"in the United States, how it spread, who got it, and why"

May 18, 2014 1:59 PM

Why Did AIDS Ravage the U.S. More Than Any Other Developed Country?
Solving an epidemiological mystery
posted by davidstandaford (72 comments total)

TL;DR: Republicans.

Interesting article. Unfortunately, it's not such a huge mystery. Good healthcare, money, and an open mind towards things like clean-needle programs are all requirements.
posted by nevercalm at 2:20 PM on May 18, 2014 [34 favorites]

Which, of course, is just a longer way of saying "Republicans".
posted by kafziel at 2:27 PM on May 18, 2014 [46 favorites]

Health insurance and hate.
posted by oceanjesse at 2:30 PM on May 18, 2014 [9 favorites]

The harm done to America by the "War on Drugs" is mind-blowing in its scope and depth.
posted by Tomorrowful at 2:35 PM on May 18, 2014 [15 favorites]

I mean, I'm as much a Democrat as you'll find (I spent a couple of hours knocking doors for my state's Democratic Coordinated Campaign yesterday), but were the Democrats much better on gay issues or drug policy in the '80s and early '90s? I was a kid at that time, so I could totally be remembering wrong, but I'm not sure they were, with some notable and admirable exceptions.
posted by ArbitraryAndCapricious at 2:36 PM on May 18, 2014 [5 favorites]

hippybear, I think the article's making the opposite case: that the relatively open and free gay life of American cities contributed to the early spread of HIV. The East vs. West Berlin comparison is also quite interesting. I fear a lot of people will read this article and only get that far and dismiss the article because it reads like some anti-gay morality tale. He's not telling that story, and the rest of the article gets to a lot more interesting factors like the hideous American health care system.

It was not that long ago that most Americans getting HIV tests did it anonymously because even testing negative would be a reason to be denied health insurance as an individual applicant. Not to mention that a lot of fuckheads making policy in America were saying AIDS was just moral punishment for the wicked. (Speaking of which, we're approaching the sixth anniversary of the death of Jesse Helms. How will you be celebrating?)

Unfortunately this whole article is a just-so story. I'd feel a lot better if his hypotheses were backed up with more data from medical professionals, particularly epidemiologists.
posted by Nelson at 2:40 PM on May 18, 2014 [10 favorites]

Nelson: Thanks for reading the article before posting. I read it the other day and found it interesting. I think clustering and relatively open acceptance of gay communities ( note I said relatively) are one of those things often overlooked in thoughtful discussions of HIV mortality. While the writer is not a scientist or epidemiologist I found it quite succinct in capturing a range of issues.
posted by rmhsinc at 2:47 PM on May 18, 2014 [3 favorites]

hippybear, I think the article's making the opposite case: that the relatively open and free gay life of American cities contributed to the early spread of HIV.

I'm not sure that's right. He's arguing that it was the concentration of gay people in the US into a few places that made the epidemic so bad here, and that's a function, I think, both of the huge stigma in most places and the relative freedom and openness in a few places.

I can't decide whether I think that's at all convincing, though.
posted by ArbitraryAndCapricious at 2:48 PM on May 18, 2014 [2 favorites]

The last paragraph says it all:

"“At the end of the day, it’s best understood as a function of health disparities writ large,” says Chris Beyrer, the director of the Johns Hopkins Fogarty AIDS International Training and Research Program. The core difference between the United States and Western Europe, he says, is that “we’re a much bigger, much more complex, and much more unjust country.”"
posted by marienbad at 2:50 PM on May 18, 2014 [2 favorites]

“we’re a much bigger, much more complex, and much more unjust country.”

Complex?
posted by Pruitt-Igoe at 2:50 PM on May 18, 2014

The fact that so man of my good friends are dead, I blame on Reagan and the Republicans. No other way around it.
posted by roomthreeseventeen at 2:52 PM on May 18, 2014 [8 favorites]

I think perhaps he means complex in that England is one country.

On preview: Hippybear said it much better than me.
posted by marienbad at 2:54 PM on May 18, 2014

The conclusion finally hits the main point: inequality and social marginalization. We have more of both, and doubled down on those policies just as the epidemic took off; Western Europe didn't.

