Public Health: From HIV to influenza, a big picture with a lot of moral traps.

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In the spring of 1983, during my fourth year of living in Dallas, TX, a state legislator (Bill Ceverha) from Amarillo proposed a draconian anti-gay law, HR2138, which would strengthen the Texas homosexual-only sodomy law 2106, which we all know now was invalidated by the Supreme Court in 2003 in the Lawrence v. Texas case.

The law was clearly motivated by the publicity and panic over the exploding AIDS epidemic, which was just starting to grow in Dallas, but had caused a sudden media storm over the cases on both coasts.

The bill would have taken a “must ask, must tell” approach to people in certain jobs, banning them from medicine, teaching, or working with food (well beyond the military).  It also made consensual sodomy a felony.

The Dallas Gay Alliance, then under the leadership of Bill Nelson and Terry Tebedo, a “supercouple”, lobbied heavily to keep it from leaving committee, headed by Wayne Peveto, where it failed a vote by 7-2 in early June, 1983.

We would not have an official recognition of HTLV-III (later called HIV) as the cause of AIDS until the spring of 1984.  The first antibody test would become available in 1985.  And in the early days, the advice of the DGA was “don’t take the test”.

The legislation had been lobbied by a right-wing group called “Dallas Doctors Against AIDS”, to whom (to the consternation of Bill Nelson) I once wrote.  In those pre-Internet days, I did a lot of letter writing, corresponding especially with Jim Curran of the Centers for Disease Control, who came to Dallas a few times.  In fact, the name “Acquired Immune Deficiency Syndrome” was actually adopted in a meeting in Dallas in late 1982.

The most alarming fact about AIDS then was that it seemed to have exploded in geometric fashion from possibly a single index case in the US, maybe around 1976.  Kaposi’s Sarcoma and pneumocystis carinii pneumonia among gay men would be reported in the major media from the CDC in mid 1981.  I first heard about KS from the local gay magazine, This Week in Texas, when I went to a screening of the Fox film “Making Love” at Northpark in February 1982.  By the end of 1982 there were 6-8 cases in Dallas, but they would soon explode.  In AIDS information forums, often held at the old Dallas MCC on Reagan St. in Oak Lawn, health department officials would say that the number of cases was doubling nationwide every six months.   Until early 1983, I had thought that AIDS would be like many other diseases, something that would affect biologically susceptible people more than others (just as Hepatitis B caused no symptoms at all in some men, who could still carry it to others who could sometimes get liver cancer as a result).  But by April 1983 it was clear that most people would die of the disease.  Gay men were told not to give blood.

When I was living in New York, I started hearing scuttlebutt about men with unusual infections (and lymphomas) in 1978.  I had a feeling something was up.  I even thought a lot about it, with an epiphany, on a west coast trip (Seattle) that May.  But after moving to Dallas in early 1979 I put it aside in my mind.  There had been other medical anomalies around, like clusters of Hodgkin’s Disease in a few small towns around the country.

The right-wing (most of all buttressed by Paul Cameron and writer Gene Antonio) had developed a theory that private homosexual acts among adult gay men really did endanger the general population and therefore create a “due process related” state interest justifying sodomy laws.  (Note that a federal judge had declared 2106 unconstitutional in 1982 in the Baker v Wade case, but it was on appeal to the Fifth Circuit in New Orleans, where it would be upheld in 1985.)  The medical reasoning was that gay men constituted a relatively closed population within whom the virus would be propagated  (or “ampilified“) by a “chain letter” of men who performed both passively and actively.  The heterosexual population, being so much larger, could not so easily develop such a change (right now, this sounds circular or Mobius-like) but more important, chains could not be sustained (in modern countries) because the virus could not pass easily from women back to men, because women could not “insert”.  The DDAA also published papers describing the supposed imperviousness of the thick vaginal wall to STD’s, compared to rectal or mouth tissue.  But then the DDAA insisted that at some point, the virus would mutate and become more contagious, and endanger everyone, which could not happen had there been no gay male population to begin with.  You can see where this could lead.

In fact, in Africa, AIDS was passing in both directions between men and women (a fact lost right now in Nigeria and Uganda) because women often had other STD’s, leading to open sores and blood exchange. But that fact didn’t invalidate what the right wing maintained could happen in western countries.  And the HIV virus (which was not yet discovered when these arguments were made) does mutate rapidly.  But in three decades of experience with it, it has never changed its transmission behavior.

It’s also possible to speculate that HIV could suddenly become transmissible by insects (the “mosquito argument”).  In fact, the New York Native, Charles Ortleb’s publication, fed the idea that AIDS could be caused by an arbovirus, ASFV.  But even if this could happen, it would probably be only a very specific insect with a limited habitat, more likely in a tropical climate.

