Timeline

The CDC's Morbidity and Mortality Weekly Report described the men as having additional infections, indicating that their immune systems were compromised.  By the time the report was published, two of the young men were already dead. While this was the first official reporting of the disease, the history of the AIDS epidemic actually reaches back to the early 20th Century, when Simian Immunodeficiency Virus made the jump from chimpanzees to humans in Central Africa. The new virus began infecting residents in Léopoldville (now Kinshasa) in the Democratic Republic of the Congo some time between 1990 and 1920.  according to History.com/A&E Networks.  More than 60 years later, when HIV tests became available, blood samples from a Congolese man who died in 1959 tested positive for HIV and this was the first confirmed HIV-related death. But the existence and spread of HIV had gone unreported in the medical community until around 1980, when a handful of doctors serving urban populations in the U.S. started to see unusual symptoms in their patients. One of these doctors was Michael Gottlieb, a young immunologist at UCLA (University of California Los Angeles) who diagnosed a rare lung infection in five young men between 1980-1981.  Dr. Gottlieb arranged for his findings to be disclosed to the medical community in the CDC's weekly alert, MMWR. Dr. Gottlieb encountered his first patient with unusual infections in November 1980, when one of his medical school residents reported a young patient suffering from a severe yeast infection in his throat.  When the patient began having breathing difficulties, Dr. Gottlieb arranged to receive a scraping of the patient's lung tissue through a non-surgical procedure.  He was astounded by the test results. The patient tested positive for Pneumocystis carinii pneumonia (PCP), a rare lung infection, in addition to oral candidiasis, also known as thrush.  Dr. Gottlieb then reached out to a colleague who specialized in the new science of T-cells, the white blood cells important to the immune system.  The colleague tested the patient's blood and found that the sample had no T-helper cells, a result so astounding that he ran the test again, with the same results. In February 1981, Dr. Gottlieb would come across another young man suffering with PCP and depleted T-cells, and shortly after that, a third patient was referred to him.  Thorough examinations of the patients about their lifestyles yielded the information that were gay, but Dr. Gottlieb couldn't determine how their sexual identity was relevant. A fourth PCP patient appeared in April 1981, and then a report of a fifth man who already died (an autopsy found PCP).   Seeing an alarming trend, Dr. Gottlieb contacted an editor at the New England Journal of Medicine, the most prestigious medical journal in the U.S., and was told that the submission-review-publication process would take at least four months.  He believed this information needed to get out to the medical community fast, so he instead submitted his report to the CDC's weekly newsletter, the Morbidity and Mortality Weekly Report (MMWR), a weekly report read by medical officials concerned with infectious disease and public health. Assisting Dr. Gottlieb in publishing his report was Dr. Wayne Shandera, who worked in the Los Angeles County Department of Public Health as a CDC liaison. "Gottlieb talked through the charts while Shandera put the information into the dry, turgid prose that the MMWR preferred," wrote Randy Shilts in his epic recounting of the early years of the AIDS pandemic, And the Band Played On: Politics, People, and the AIDS Epidemic.  "The report noted the links between PCP, CMV (cytomegalovirus), and the oral candidiasis that commonly preceded the pneumonia." Dr. Gottlieb's report also stated, "The fact that these patients were all homosexuals suggests an association between some aspect of homosexual lifestyle or disease acquired through sexual contact and Pneumocystis pneumonia in this population." The five Los Angeles men in Dr. Gottlieb's report were not the only early cases in the U.S.  Starting around 1979, previously healthy men in New York City and San Francisco were their seeing doctors and baffling them with a range of symptoms that included fatigue, enlarged lymph nodes, flat purple lesions, oral candidiasis, shortness of breath, eczema, fevers, and amebic dysentery.  Their medical charts would be marked with notes like "fever of unknown origin," "Kaposi's sarcoma," "cytomegalovirus," and "toxoplasmosis."   But the traditional treatments for these conditions were not working. While sporadic cases of AIDS were documented prior to 1970, available data suggests that the epidemic started in the mid- to late 1970s. Grethe Rask, a Danish physician who worked in the Congo, died of pneumonia on December 12, 1977 after suffering for several years from opportunistic infections.  Ten years after her death, samples of her blood were tested and found to be positive for HIV. By 1980, HIV may have already spread to five continents (North America, South America, Europe, Africa and Australia), and in this period, it is possible that up to 300,000 people were already infected. In April of 1980, the CDC received a report on Ken Horne, a gay man in San Francisco who was diagnosed with Kaposi’s sarcoma.  Horne died on November 30, 1981.  The CDC would retroactively identify Horne as the first American patient of the AIDS epidemic. Following Dr. Gottlieb's report in the CDC's MMWR, he and his team published a more detailed report in the New England Journal of Medicine on December 10,  1981. Today, Dr. Gottlieb is an Associate Clinical Professor of Medicine at UCLA’s David Geffen School of Medicine and still treats patients exclusively at AIDS Project Los Angeles (APLA Health).  He is also a member of the Council of Advisors to STORIES: The AIDS Monument. * * * * Sources: Morbidity and Mortality Weekly Report | Centers for Disease Control and Prevention, "Pneumocystis Pneumonia - Los Angeles," June 5, 1981 American Journal of Managed Care, "A Q&A With HIV/AIDS Pioneer Dr Michael Gottlieb" by Maggie L. Shaw, June 4, 2021 And the Band Played On: Politics, People, and the AIDS Epidemic by Randy Shilts www.Be In The Know.org, "Origin of HIV and AIDS" PBS News Hour, "America's HIV Outbreak Started in This City, 10 Years Before Anyone Noticed" by Nsikan Akpan, October 26, 2016 www.History.com | A&E Television Networks, "AIDS Crisis Timeline" The New England Journal of Medicine, "Pneumocystis carinii Pneumonia and Musocal Candidiasis in Previously Healthy Homosexual Men -- Evidence of a New Acquired Cellular Immunodeficiency" by Michael S. Gottlieb, M.D., Robert Schroff, Ph.D., Howard M. Schanker, M.D., Joel D. Weisman, D.O., Peng Thim Fan, M.D., Robert A. Wolf, M.D., and Andrew Saxon, M.D.; December 10, 1981

