Artist: Keith Haring

Annie Baker | University of Kentucky

Acquired immunodeficiency syndrome, or AIDs, is a failure of the immune system caused by the progression of an infection with Human Immunodeficiency Virus, or HIV. When you’re first infected with HIV, you will experience a fairly short period of flu-like symptoms, but when you die from AIDS, you actually die from “opportunistic infections” (infections that take advantage of your immunocompromised status) or tumors. These opportunistic infections are caused by the bacteria that usually sit dormant all around and in us. The specific AIDS-related cause of death of Freddie Mercury, the famous Anglo-Indian singer, is listed as bacterial pneumonia. The tumors are formed by viruses one is already infected with, such as a particular strain of herpesvirus that can lead to a type of cancer called Kaposi’s sarcoma, which you may know as the large red skin cancers on the faces of dying men from photos of the AIDS crisis.

AIDS came to the attention of the medical world in the early 80s when gay and bisexual men at their physical prime, who should otherwise have nearly perfect immune systems, began suffering from bacterial pneumonias and rare cancers that should only affect immunocompromised individuals. Medical panels showed these men to be immunocompromised indeed. As a result of the sexual orientation of these men, the unknown syndrome causing this was initially in May of 1982 called GRID, or gay-related immune deficiency. Years of research eventually showed the connection between what was soon (by August of 1982) renamed AIDS and the virus that came to be known as HIV.

Even though HIV is hypothesized to have made the jump from non-human primates to human sometime in the early twentieth century, the earliest confirmed case of AIDS was in a Danish surgeon working in what was then Zaire, named Margrethe “Grethe” Rask. She is in all likelihood one of the first non-Africans to become infected, probably catching the virus from human blood while performing surgery. Her 1977 death was mysterious at the time—a once-healthy woman in very early middle age dying of rare bacterial pneumonia, until ten years later when technology had advanced enough to detect the presence of HIV antibodies in remaining samples of her blood. Interestingly, she was in a longtime relationship with another woman at the time of her death.

HIV is hypothesized to have left the villages of West Africa sometime in the 70s, reached the United States, and spread across the country and across the world after the 1976 American bicentennial celebration in New York City. Its particular effect on gay men is likely sheer chance of hitting that community to begin with—gay/bisexual men often associate with, share drugs with, and have sex with other gay/bisexual men, just as heterosexual individuals often associate with, share drugs with, and have sex with other heterosexual individuals. The book, And the Band Played On tells this story, with an emphasis on the gay community, in far more detail than I have room to and with the beautiful prose of a well-written horror novel, and one more terrifying than any fiction. It is important to note that, even though in the United States 15% of gay/bisexual men and 28% of transgender women test positive for HIV, heterosexual sex is the most common method globally of transmission of the virus.

An infection with HIV was a death sentence until the mid-90s. In 1987, the first anti-retrovirals—nucleoside reverse transcriptase inhibitors, NRTIs, were introduced, but having been failed by the government and by big pharma for nearly a decade, many patients were afraid to try the experimental drugs. And the new drugs were in fact fairly ineffective long-term. In 1995, Merck and the NIAID introduced combination anti-retroviral therapy, which combined two different NRTIs with a new class of anti-retrovirals—protease inhibitors. The NRTIs prevent the virus from replicating its genome and the protease inhibitors prevent the virus from assembling itself into infectious particles. As with antibiotics, there is the risk of the virus mutating to become resistant to the effects of the drugs. Combining three different drugs that target different aspects of viral replication helps in preventing this.

These days, with strict treatment, the life expectancy of HIV-positive individuals is roughly normal.

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