~ By Erika Mills
In the June 5, 1981 edition of the Morbidity and Mortality Weekly Report (MMWR), the CDC described a rare lung infection among a group of gay men in Los Angeles. This article, titled “Pneumocystis Pneumonia—Los Angeles,” marked the first official report of what would later be named AIDS (Acquired Immune Deficiency Syndrome). A few physicians and public health workers in coastal cities had noticed strange opportunistic infections in otherwise healthy gay men in the years prior, but the report served to put the phenomenon on record.
The disease spread quickly in the time that followed, devastating lesbian, gay, bisexual, transgender and queer (LGBTQ) and minority communities, while policymakers’ inactivity and societal stigma compounded the issue. In response, scientists worked with limited resources to understand the disease, healthcare professionals, friends and family, and citizen volunteers cared for the sick, and activists pushed for more government action, fought discrimination, and raised awareness. To commemorate the 40th anniversary of its publication, we take a look at the landmark historical document that effectively kicked off the U.S. fight against HIV/AIDS.
The report details the cases of five patients—all young and previously healthy gay men, with life threatening pneumocystis pneumonia (PCP), an infection that rarely causes serious illness in healthy adults. Between October 1980 and May 1981, the patients sought care at three Los Angeles area hospitals, presenting with PCP and other, unusual opportunistic infections, like cytomegalovirus (CMV) and candidiasis. One patient had recovered from Hodgkin’s lymphoma, a cancer that HIV positive people are at increased risk of developing, a few years prior. The editorial notes suggest that some cellular-immune deficiency was at work, although it was unclear what role PCP or CMV played in the dysfunction of the body’s defenses. Despite treatment, two patients had died at the time of publication. The remaining three would perish soon after.
After the article’s publication and media coverage by outlets like the Associated Press, reports of opportunistic infections among men who have sex with men came from urban centers across the country, prompting more scientific investigation. The CDC established a taskforce on June 8th and ramped up its surveillance efforts, while the NIH Clinical Center admitted its first patient with AIDS later that month. In September, the NIH and the CDC cohosted the first conference on AIDS research. In Los Angeles, New York, and San Francisco, LGBTQ communities began to spread the word about the new health threat through local publications and to raise money for research. Physicians in these metros led the medical response, treating illnesses, providing epidemiologists with valuable insights, and saving tissue samples to be tested in subsequent years. By December 1981, there were 337 reported cases of severe immune deficiency. The CDC estimates that roughly 42,000 people were unknowingly HIV positive at the time. Not until the following year would scientists observe severe immune deficiency in other populations—including newborn babies and people with hemophilia who had received blood transfusions—and officially name the disease AIDS. Naming of the AIDS virus, HIV, followed a few years later.
You can explore selections from NLM’s diverse collection of historical documents through curated resources on the early history of HIV/AIDS in the U.S. For example, the exhibition Surviving and Thriving: AIDS, Politics, and Culture illustrates an iconic history of AIDS from the early 1980s to the 2010s, alongside lesser-known examples of historical figures who changed the course of the epidemic. The online exhibition features links to early scientific literature published as researchers learned about the inner workings of the disease and the effects on the population. AIDS Ephemera presents a selection of posters, comic, postcards, and pins from the Prints & Photographs collection. Another exhibition on AIDS posters and the community response to the disease will launch later this year.
Today, over 1.2 million Americans live with HIV, and nearly 38 million worldwide. Once a death sentence, HIV infection is now considered a chronic condition, which once diagnosed can be managed with medication. But there is still much work to be done, education, testing, and access to care remain issues in many places. The NIH, the CDC, communities, and organizations around the world continue the work of discovery, innovation, care, education, and advocacy. At this 40 year of mark, we reflect on the past, mourning those lost while honoring scientists, activists, and everyday citizens who have worked to understand and address the disease. With lessons learned and hopeful determination, we renew our commitment to a future free from HIV/AIDS.