These news stories -- which were published by the Los Angeles Times, San Francisco Chronicle and Associated Press -- captured the attention of the gay community and medical personnel nationwide. In response to the outpouring of reports and concerns to the CDC, the Task Force on Kaposi’s Sarcoma and Opportunistic Infections was created to identify risk factors and to develop a case definition for the as-yet-unnamed syndrome.  The Task Force worked under the CDC's Field Services Division in the Epidemiology Program.

Donald F. Austin, M.D.; Erwin Braff, M.D.; James W. Buehler, M.D.; James Chin, M.D.; J. Lyle Conrad, M.D.; Selma Dritz, M.D.; Diane M. Dwyer, M.D.; Shirley L. Fannin, M.D.; Yehudi M. Felman, M.D.; Stephen M. Friedman, M.D.; Robert A. Gunn, M.D.; John P. Hanrahan, M.D.; Robert J. Kingon, M.D.; Michael D. Malison, M.D.; Stanley I. Music, M.D.; Mark A. Roberts, M.D.; Alain J. Roisin, M.D.; Richard B. Rothenberg, M.D.; and R. Keith Sikes, M.D.

* * * * * Sources: National Institutes of Health, "In Their Own Words ... NIH Researchers Recall the Early Years of AIDS" Frontline | PBS,  "Interview: Jim Curran," interviews conducted Jan. 18, 2005 and Feb. 15, 2006 The New England Journal of Medicine, "Epidemiologic Aspects of the Current Outbreak of Kaposi's Sarcoma and Opportunistic Infections," January 28, 1982