It's a national shame and hundreds of thousands died needlessly as a result. Needle exchanges are still to this day difficult to operate in the US and other elements of effective harm reduction strategies remain illegal.
posted by Dip Flash at 3:06 PM on May 18, 2014 [1 favorite]

The United States, on the other hand, refused to provide federal funds for needle exchanges or even fund research into whether they were effective.

Yeah, I gotta say, as I remember it, this was all on Reagan's watch. I'm not saying the Democrats have anything to be proud of in their history on gay issues (or needle exchanges), but the lack of action on AIDS was all the non-doing of the Reagan White House.
posted by GenjiandProust at 3:09 PM on May 18, 2014 [5 favorites]

You can't point to "Republicans" as being at fault. It was the fault of everything in US society on so many levels.
posted by hippybear

Bullshit.

As America remembers the life of Ronald Reagan, it must never forget his shameful abdication of leadership in the fight against AIDS. History may ultimately judge his presidency by the thousands who have and will die of AIDS.

Following discovery of the first cases in 1981, it soon became clear a national health crisis was developing. But President Reagan's response was "halting and ineffective," according to his biographer Lou Cannon. Those infected initially with this mysterious disease -- all gay men -- found themselves targeted with an unprecedented level of mean-spirited hostility.

A significant source of Reagan's support came from the newly identified religious right and the Moral Majority, a political-action group founded by the Rev. Jerry Falwell. AIDS became the tool, and gay men the target, for the politics of fear, hate and discrimination. Falwell said "AIDS is the wrath of God upon homosexuals." Reagan's communications director Pat Buchanan argued that AIDS is "nature's revenge on gay men."
...
By Feb. 1, 1983, 1,025 AIDS cases were reported, and at least 394 had died in the United States. Reagan said nothing. On April 23, 1984, the Centers for Disease Control and Prevention announced 4,177 reported cases in America and 1,807 deaths. In San Francisco, the health department reported more than 500 cases. Again, Reagan said nothing. That same year, 1984, the Democratic National Convention convened in San Francisco. Hoping to focus attention on the need for AIDS research, education and treatment, more than 100,000 sympathizers marched from the Castro to Moscone Center.

With each diagnosis, the pain and suffering spread across America. Everyone seemed to now know someone infected with AIDS. At a White House state dinner, first lady Nancy Reagan expressed concern for a guest showing signs of significant weight loss. On July 25, 1985, the American Hospital in Paris announced that Rock Hudson had AIDS.

With AIDS finally out of the closet, activists such as Paul Boneberg, who in 1984 started Mobilization Against AIDS in San Francisco, begged President Reagan to say something now that he, like thousands of Americans, knew a person with AIDS. Writing in the Washington Post in late 1985, Rep. Henry Waxman, D-Los Angeles, stated: "It is surprising that the president could remain silent as 6,000 Americans died, that he could fail to acknowledge the epidemic's existence. Perhaps his staff felt he had to, since many of his New Right supporters have raised money by campaigning against homosexuals."

Reagan would ultimately address the issue of AIDS while president. His remarks came May 31, 1987 (near the end of his second term), at the Third International Conference on AIDS in Washington. When he spoke, 36,058 Americans had been diagnosed with AIDS and 20,849 had died. The disease had spread to 113 countries, with more than 50,000 cases.

posted by jamjam at 3:11 PM on May 18, 2014 [26 favorites]

were the Democrats much better on gay issues or drug policy in the '80s and early '90s?

I was also a kid at the time, but my understanding based on what I know about it (the AIDS crisis fascinates me, so I've read a lot, seen a lot of documentaries, etc) I think it's a little more complicated than Republican vs. Democrat, at least in terms of specific politicians taking particular actions in one direction or another.

Ronald Reagan is famous for being counterproductive. On the other hand, IIRC, New York's mayor at the time, Ed Koch, a liberal Democrat, was also not great on HIV public health measures, because he wanted to distance himself from gay causes due to whispers about his own homosexuality (he lived in and represented the Village before being elected mayor, he was unmarried, etc).

So I don't think it was something that Democrats were in lockstep supporting in contrast to the evil, evil Republicans.

I also have a vague recollection of (Democrat and then-mayor of San Francisco) Dianne Feinstein having a particularly mixed record on HIV/AIDS issues, though I think SF handled the crisis better on a local governmental level than NYC did.
posted by Sara C. at 3:16 PM on May 18, 2014

"George Bush doesn't care about black people" was actually a very apt phrase, expanding "black people" to include all undesirables.
posted by bleep at 3:25 PM on May 18, 2014 [1 favorite]

Reading the article, I'm curious about how much of this -- at least as it translates to HIV/AIDS related deaths nowadays -- has to do with the American healthcare situation.

