- The AIDS Epidemic edited by Kevin Cahill
Hutchinson, 175 pp, £3.95, January 1984, ISBN 0 09 154921 3
- AIDS: Your Questions Answered by Richard Fisher
Gay Men’s Press, 126 pp, £1.95, April 1984, ISBN 0 907040 29 2
- Fighting for Our Lives by Kit Mouat
Heretic Books, 160 pp, £2.50, April 1984, ISBN 0 946097 14 3
Flu has just hit London, and you are not feeling very well. You have swollen glands and a cough, perhaps with a sore throat; you are running a temperature, tend to sweat in bed at night, and your bowels are a bit upset. To most of us an attack of this kind is unpleasant and inconvenient, little more than that. For others it brings doubts that are a plague worse than the disease, fears that cause rifts between themselves and their loved ones, and a growing realisation that they are going to be cast off by mankind, possibly for good. These men – for it is principally men that are concerned – are members of the metropolitan homosexual communities – in London, Paris and, above all, New York, San Francisco and Los Angeles. Over the last five years their lives have been overshadowed by the spread of a mysterious, entirely fatal disease which has, ironically, become known as AIDS.
The acquired immune deficiency syndrome, to give it its full name, first surfaced in the West in 1979. Reports of rare parasitic infections, of cancers till then hardly more than descriptions in the literature, began to appear. The Centre for Disease Control (CDC) in Atlanta began to receive unusual numbers of requests for pentamidine, a drug used to treat Pneumocystis carinii pneumonia; the condition is hardly known in adults outside famine-struck refugee camps. This and at least twenty other opportunistic infections are now known to be accompaniments of AIDS, passengers of the underlying disease driven by some unknown agent. The syndrome was recognised in 1981. Since then it has afflicted several thousand people. The first signs are hard to distinguish from many less serious viral infections; there is no quick way of reassuring a patient who suspects he may have the disease. (The BMJ recently carried advice to doctors on a whole new problem – the treatment of anxiety and depression among homosexuals who fear they may have AIDS.) Time alone can tell: but if you have the disease, usable life will be short, and at present there is no cure.
Infectious diseases have lost much of their power to terrify. Until this century they made death a familiar part of life; for young as well as old life was less predictable, and perhaps – for that reason if for no other – more to be prized. The natural love of man for the comfort and company of his kind was edged with the realisation that it was also from his fellow mortals that he risked mortality. Leprosy, pox, plague: the image of these strange pestilences supplied priests and holy men with their texts, and artists with breeding metaphors of corruption, despair, pity – of the whole brief urgency of life. Waiting as most of us do now for a death which comes from within, a slow death, an aged death, a death which is incommunicable and for the most part invisible, we are more solitary than our ancestors – both in our enjoyment of life, and in the manner in which we are condemned to relinquish our hold on it.
For this reason, any outbreak of serious infectious disease alters the way in which we view ourselves and our lives. Such an event is mercifully rare, but it may not always be so. People sometimes talk as though the advances of medicine were permanent. They are no more permanent than the advances of an empire over hostile peoples. New organisms, causing new diseases, are continually evolving; and those which cause the familiar diseases learn how to evade such defences as we already have. It is well-known that the flu epidemic of 1918-19 killed more people than died in the Great War. What is perhaps not so well known is that the same virus was isolated in New Jersey in 1977, where it killed a soldier in the US Army. A painful decision had to be made: 45 million people were inoculated, the vaccine condemning several hundred to die of an ascending paralysis, resulting from a neuropathy known as Guillain-Barré syndrome. Early-warning stations are on constant alert to prevent the recurrence of globally fatal diseases, but even if we succeed in preventing them, we do so at a cost.
Drugs, too, go out of date very fast, not because they are being constantly improved, but because they soon cease to be effective. Bacteria learn with a speed which is awe-inspiring how to outwit the defences summoned against them. Put two cultures of different types of bacteria together, one of which is resistant to one drug and the other to another, and in a matter of minutes you will be breeding bacteria which are resistant to both. Some bacteria transfer information on drug resistance during sex. This performance, which has to be seen to be believed, involves the male, which is shaggier than the female, getting the female on the end of a long rod, known as the sex pilus, and transferring a chunk of DNA which contains information both on drug resistance and how to make a sex pilus: ‘she’ now becomes a ‘he’, and passes the news on to her next partner. Even viruses which prey on bacteria may inadvertently take up the plasmid (the chunk of DNA), and instead of injecting their own genes into the next victim, confer on it the ability to resist certain antibiotics. Staphylococcus aureus, a common hospital bacterium, was nearly 40 per cent resistant to penicillin within a year or eighteen months of the drug’s introduction, and 60 per cent resistant by the following year; penicillin nowadays is virtually useless against it.