Chronicle of an Epidemic

John Ryle

  • And the band played on: Politics, People and the Aids Epidemic by Randy Shilts
    Viking, 630 pp, £15.95, March 1988, ISBN 0 670 82270 1
  • Crisis: Heterosexual Behaviour in the Age of Aids by William Masters, Virginia Johnson and Robert Kilodny
    Weidenfeld, 243 pp, £9.95, March 1988, ISBN 0 297 79392 6
  • The Forbidden Zone by Michael Lesy
    Deutsch, 250 pp, £11.95, February 1988, ISBN 0 233 98203 5

There is no good news about Aids. With a total of 85,000 cases reported at the beginning of this year the World Health Organisation estimate of the true figure is nearer 150,000. Their global estimate for HIV infection is between five and ten million. Most HIV-positive individuals have no symptons and don’t know they are infected: but the majority of them – possibly all of them – will eventually develop Aids and die; in the meantime, of course, they may infect anyone they have sex with and any children they bear.

Projections for the rest of the century show that a dozen years hence, in the year 2000, barring unprecedentedly rapid progress in the development of a vaccine, or an unpredictable change in the behaviour of the virus, 25 million people are likely to have died or be dying of Aids: that is, half a per cent of present world population – a fraction, but more than the victims of the 1918-19 flu epidemic, more than have been killed in a century of automobile accidents, almost as many as died in two world wars. Such figures would put Acquired Immune Deficiency Syndrome in the TB league, among the greatest killers.

The comparison with tuberculosis suggests a further grim prediction: although effective treatment for tubercular illness has existed for a quarter of a century, it is still one of the leading causes of death in the Third World; similarly, any advances in the treatment or prevention of Aids will benefit Westerners immediately, but their implantation in countries of the Southern hemisphere, including the African Aids epicentres, will certainly be slower and less effective. Aids will be taking its toll in such countries long after it has been contained in the West. Western countries, with their advanced systems of communication and established traditions of preventive medicine, are beginning to slow down the spread of the disease by promoting changes in sexual behaviour among their citizens. Few Third World countries are in a position to do this at all effectively; most are still struggling to establish facilities for primary health care. In the West, the comparative youth of Aids victims has been one of its most shocking features. (In the United States it has displaced homicide as the leading cause of death among males in their twenties and early thirties.) But in other regions of the earth low life-expectancy and the heavier burden of suffering from chronic infectious diseases like tuberculosis, not to speak of malnutrition, blur the effects of any new epidemic. Aids is just one more in a bundle of afflictions.

Randy Shilts argues convincingly in And the band played on, a massive chronicle of the epidemic from its putative origin in the mid-Seventies up to the mid-Eighties, that public health agencies and news media in the United States dawdled in their response to the epidemic because its early victims did not come from the mainstream of society. Newspapers that had put Legionnaire’s Disease and Toxic Shock on the front page fought shy of the new illness because of the homosexual angle; blood banks that could have acted sooner baulked at the expense of making their blood safe from the virus; and gay leaders failed, on the whole, to confront the challenge to sexual mores that the epidemic posed for their constituencies. In the five years from 1980, when the first homosexual men began to fall seriously ill from obscure ailments, to 1985, when Rock Hudson died and Aids became a household word, the story is one of reluctance and embarrassment and delay. Shilts’s heroes are a few isolated teams of scientists in Europe and America who pioneered research in Aids and a handful of gay leaders in New York and San Francisco who withstood vilification from fellow activists and commercial interests in the gay world to lobby for funds to combat the epidemic and campaign against the aspects of homosexual practice that spread it so quickly.

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