The article says that 800 people a year die of AIDS in Germany every year, now (not in the 80s), to the US's 15,000. The obvious reason that I can see is that it's likely that Western European HIV patients aren't as likely to die of the disease because they have access to the right medications. Whereas in the US it wouldn't surprise me to learn that insurance companies are just itching to drop HIV patients, let alone actually covering their treatment.

Obviously this doesn't explain the AIDS Crisis at all. But it wouldn't surprise me to learn that HIV is more fatal in the US than in Europe.
posted by Sara C. at 3:27 PM on May 18, 2014 [1 favorite]

I think it's also true to say that here in Britain (and I would guess throughout Western Europe too), the idea that God had some sort of objection to simple preventative measures like condoms and clean needles was taken a lot less seriously than it may have been in some US states.

We had our own God-bothers hampering the fight too, but here they have far less influence. Mostly, we've left religious ideas behind when it comes to public policy and that was a big help in letting pragmatic rationality win out.

Here's an extract from a BBC news story, which I think sums up that conflict rather well:

Those in authority who wanted to take action had to confront high-level antipathy. The then-Chief Constable of Greater Manchester Police, James Anderton, referred to victims "swirling about in a human cesspit of their own making".

Nonetheless, Norman Fowler, now Lord Fowler, then health and social security secretary, and Sir Donald Acheson, the chief medical officer, were convinced that action had to be taken. By the middle of the decade, scientists were predicting that the cumulative total of UK HIV cases could reach 300,000 by 1992 if nothing were done.

"There were people in government and also people in the media who said, 'Why are you spending all this time concerned about gay people and drug addicts?'," Fowler recalls. "But that was a minority view."

As a result of the two men's lobbying, the government's drive against Aids was not run from Downing Street but instead co-ordinated by a cabinet committee chaired by the plain-spoken Tory grandee Willie Whitelaw. "It was like he was running a VD campaign in the Army," recalls Fowler wryly. "I think it's an advantage it wasn't done at No 10. It wasn't a natural subject for Margaret Thatcher.

"We did it in an extremely pragmatic way. We treated it as a public health issue."

I'm not suggesting Britain's response was perfect by any means: as Anderton's comments show, we certainly had our own share of unhelpful moralising too. But I don't think the striking difference in the statistics pointed out by the original article can be hand-waved away either.

The full BBC story's here: http://www.bbc.co.uk/news/magazine-15886670
posted by Paul Slade at 3:40 PM on May 18, 2014 [6 favorites]

Elizabeth Taylor came in and showed the leadership Reagan should have, istr, because Rock Hudson and other friends of hers were dying.
posted by joseph conrad is fully awesome at 3:41 PM on May 18, 2014 [2 favorites]

Elizabeth Taylor came in and showed the leadership Reagan should have, istr, because Rock Hudson and other friends of hers were dying.

Thing is, Rock Hudson was Reagan's friend too. On a personal level, Reagan wasn't a homophobe, and even politically, during his time as Governor of California, he was very vocal in campaigning against the Briggs Initiative which would have banned LGBT people from working in public schools. His foot-dragging re: AIDS is pretty baffling in that regard.
posted by Sys Rq at 3:43 PM on May 18, 2014 [1 favorite]

There is simply no question at all that Republicans and Democrats differed sharply on the reaction to the AIDS crisis. The notion that everyone in America, on all sides of the political spectrum, was equally likely to welcome the "gay plague" that would eradicate the queers is just bizarrely ahistorical: of course there were enlightened Republicans and recalcitrant Democrats, but there was just no question, at all, that the median Republican and the median Democrat were poles apart on the issue. When the first major bill to address AIDS was passed by Congress in 1988 it was largely a Democratic Party initiative (Ted Kennedy being one of the leaders) and it was the conservative Republicans who did everything they could to trash it (notably under the leadership of Jesse Helms).

