The Coming Plague (56 page)
Authors: Laurie Garrett
By contrast, during the spring of 1983, Curran, Francis, and Harvard's Max Essex collaborated on an editorial wake-up call to be published in the
Journal of the National Cancer Institute
. Their intention was to state in no uncertain terms that AIDS was caused by an infectious agent and to suggest that one of the candidates for causation of AIDS was HTLV-I.
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Essex already had evidence that many AIDS patients were infected with HTLV-I.
Journal of the National Cancer Institute
. Their intention was to state in no uncertain terms that AIDS was caused by an infectious agent and to suggest that one of the candidates for causation of AIDS was HTLV-I.
87
Essex already had evidence that many AIDS patients were infected with HTLV-I.
“We checked a series of 75 patients with AIDS that were sent to us from CDC,” Essex explained in May. “And the patients were classified as either having Kaposi's or
Pneumocystis
. And in that series of 75 ⦠between a quarter and a third of the patients had evidence of prior exposure to the HTLV.
Pneumocystis
. And in that series of 75 ⦠between a quarter and a third of the patients had evidence of prior exposure to the HTLV.
“One possibility that I should underline is that the HTLV has nothing to do with this disease, and that the HTLV is opportunistically infecting some of the patients with AIDS, but not all of them,” Essex hastily added.
Gallo was ecstatic. Essex had evidence that implicated his personal
nominee for the AIDS culprit. Gallo's lab staff had just isolated HTLV-I from the white blood cells of three New York City gay men with AIDS, and in a survey of 33 AIDS patients in New York Hospital, Gallo's group found HTLV-I in the T cells of two men. Together, these findings seemed to argue strongly, in Gallo's view, that HTLV-I, or one of its close cousins, caused AIDS.
nominee for the AIDS culprit. Gallo's lab staff had just isolated HTLV-I from the white blood cells of three New York City gay men with AIDS, and in a survey of 33 AIDS patients in New York Hospital, Gallo's group found HTLV-I in the T cells of two men. Together, these findings seemed to argue strongly, in Gallo's view, that HTLV-I, or one of its close cousins, caused AIDS.
The four Essex and Gallo papers were published as a package in the journal
Science
, along with a study from the Pasteur Institute group that an official U.S. Department of Health and Human Services press release that day described as reporting “isolation of an HTLV-related virus from a homosexual patient with persistent, multiple lymphadenopathies and evidence of infections who may be at risk of developing AIDS.”
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Science
, along with a study from the Pasteur Institute group that an official U.S. Department of Health and Human Services press release that day described as reporting “isolation of an HTLV-related virus from a homosexual patient with persistent, multiple lymphadenopathies and evidence of infections who may be at risk of developing AIDS.”
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But that wasn't what the French study showed. Not at all.
On February 4, 1983, the Pasteur Institute's Charles Dauguet observed dozens of spherical viruses poking out of Frederic Brugière's T cells. However, though the mysterious viruses under Dauguet's microscope and HTLV-I were both spherical, they did not appear to the French scientist to he identical. More importantly, Montagnier's group was unable to get strong cross-reactivity between antibodies against Gallo's HTLV-I virus and their AIDS-related microbe. They suggested that the two agents might share some genetic similarities, but were clearly different species of viruses.
Nevertheless, at Gallo's urging Montagnier had inserted the following in his article: “We tentatively conclude that this virus, as well as all previous HTLV isolates, belong to a family of T-lymphotropic retroviruses that are horizontally transmitted in humans and may be involved in several pathological syndromes, including AIDS.”
Throughout the summer of 1983 the two competing laboratories toiled to grow the apparent AIDS viruses in cell cultures. But the viruses only grew well inside human T cells, which they also killed. So in a matter of days all the cells in a culture would be dead, along with the elusive viruses. Barré-Sinoussi and Chermann tried a variety of unsuccessful strategies to grow the viruses. Finally, during the dog days of summer Montagnier's team figured out that the trick was continuously, every three days, passing virally infected liquid (supernatant) from cells grown in the presence of T-cell stimulators interleukin-2 and phytohaemagglutinin to fresh T cells, and repeating the process over and over for several weeks. Eventually one would get a culture dish chock-full of viruses.
Meanwhile, panic was growing in North America.
Though the absolute number of reported AIDS cases in Canada and the United States was still below 2,000, the dimensions of the epidemic were expanding. Drs. James Oleske at the New Jersey Medical School in Newark and Arye Rubinstein of the Albert Einstein School of Medicine in the Bronx were treating babies and toddlers who seemed to have contracted AIDS from their parents. Oleske was treating eleven such children, Rubinstein twenty-five.
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All of the children had a parent who either used injectable
narcotics, had recently emigrated from Haiti or the Dominican Republic, or was “promiscuous,” as the physicians put it.
