The evil that is in the world always comes of ignorance, and good intentions may do as much harm as malevolence, if they lack understanding. On the whole, men are more good than bad; that, however, isn’t the real point. But, they are more or less ignorant, and it is this that we call vice or virtue; the most incorrigible vice being that of an ignorance which fancies it knows everything and therefore claims for itself the right to kill. There can be no true goodness, nor true love, without the utmost clear-sightedness.
-Albert Camus, The Plague
An important anniversary passed recently without my notice. Over the past weekend, as I was “wasting” time on YouTube and Wikipedia, I realized my mistake. The discovery of what would soon be called AIDS happened thirty years ago. On June 5, 1981, a small paper in the CDC’s Morbidity and Mortality Weekly Report presented a cluster of five young, gay men in Los Angeles with Pneumocystis carinii pneumonia, a disease that, up to that point, only affected older individuals suffering from immune system degradation.
I realized then that I have lived through some epochal changing moments in my life: the creation of personal computers, the end of the Cold War, the advent of the hypertextual Internet that allows web searching, the events of September 11, 2001. I remember a world before these events. However, I am an individual born in the late 1970s, and I have no recollection of a world without AIDS.
In the intervening years, between 25 and 35 million people have died from the disease and an estimated 33 million people are currently living with HIV infection.1 However, now even children in the developing world know how HIV is transmitted and how you can prevent becoming infected. Humankind has discovered the zoonotic connection between HIV and the Simian immunodeficiency virus found in green monkeys and chimpanzees (thankfully, evolution is an unproven theory so we don’t have to worry about this). And, humankind has been able to create the “triple cocktail” of protease inhibitors and antiretrovirals that has allowed millions in the developed world to live nearly normal lives with a nearly normal life expectancy. But, people are still dying in the 21st century from a virus, an infectious disease.
AIDS came about at a time when government was cutting domestic spending not related to the military (e.g. the CDC went from over $300 million to less than $200 million between the 1980 and 1981 budgets2). AIDS came about as an oppressed minority group was making its first strides towards emancipation. Unfortunately, a major facet of that movement was in sexual liberation. For instance, the first case-control study done on AIDS in the first years of the epidemic demonstrated that the first cases of AIDS in the United States had on average 1,100 sexual partners.2 AIDS came about when that same minority group was still seen as an “abomination” (it is wonderful that this is no longer true). Religious leaders went on television and explained how AIDS was god’s punishment for homosexuality. Unfortunately, many people agreed and allowed fear to guide their decisions toward inaction.
It was not until the mid-1980s that the effects of inaction became too horrible to contemplate. Hundreds of deaths quickly progressed to thousands. Rock Hudson, a Hollywood leading man and closeted homosexual, became the first celebrity to die of AIDS. The Surgeon General’s report damned the actions of the government and described all that we had been doing wrong and outlined what we should be doing right (e.g. health and sex education in schools from the earliest ages, etc.). In November of 1991, Magic Johnson, among the brightest stars of sport at the time, announced that he was infected with HIV. I can personally remember seeing the press conference on the television in my mother’s day care center. I can remember that the common wisdom of the time indicated that he would be dead within five years (Magic Johnson is still alive as of summer of 2011).
The discoveries, the advances were still a few years away. Even so, the history of the AIDS epidemic in this country is one of failure. A nation created from the enlightenment, a nation that has lit the world with the light of freedom for more than two centuries, a nation that created the modern world of the middle class, a nation that split the atom and landed on the moon, that nation allowed an infectious disease to wipe out an entire segment of its population based on Bronze Age superstition. And, this segment was in the optimal productive phase of its life, 30 to 60 years old. It costs a society a lot to educate and raise children to the point where they then become the producers that carry the young and old. We cared not for this. We let them die because they were a danger to Judeo-Christian morals.
I began this writing with a quote from Albert Camus’s The Plague, a book that outlines the failure of a society in reacting to an epidemic. If you have never read it, I would suggest that you do so. If you are a public health professional and have never read it, I would demand that you do so. Or better yet, read The Plague at the same time that you read Randy Shilts’s And The Band Played On. Compare how little we have learned. Watch how history repeats. Read, or better yet, go to a production of Larry Kramer’s play The Normal Heart, a play with a name that originates from a line in a W. H. Auden poem, September 1, 1939 (another period of humanity’s failure). The last line of a stanza is “We must love one another or die.” When we fail to see each other’s humanity because of ignorance, we invite, create, and become evil.
I would like to end with another quote, as art and literature is best suited at crystallizing concepts to a point of understanding, this time from the Bard himself. I would like this excerpt to be as a message that blazes out to the memories of every individual taken from us by this disease, to those angels crowding the streets of heaven, as Tom Hanks said in his Oscar acceptance speech for his role in Philadelphia. I would like it to be my metaphorical eulogy at their collective funeral. It is a quote from Macbeth. In the final act, the usurper is dead, but there has been a cost to gain victory. A father is being told that his son’s life has ended as lives end in a war.
ROSS: Your son, my lord, has paid a soldier’s debt:
He only lived but till he was a man;
The which no sooner had his prowess confirm’d
In the unshrinking station where he fought,
But like a man he died.
SIWARD: Then he is dead?
ROSS: Ay, and brought off the field: your cause of sorrow
Must not be measured by his worth, for then
It hath no end.
2. Shilts, Randy. And the Band Played On. St. Martin’s Griffin, New York. 1987.
“Silence = Death” image from ACT UP NY .
“The Normal Heart” image taken from The Normal Heart playbill logo.
About the Author: Mark Stewart holds a M.A. in Secondary Education and a B.S. in Cellular Molecular Biology, both from the University of Michigan. He is currently finishing work on a lung caner study to complete his M.P.H. in Hospital and Molecular Epidemiology . He was a Health and Water Sanitation Peace Corps Volunteer in Cameroon from 2003-2005. He lived in Beijing working as an English teacher to business professionals of multinational corporations such as Kraft, Westinghouse, Otis, and others. Over the past few years has worked as a math and science teacher in inner city high schools in Michigan. He has recently been a regular contributor on the University of Michigan Risk Science Center blog .
The views expressed are those of the author and are not necessarily those of Scientific American.