When Dr. Deborah Greenspan started seeing a white lesion on the tongue of gay men coming to her clinical practice, she consulted with her pathologist husband, who suggested a biopsy to find out what was causing it.  Dr. John Greenspan (1937-2023) identified the oral lesions as a rare form of cancer which impacted the lymphatoid system, and he decided it warranted a closer look. "I thought this was strange,” he said in 2012 on the occasion of receiving the Gold Medal Award for Excellence in Dental Research.  “We typically saw it in Africa. But in this country, we only used to see it rarely -- for example, in immunosuppressed patients, such as kidney transplant recipients. So, we ended up seeing one of the first AIDS lymphoma patients reported in the world.” The Greenspans conducted studies that showed the lesions -- dubbed "oral hairy leukoplakia" (HL) because of its corrugated or shaggy appearance -- failed to respond effectively to the usual treatment of antifungal applications.  In fact, many of their patients already had or soon developed other immune-depressed symptoms associated with AIDS, such as pneumocystis carinii pneumonia (PCP) and Kaposi's sarcoma (KS). They would publish the first description of HL and the results of their research in a 1984 medical report in The Lancet.  Co-authors of the research article included Marcus Conant, Sol Silverman Jr., Vibeke Petersen, and Yvonne De Souza, all researchers at UCSF. The Greenspans would then go on to establish a connection between HL and Epstein-Barr virus (EBV) in a 1985 report.  By 1987, they would be able to announce that HL and EBV were symptoms associated with AIDS. They would continue their work at UCSF over the next 30-plus years, leading a series of studies relating to the mouth and HIV/AIDS.  Their work has been instrumental in teaching physicians, nurse practitioners and other clinicians how to identify oral lesions associated with HIV infection. “The work of Dr. Greenspan and his colleagues has provided guidelines that enable dentists to recognize early oral manifestations of HIV/AIDS and thereby assist with early diagnosis and referral for treatment,” said John Featherstone, dean of the UCSF School of Dentistry.  “This is of particular importance in the global health world.”

The short item advised gay men experiencing progressive shortness of breath to see their physicians. * * * * * Source: Bay Area Reporter, "Health Shorts: 'Gay Men's' Pneumonia," July 2, 1981

The MMWR article, “Follow-Up on Kaposi’s Sarcoma and Pneumocystis Pneumonia,” reported that CDC received information on 70 additional cases of KS and/or PCP since its July 3 edition, making a total of 108 known cases. News of the article alarms the gay community for its indication that the new disease is spreading and that the outcome of those infected was likely to be a quick and brutal death. * * * * * Source: Morbidity and Mortality Weekly Report, “Follow-Up on Kaposi’s Sarcoma and Pneumocystis Pneumonia,” August 28, 1981

Overseen by Bay Area dermatologist Dr. Marcus Conant, the Kaposi's Sarcoma clinic was also staffed by oncologist Dr. Paul Volberding, Dr. Constance Wofsy and Dr. Donald Abrams.  Collectively, the physicians guided much of the early response to AIDS in San Francisco. Dr. Conant would go on to create the San Francisco AIDS Foundation (first called the Kaposi's Sarcoma Research and Education Foundation) to address both the need to go into the community, which was still in denial about the disease, and the need to find non-government funding sources. On July 1, 1981, Dr. Volberding saw his first patient with Kaposi’s sarcoma (KS), a rare cancer later linked to AIDS, on his first day working at San Francisco General Hospital. * * * * * Sources: University of California Libraries, "Marcus A. Conant Papers: 1981-1993" American College of Physicians, "Dr. Volberding was at the Forefront of the AIDS Epidemic," December 2017 The New York Times, "Constance Wofsy, 53, Doctor Who Directed an AIDS Program," June 9, 1996 San Francisco Chronicle, "The Good Doctor: He's been in on the AIDS Battle Since the Beginning," August 12, 2001

Drs. Marc Conant, Alvin Friedman-Kien, and James Groundwater stationed themselves at the entrance of the annual meeting of the American Academy of Dermatology and distributed to incoming attendees a pamphlet they hastily put together about Kaposi's sarcoma, a rare form of skin cancer that was being diagnosed in previously healthy young men in San Francisco and New York City. Held on Dec. 5-10, the conference drew thousands of dermatologists in the United States and Canada to San Francisco to hear the latest developments in their medical field.  The pamphlet was likely the first information that most conference attendees received about Kaposi's sarcoma (KS) and its role in the yet-unnamed disease of AIDS.