As for needle exchanges, federal funding for needle exchanges was originally included in the bill (i.e., the Democrats were for it). Jesse Helms tried to pass a motion outlawing needle exchanges altogether--under any circumstances. Ted Kennedy got together with Orrin Hatch to craft a compromise amendment under which federal funding for needle exchanges would be outlawed until such time as government studies had determined that they were an effective means of combating AIDS. Here's some contemporary reporting from the NYT. That was the "ban" that remained in place (again, solely because reliable majorities of the Republicans in one chamber or the other wanted it to remain in place) until Obama approved federal funding for needle exchange programs in 2009. And, again, it was the Republicans who reversed that action in 2011.

Ed Koch, by the way, although initially skeptical, approved and ran a city-based needle exchange program in NYC. It was eventually disbanded by Mayor Dinkins: in part in response to massive protest by black opinion leaders in NY who regarded the distribution of free needles as a deliberate attempt to spread drug addiction in the black community.
posted by yoink at 3:47 PM on May 18, 2014 [27 favorites]

Well, and I think that only person in the Reagan administration who called for effective measures to counter AIDS was C. Everett Koop, who was an honest-to-goodness God-bothering Evangelical Christian.
posted by ArbitraryAndCapricious at 3:48 PM on May 18, 2014 [4 favorites]

To be fair, the ban on federal funding for syringe access came very, very close to being lifted under Clinton. The intervention of Barry McCaffery, Clinton's drug czar, was what stopped it. A man with a lot of blood on his hands. Clinton has since acknowledged that not lifting it then was a huge mistake.
posted by gingerbeer at 4:01 PM on May 18, 2014 [3 favorites]

Sara C., I don't know if you've gotten all the way through the article yet, but it does discuss the healthcare angle at the end. A lot of people in the US don't even seek treatment because it's too expensive. In the UK, doctors are incentivized to make sure people get (entirely free) treatment not long after diagnosis. Death rates in southern states that have rejected the Medicaid expansion under Obamacare are higher. The prevalence rates between northern and southern states are startling, as are the rates between blacks and whites. I was also too young to be cognizant of the political angle in the 80s, despite the fact that I have close family member who is gay and another close friend who died of AIDS in 1992, but I remember knowing that just getting an AIDS test was enough to ensure that no health insurance company would touch you, even if you tested negative.

This is a great article. I think it shows how a confluence of so many different things - war on drugs, homophobia, fucked up healthcare system, poverty, race, even geographical factors - coming together can have such a devastating impact.
posted by triggerfinger at 4:03 PM on May 18, 2014 [6 favorites]

Ronald Reagan is famous for being counterproductive. On the other hand, IIRC, New York's mayor at the time, Ed Koch, a liberal Democrat, was also not great on HIV public health measures, because he wanted to distance himself from gay causes

It's hard to reconcile that claim with this NYT op-ed piece by Ed Koch, lambasting Jesse Helms for an anti-gay (and anti AIDS education) amendment to the 1988 fiscal 1988 appropriations bill for the Departments of Labor, Health and Human Services.

Some extracts:

Mr. Helms introduced it because he's upset with New York's Gay Men's Health Crisis. The organization has established a brilliant reputation in caring for and counseling those with AIDS and in educating others on how to prevent the spread of AIDS.

It serves gay men - Mr. Helms's ''perverts'' - because they're a primary AIDS risk group. Gays comprise about 10 percent of the United States' adult population, or 20 million people. If only half are male, 10 million men are at risk and in need of education and counseling on how to cut the risk. That's why the Gay Men's Health Crisis and organizations like it around the country exist.

...

To date, New York has had 11,513 AIDS cases reported; of these, 6,605 have died. Of the total cases, 55 percent are homosexual or bisexual men. Among these, the Gay Men's Health Crisis and city educational efforts have helped contribute to a decline in the seroconversion rate to 1 percent annually. In nonscientific terms, this means that if you took blood samples from homosexual or bisexual men one year and found them not infected with the AIDS virus, there's only a 1 percent chance that samples from the same men would be infected the next year.

Among intravenous drug users there's an 8 percent seroconversion rate. Obviously, education changes behavior among those whose faculties aren't impaired and enslaved by needles and drugs.

....

Senator Helms may not like homosexuals. But he and those who voted for the amendment should remember that homosexuals - and intravenous drug users - are the sons and daughters of families who love them. They too deserve protection against the gravest public health threat our nation faces.

