AIDS—and what we know about AIDS—has changed dramatically in 15 years
By Kelly McCann
As you know, OutSmart magazine begins its 15th year of publishing this month. I well remember the first issue and the excitement it generated in me personally as well as within the Houston gay community. Finally, we Houston homos had a gay publication we could be proud of that offered news, features, and humor without dozens of pages of ads for phone sex services and full-release massage! Thank you, OutSmart! At the time of that first issue, Bill Clinton had recently been inaugurated, Melissa Etheridge had publicly come out, and freedom rings were a fashionable symbol of gay pride. Ah, those were the days.
Or were they? If we consider the state of AIDS 15 years ago, the picture is not so rosy. As 1993 began, as the concept to create OutSmart was being hatched, we learned that the number of AIDS diagnoses occurring in the United States in a single year had hit an all-time high (and history would eventually show us that 1992 was the peak year in this epidemic.) Approximately 78,000 persons were diagnosed with AIDS in 1992, bringing the cumulative number of U.S. AIDS cases to 335,211. (That’s AIDS diagnoses, not HIV infections.)
The overwhelming majority of persons living with HIV/AIDS in early 1993 were male and most (51 percent) were white. But this disease was increasingly impacting women and persons of color, especially black Americans. In fact, disproportionately high rates of HIV infection among African-American women became news 15 years ago. Sadly, the trend continues today.
In January of 1993, the Centers for Disease Control and Prevention (CDC) officially expanded the definition of AIDS and the list of AIDS-defining illnesses to include invasive cervical cancer, pulmonary Mycobacterium tuberculosis (TB), and recurrent pneumonia. This was done to correct the undercounting of women and others with serious HIV illness who previously (and erroneously) would not have been diagnosed with AIDS.
Fifteen years ago, HIV treatment was still in its infancy. Protease inhibitors and other highly active antiretroviral medications had not yet been developed. However, the first “AIDS cocktail” or combination therapy, utilizing ddC and AZT, was approved by the Food and Drug Administration in 1993, and it proved somewhat effective in the treatment of adults with advanced HIV disease who showed continued signs of immunological decline. Along with that good news came an ominous warning. Drug resistant strains of HIV were first reported.
AIDS was largely a terminal illness back then. Almost 60 percent (198,322) of the people diagnosed with AIDS had died by the end of 1992, and the annual AIDS death rate approached 45,000. One year before the first issue of OutSmart was released, Arthur Ashe and Rudolph Nureyev succumbed to AIDS-related illnesses. Later that year, AIDS became the leading cause of death for American men, ages 25 – 44.
Discrimination against those living with HIV/AIDS was common 15 years ago. For example, the VIII International AIDS Conference was to be convened in Boston in 1992 but was instead held in Amsterdam because of U.S. immigration policies forbidding entrance of HIV-infected persons into this country. Then, in March of 1993, the U.S. House of Representatives voted, by a huge margin, to retain the ban.
Despite the enactment of the Americans with Disabilities Act in 1990, people with HIV/AIDS routinely experienced discrimination in 1993. HIV-infected persons were denied jobs, housing, and even medical and dental care due to their health status. Although legislative history indicates Congress intended the ADA to protect persons with HIV/AIDS from discrimination, such protection was not a sure thing 15 years ago. In fact, it would be 1998 before the Supreme Court’s ruling the ADA covers persons with HIV infection.
AIDS stigma was ever-present in 1993 due, in part, to the association of AIDS with homosexuality. As you may remember, acceptance of homosexuality was not particularly customary in those days. For example, the FDA approved the polyurethane female condom that provided a safe alternative to traditional male latex condoms. But the FDA refused to allow testing of the female condom for use during anal sex because “sodomy is illegal in too many states.”
Current presidential hopeful Mike Huckabee (or Gomer Pyle, as I like to call him) supported homosexuality- and AIDS-related stigma when he completed an Associated Press survey during his 1992 bid for the Senate. He stated that homosexuality was “aberrant, unnatural and sinful” and that persons living with HIV/AIDS should be isolated from the general population. So far, he has refused to recant those statements.
Over the last 15 years, there have been many advances in HIV/AIDS treatment, which have resulted in significantly longer and healthier life spans for those living with the disease. We’ve seen fewer AIDS-related deaths and lower AIDS diagnosis rates each year. And we’ve achieved greater legal protections for people with AIDS. Despite all that progress, Governor Gomer’s viewpoints serve as evidence that some things never change.
Kelly McCann is the chief executive officer of AIDS Foundation Houston, which recently marked its 25th year of service. Details: www.aidshelp.org.