
Rare Cancer Seen In 41 Homosexuals (1981) - patdennis
http://www.nytimes.com/1981/07/03/us/rare-cancer-seen-in-41-homosexuals.html
======
patdennis
This is the first New York Times article reporting on what would later be
known as the AIDS epidemic.

Edit: Here's the takeaway quote, in my opinion: "Cancer is not believed to be
contagious, but conditions that might precipitate it, such as particular
viruses or environmental factors, might account for an outbreak among a single
group."

Edit2: "Dr. Curran said there was no apparent danger to nonhomosexuals from
contagion.'"

~~~
kmfrk
Even today, people have a very poor understanding on how you can - rather _can
't_ \- contract it from HIV+ people, alas. (Not saying that HIV==AIDS.)

[http://aids.gov/hiv-aids-basics/hiv-aids-101/how-you-get-
hiv...](http://aids.gov/hiv-aids-basics/hiv-aids-101/how-you-get-hiv-aids/)

If an HIV+ person sneezes in an elevator, some will have a panic attack, I
reckon.

Not to mention the travel bans some countries impose.

1) [http://www.huffingtonpost.com/2009/10/30/hiv-travel-ban-
lift...](http://www.huffingtonpost.com/2009/10/30/hiv-travel-ban-lifted-
by_n_340109.html)

2) [http://plwha.org/](http://plwha.org/)

3)
[http://www.unaids.org/en/targetsandcommitments/eliminatingtr...](http://www.unaids.org/en/targetsandcommitments/eliminatingtravelrestrictions/)

Still much work to be done in informing people, so let this be an opportunity
to ask your friends and family whether they know their facts on the matter, as
HIV+ people are treated like lepers oftentimes.

Bonus trivia for reading along this far: Andrew Sullivan is HIV+.

[https://en.wikipedia.org/wiki/Andrew_Sullivan#Personal_life](https://en.wikipedia.org/wiki/Andrew_Sullivan#Personal_life)

~~~
seiji
_(Not saying that HIV==AIDS.)_

Why make that disclaimer?

~~~
snowwrestler
Not everyone who is HIV-positive develops AIDS.

~~~
akiselev
Actually, I think the going medical opinion is that, except for new mutated
strains (and they'd have to be heavily mutated), anyone who contracts HIV
today is never going to develop AIDS if they have access to modern treatment
options (for the rest of their life).

~~~
snowwrestler
Some people who are HIV positive never develop AIDS even without drugs.

------
enraged_camel
In the movie Forrest Gump, there is a scene taking place in the late 70s or
early 80s where Jenny is explaining to Forrest that she is ill and the doctors
do not know what it is. She dies a few years later. It is never stated
explicitly, but the idea is that she was suffering from AIDS, which she
contacted during her years as a promiscuous drug addict groupie.

In my opinion it is one of the most powerful scenes in the movie, in the sense
that it does an amazing job with taking the viewer back to that time period
where AIDS was a mystery disease.

~~~
bruceb
I thought it was pretty obvious. Was also a tad annoying as because she was
liberal and anti war and was a sexually liberated woman...well then she is a
whore that will get her payback by being given aids.

I thought it was a good movie but it had touches of right-wing propaganda.

~~~
newnewnew
What's really going to blow your mind is the statistics on who gets HIV
infections in the United States today:

[http://www.cdc.gov/hiv/statistics/basics/ataglance.html](http://www.cdc.gov/hiv/statistics/basics/ataglance.html)

What an un-PC virus. Doesn't it know we're living in 2013? I'm told reality is
supposed to have a liberal bias now.

~~~
jaxytee
It actually didn't suprise me at all that oppressed groups have the highest
incident of HIV infection.

~~~
peterjancelis
Are you saying people are being oppressed into having unprotected sex?

~~~
maerF0x0
or that they receive fewer opportunities for education and distribution of
said protection (eg, a richer school may have free condom distribution, but a
poorer one does not?). Maybe because cultures of "Abstinence" (eg, teach them
abstinence and dont give them condoms/protection, then wonder why they get
diseases)...

This is all supposition, I'll let others lay down the facts.

------
samspot
My vote for the key quote (from the bottom of the article):

"Dr. Friedman-Kien said he had tested nine of the victims and found severe
defects in their immunological systems. The patients had serious malfunctions
of two types of cells called T and B cell lymphocytes, which have important
roles in fighting infections and cancer.