Regrettably, lousy politics overwhelmed good public health policy. Apparently fearing an adverse reaction that a homophobic demagogue might inflame in their home state or districts, members of Congress gave in to homophobic hysteria.

posted by yoink at 4:10 PM on May 18, 2014 [7 favorites]

It may be easier to reconcile after reading this. Koch had a bit of an about face toward the end of his last term in office, but his years of inaction, and the gay community's frustration, are hardly a secret.
posted by evidenceofabsence at 4:19 PM on May 18, 2014 [1 favorite]

Also, for what it's worth, I think it's possible to take intolerant and apathetic Democrats to task without letting the religious right off the hook for hastening the propagation of a plague.
posted by evidenceofabsence at 4:23 PM on May 18, 2014 [6 favorites]

Certainly, people at the time blamed Reagan.
posted by GenjiandProust at 4:24 PM on May 18, 2014

Oh wow Diseased Pariah News is scanned and online? That deserves its own FPP. Here's a recent interview with Tom Ace, the non-dead editor.
posted by Nelson at 4:32 PM on May 18, 2014 [13 favorites]

Can you imagine a new, unknown infectious illness occurring in the US today, killing 1,000 then 5,000 then 10,000 then 25,000 people -- and having the president not so much as mention it in a single speech or address it in any policy way? It's surreal to think of now and was surreal and terrible to live through then. Never mind the politics of it, it was totally irresponsible from a pure public health perspective. How was that safeguarding the American public, isn't that supposedly one of the primary responsibilities of the president?

It's the first thing I think of when I think of "Saint" Reagan, the blood on his hands. And it was and is a great shame on the American public that he was voted in a second time.
posted by madamjujujive at 4:50 PM on May 18, 2014 [17 favorites]

Among intravenous drug users there's an 8 percent seroconversion rate. Obviously, education changes behavior among those whose faculties aren't impaired and enslaved by needles and drugs.

Koch was such an asshole. I remember meeting the people who worked for the city's original pilot needle exchange programme -- overseen by the NYC Public Health Dept. They were lovely people, but the programme was tied up with so many restrictions that nobody could actually use the damn thing.

So fuck your impaired and enslaved. People here changed their behaviour just fine -- but you've got to give them the means to actually do so.
posted by PeterMcDermott at 5:01 PM on May 18, 2014 [5 favorites]

Yeah, that line stood out to me, too. Koch was an asshole even when he was trying to be nice. Public health departments and harm reduction aren't always a good match. Much as I am fans of both and spend much of my time trying to match them up!
posted by gingerbeer at 5:06 PM on May 18, 2014

That deserves its own FPP.

Yes, it does. I am looking at it now and it is amazing.
posted by Dip Flash at 5:14 PM on May 18, 2014 [2 favorites]

Somewhere in a box I think I have all the DPN issues. That brings back memories.
posted by gingerbeer at 5:30 PM on May 18, 2014 [4 favorites]

Turns out GenjiandProust made a post about DPN back in 2010.
posted by Nelson at 5:32 PM on May 18, 2014 [5 favorites]

Interesting article, although I think he makes too many excuses for the US. The so-called crack epidemic of the 80s that he cites, for example, as a factor in the spread of HIV among intravenous drug users was greatly mythologized and misrepresented: http://progressivepupil.wordpress.com/2012/03/12/crack-dens-houses-heads-and-babies-five-myths-of-the-crack-cocaine-epidemic/
posted by binturong at 5:40 PM on May 18, 2014

Complex. Yes. individual states have their own health care systems and fund indigent care differently, the gigantic size of the US makes everything more complex, the difference between rural and urban is much greater here than in smaller countries.

Which, of course, is just a longer way of saying "Republicans."
posted by JackFlash at 5:41 PM on May 18, 2014 [3 favorites]

That's not really a fair characterization.
posted by maryr at 5:47 PM on May 18, 2014 [2 favorites]

I didn't read the article as saying that crack was a factor in the spread of HIV among injection drug users (nor was it), but that the stigmatizing of people who use drugs was part of both the hyped up response to crack and the refusal to authorize syringe access.
posted by gingerbeer at 6:02 PM on May 18, 2014 [1 favorite]

He states as a context: "America was in the middle of a crack epidemic" and seems to accept that was the case as an excuse, for example, to ban syringe access. I'm just saying the "epidemic" panic was very much hyped and racist and not reflective of the reality (more whites used crack than blacks.)
posted by binturong at 6:14 PM on May 18, 2014

There were a lot of myths about crack, binturong, and the response to it was really horrible and counterproductive. But the epidemic was not hype, and I actually don't think that your article claims that it was.
posted by ArbitraryAndCapricious at 6:19 PM on May 18, 2014

And it was and is a great shame on the American public that he was voted in a second time

i didn't really understand why my parents, who were in their 20s during the reagan years, weren't at all surprised that bush got elected for a second term until i learned more about reagan.
posted by emptythought at 6:24 PM on May 18, 2014 [1 favorite]

Crack is primarily a smoked drug, yes, and is still true that it is used by more whites than blacks.

