Authors: Laurie Garrett
The Coming Plague (82 page)
Furthermore, no facile measures could be taken by a government to bring AIDS to a halt. Unlike Ebola, Marburg, drug-resistant cerebral malaria, or Lassa, HIV hit specific social targets. It was a sexual disease. It was associated with homosexuality, promiscuity, and drug abuse. It pitted public health against organized religion and the moral pillars of society.
It was, in short, easy to ignore and uncomfortable to confront.
The World Health Organization, acutely aware of the unsettling aspects of AIDS, initially chose the first routeâignoring the emerging disease.
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From 1981 to late 1986 barely a whisper about AIDS emanated from Geneva. By the time Mann and his crew started sounding every alarm they could get their hands on, HIV had successfully emerged and reached full-fledged epidemic status in all the major cities of North America and Western Europe, as well as most of the urban centers of sub-Saharan Africa.
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From 1981 to late 1986 barely a whisper about AIDS emanated from Geneva. By the time Mann and his crew started sounding every alarm they could get their hands on, HIV had successfully emerged and reached full-fledged epidemic status in all the major cities of North America and Western Europe, as well as most of the urban centers of sub-Saharan Africa.
The GPA group felt justified in, figuratively speaking, yelling about AIDS at the top of their lungs.
But yelling, figuratively or literally, simply wasn't done inside the World Health Organization. Mahler might approve, but his underlings, and officials elsewhere in the UN system, did not. Indeed, in the entire United Nations system, “yelling” was the exclusive right of the General Assembly and the Security Council. The peripheral UN agencies were
intended
to plod.
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intended
to plod.
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Rubbing against the bureaucratic grain, the Programme staff group moved with both haste and deliberation. They decided on a strategy for control of AIDS in which vaccine and drug research efforts, already underway in key wealthy nations, received the Programme's encouragement but not significant emphasis. With no cure in sight, the Programme's best focus, they felt, was on prevention of further spread of HIV. Though details would come much later, during 1987 the GPA outlined the need for national AIDS programs in every countryâprograms that would coordinate mass education campaigns about the disease. Societal awareness was the first stepâthat was Tarantola's job. To prevent further spread of HIV it was crucial that every nation's blood banks be free of HIV, sterile syringes had to be available to health providers, and people who were infected with HIV had to be counseled carefully so that they wouldn't pass their virus on to others. Counseling was Carballo's job. Anti-AIDS programs had to be coordinated not only within countries but worldwide.
And perhaps most important in Mann's mind was the need to eliminate the atmosphere of discrimination and prejudice that surrounded every aspect of AIDS.
“Discrimination simply drives AIDS underground,” Mann repeatedly asserted. “The epidemic doesn't go away, it simply becomes harder to see, more alienated from public health. If you drive it underground, you guarantee its spread.”
With those vague principles in mind, the Programme targeted sequentially each of the international bodies whose support the GPA staff felt was crucial. On May 15, 1987, the Fortieth World Health Assembly, the legislative body of WHO, passed the Global Strategy for the Prevention and Control of AIDS,
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endorsing the strategy of the Global Programme on AIDS.
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That gave the Programme its mandate, power, and seal of approval. In subsequent months Mann and his team sewed up further political support by gaining formal endorsements at the Venice Summit of the European Economic Community and the Economic Council of the UN. And on October 26, 1987, Jonathan Mann did something no WHO functionary at his level had ever done: he addressed the General Assembly of the United Nations. For the first time in its history the UN passed a resolution on a specific disease, formally endorsing WHO's leadership in the war against AIDS.
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endorsing the strategy of the Global Programme on AIDS.
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That gave the Programme its mandate, power, and seal of approval. In subsequent months Mann and his team sewed up further political support by gaining formal endorsements at the Venice Summit of the European Economic Community and the Economic Council of the UN. And on October 26, 1987, Jonathan Mann did something no WHO functionary at his level had ever done: he addressed the General Assembly of the United Nations. For the first time in its history the UN passed a resolution on a specific disease, formally endorsing WHO's leadership in the war against AIDS.
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Over the next three months the Programme staff carefully prepared for the London Summit, further detailing its strategy for control of the emerging pandemic, collecting data on the epidemic's scope, and carefully monitoring the AIDS-related activities of governments around the world. Though they loudly decried all attempts to keep AIDS at bay through legislation against HIV-positive individuals or members of social groups considered at greatest risk for exposure to the virus, the GPA members watched helplessly as eighty-one nations passed such laws.