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All of the children had a parent who either used injectable
narcotics, had recently emigrated from Haiti or the Dominican Republic, or was “promiscuous,” as the physicians put it.
“Clearly none of the children that we have seen were sexually abused or given illicit drugs,” Oleske said in May 1983. “So the implications are that, if you will, ânormal' people can acquire AIDS.”
Rubinstein agreed, saying that it was likely most of the children got the presumed AIDS virus from their mothers during or immediately after pregnancy, but “we find discrete immune deficiencies in other members of the [families his group was studying]. Something that may suggest that the transmissible agent can be acquired in a different mode: not only transplacentally, not only sexually, not only by sharing of needles.”
In early 1983, a joint CDC/Montefiore Medical Center study in New York City described two women with AIDS who had no other apparent risk factors save marriage to men who had the disease.
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By May, Montefiore's Dr. Neil Steigbigel had uncovered five more cases of apparent heterosexual transmission.
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By May, Montefiore's Dr. Neil Steigbigel had uncovered five more cases of apparent heterosexual transmission.
“We do feel now that this does show that AIDS should be considered threatening to the health of our general population, not only to male homosexuals, abusers of intravenous drugs, Haitians, or hemophiliacs,” Steigbigel said at the time. “Of course, if one is dealing with a potentially fatal disease, that is tremendously frightening. To have a potentially fatal venereal disease, that is ⦠present in our general population.”
Other studies confirming the sexual passage of the mysterious AIDS agent flooded in during the summer and fall of 1983.
In many ways the most alarming news for the CDC's AIDS Task Force members came from the users of injectable drugs. Curran, Jaffe, Francis, Guinan, Darrow, and the others all cut their public health teeth on sexually transmitted diseases; even so, they were surprised, even shocked, by what they learned about the sexual fast lane in the gay community. Before AIDS, they were similarly ignorant about the drug-using population. They didn't know about all the years that Greggory Howard, and thousands like him, had been stashing their “works” in shared hiding places. They didn't know about the allegedly abandoned buildings filled with the commerce of narcotics.
When New York City and Newark drug researchers brought their familiarity with the desperate details of drug addiction into the growing circle of American AIDS scientists, their insights hit Curran and his colleagues with a jolt: one could debate theoretical probabilities of contracting AIDS through sexual transmission, but injecting it into one's bloodstream seemed to guarantee infection.
Soon the CDC group was learning about shooting galleries where junkies could pay to get injected with just about anything by a dealer who used the same needle and syringe on dozensâeven hundredsâof customers a day. Experts like Dr. Don Des Jarlais, who ran a drug rehabilitation program inside Manhattan's Beth Israel Hospital, told the CDC scientists that few
addicts in 1983 used just one drug: they were addicted to two, three, or more drugs, often including cocaine, alcohol, amphetamines, barbiturates, Valium, and other benzodiazepines. After years of periodic heroin “famines,” due either to police actions or to wholesaler market manipulations, expert narcotics users had adapted by mixing their drugs. One “cocktail” to start the day, another to smooth the rocky edges of coming down off the first, and still another to shoot the user straight to temporary paradise.
addicts in 1983 used just one drug: they were addicted to two, three, or more drugs, often including cocaine, alcohol, amphetamines, barbiturates, Valium, and other benzodiazepines. After years of periodic heroin “famines,” due either to police actions or to wholesaler market manipulations, expert narcotics users had adapted by mixing their drugs. One “cocktail” to start the day, another to smooth the rocky edges of coming down off the first, and still another to shoot the user straight to temporary paradise.
It was naive in the extreme, the CDC scientists learned, to build stereotypes around junkies, or to assume that any single behavior explained the skyrocketing increase in AIDS among users. The array of individual drug-use patterns could range from lethargy to hyperactivity. These people were neither easy to study nor easy to educate.
“We just don't know what to make of all of this,” Curran said. “We can't explain why almost all IVDU (intravenous drug user) cases are showing up in New York and New Jersey, while most of the West Coast casesâmore than 90 percentâare among gay men. We don't really understand the distribution.”
“All you have to do is walk the streets,” Howard would claim. “Greggory knows what's going on.”
Howard was trying to stick with methadone, but it was tough. The clinic staff treated the junkies like animals, he said, and it was often questionable which was more demeaning: pulling down your pants in front of a hulking clinic guard and struggling to pee into a Dixie Cup while in drug withdrawal so they could test for heroin; or searching frantically for a usable vein to bare to a scowling dealer who jabbed the needle in, shoved down the plunger, released the tourniquet, and turned to the next customer while you swayed off into suspended animation.