But Dr. Friedman-Kien emphasized that the researchers did not know whether the
immunological defects were the underlying problem or had developed secondarily
to the infections or drug use."

~~~
encoderer
And I love that this was at the very bottom of the article! Inverted
pyramid... clearly the author thought this to be a somewhat irrelevant aside.

------
rdl
"There is no national registry of cancer victims, but the nationwide incidence
of Kaposi's Sarcoma in the past had been estimated by the Centers for Disease
Control to be less than six-one-hundredths of a case per 100,000 people
annually, or about two cases in every three million people. However, the
disease accounts for up to 9 percent of all cancers in a belt across
equatorial Africa, where it commonly affects children and young adults."

Is that because GRID already was occurring in Africa, and people getting KS
and dying of it, or was it just a common cancer in Africa for unrelated
reasons?

~~~
ronaldx
I wondered the same thing... I collected some thoughts but haven't reached a
clear conclusion on that. I tend towards common for unrelated reasons.

Kaposi's Sarcoma (KS) is caused by a herpes virus: KSHV,
[https://en.wikipedia.org/wiki/Kaposi_sarcoma-
associated_herp...](https://en.wikipedia.org/wiki/Kaposi_sarcoma-
associated_herpesvirus)

We see KS in HIV patients because they are often concomitant infections _and_
because KS is opportunistic, attacking immune-suppressed people. But, this
doesn't mean that KS necessarily goes hand-in-hand with HIV infection.

Particular forms of KS affect younger people:
[https://en.wikipedia.org/wiki/African_cutaneous_Kaposi_sarco...](https://en.wikipedia.org/wiki/African_cutaneous_Kaposi_sarcoma)
[https://en.wikipedia.org/wiki/African_lymphadenopathic_Kapos...](https://en.wikipedia.org/wiki/African_lymphadenopathic_Kaposi_sarcoma)

KS may have been 9% of all cancers in equatorial Africa just because of a very
high KSHV prevalence and because lower life expectancy = fewer age-related
cancers.

There was a similar rate recogised since the 1950s
[http://www.nejm.org/doi/full/10.1056/NEJM200004063421407](http://www.nejm.org/doi/full/10.1056/NEJM200004063421407)
This article also notes that KS now accounts for 50% of tumours in some
countries, with and without HIV infection.

An NHS article which admits that, even today, they're not exactly sure how
many incidents of KS are HIV-related [http://www.nhs.uk/Conditions/Kaposis-
sarcoma/Pages/Introduct...](http://www.nhs.uk/Conditions/Kaposis-
sarcoma/Pages/Introduction.aspx)

------
run4yourlives
An article like this makes you wonder how many different diseases (answer -
over 200) get lumped together under the large "cancer" umbrella.

One wonders if we are doing ourselves a disservice maintaining a term more
inline with shared symptoms instead of separating the diseases into shared
causes.

At any rate I'm digressing, but cancer is a fascinating (while horrible)
concept that exists in our reality. When you think about it, it is probably
more responsible for what we are today than any other force on the planet, in
evolutionary terms.

As for AIDS: The fact that it was a "gay disease" hampered everything about
our response to it. I'd like to think that we would be much more in tune with
emerging health threats these days, but somehow I doubt it. I really hope we
have HIV licked in a few years though, because Africa really, really needs a
vaccine before it can do anything else really.

~~~
GhotiFish
I always though cancer was an umbrella term for when a cell mutates in such a
fashion to lose it's reproductive throttle, and consequently starts consuming
as many resources as possible, eventually fragmenting and spreading throughout
the body.

What kind of cancers don't fit this definition?

~~~
bencollier49
Oh, they all fit this definition, but the mutation isn't always spontaneous.

For example, cervical cancer is often caused by HPV, which is why school-age
girls are routinely immunised against it in the UK.

~~~
ownagefool
I'd be suprised if any cancers were completely spontaneous rather than us just
not knowing what causes them.

~~~
robbiep
Let's break that down a bit:

There are many genetic determinants of whether you will develop a cancer, or a
particular type of cancer. People with FAP, or HNPCC, or other proto-oncogene
mutations such as BRCA2 will have a very high probability of developing a
specific cancer in their lifetime.

But the mutation that leads to cancer is a spontaneous event, that is allowed
to occur due to a failure of cellular regulation.

There are many viral causes of cancer, as OP mentions HPV for cervical and
penile cancer. Other strains of HPV are linked to SCc (a form of skin cancer)
and throat cancer. Hepatitis C will cause liver failure and Hepatocellulr
carcinoma in approx 20% of infected patients. Infection with H. Pylori can
predispose to gastric carcinoma.

