The acquired immune deficiency syndrome (AIDS) began to surface during the late 1970s, as physicians in the United States reported a number of unusual disease conditions among otherwise healthy homosexual men. By 1981 the illness had been formally described, and by 1983 research in laboratories in the United States and France had identified its cause as a previously unknown human retrovirus, HIV-1. It was determined that the virus passes from person to person through bodily fluids. The disease had seemed at first to be an exclusively American problem that was centered in the country 's gay communities and among injection drug users who shared needles, but it quickly became apparent that Caribbean populations and Africans south of the Sahara were also afflicted with this horrifying ailment, which causes the immune system to collapse. Then in 1985 a related virus, HIV-2, which passes through heterosexual activity, was discovered to be widespread in Africa.
With many of its citizens having contacts in the United States, the Caribbean, and Africa, Europe had no chance of escaping AIDS; in addition, many of its hemophiliacs were infected with blood from America. By the early 1990s the disease had spread throughout the world, and in 1996 the number of cases was estimated to exceed 22 million.
Although about 90 percent of the more than 22 million cases in the world are in developing countries, some 2 million are not--and these patients have found themselves subjected to the same kind of cruel stigmata that plague and syphilis victims experienced centuries before. Indeed this latest plague, which at one time was regarded as the Black Death of the twentieth century, came not only at a time of medical complacency but also at a point when any social or political experience in confronting such a widespread public health crisis had long since been forgotten. In the West medical science at the turn of the century began at last to have some success in grappling with the disease--at least in increasing survival time--and the din of stigmatism faded somewhat. But the epidemic is far from over, and sequels such as a sharp increase in the incidence of tuberculosis also remain to be dealt with.
AIDS administered a number of brutal lessons, and one stands out starkly. The disease showed how, in an age when one can travel to almost any place on the globe in a matter of hours, the West is now vulnerable to diseases that break out anywhere in the world. Globalization of pathogens seems as inevitable as the globalization of food and economies, and as a consequence, it appears doubtful that we can hope to experience any reprieve from epidemics of the kind that ranged from the influenza of 1918 to AIDS.
The emergence of a new killer infection in the early 1980s reawakened all the public health concerns associated with an earlier era. AIDS was initially compared to dramatic historical invasions of the past such as plague and cholera. The initial impact of AIDS upon popular, political, and expert perceptions raised familiar issues regarding the right of the state to police and regulate the spread of infection through surveillance, notification, screening, and quarantine. Those who favored authoritarian intervention called for the institution of compulsory testing, identity cards for people who were HIV-positive, and their isolation.
By the late 1980s its transmission through needle-sharing among impoverished intravenous drug users meant that AIDS was spread more and more by poverty and social despair rather than unprotected sexual intercourse. The length of time between contracting the HIV virus, the onset of the AIDS syndrome, and the death of the sufferer lengthened as more effective therapeutic treatment slowed the physiological progress of the disease. Thus by the 1990s AIDS began to be perceived as a chronic disease among minority high-risk groups rather than an epidemic infection. AIDS victims have suffered legal and social discrimination in the popular mind and by official agencies. The implication of bodily and spiritual corruption has persisted as a powerful contemporary trope.
A new social contract of health has been promoted in public health campaigns from antismoking to AIDS prevention. It is a contract based upon a model of prevention that utilized medical and social scientific analysis to maximize health chances by encouraging individuals to change their lifestyles. However, the state and its public health agencies have not had a monopoly on the promotion of health through lifestyle management. Health promotion through lifestyle education has also been successfully commercialized.