Fears of the crack epidemic were very much a part of the context in which the war on drugs was expanded, including the pushback against syringe access. That those fears weren't based in reality doesn't mean that they weren't a significant part of why things happened the way they did.
posted by gingerbeer at 6:35 PM on May 18, 2014 [5 favorites]

This analysis is well done and spares us from moralizing. I'm 50 and lived in SF in the late eighties so I remember AIDS all too well. This, from the article, stood out as a particularly trenchant observation:

It turns out that, just as the AIDS virus seems almost designed to perfectly exploit the weaknesses of the human immune system, treating it seems designed to exploit the weaknesses of our national health care system.

To that I would add that a virus also exploited a moral panic in a timely manner.

I don't believe though that any one word explanation a la "Republicans" is either a correct or sufficient explanation. AIDS was a perfect storm that gathered strength from several varietes of fear, ignorance and misinformation - as it continues to do so to this day.
posted by vapidave at 9:20 PM on May 18, 2014

I think perhaps he means complex in that England is one country.

Except he says the US is more complex than Western Europe, which seems obviously false. Elsewhere the piece argues that the uniformity and lack of borders of the US facilitates bigger concentrations of gays.

I think it's possible that just getting it first was quite important. It could be that the thing had time to gain critical mass in the US before effective interventions could start; in Europe it had less of a free run to start with. Maybe.
posted by Segundus at 9:57 PM on May 18, 2014

It isn't just a longer way of saying Republicans.

I grew up in downtown Manhattan in the 1980s in a family that consisted almost entirely of dyed-in-the-wool, union-card-carrying Democrats, and the shitty truth is that we were able to more or less ignore the SILENCE=DEATH stickers plastering the city streets. After all, there were plenty of other things to worry about, like hating Reagan and Oliver North, or worrying about crime, or fretting about how "all the jobs are going to Japan," or what have you.

It's not that my parents wanted all gay people and injecting drug users wiped from the face of the earth, or held particularly moralistic views. It's that they, like most Americans, were able to focus on other things, because even though we lived at the epicenter of the crisis—I mean, shit, my brother was born at St. Vincent's in 1985—we didn't belong to the marginalized groups that AIDS was affecting the most.

Should the Moral Majority asshats be called out for their crimes? Absolutely. But leaving it at "a longer way of saying Republicans" ignores what I see as a larger problem: how easily we, as a society, overlook swaths of people and ignore their needs, even at our own peril, and even if we belong to the superior political club.
posted by evidenceofabsence at 10:27 PM on May 18, 2014 [9 favorites]

Mod note: One comment deleted. Let's not reduce this entire thread to just "Republicans Suck amirite NO REALLY"? It's an interesting article, and well worth discussing for its actual content.
posted by taz (staff) at 10:33 PM on May 18, 2014 [1 favorite]

I have dyed-in-the-wool Democrat family members who disowned their own son when he came out in the late '70s. I have different dyed-in-the-wool Democrat family members who didn't reject their son but begged him not to tell the rest of the family that he was gay or HIV+, which meant that we were unable to support him when he could have used our support. I'm not excusing or downplaying Reagan or Jesse Helms, but it seems like a gross oversimplification that say that the problem with American society was Republicans.
posted by ArbitraryAndCapricious at 10:41 PM on May 18, 2014

When people condemn the US Government's poor response to AIDS, it has to be understood in the context of other disease outbreaks of the 1970s. In July 1976, 5 members of the American Legion died after returning from a conference in Philadelphia, and the CDC went on an all-out investigation in collaboration with the Philadelphia Health Department to uncover the cause, and by January of 1977 they had isolated the bacterium that caused it. A 1976 outbreak of H1N1 at Fort Dix resulted in a nationwide immunization effort to make sure the outbreak was stopped in its tracks. A cluster of juvenile rheumatoid arthritis led to the discovery and treatment of Lyme Disease in relatively short order. Meanwhile, they discovered a pattern of gay patients dying in the 80s, and the response was more or less a shrug from the feds and a message to doctors treating these patients of more or less, "let us know if you find anything interesting."

