Public Health Law Map - Beta 5 - Medical and Public Health Law Site

our view, AIDS poses no new and unique medical problems. It is unique only when
the history of communicable disease control in this century is ignored.
a) History
Antibodies to HIV were found in blood and tissue samples as early as 1969.
Retrospectively, it is believed that there may have been sporadic cases of the
disease in the United States since 1965. The clinical syndrome of AIDS was first
recognized among gay men in San Francisco and New York in 1981. The isolated
cases of Kaposi’s sarcoma and uncontrollable infections with normally
nonpathogenic organisms were quickly recognized to be part of a single pathologic
process. This identification was possible because the syndrome occurred in a
subpopulation that was easily recognizable and well known to venereologists and
infectious disease experts. Had an equally small number of cases been diluted in
the general population, it might have taken several more years to recognize that
AIDS was an epidemic infectious disease.
(1) Hepatitis B in the Bathhouses
The emergence of a new disease, particularly if it affects a particular group,
always suggests an infectious agent or a toxin of some type. In AIDS, the disease
appeared in a subpopulation that was known to have significant risk for venereal
infection and for illicit drug use: the small population of gays whose lifestyle
included high- frequency, anonymous sex in bathhouses, frequently accompanied
by the use of amphetamines and amyl nitrite.
The high-frequency, anonymous sex in the bathhouses made them ideal places to
spread infections of all types. In addition to gonorrhea and syphilis, hepatitis B
was spread widely through homosexual bathhouses. The epidemiology of this
disease was studied intensively as part of the effort to develop a hepatitis B
vaccine. It was evident that hepatitis B was spread by both sexual activity and by
sharing needles when using intravenous drugs. By 1980 a high percentage of
those who frequented bathhouses regularly were infected with hepatitis B.
The most interesting aspect of this hepatitis B epidemic was that few people in
public health tried to stop it. Hepatitis B is a debilitating, sometimes fatal disease
and the leading cause of cancer worldwide. Although only a small percentage of
infected persons die of acute fulminate hepatitis, a substantial number of infected
persons become chronic carriers, who may continue to spread the disease for
years. These chronically infected persons develop liver cancer or cirrhosis at a
much higher rate than the general population.
Despite the personal and public health costs of the disease, public health officials
did not want to jeopardize their relationship with the gay community by closing
the bathhouses, and they argued that this would compromise other disease control
efforts. More fundamentally, it would have been political suicide. In New York
City, San Francisco, Los Angeles, and Houston, gay men were a well-
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