The Kaiser Daily HIV/AIDS Report Examines Early Media Reporting on AIDS, 20 Years Later
On June 5, 1981, the CDC introduced the world to the disease that eventually became known as AIDS. Although the disease had been present in the United States and elsewhere before this time, it was the first known mention of AIDS in a media report. Over the years, media coverage of AIDS has evolved from having an air of mystery to reports of panic, stigma and homophobia; from domestic epidemiology and policies to international crises and drug access. This week, the Kaiser Daily HIV/AIDS Report will feature stories on different aspects of the media's coverage of the disease over the past 20 years, including treatment advances, federal legislation, public fear and stigma and AIDS in the arts. The following report, the first in our series, examines the first few years of media reports on the epidemic to the discovery of the causative agent of AIDS, the human immunodeficiency virus.
In The Beginning...
"In the period October 1980-May 1981, five young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at three different hospitals in Los Angeles, California. Two of the patients died."
-- Morbidity & Mortality Weekly Report, 6/5/1981
With that statement, the CDC's MMWR published the first clinical reports of what would become known as acquired immune deficiency syndrome, or AIDS. The report documented five cases of young homosexual men who had developed Pneumocystis carinii pneumonia, a type of pneumonia that at that time was "almost exclusively limited to severely immunosuppressed patients," such as older patients or those receiving cancer chemotherapy. The CDC report stated, "All the above observations suggest the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections such as pneumocystosis and candidiasis" (a fungal infection). Although the report noted that the "patients did not know each other and had no known common contacts or knowledge of sexual partners who had had similar illnesses," it stated, "The fact that these patients were all homosexuals suggests an association between some aspect of a homosexual lifestyle or disease acquired through sexual contact and Pneumocystis pneumonia in this population" ( MMWR, 6/5/1981). The Los Angeles Times picked up the story on the same day and ran a short article titled, "Outbreaks of Pneumonia Among Gay Males Studied" (New York Times, 6/3). In a second MMWR report appearing on July 4, 1981, the CDC still had no concrete answers pertaining to what was causing outbreaks of PCP and Kaposi's sarcoma, a form of skin cancer, among young, gay men. Although this report also drew a link between immune system depression and the opportunistic infections, it repeatedly tempered its findings with phrases such as "it is not yet clear" and "it is not certain" ( MMWR, 7/4/1981). A follow-up MMWR report published on Aug. 28, 1981, emphasized that the high number of occurrences of KS and PCP were "rare" and "highly unusual" in "persons without known predisposing underlying disease," such as cancer or organ transplant patients on immunosuppressive therapies. Since 40% of the infected men had died, the unknown condition was not yet seen as ultimately fatal ( MMWR, 8/28/1981). Although each of the CDC reports from 1981 mentioned immunosuppression as a common cause of opportunistic infections such as PCP and KS, no connection was made between the patients' depressed immune systems and an underlying viral infection. Therefore, no mention was made of a possible transmissible agent. Instead, all of the reports emphasized that the patients were young and homosexual.
'No Apparent Danger to Non-Homosexuals'
The unexplained outbreaks of KS and PCP generated some media coverage in 1981, though not much. A New York Times article published on July 3, 1981, covering the CDC's second report of the disease, described outbreaks of "a rare and often rapidly fatal form of cancer" that has made a "sudden appearance" among homosexual men. The Times stated that the KS outbreaks "prompted a medical investigation that experts say could have as much scientific as public health importance because of what it may teach about determining the causes of more common types of cancer." The end of the article stated that the researchers examining the outbreaks said that "some indirect evidence actually points away from contagion as a cause" and quoted CDC spokesperson Dr. James Curran as saying that there is "no apparent danger to non-homosexuals from contagion" (Altman, New York Times, 7/3/1981). The Washington Post on July 4, 1981, reported that the "rare form of cancer," which "primarily affects men over 50" and was believed to "progress slowly over about 10 years," had killed eight of the approximately 26 "victims" within two years of diagnosis (Washington Post, 7/4/1981). In an Aug. 30, 1981, article, the Post reported that the "two rare diseases" were a "medical mystery ... on the scale of the toxic shock syndrome or Legionnaire's disease" (Hilts, Washington Post, 8/30/1981). On Dec. 10, 1981, an AP/Toronto Globe and Mail article described the KS and PCP outbreaks as "a wave of pneumonia and cancer that is killing homosexual men across the United States." The article mentioned the link between the infections and a possible immune system disorder, but described the disorder as "mysterious" and "so new it does not have a name" (AP/Toronto Globe and Mail, 12/10/1981). The following day, the Post reported on a series of studies that appeared in that week's New England Journal of Medicine that provided the "first data showing that the defect is primarily a cellular immune deficiency," according to David Durack, then chief of infectious diseases at Duke University Medical Center. Durack continued, "That means that the lymphocytes, one of the important white blood cells, are not functioning normally and infections take the opportunity and cause serious disease" (Russell, Washington Post, 12/11/1981).