Basically, the response to outbreaks of previously unknown or potentially dangerous transmittable diseases is usually "stop whatever the public health infrastructure is doing to figure out what it is, how it's caused, and how it's treated, and do everything you possibly can to stop it in its tracks." That didn't happen, and as the article points out, the concentration of gays meant that it spread really quickly before we created an infrastructure to slow the spread.
posted by deanc at 10:44 PM on May 18, 2014 [25 favorites]

Anyone reading this who hasn't read And The Band Played On should close their browser and go take care of that. It goes into extremely heavy detail on what deanc just mentioned.
posted by Sara C. at 10:50 PM on May 18, 2014 [6 favorites]

I would bet our stunning incarceration rate combined with the sexual violence in our prisons is a factor as well.
posted by vorpal bunny at 10:51 PM on May 18, 2014 [2 favorites]

I love this article, not least for its opening sentence:
How Magic Johnson Fought the AIDS Epidemic

Donald Sterling, the racist cretin who owns the Los Angeles Clippers, [...]

posted by Joe in Australia at 11:44 PM on May 18, 2014 [1 favorite]

If you're interested in more on the UK response to AIDS I recommend Simon Garfield's book The End of Innocence, and his articles in the Guardian on AIDS: The First Twenty Years.
posted by penguinliz at 4:34 AM on May 19, 2014 [1 favorite]

Except he says the US is more complex than Western Europe, which seems obviously false. Elsewhere the piece argues that the uniformity and lack of borders of the US facilitates bigger concentrations of gays.

Well, yes and no. France didn't have to get its prevention and treatment efforts approved or funded by Germany, which didn't have to look to Italy for input before establishing its treatment efforts and Italy didn't have to ask the Netherlands for the okay to hand out condoms. And it helped that much of health policy across most of Western Europe ignores/ignored "But God said!" as a reason to stigmatize people who were getting infected in favor of actual epidemiological and educational protocols.
posted by rtha at 6:31 AM on May 19, 2014 [5 favorites]

If it's any clarification, I clearly remember attending international AIDS conferences in the early 90's and seeing the prevention efforts of the Netherlands, Germany and other European countries and thinking, there's no way in hell we could get those messages paid for in the U.S. Funders just would never allow us to show images or use words that were explicitly sexual.
posted by Sophie1 at 7:18 AM on May 19, 2014 [1 favorite]

"One of the most staggering numbers I came across was that, from the beginning of the epidemic until HIV treatment became widely available in 1996, 124,800 intravenous-drug users were diagnosed with HIV in the United States. In the United Kingdom, it was just 3,400."

And yet, this can't be the only reason HIV spread was so widespread in the U.S. By far, as Los Angeles and San Francisco has a very significant epidemic, but very little of it is from IDUs. Most of the epidemic is among men who have sex with men on the West Coast. While we have plenty of IDUs here, we also have black tar heroin (coming from Mexico) rather than powder which is far more prevalent on the east coast coming from Europe. Black tar takes a lot more heat and dilution to bring to injectibility and with the heat, blood that is pulled up into the syringe is heated and reheated, so while it is possible to get HIV sharing needles using black tar, it is far less likely than when using powdered due to powdered's solubility.

The more you know...
posted by Sophie1 at 7:29 AM on May 19, 2014 [1 favorite]

A supplementary article on comparing the numbers: The statistical quirks of looking at AIDS across countries
posted by Gordafarin at 7:49 AM on May 19, 2014

> Crack is primarily a smoked drug

Crack is only consumed by smoking.
posted by lupus_yonderboy at 8:08 AM on May 19, 2014

Crack is only consumed by smoking.

Apparently not:

But in the 1980s, people began using baking soda to strip away the hydrochloride, forming a rock crystal, or crack, that can be smoked. And sometime in the mid-1990s, people began mixing crack with vinegar or other acids to make an injectible form of the drug.

"But we weren't sure how common this behaviour was," says Scott Santibanez, an epidemiologist at the Centers for Disease Control and Prevention in Atlanta, Georgia, US.

