As we have seen in the course of chronicling responses to sexually transmitted diseases in the twentieth century, the process by which a disease is defined has a fundamental impact on the character of policies devised to eliminate it. In the unfolding of the AIDS epidemic, we see this process at work. 1
In light of the history of sexually transmitted diseases in the last century, it is almost impossible to watch the AIDS epidemic without experiencing a sense of déià vu. AIDS raises a host of concerns traditional to the debates about venereal infection, from morality to medicine, sexuality and deviancy, prevention and intervention. In many instances the situation today with AIDS is similar to that with syphilis in the early twentieth century. Like syphilis, AIDS can cause death; presently has no effective treatment; education and social engineering characterize efforts to halt the epidemic -- given that no magic bullet is on the horizon; fears, reflecting deeper social and cultural anxieties about the disease, its victims, and transmissibility, abound.
And yet AIDS is different.
In June 1981 in a weekly report surveying disease patterns in the United States, the federally operated Centers for Disease Control announced an unusual outbreak of disease in Los Angeles. Five homosexual men were reported to have a rare form of pneumonia caused by Pneumocystis carinii, a protozoan infection usually seen only in individuals whose immune systems have been compromised. The report suggested the possibility of "an association between some aspect of homosexual lifestyle or disease acquired from sexual contact." 2 By the following month, CDC revealed that Kaposi's sarcoma, a rare cancer, had been diagnosed in 26 gay men during the previous two and a half years. Kaposi's sarcoma is also associated with damage to the immune system. Physicians, rec-