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

organized, powerful political lobby. Mayors did not want to risk offending them
by supporting the control of a communicable disease with which their own
community was not concerned. Thus, the rights of gay men were protected by
denying them public health protections. This was the precedent for
nonintervention that characterized the first several years of the AIDS epidemic.
(2) How Infectious Diseases Emerge
AIDS is not the first disease that just appeared as if from nowhere. The classic
example is syphilis. We often hear of the syphilization of Europe being attributed
to Columbus’s sailors bringing the disease back from the New World. However,
since the disease was a major problem in the armies of both France and Naples in
a war that broke out four months after the return of the explorer’s ships to Spain,
it is unlikely that a handful of sailors can be responsible. A spirochetal disease
similar to yaws had been well known in northern Africa for centuries. It is
probable that syphilis was a mutation of this disease. For the first 40 years that
the disease existed, it was much more severe than syphilis is today. Secondary
syphilis had a mortality rate of 20% to 40 % during this early time. The virulence
of the disease then decreased to the level we know today.
Changing virulence is a common phenomenon in infectious diseases. The great
plagues of the Middle Ages came and went in waves that had little to do with
medical care, hygiene, or immunity in the general population. Today plague is
endemic in Asia and the western United States. We have the necessary insect
vectors, the animal reservoir of infection, and the potential human exposure yet
there are only sporadic cases instead of epidemics. At the beginning of this
century, streptococcal disease was dreaded. Even well-nourished and well- caredfor
children died of strep throat and rheumatic fever. The severity of this disease
has decreased so much that many states have removed it from the list of
reportable diseases. Although this has been attributed to penicillin, the change
occurred before the era of antibiotics and extends to children who have not
received treatment. The cycle now is reversing as the severity of strep and the
incidence of rheumatic fever increase. [Med World News. 1990;31:20.]
(3) Initial Concentration in the Gay Community
Three factors were responsible for the original concentration of AIDS in the male
homosexual population in the United States. First, it appears that AIDS originated
in Africa as a mutation of an endemic virus and was carried from there to Haiti.
Haiti was a popular vacation spot for homosexuals, and male prostitution was
widespread among the impoverished Haitians. Irrespective of how the initial
introduction of the disease occurred, the second factor was the existence of the
bathhouses. These provided large numbers of sexual contacts and a high
incidence of other sexually transmitted diseases. It is likely that genital lesions
secondary to these other venereal diseases made the spread of HIV easier. The
third factor was that the HIV subtype initially introduced into the United States is
472