AIDS at 25

Article excerpt

WASHINGTON

Those words 25 years ago announced the arrival of something most Americans thought anachronistic -- an infectious disease epidemic. At first it was called GRID -- gay-related immune deficiency. In September 1982, CDC renamed it acquired immune deficiency syndrome - - AIDS.

Its worldwide toll has already exceeded the 20 million killed by the 14th-century bubonic plague. By 2020, it probably will have killed more than has any epidemic in history, with most fatalities in sub-Saharan Africa, where it probably began about 75 years ago after some people who ate wild chimpanzees in Cameroon became infected with a low-virulence progenitor of the virus that causes AIDS.

An epidemic requires both a microbe and an enabling social context. In Africa, aspects of modernity in a primitive setting became a deadly combination: HIV was spread by roadside prostitutes serving truckers and soldiers traveling on modern roads. Africa's wars caused population dislocations; economic development caused migrations of workers across porous borders. Both weakened families and dissolved traditional sexual norms. Jet aircraft integrated Africa into the world flow of commerce and tourism.

In 1980s America, the enabling context included a gay community feeling more assertive and emancipated and IV drug users sharing needles.

AIDS arrived in America in the wake of the Salk vaccine, which, by swiftly defeating polio, gave Americans a misleading paradigm of how progress is made in public health. Pharmacology often is a small contributor. By the time the first anti-tuberculosis drugs became available in the 1950s, the annual death rate from TB had plummeted to 20 per 100,000 Americans from 200 per 100,000 in 1900. Drugs may have accounted for just 3 percent of the reduction.

The other 97 percent was the result of better nutrition and less urban crowding. Thanks to chlorination of water and better sanitation and personal hygiene, typhoid, too, became rare before effective drugs were available.

Which suggests that the most powerful public health program is economic growth. And the second-most powerful is information.

The 14th-century Black Death killed one-third of Europe's population but it was in the air, food and water, so breathing, eating and drinking were risky behaviors. …