Monday, October 21, 2013

AIDS-HIV "denial" has never helped gay men politically, or medically

The appeal of “AIDS denialism” or specifically “HIV denial” doesn’t go away completely, as evidenced from a court case I discuss on my main blog Aug. 16, 2013.
In the mid 1980s, much of the male gay community was reluctant to accept the science that seemed to show that a virus then called HTLV-III causes AIDS. 
There had been some subtle warnings that a severe health crisis was coming, even during my last year living in New York, 1978.  Rumors of clusters of contagious cancer had spread even then (and even out in the general population, as with Hodgkin’s Disease).  I moved to Dallas in early 1979. I first heard about Kaposi’s Sarcoma in a gay magazine called “This Week in Texas” on the day in February 1982 that I went to see “Making Love”.  It wasn’t until early 1983 that the epidemiology of AIDS really attracted attention, because the number of official cases was doubling so quickly, every six months.  An epidemic starting from almost one case and spreading geometrically would have to yield a novel explanation.  A novel virus was the most probable.
HTLV-3 was formally identified in the spring of 1984, and a test was available in 1985.  The gay community often argued “don’t take the test” out of very real political fears.  But it’s also arguable that the community was better off politically once a virus was identified and could be understood.
There were lots of conspiracy theories.  The New York Native, published by Charles Ortleb, indulged some of them, with reports about experiments at Plum Island, and the idea that ASFV, African Swine Fever Virus, could be the cause.  This was a dangerous idea, because ASFV is an arbovirus, spread by mosquitoes.  There were other theories, like that a bizarre fungus from Scandanavia was the cause, or that even some strange primitive bacteria (reportedly found in KS lesions) caused it. With a provocative article in a 1983 Discover issue, there were even ideas that prions ("infectious" proteins that destroy brain tissue by corrupting the surface geometry of certain proteins, in a domino fashion) could be responsible for AIDS (they do cause neurological disease).  
Before HTLV-3, to be renamed HIV, was identified and accepted, the religious right in Texas (and a group called “Dallas Doctors Against AIDS) proposed, in early 1983, a state law increasing the penalty for sodomy and imposing a military-style ban on gays in most occupations.  The right wing (supported by Paul Cameron and Gene Antonio) proposed that within the gay male community a deadly “chain letter” had formed which amplified the virus.  Were it to turn out to be spread by insects later (which it fortunately was not), it could then spread to the general population.  This was the “compelling state interest” that would have justified Sodomy laws from a “public health” viewpoint.   (The right wing also claimed that mutation alone could cause this, but probably not without its being an equally heterosexual disease in short order, and probably becoming less lethal.)  In fact, in the early 80’s, some writers speculated that other viruses would get amplified by the male gay community.  This has not happened, because transmission patterns of viruses are more different than we realize, and also because the behavior in the community did get more cautious -- yes, most of the Baths were closed, but condoms became much more popular..  But before HIV, Hepatitis B had been more common among MSM. It’s a lot less clear, though, with other bloodborn viruses, that there has been any particular affinity for the male gay community.  Some viruses seem spread by needles but not as easily by sex.  In 1984, I actually tried to correspond with DDAA, to the horror of the Dallas Gay Alliance (especially its president then Bill Nelson).  DDAA wrote back a letter with graphic arguments about the mechanics of both male sexual practices and ordinary heterosexual intercourse, trying to justify its draconian position.  Fortunately that bill died in committee in the late spring of 1983, but only after heavy lobbying by more moderate elements and by the medical community.   The story of HR 2138 is now largely forgotten Texas history – with implications for the entire community.
In 1988, I was evaluated to be a subject for the GP160 vaccine.  I was accepted but decided not to participate because of the time required from work.
Today, blood donation remains an issue.  I think the case of allowing MSM who test negative by all indicators and who have refrained from sex for some period (like 180 days) to donate blood or organs (post mortem) again is a strong one.  Other countries are starting to lift the ban on blood donations in certain circumstances.
Another argument supporting HTLV-3 as a cause was that a similar virus, HTLV-1, had already been found (in 1982) to cause a T-cell leukemia.
In general, trying to deny HIV as a cause does not help gay men.   That is not to say that some prosecutions for transmission may be wrong or that some pharmaceutical companies may not have behaved unethically at times.

Public health can always be affected unexpectedly by activity in certain communities.  Although avian influenza (“bird flu”) is very different from retroviral disease and much more contagious, it likewise has a public health lesson.  Here the problem is that agricultural practice in the developing world, where people live near the poultry they raise, seems to contribute to amplification and  (after mutation) subsequent global risk. Again, most viruses, if the mutate and spread to more people, become less lethal.  
Today, I don't hear about new cases of AIDS often, but there are reports that it is returning in some cities in younger gay men.  Fortunately, the protease inhibitors do work for maany, if not most, patients.  

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