Additionally exposure to various 'environments' can lead to cancer - if you
have GORD you can develop Barett's Oesophsgus due to the gastric acid
irritating lower oesophageal mucosa, which can predispose to oesophageal
cancer. if you are an alcoholic you can develop cirrhosis and later
Hepatocellular carcinoma due to prolonged inflammation in the liver. If you
are pale skinned and live in a sunny climate you are at higher risk for
melanoma and if you eat a poor diet you have an increased risk of colon
cancer. Smoking and exposure to smoke can give you lung, oropharynx, stomach
and bladder cancer.

As of yet we have no idea what, of any, are associations for many of the
Brain, bone or Kidney cancers (excluding some toxins for kidney cancer).

Possibly there is no cause.

But in all of these cases, the mutation still arises 'spontaneously'. That is,
we all have a probability of developing a mutation that can cause cancer every
time a cell divides in our body. In people with Li-Fraumeni syndrome, who have
a mutation of p53, almost everyone will develop cancer by the time they are in
their 40s. So we know the rate of gene knockout is quite high over our lives,
and if it wasn't for immunosurvielance, we would likely fall prey to cancer
much faster than we do anyway..

All having a risk factor or infection does is increase the probability that a
cell will 'spontaneously' develop a mutation that will make it cancerous, and
having more of these mutated cells arising increases the chance that one will
evade immunosurviellance and continue to grow and expand.

Bottom line: as a doctor I see all cancers as spontaneous. You could say that
x causes y, and in many cases there is a strong association, but in no case is
that association as strong as, say, life leading to death, for which there is
a correlation coefficient approaching 1.

~~~
ownagefool
While I appreciate the information and agree that it's pragmatically
spontaneous my point was that I was suggesting we'll find that it won't be the
case if and when we gain a deeper understanding, which we may never do.

------
rootbear
Today is the 60th birthday of a friend who has been HIV+ since 1983. When we
met, ca. 1986, I didn't expect him to live long. I am pleased beyond my
ability to express that I was completely wrong. The party he and his husband
are throwing on Sunday will be epic.

------
res0nat0r
I'm currently reading And The Band Played On which is a detailed account of
the rise of the AIDS epidemic and how it was ignored and mishandled back in
the 80s. Definitely check it out if this subject interests you.

~~~
tptacek
Curious: if we call t_0 1981, the Kaposi's Sarcoma article, and t_x 1996, the
advent of HAART, and consider (t_x - t_0) "the AIDS epidemic" \--- ignoring
the ongoing epidemics in Sub-Saharan African and India, which are enormous
problems but somewhat orthogonal to the problem described by your book ---
what comparably lethal disease in human history was more effectively addressed
by the medical establishment? How can we quantify the mishandling of AIDS in
the 1980s?

~~~
pqqqqq
Just to give you an idea, the FDA didn't start screening its blood until 1985
after several documented cases where patients received AIDS from blood
transfusions.

[http://aids.gov/hiv-aids-basics/hiv-aids-101/aids-
timeline/](http://aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/)

Reagan has been criticized for his complete non-response to AIDS as well. He
mentioned it in passing in 1985, and didn't actually address the issue until
1987. Since AIDS mostly affected homosexuals and drug users, AIDS wasn't
exactly a high priority for the Reagan administration in light of the
Religious Right's massive power at the time. The popular rhetoric of the era
was more akin to "AIDS is God's punishment for homosexuality" than compassion.

[http://www.nytimes.com/2004/06/09/politics/09policy.html](http://www.nytimes.com/2004/06/09/politics/09policy.html)

To quote Reagan's biographer: "Reagan's response to this epidemic was halting
and ineffective."

~~~
tptacek
I believe that AIDS wasn't a high priority for Reagan, but from my vantage
point it looks like HIV is an instance of an enormously complicated biological
challenge being addressed with extraordinary effectiveness and rapidity by the
medical establishment.

I take your point (and the sibling commenter's point) about the epidemiologic
response to AIDS; I may be over-fixated on the research and development side
of the issue.

~~~
timr
It's important to remember that AZT (the first effective anti-retroviral
treatment for HIV) was invented in the 60s as part of cancer research. It
wasn't until the mid-80s that HIV researchers started testing it.

In other words, it's not as if the drug was _invented_ in response to the AIDS
crisis. Once the NIH/NCI made AIDS research a priority, it was a rather
straightforward matter to start testing known anti-retroviral drugs. One can
reasonably argue that if the government had made HIV research a priority in
the late 70s and early 80s, the effective treatments would have been found
before the epidemic exploded (for example, contrast to SARS or bird flu, where
the index patients are chased down and isolated, and immunological research
begins before there are even tens of thousands of patients.)