"At that point in time, not many people knew about this problem, and it wasn't getting a whole lot of attention," Dr. Groundwater later recalled for the San Francisco AIDS Oral History Project.  "I don't think the seriousness of it was widely appreciated -- the potential for major problems in the future."

Dr. Groundwater said he wrote the copy for the brochure and used photographs of a patient's KS lesions so dermatologists could see how the disease manifested.  The patient was Ken Horne, the first KS case to be reported to the Centers for Disease Control.  Horne had died on November 30, 1981, just days before the conference. * * * * * Source: University of California Libraries, "The San Francisco AIDS Oral History Series | The AIDS Epidemic in San Francisco: The Response of Community Physicians, 1981-1984," interview with James R. Groundwater, M.D., conducted by Sally Smith Hughes, Ph.D. in 1996

At the conference, researchers debate whether the opportunistic infections were being caused by one or more transmissible or immune-suppressing agents. * * * * * * Source: National Institutes of Health, "Timeline (1981-1988)"

The MMWR article describes a potential sexually transmitted agent as being the link to outbreaks of KS, Pneumocystis carinii pneumonia (PCP), and other infections recently found among young gay men. The report describes a study of 19 case subjects from June 1, 1981 to April 12, 1982 involving biopsy-confirmed KS and/or PCP among previously healthy male residents of southern California.  Following a report of possible personal connections among the KS/PCP case subjects in Los Angeles and Orange counties, interviews were conducted with the eight subjects still living and with seven of the close friends of 11 subjects who had died. Through these interviews, the CDC was able to collect data on sexual partners for 13 of the 19 subjects. The study considered "sexual contact" to be established if the KS/PCP case subjects was reported to have "exposure" to another person that was either substantiated or not denied by the other person involved in the relationship (or by a close friend of that person). Within five years of the onset of symptoms, nine of the KS/PCP case subjects had had sexual contact with others who had KS or PCP.  They consisisted of seven case subjects from LA County who had sexual contact with other patients from LA County, and two case subjects from Orange County had sexual contact with one patient with KS who resided outside California. Four of the nine KS/PCP case subjects had been exposed to more than one patient who had KS or PCP. Three of the nine KS case subjects developed their symptoms after sexual contact with persons who already had symptoms of KS.  One of these three subjects developed symptoms of KS about nine months after sexual contact, another subject developed symptoms 13 months after contact, and a third subject developed symptoms 22 months after contact. The other four KS/PCP case subjects in the group of 13 had no known sexual contact with reported cases. However, one KS case subject had an apparently healthy sexual partner in common with two persons with PCP; one KS case subject reported having had sexual contact with two friends of the non-Californian with KS; and two PCP case subjects had most of their anonymous contacts (greater than or equal to 80%) with persons in bathhouses. The editorial note to the report included these points:

• An estimated 185,000-415,000 homosexual males lived in LA County in 1982.
• If one assumes each homosexual male in LA County has between 13 and 50 different sexual partners per year during 1977-1982, "the probability that seven of 11 patients with KS or PCP would have sexual contact with any one of the other 16 reported patients in LA County would seem to be remote."
• With this same assumption, "the probability that two patients with KS living in different parts of Orange County would have sexual contact with the same non-Californian with KS would appear to be even lower."
• Thus, observations in LA and Orange counties imply the existence of an unexpected cluster of cases.