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As the New Year and the London Summit approached, at least ten more governments were debating passage of similar legislation and the international mood was growing ugly.
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As the New Year and the London Summit approached, at least ten more governments were debating passage of similar legislation and the international mood was growing ugly.
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In the Middle East tough laws in some Islamic countries passed in 1986â87 made failure to submit to HIV tests and “promiscuous” behavior punishable by imprisonment.
In Western Europe the EEC repeatedly condemned all efforts to legislatively restrict the travels, employment, or reasonable freedoms of people infected with HIV. Nevertheless, laws and condemnations were forthcoming.
Just four days before the opening of the London Summit of Ministers of Health, on January 22, 1988, American Gene Meyer was forcibly detained by British authorities when he attempted to enter the U. K. It was the second time Meyer had faced such problems with British authorities: in September 1987 immigration officers at London's Gatwick Airport, surmising that Meyer was a homosexual, read his diaries, saw references to medical tests, assumed he had AIDS, and designated the man “medically undesirable.” Meyer was eventually permitted entry on January 22, 1988, when a very embarrassed Ministry of Health intervened, countermanding immigration officials.
There were contradictions to EEC cries of openness in other Western European government efforts, particularly directed against Africans. Belgium, West Germany, Greece, Finland, and Spain all passed new legislation, or interpreted preexisting public health law, to permit expulsion or visa denial to HIV-positive foreigners who were seeking work permits or
student credentials. In practice, these regulations were primarily directed against Africans and, in the case of Germany, Turks.
student credentials. In practice, these regulations were primarily directed against Africans and, in the case of Germany, Turks.
Germany offered a unique set of challenges to the Global Programme on AIDS and the rest of the European Community. On the one hand, Germany was one of the first countries to respond to AIDS with a national education campaign, distributing 27 million leaflets on the disease during 1985 and promoting condom use.
But a gay, retired U.S. Army sergeant living in Nuremberg was arrested by German authorities in February 1987 and charged with knowingly spreading the disease to his sexual partners. He was ultimately convicted and sentenced to four years' imprisonment. A German homosexual was shortly thereafter brought up on similar charges. As AIDS panic in Bavaria increased, and public support for the arrests was loud and clear, Bavaria's Interior Minister, August Lang, announced that all prostitutes, civil service job applicants, drug addicts, immigrants, prisoners, and foreigners applying for extended residency permits would be required to undergo HIV blood tests. Days later the Bavarian city of Munich announced plans to dismiss all HIV-positive civil servants.
The Bavarian actions received a surprising amount of support from German residents of other, typically more liberal states. Federal Interior Minister Friedrich Zimmermann was prompted to order the nation's border patrol to deny entry to all foreigners who carried the AIDS virus.
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The European Community was outraged. Officials denounced the German actions as clear violations of Community principles of freedom of movement on the continent.
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The European Community was outraged. Officials denounced the German actions as clear violations of Community principles of freedom of movement on the continent.
In November 1987 the president of the German Federal Court of Justice, Gerd Pfeiffer, announced that in the absence of an HIV vaccine it might soon prove necessary to tattoo and quarantine people who were infected with the virus. The last time Germany had carried out tattoo-and-quarantine measures on its residents was during World War II, when “misfits,” Jews, and other “undesirables” were placed in concentration camps and exterminated. Not surprisingly, Judge Pfeiffer's pronouncement sent shock waves throughout the world.
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The Eastern bloc and the Soviet Union posed special difficulties for Mann and his colleagues, because, in general, the communist states claimed not to have muchâor anyâAIDS, and they wanted to keep it that way.
The Soviet Union, after long denying that it had any indigenous AIDS cases, issued fiats in late 1987 requiring testing of most foreigners and giving the KGB and the police powers to order HIV testsârefusal punishable by imprisonmentâon its citizens.
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Elsewhere in the communist world two nations clearly stood out: Cuba and China.
No nation on earth had ordered as broad a sweep of AIDS regulations as had Cuba. Between March 1986 and January 1988 the government
conducted 1,534,993 HIV tests, according to the Ministry of Health, and the intention was to test every citizen and nontourist visitor to the country, or 10.4 million people.
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conducted 1,534,993 HIV tests, according to the Ministry of Health, and the intention was to test every citizen and nontourist visitor to the country, or 10.4 million people.
