explanation for the epidemic, many other scientists disagree. "They've gone overboard," says N.Y.U. Microbiologist Alvin Friedman-Kien. "There are any number of possibilities." Friedman-Kien favors the theory that AIDS is caused by a combination of factors, perhaps including a new agent. "It is likely that there is a genetic predisposition," he says, since, according to one study, 63% of AIDS patients with KS have a tissue type that occurs in only 23% of the general population. Many researchers believe that a history of multipie venereal diseases and other infections plays a role in suppressing the immune system. Such a history is characteristic of sexually active gay men and may help explain why they are prone to AIDS.

The blood-related cases, which represent some of the strongest evidence for the transmissible-agent theory, were sharply challenged at last week's conference. There is evidence that the blood byproduct AHF might cause immunosuppression in hemophiliacs, says Dr. Joseph Bove of Yale University. The substance has been available only since the early 1970s, which may be why an AIDS-like reaction is turning up now. As for the transfusion cases, Bove pointed out that except in one instance, "We have been unable to make a definite connection between a recipient with AIDS and an infected donor." Said he: "I cannot conclude that the nation's blood supply is contaminated."

The bottom line and the conclusion of virtually every speaker at the conference was that further study is needed. Said Dr. Lewis Thomas, noted author and researcher: "What we learn about Kaposi's sarcoma in AIDS will be useful for the study of cancer in general." Yet, some scientists complain, the National Institutes of Health has been dragging its heels about awarding $4 million set aside for AIDS research. "It's a disgrace," says Dr. Michael Lange, of St. Luke's Hospital in New York City.

The lack of funds has also embittered the gay communities of San Francisco, New York City, Los Angeles and Miami, where the epidemic is concentrated. Says Donald Currie, manager of San Francisco's KS hotline: "If the same number of Boy Scouts had been dying of this, there would have been a hell of a lot more money for research."

For their part, gay leaders have responded to the epidemic with energy and organization. Health-advisory services, hotlines, lobbies and fund-raising groups have sprung up in eleven large cities. Support groups have been formed to meet the emotional needs of frightened patients. Alarmed by the association of AIDS with promiscuity, many homosexuals are radically altering their lifestyles; some are even turning to celibacy.

In what is perhaps the most dramatic effort to raise money and bring attention to the epidemic, an organization called Gay Men's Health Crisis has bought all the admissions for the April 30 performance of Ringling Brothers and Barnum & Bailey Circus in New York's Madison Square Garden. By reselling the tickets at a profit, the group hopes to raise $200,000 for patient support and research. "It will be the largest number of gay men ever under one roof," says Novelist Larry Kramer, co-founder of the group. Few individuals have a more sober appreciation for what is at stake. Says Kramer: "I have lost 21 friends in the past 18 months; another 30 are seriously ill. It is a tragic thing that is happening."

--By Claudia Wallis.

Reported by Mary Carpenter/New York and Dick Thompson/San Francisco

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