Ten years ago I treated a few patients with mysteriously high fevers, weight loss and unusual lung infections. On June 5, 1981, the Centers for Disease Control published my description of this rare array of symptoms. At first I naively thought the patients would recover and they would be healthy once again. I was wrong. All of them died. It was clear to me before too long that we were on the brink of a natural disaster.
In 1981 less than 100 people died of the disease that came to be known as acquired immune deficiency syndrome (AIDS). By the end of 1990, approximately 160,000 people in the United States had been diagnosed with AIDS and 100,000 had died. What we thought might be a curable outbreak was a holocaust.
How did this epidemic happen? Why wasn't every possible step taken to halt the further spread of this virus? And, perhaps most important, why has President Bush never spoken out strongly on the most costly epidemic of our time?
The tragedy, of course, is thatthe AIDS epidemic was preventable. The war could have been won early if there had been a commitment at the highest levels of the government. As in Vietnam, the war was fought without a will to win. The leadership in Washington underestimated the enemy and mistook the threat as coming from people who had the virus rather than from the virus itself. They paid lip service to the cause but never sent the "troops" or funds needed to halt the invading disease.
Americans may tend to regard AIDS as a problem of the 1980s, yet the 1990s will be much worse. According to the Centers for Disease Control, by the end of 1993 there will have been 285,000 to 340,000 deaths. It is estimated that in each year of the 1990s at least 2,000 babies will be born infected with the AIDS virus.
Despite these astounding figures, two presidents of the United States have been reluctant to be the commander in chief in this fight. Ronald Reagan gave AIDS only passing notice, and Bush has failed to enter the battle as forcefully as the crisis demands.
We need a war plan for AIDS in the 1990s. Mine would aim to do the following:
Persuade Bush to take charge of this crisis by putting AIDS at the top of his domestic agenda.
Revive the prevention message first voiced by Surgeon General C. Everett Koop and neglected since he left the government in 1988. He made condoms a household word. Because of inadequate prevention strategies, 40,000 to 50,000 Americans are newly infected each year.
Prevent the spread of the virus among drug users, their sexual partners and babies. This strategy must include distributing free,clean needles to addicts and expanding methadone programs and basic health care for this impoverished population.
Increase access to prenatal care and testing for the 80,000 or so women of childbearing age who are infected with the HIV virus.
Expand financing for research on treatment and vaccines.
AIDS is still a medical emergency and warrants urgent expenditures. These measures must be carried out quickly. Our leaders have ducked the issue for too long. In the next elections failure to take a stand in favor of a sane policy should become a severe liability.
One-million Americans are already infected with HIV, and each year an additional 40,000 to 50,000 become infected. The AIDS crisis has not passed. The worst is yet to come. It is likely that in three or four years every American will know someone who has AIDS. Maybe that is what it will take to change attitudes and make all Americans activists.
Michael S. Gottlieb is a physician specializing in patients with AIDS and HIV infections.