Ethnic differences

So he and colleagues analysed data taken in the late 1990s on the behaviours and blood test results from almost 2200 young, intravenous drug users. The study sampled six sites around the US. "We found out crack injection was more common than we expected," Santibanez told New Scientist.

About one in seven (15%) of those interviewed had injected crack at some time in their lives. The users did not show significant differences by gender, age, or sexual orientation.
posted by Dip Flash at 8:55 AM on May 19, 2014 [1 favorite]

One word that I looked for in this article and did not find was subtype. It is pretty clear that the international transmission of the dominant subtype in the US and Europe began here after an incubation period in the Caribbean, primarily Haiti. In other words, while HIV is from Africa originally, it took the right social conditions for the virus to form itself into the shape it would need to really spread the way it did.

I don't think there's a really simple answer -- while Western Europe certainly has a less Puritanical response to sex generally, it's not like there isn't (or more precisely wasn't) discrimination against gays, and prostitution and bath houses are an obviously international phenomenon. I do wonder whether our prison system is indeed part of the problem, as vorpal bunny pointed out. Even in the 1980s we had a much higher incarceration rate than most other countries, but also, prison reform was taking place in Western Europe right then. This is also borne out by the heavy infection rate among African-Americans, who are 12% of the population but have 44% of the HIV cases. Contrary, however, to vorpal bunny's supposition about prison rape, this seems to be epidemiologically tied to intravenous drug abuse.
posted by dhartung at 12:20 PM on May 19, 2014

Some people here dissolve crack in lemon juice and inject it.
posted by Pruitt-Igoe at 2:36 PM on May 19, 2014

13 Times The Reagan White House Press Briefing Erupted With Laughter Over AIDS
posted by homunculus at 2:51 PM on May 19, 2014 [3 favorites]

Q: Over a third of them have died. It’s known as “gay plague.” (Laughter.)
No, it is. I mean it’s a pretty serious thing that one in every three people that get this have died. And I wondered if the President is aware of it?

MR. SPEAKES: I don’t have it. Do you? (Laughter.)

I am at a loss for words.
posted by evidenceofabsence at 3:40 PM on May 19, 2014 [5 favorites]

Goodness gracious. Mr. Speakes inspires me to say, draw, and poop all kinds of things.
posted by Sticherbeast at 3:59 PM on May 19, 2014

That's probably the worst thing I've seen from a White House press briefing, but Speakes' technique was pretty standard. The US administration, understandably, does not wish to provide serious and substantial answers to weighty questions; that's not actually its job. The problem is that it also wants the ability to control the public debate by feeding information to journalists in an impressive and official setting. So it has these briefings, but its the speakers really only respond to questions that are on-message. The same thing could be accomplished by issuing official statements, but then media representatives wouldn't be able to pretend that they're doing journalism by asking questions.
posted by Joe in Australia at 4:23 PM on May 19, 2014

questions that are on-message

I think this is at the core of one of the great tragedies of the AIDS crisis, which is that it got caught up in all kinds of political nonsense outside of the clean dichotomy of "conservative god-botherers welcoming the coming plague" and "good liberals who wanted to do the right thing, but were prevented from doing so".

Because over and over you see a much bigger stumbling block. This office doesn't want to deal with it because it's not "on-message". That politician is trying to distance himself from anything too close to gay rights issues. These people have no interest because it doesn't further their particular policy goals. The part where people are dying in the thousands gets lost in political football very quickly, and with not much outrage until ACT UP came along.
posted by Sara C. at 4:32 PM on May 19, 2014

Oh, there was plenty of outrage before ACT UP.
posted by gingerbeer at 4:41 PM on May 19, 2014 [1 favorite]

Sorry, I just googled and discovered ACT UP wasn't founded till '87. For some reason I pegged it as more like '83-84. Yay, facts!
posted by Sara C. at 4:43 PM on May 19, 2014

We just came up with better ways to express our outrage.
posted by gingerbeer at 4:43 PM on May 19, 2014 [2 favorites]

my god homunculus, that laughing at AIDS link is horrifying.
posted by madamjujujive at 7:00 PM on May 19, 2014

"13 Times The Reagan White House Press Briefing Erupted With Laughter Over AIDS"

Jesus, that truly is sickening.
posted by marienbad at 3:56 AM on May 20, 2014