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Confronting AIDS in the Early 1980s: Biomedicine, Public Health, and the Fourth Estate

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A Correction to this article was published on 07 April 2023

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Abstract

Detection of a mysterious and fatal disease among young, previously healthy, homosexual men in spring 1981 warranted a rapid and effective response. An adequate response failed to materialize during the first 5 years of the AIDS pandemic. The failure of biomedicine, public health, and The Press to stop the outbreak was attributed by Randy Shilts to institutional failures. This commentary considers the possibility that organizations, agencies, and authorities failed to safeguard the public’s health because they succeeded in carrying out their appropriate tasks of (1) meticulously conducting systematic, scientific, research, (2) cautiously reporting evidence-based observations and alternative interpretations, and (3) carefully exercising rigorous controls over unauthorized and potentially wasteful spending. As practiced in the early 1980s by the National Institutes of Health, Centers for Disease Control and Prevention, and major newspapers and other media outlets, essential features of biomedicine, public health, and The Press inhibited a rapid and effective response.

Resumen

La detección de una enfermedad misteriosa y mortal entre hombres homosexuales jóvenes, previamente sanos, en la primavera de 1981 justificó una respuesta rápida y efectiva. Una respuesta adecuada no se materializó durante los primeros cinco años de la pandemia del SIDA. El fracaso de la biomedicina, la salud pública y The Press para detener el brote fue atribuido por Randy Shilts a fallas institucionales. Este comentario considera la posibilidad de que las organizaciones, agencias y autoridades no hayan salvaguardado la salud pública porque lograron llevar a cabo sus tareas apropiadas de (1) realizar meticulosamente investigaciones sistemáticas, científicas, (2) informar cautelosamente observaciones basadas en evidencia e interpretaciones alternativas, y (3) ejercer cuidadosamente controles rigurosos sobre gastos no autorizados y potencialmente derrochadores. Como se practicó a principios de la década de 1980 por los Institutos Nacionales de Salud, los Centros para el Control y la Prevención de Enfermedades y los principales periódicos y otros medios de comunicación, las características esenciales de la biomedicina, la salud pública y la prensa inhibieron una respuesta rápida y efectiva.

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Fig. 1
Fig. 2

(Source: Bill Darrow Collection—Miami)

Fig. 3

(Source: Bill Darrow Collection–Miami)

Fig. 4

(Source: Bill Darrow Collection—Miami)

Fig. 5

(Source: Bill Darrow Collection—CDC; KAPOSI’S SARCOMA: EARLY CASES. Available at The Global Health Chronicles, https://www.globalhealthchronicles.org/items/show/7985. Accessed November 18, 2022)

Fig. 6

(Source: Bill Darrow Collection—Miami)

Data Availability

Digital copies of a monthly calendar page, map, envelope, typed and handwritten letters, and notes from a telephone call belonging to the author are included as electronic supplementary material in the online version of this article, which is available to authorized users.

Code Availability

Not applicable.

Change history

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Acknowledgements

Many thanks to my many friends and colleagues within and outside of CDC for helping me with my 60-plus years of research and the preparation of this commentary. In particular, I wish to thank Drs. David Auerbach, Harold Jaffe, Alvin Friedman-Kien, Linda Laubenstein, and Ms. Rebecca Reiss for their assistance with CDC AIDS Project 6 (“the cluster investigation” of 1982). Bob Damron, Laud Humphreys, Jim Kepner, Marty Levine, Brian Miller, Paul O’Malley, and David Ostrow were essential in helping me become acquainted with the gay communities of Chicago, Los Angeles, New York, and San Francisco in the late 1970s and early 1980s, Doctoral students Karen Iglesias, Islam Khalil, and Ian Lee assisted me with locating, identifying, and cataloguing original documents, Digital Assets Project Manager Rhia Rae helped me review, select, and digitize historical materials, and nephew Tycho Biersteker redacted personal identifiers in Fig. 1. Vicky Vazquez-Barrios, Ph.D., translated my abstract from English into Spanish. Dr. Larry Mass, Rev. Ken South, Dr. Vicky Vazquez-Barrios, and two modest historians (one living on the East Coast and the other living on the West Coast) kindly read earlier drafts of this manuscript; each offered helpful suggestions. An earlier version of this report was presented on October 11, 2022, as part of the Joseph J. Schott Health and Human Performance Speaker Series at the College of Charleston. All the errors that remain in this publication are mine and mine alone.

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    William W. Darrow

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Darrow, W.W. Confronting AIDS in the Early 1980s: Biomedicine, Public Health, and the Fourth Estate. AIDS Behav 27, 371–387 (2023). https://doi.org/10.1007/s10461-022-03976-z

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