Sex and Sickness
On June 18, 1982, the CDC released its first report connecting a sexually transmitted agent with the outbreaks of KS, PCP and other opportunistic infections appearing among young, gay men. The report stated that one "hypothesis" pertaining to the outbreaks is that "infectious agents" responsible for the diseases are being "sexually transmitted among homosexually active males." Although the infectious agents were "not yet identified," CDC researchers believed that the agents "may cause the acquired cellular immunodeficiency that appears to underlie KS and/or PCP among homosexual males." Concurrent with these findings, the report stated, "If infectious agents cause these illnesses, sexual partners of patients may be at increased risk of developing KS and/or PCP" (MMWR, 6/18/1982). This report marked the first time a link was drawn between the outbreaks of opportunistic infections, acquired immunosuppression and sexual transmission, although homosexual males were still the only identified risk group, and the syndrome had come to be known as "gay-related immune deficiency." The New York Times subsequently described the syndrome as a "serious disease" that has "touched off anxiety among homosexuals," "engendered ... fear" and caused physicians to become "panic-stricken." Although researchers had by now named the condition acquired immune deficiency syndrome -- a name used by the Times in this article -- the paper stated that the condition "remains largely mysterious" (Herman, New York Times, 8/8/1982).
Not Just a 'Gay Disease'
In 1982, several CDC reports revealed AIDS' appearance in other populations, such as hemophiliacs, Haitians and intravenous drug users. On Dec. 10, 1982, the agency stated that although the etiology of AIDS was still "unknown," an infectious agent that caused the condition might be transmitted through blood. "This report and continuing reports of AIDS among persons with hemophilia A raise serious questions about the possible transmission of AIDS through blood and blood products," MMWR reported (MMWR, 12/10/1982). The Washington Post reported on the "alarming discovery" by health officials that a non-hemophiliac infant had developed AIDS after receiving a blood transfusion from a man who "unknowingly had the disease." Dr. Harold Jaffe, an AIDS researcher, said, "This is the first possible case of AIDS that can be linked with another case directly through a blood transfusion" (Russell, Washington Post, 12/10/1982). Although newspapers reported these findings, they continued to emphasize that the condition was mainly found in gay men. For example, a New York Times article on the infant case stated twice in the first two paragraphs that the condition "has been linked primarily to homosexual men" and "has principally afflicted homosexuals" (Schmeck, New York Times, 12/10/1982). The inclusion of more possible methods of transmission heightened fears of the disease, and a 1982 Globe and Mail article stated that AIDS "has reached epidemic proportions" (Globe and Mail, 3/13/1982).
In mid-1983, researchers reported that AIDS might be transmitted through heterosexual sex as well (Altman, New York Times, 5/19/1983). Subsequently, a number of news reports, opinion pieces and editorials appeared documenting the disease. On April 22, 1983, Kevin Cahill, then director of the tropical disease center at New York's Lenox Hill Hospital, wrote in a New York Times op-ed that as "the numbers afflicted [by AIDS] grew ... an insidious outbreak exploded into a frightening epidemic." He wrote that the "puzzling" condition "led to fear, then panic" as more groups of people were classified as at risk for the disease (Cahill, New York Times, 4/22/1983). In a New York Times magazine piece, author Robin Henig described AIDS as a condition "as relentless as leukemia" and "as contagious as hepatitis," which is spreading so quickly that "scientists simply cannot catch up with it." Henig noted that although AIDS was primarily spotted in homosexual men, it "has now struck so many different groups that its course cannot be predicted" (Henig, New York Times, 2/6/1983). A 1983 New York Times article noted: "In many parts of the world there is anxiety, bafflement, a sense that something has to be done -- although no one knows what -- about this fatal disease whose full name is Acquired Immune Deficiency Syndrome and whose cause is still unknown" (Altman, New York Times, 5/24/1983).
Pulling it all Together
With the 1984 discovery of what would later be known as human immunodeficiency virus, scientists filled in one of the most significant missing pieces of the AIDS puzzle. However, some controversy surrounded the findings, as both French and American research teams claimed they had first discovered the virus that causes AIDS. In mid-April, CDC officials reported that Dr. Luc Montagnier and a group of scientists at Paris' Pasteur Institute in 1983 had isolated what they called LAV, or lymphadenopathy-associated virus, as the "leading candidate as the cause of AIDS" (Altman, New York Times, 4/22/1984). Montagnier and his colleagues had published its findings in the April 7, 1984, edition of The Lancet, but "international controversy" arose when Dr. Robert Gallo and a group of scientists from the National Cancer Institute made a "competing claim" stating that they had discovered the virus that caused AIDS. Gallo's team, which published their findings in the May 1, 1984, issue of the journal Science, called their virus HTLV-III because it represented the third member of the Human T-cell Leukemia Virus family (Chase, Wall Street Journal, 4/24/1984). In 1986, an international committee recommended that the newly identified virus be called the human immunodeficiency virus -- grouping HTLV-III, LAV and another AIDS-associated retrovirus called ARV under the term (Marx, Science, 5/9/1986). But the competition over who discovered the virus and who should receive patent rights for blood tests to screen for it led to three years of "scientific feuding" between France and the United States (Shilts, San Francisco Chronicle, 4/1/1987). The countries eventually agreed that each research team would equally share the credit for discovering the virus and the rights to develop a blood test (Specter, Washington Post, 4/1/1987).
With the discovery of HIV, health officials knew how AIDS was transmitted and began educating the general public about how to avoid contracting the virus. However, the public's fear of the disease played a role in creating stigma surrounding the four groups the CDC continued to identify as "high risk": homosexuals, intravenous drug users, Haitian immigrants and hemophiliacs. In tomorrow's report, the Kaiser Daily HIV/AIDS Report examines why those groups were tagged as high risk, and how the media contributed to the stigma surrounding them.
The other parts of the Kaiser Daily HIV/AIDS Report 20th anniversary series are available online:
- The June 5 article examines the stigmas surrounding HIV/AIDS.
- The June 6 article examines HIV/AIDS in the arts.
- The June 7 article looks at 20 years of legislation and policies on the disease.
- The June 8 article recaps advances in treatment.