Though Howard didn't yet know much about AIDS by the fall of 1983, he was an expert on lifestyles of the stoned and addicted. He could have told the CDC team enlightening and unsettling stories, if they had bothered to ask. But they didn't. Curran knew his team was out of their depth when it came to injecting drug users, and he lobbied hard for research efforts at the agencies that were supposed to be on top of such things, particularly NIDA (National Institute on Drug Abuse). But under the Reagan administration, NIDA was far more concerned with eliminating drugs than with keeping users alive.
If anybody had asked him, Howard would have told the government scientists the same things he said to anyone who asked.
“How much
Greggory uses,” Howard would say,
“when
he uses it,
how
he uses it, all depends on
what
he's using. It's as simple as that.”
“How much
Greggory uses,” Howard would say,
“when
he uses it,
how
he uses it, all depends on
what
he's using. It's as simple as that.”
If it boiled down to nothing more than heroinâwhich it rarely didâone or two injections per day with his personal works would be adequate. If, however, he mixed heroin with downers like alcohol or barbiturates, and “wildness” like injected cocaine or speed, things got more complicated.
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Heroin might last for hours, but cocaine's rush persisted for only
minutes. A heavy injected dose of speed might have the user walking through Newark, barefoot and unfueled by food or sleep, for two or three days unless he smoothed it over with some serious downers, like Valium or barbiturates, both of which would come on faster if the pills were washed down with high-proof alcohol.
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Heroin might last for hours, but cocaine's rush persisted for only
minutes. A heavy injected dose of speed might have the user walking through Newark, barefoot and unfueled by food or sleep, for two or three days unless he smoothed it over with some serious downers, like Valium or barbiturates, both of which would come on faster if the pills were washed down with high-proof alcohol.
So Howard would explain as he strolled the familiar Newark slums, the drugs dictated what he did every day, how many times the needle entered a vein, whose needle it was, and how many other people used it.
The CDC wanted studies done among drug users as soon as an AIDS test of some kind was available. If the drug experts were right, the addicts might have an even greater AIDS incidence than gay men. But gaining access to drug users, especially those who weren't in methadone or rehabilitation programs, or didn't live in drug ghettos like Howard's Newark niche, would be extremely difficult. The greatest challenge would be finding drug injectors who simultaneously led middle-class existences and clandestine lives of addiction.
Even without such data, concern was high that AIDS would make its way to the general population via addicted prostitutes or the sexual partners of injecting drug users. The heterosexual transmission reportsâexcluding those mistakenly labeled as “Haitian cases”âwere predominantly among the female sexual partners of male drug addicts.
Another grave concern for the CDC stemmed from reports by two U.S. primate research centers of outbreaks of what looked remarkably like AIDS among their monkeys, in California
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and Massachusetts.
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Though these were not of particular concern to the general public, scientists worried that whatever new virus was killing people might have fairly recently arisen from monkeys. If that were so, then few, if any, humans could be expected to have natural immunity to the monkey microbe.
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and Massachusetts.
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Though these were not of particular concern to the general public, scientists worried that whatever new virus was killing people might have fairly recently arisen from monkeys. If that were so, then few, if any, humans could be expected to have natural immunity to the monkey microbe.
As public awareness of the epidemic's widening scope increased, so did panic. Police officers in San Francisco demanded, and received, specially designed masks and gloves for their protection when performing artificial resuscitation or “handling” of “potentially dangerous” citizens. A New York City garbage collector was terrified that he had become infected as a result of grabbing a trash bag from which protruded a syringe. Also in New York the city's Health Department was swamped with calls from fearful citizens asking whether it was safe to share laundry facilities with gay men, whether the virus could be passed via seats or handrails on the subways, or on public toilet seats.
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In Europe, thoroughly respectable, usually conservative scientists were openly comparing AIDS to the plague.
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And inside America's gay community a great political-cultural battle was being waged. Many men were duly terrified and were radically altering their behavior. Bathhouses in San Francisco, for example, reported 40 to 60 percent declines in revenues during May 1983.
But as June 27 approachedâthe anniversary of the Stonewall riot, now
celebrated as Gay Freedom Dayâshouting matches reverberated through the halls of government in San Francisco and New York. Those most concerned about AIDS feared that the party atmosphere and bathhouse frolicking that had prevailed since 1969 was too dangerous in 1983. Opponents of bathhouse restrictions derided such sentiments as government-inspired paranoia, intended to stifle the gay liberation movement.
celebrated as Gay Freedom Dayâshouting matches reverberated through the halls of government in San Francisco and New York. Those most concerned about AIDS feared that the party atmosphere and bathhouse frolicking that had prevailed since 1969 was too dangerous in 1983. Opponents of bathhouse restrictions derided such sentiments as government-inspired paranoia, intended to stifle the gay liberation movement.
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