What’s more relevant is that when viruses change their mode of transmission, they often become less virulent and essentially change into milder diseases.  It might no longer be anything like AIDS.  Yet, this scary science fiction scenario can’t be entirely dismissed.  A variation of it appears in my own novel draft, “Angel’s Brothers”, which I’ll talk about later. As far back as 1983, Robert Bazell, science reporter of NBC, had suggested than in time other horrific diseases would occur in the gay population – but then the behavior changes (condoms, fewer partners, partnerships and finally marriage today) came.  Even Robert Fauci at NIH once intimated this, as Randy Shilts reports in “And the Band Played On”.  Some observers suggested that gay men should self-segregate by age (and attractiveness) to protect younger men.

In any case, there’s the obvious observation that the DDAA theories could give heterosexuals a false sense of security.  The other half of the gay world, lesbians, were actually safer than the general population, as the CDC repeated that lesbians have very few STD’s. The right had to punt on that one.

In time, it would be discovered that Kaposi’s sarcoma is itself caused by a separate virus, Herpes Type 8.  KS would drop in frequency as a presenting “OI” in the years that followed. (The virus is harmless until cellular immunity is compromised.)  Apparently, use of condoms or safer sex is particularly effective in stopping HH8 or KSHV transmission.

The rate of percentage increase in cases would slow in the late 1980s. The introduction of anti-retroviral drugs, first starting with AZT and soon protease inhibitors, was very effective in time. By the mid 1990s, many men were able to live and work for years or decades and control symptoms and viral infection. Side effects of the drugs (like loss of muscle) would be reduced as the drugs improved.

In most cities, non-profits to help PWA’s (People with AIDS) were developed.  In the earlier years, the need for “buddies” was great, and I volunteered for this in Dallas in the mid 1980’s,  The nature of volunteer needs would change over the years and become more specialized, as with food delivery services (like Food and Friends).

I would go through my own scare, having one skin biopsy in July 1983, before testing and remaining negative.

Gay male sex had long been known to be transmit Hepatitis B, but by 1982 a vaccine was available.  It is likely that Hepatitis C behaves similarly, but no particular clusters in gay men comparable to the history of HIV developed, probably because of behavior changes. It’s interesting that just before HTLV-III was discovered, there were ride reports about a similar retrovirus, HTLV-I, which actually causes T-helper cells to become leukemic rather than disappear.  But that virus, whatever theories suggest, never took hold in the male gay community.

The real lesson of all of this for public health is discerned when one talks about other diseases that are much more potentially dangerous to the general population. Consider the hemorrhagic fevers, like Lassa, Marburg and Ebola, as covered in books like Robert Preston’s “The Hot Zone” and Laurie Garrett’s “The Coming Plague”.  They are more transmissible than HIV or HBV, but still require direct blood or body fluid contact.  But Preston gives an account of a simian strain of Ebola that mutated into an airborne form, “Ebola Reston”.

The most pressing problem today is, of course, influenza.  We had our scare with swine fly again, H1N1, in 2009.  But the real question is whether “bird flu”, like H5N1 or now H7N9, would migrate from being bird-human transmissible to human-human transmissible in any appreciable fashion, and carry over to the US from China by airplane.  Laura Garret updates us on this matter in her blog here.    Likewise, corona viruses (like SARS) have produced epidemics in China and the Middle East.  It seems critical that vaccines be developed for all of these.  There have been a few films about these possibilities, like “Bird Flu in America”, “Pandemic”, and “Contagion”.

The influenza problem brings up other issues where normally accepted behavior has public health consequences.  In southeast Asia, the big problem seems to be people living near poultry.  When a really dangerous  epidemic occurs, then “social distancing” becomes an issue, causing cancellation of many activities and closing businesses, and causing families to become centric.  The vaccine debate also is painful:  parents may fear a slight increase in risk of autism in vaccinated kids (not likely), but the idea of “herd immunity” is important to preventing pandemics.

We could add to this discussion the debate over re-implementing the smallpox vaccine, to protect ourselves from bioterror.  The idea of being prepared with anthrax vaccines and medication has become a homeland security topic (given the 2001 outbreak).  Other potential public health vectors (ricin, polonium) so far have remained very remote indeed.

It’s notable that the political scare in Dallas in 1983 followed a period in 1979 and 1980 when rogue members of the Dallas Police Department would troll gay bars and arrest patrons on false charges of “public lewdness”.  The Dallas Gay Alliance, and particularly SMU Professor Campbell Reed, helped put a stop to this, when one particular man, a computer operator from Plano, was acquitted.  I actually went to one of the bench trials before and saw a man be convicted.  I would later, in 1982, be a jury foreman on a trial in front of the same judge!

DADT footnote key:  “C2-0004-02140211-44-80”

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