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By January 1988 the Cuban government had identified 174 HIV-positive individuals and placed them under lifetime quarantine. Several of the infected people were recently returned veterans of the Angolan civil war, in which Cuban military advisers played a pivotal role in defense of the Luanda government. More than 300,000 Cubans returned from Angola between 1975 and 1987; HIV-1 was clearly present and causing AIDS in Angola at least as early as 1983.
In the People's Republic of China there were also practices underway that troubled the GPA. Beginning in December 1986, the Chinese government instituted mandatory testing for all foreign students: in reality, the edict was carried out with greatest vigor on Americans and Africans.
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Students who failed to comply with the tests were barred entry or deported. The mandatory testing list had expanded by 1987 to include all foreigners who wished to stay in China for more than a year and all Chinese citizens returning from overseas.
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Students who failed to comply with the tests were barred entry or deported. The mandatory testing list had expanded by 1987 to include all foreigners who wished to stay in China for more than a year and all Chinese citizens returning from overseas.
By the time the world's Health Ministers gathered in London for their AIDS Summit, China had already tested more than 10,000 foreign students, 20,000 returning Chinese students, and thousands of foreign businessmen: all in a period of less than four months. In addition, the Chinese government issued strict laws against “illicit sexual contacts with foreigners,” which included all forms of nonmarital sex. All foreigners caught having such relations with Chinese citizens could be deported, and the government stipulated that entertaining local citizens in one's hotel roomâregardless of what actually transpired in the roomâwould be considered in violation of the law.
Asia was a very special concern for the World Health Organization; though AIDS hadn't yet emerged in most of the area, those familiar with social and medical practices in much of the region felt sure that the virus could easily overwhelm the continent. WHO Director-General Mahler was so worried that in mid-1987 he broke with the usual diplomatic UN niceties that precluded mentioning countries by name when sounding an alarm. He predicted that a “major catastrophe” loomed for Asia if the continent failed to come to grips with AIDS, and specifically named India, Bangladesh, Thailand, Indonesia, and the Philippines as countries at greatest risk. Mahler did not break with UN decorum far enough to enunciate the reasons for naming those particular countries, but WHO officials privately voiced deep concerns about rapidly rising heroin and prostitution markets in urban centers of those countries.
Some of the countries in question seemed to recognize the veracity of Mahler's comments and responded aggressively. The nature of their responses, however, troubled WHO.
Thailand, for example, had a thriving sex and prostitution trade. Long
a major source of foreign exchange for the nation, the prostitution and “entertainment services” industry swelled radically during the Vietnam War, as Thailand was designated an official R&R (rest and recreation) site for U.S. military personnel. By the end of the war Thailand's revenues from the sex trade equaled a quarter of all rice trade income.
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Not wishing to call attention to potential problems in so lucrative an industry, the Thai government ignored all WHO pleas to institute nationwide AIDS education campaigns and promote condom use. Instead, Thailand alternately tried to repress or ignore the virus, imprisoning some HIV-positive foreigners while issuing so-called AIDS-free certificates to male and female prostitutes who serviced tourists.
a major source of foreign exchange for the nation, the prostitution and “entertainment services” industry swelled radically during the Vietnam War, as Thailand was designated an official R&R (rest and recreation) site for U.S. military personnel. By the end of the war Thailand's revenues from the sex trade equaled a quarter of all rice trade income.
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Not wishing to call attention to potential problems in so lucrative an industry, the Thai government ignored all WHO pleas to institute nationwide AIDS education campaigns and promote condom use. Instead, Thailand alternately tried to repress or ignore the virus, imprisoning some HIV-positive foreigners while issuing so-called AIDS-free certificates to male and female prostitutes who serviced tourists.
India also perceived AIDS as a foreign problem and declined to conduct any form of domestic AIDS education. By the end of 1986 India had in place laws requiring HIV tests of all foreign students. As was the case in so many other countries, these laws were almost exclusivelyâand often brutallyâenforced against African students.
Despite such measures, by mid-1987 scattered surveys of female prostitutes in India were already revealing that AIDS was emerging in the country. As the numbers of documented AIDS cases in India rose during 1987, the Ministry of Health declared that foreign students and tourists were chiefly responsible, as were “foreign priests attending Christian conventions.”
By the end of 1987 fear of foreigners with AIDS had reached such heights that villagers in Goa fell upon a group of German tourists, smearing them with dung because of their allegedly filthy foreign ways.
Other Asian countries responded with similar anti-foreigner laws and actions, notably Japan, South Korea, Indonesia, Malaysia, and Singapore.
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