~~~
theorique
Was HIV even identified in the late 1970s and early 80s though? I thought it
was identified as a consequence of looking at the causes of the AIDS epidemic.

~~~
timr
The virus was discovered in 1983, but knowledge of the "gay cancer" was around
in the late 70s. I shouldn't have said "HIV research" there, but rather, "AIDS
research". The medical world's interest in AIDS was pretty limited until it
started to break out of the marginalized populations of gay men and drug
users.

~~~
theorique
Ah, OK, makes sense. That's when it was realized that it was not exclusively
"GRID" (Gay-related Immune Disorder) and that it was transmitted by virus.

------
bdcravens
Similar to early diagnoses of Cystic Fibrosis, where the focus was on symptoms
and less on the underlying cause. With CF, it's an issue of NaCl passing
through cells, resulting in thick mucus which damages lungs, pancreas, etc.
The first cases observed cysts and fibrotic tissues on the pancreas, hence,
"Cystic Fibrosis". As there weren't digestive enzymes supplements then to
augment the damaged pancreas, patients died of malnutrition. It wasn't until
those treatments developed that the lung conditions developed in older
patients, which is what CF is known for now. By then, however, the name Cystic
Fibrosis had stuck.

------
patrickg_zill
I cannot find the article by Peter Collier and David Horowitz, which describes
how the public health officials in San Francisco bowed to political pressure
and did not do the typical contact-tracing, public announcements, etc. that
would normally be done - because they feared getting in trouble if they
pointed out that the carriers were almost all gays. But it makes an
interesting counterpoint to the idea that there was a lack of concern about
it.

------
bajsejohannes
I recommend the movie How To Survive a Plague, which also shows the beginnings
of AIDS in New York. Must have been a frightening time.

[http://www.imdb.com/title/tt2124803](http://www.imdb.com/title/tt2124803)

~~~
kmfrk
Has anyone found a version of this that works on European DVD players?

~~~
TazeTSchnitzel
Get a region-free (or unlockable) DVD player.

------
decasteve
Soon after they identified the 4H's of HIV/AIDS: homosexuals, haemophiliacs,
heroin addicts, and Haitians.

~~~
aasarava
Haitians in the US were discriminated against on the belief that they were
bringing AIDS into the country. But medical anthropologist Paul Farmer has
done a good job of showing that Haitians were only more "susceptible" to the
virus than other populations because American sex tourists often visited Haiti
and inadvertently spread the disease to Haitian sex workers.

[http://www.amazon.com/AIDS-Accusation-Haiti-Geography-
Blame/...](http://www.amazon.com/AIDS-Accusation-Haiti-Geography-
Blame/dp/0520248392)

~~~
vilhelm_s
As I understood it, there was a long standing debate about whether the AIDS
epidemic spread from Haiti to the US or the other way around, but genetic
evidence eventually found that it did come from Haiti:
[http://www.pnas.org/content/104/47/18566.long](http://www.pnas.org/content/104/47/18566.long)

------
jmedwards
Here's a good article about that particular doctor and the discovery:
[http://nymag.com/health/features/49240/index4.html](http://nymag.com/health/features/49240/index4.html)

------
theorique
Wow, this is back when it was called GRID.

~~~
baxter001
This is back before it was discovered to be an immune deficiency.

~~~
wisty
Being a little picky, GRID (Gay Related Immune Deficiency) was certainly
thought to be an immune deficiency.

But they didn't know it was acquired, or that it was a virus, or that it
wasn't just gay related, or anything else much.

------
mcdoh
There's a great Radiolab episode, Patient Zero
([http://www.radiolab.org/2011/nov/14/](http://www.radiolab.org/2011/nov/14/)),
that covers the the spread of AIDS and tracing the disease back to its origin.

------
caycep
Contrast this from recent papers describing the breathtaking molecular
capabilities we have these days with the HIV virus (using inactivated/re-
engineered HIV to treat T cell lymphomas/leukemias, bone marrow transplants to
treat HIV itself), and it's humbling both - how far we've come, and with HIV
still a major killer on the global scene, how far we have to go....

------
azinman2
So sad to read that article especially seeing that they were giving people
chemotherapy right away. As if dying from AIDS weren't bad enough. Yet the
article did dance around the core problem in talking about a group of
promiscuous people, but the connection was not made. I hope medicine has
learned better the signs of a viral outbreak.

------
Shank
There's a lot of info in the book "The Coming Plague" about the initial
reaction to the disease GRID, which would later become AIDS.

[http://www.amazon.com/The-Coming-Plague-Emerging-
Diseases/dp...](http://www.amazon.com/The-Coming-Plague-Emerging-
Diseases/dp/0140250913)

------
smickie
Scary when it starts to dawn on you what you're reading...

------
smegel
I wonder why they identified it as cancer, and if the chemo had any effect.