The CDC then puts forth the hypothesis that infectious agents are being sexually transmitted among homosexually active males. "Infectious agents not yet identified may cause the acquired cellular immunodeficiency that appears to underlie KS and/or PCP among homosexual males. If infectious agents cause these illnesses, sexual partners of patients may be at increased risk of developing KS and/or PCP," the CDC report posits. The CDC proposes another hypothesis:  "Sexual contact with patients with KS or PCP does not lead directly to acquired cellular immunodeficiency, but simply indicates a certain style of life. The number of homosexually active males who share this lifestyle may be much smaller than the number of homosexual males in the general population." The CDC goes on to suggest the possibility of exposure to "some substance (rather than an infectious agent)" leading to immunodeficiency among homosexual males that share a particular style of life. The report cites a New York City-based report suggesting a connection between amyl nitrite (commonly referred to as "poppers") and an increased risk of KS.  This hypothesis would later be scientifically disproved. * * * * * Sources: Mortality and Morbity Weekly Report, "A Cluster of Kaposi's Sarcoma and Pneumocystis carinii Pneumonia among Homosexual Male Residents of Los Angeles and range Counties, California," June 18, 1982

In the summer of 1982, life-threatening opportunistic infections and Kaposi's sarcoma were reported among 32 Haitian migrants to the United States.  The CDC stated in its Morbidity and Mortality Weekly Report that most were heterosexual men with no known risk factors who had migrated from Haiti within the past two years. The MMWR also mentioned that the CDC received reports of KS cases in Port-Au-Prince, and the combined reports indicated "an epidemiologically distinct pattern of illness" that occurred via heterosexual transmission. Years later, in its report "AIDS: The Early Years and CDC's Response," the CDC conceded that by publicly reporting these cases as "Haitian entrants," the CDC inadvertently contributed to the stigma associated with "AIDS labeling."  This stigma would be endured by thousands of Haitian migrants fleeing poverty and political persecution in the 1980s and 1990s. From April 1, 1980 through June 20, 1982, 19 Haitian patients were admitted to Jackson Memorial Hospital in Miami with evidence of opportunistic infections (including Pneumocystis carinii pneumonia, cryptococcal meningitis or fungemia, toxoplasmosis, and esophageal candidiasis) and one patient also had Kaposi's sarcoma.  Seventeen were men and two were women.  At the time the CDC released its MMWR, 10 of the 19 Haitian immigrants in Florida had already died.  Their average age was 28 years old. From July 1, 1981, through May 31, 1982, 10 Haitian residents of Brooklyn, New York -- all men, aged between 22 and 37 years old -- were diagnosed with opportunistic infections (including Pneumocystis carinii pneumonia, cryptococcal meningitis or fungemia, toxoplasmosis, and esophageal candidiasis).  Five of the 10 immigrants in Brooklyn had already died. The remaining three cases were reported from health officials in California, Georgia, and New Jersey. The CDC warned medical officials and doctors who care for Haitian patients to "be aware that opportunistic infections may occur in this population."

The MMWR article also includes the first case definition for AIDS: “A disease at least moderately predictive of a defect in cell-mediated immunity, occurring in a person with no known cause for diminished resistance to that disease.” Today, AIDS is defined as a set of symptoms (or syndrome) caused by the HIV virus. A person is said to have AIDS when their immune system is too weak to fight off infection. This is the last stage of HIV, when the infection is very advanced. * * * * * * Source: Mortality and Morbidity Weekly Report | Centers for Disease Control and Prevention, September 24, 1982

In the 10 months leading up to the conference, the number of known AIDS cases in Canada had grown from one to 14.  So the issue of AIDS was on the minds of many health officials and medical practitioners attending conference hosted by the CPHA's new Sexually Transmitted Diseases division. At the conference, Dr. Marc Steben told participants that, due to a dearth of information from the medical community, gay men had resorted to passing information about the new disease amongst themselves.  Dr. Steben would go on to dedicate much of his career to HIV/AIDS treatment and become co-president of HPV Global Action, based in Montréal. According to An Annotated Chronology of the History of AIDS in Toronto: The First Five Years, 1981-1986 by Mark L. Robertson, there was wide speculation among health officials at the conference as to the cause of AIDS.  Poppers, promiscuity, and specific sexual acts were discussed as possible candidates. At the time of the conference, 14 AIDS cases had been reported in Canada and 10 people had already died.  Eleven of the cases were reported in Montreal, and one each in Vancouver, Toronto, and Windsor.  Medical officials were reviewing four more cases that they expected to be AIDS. Many of the conference attendees were also aware of the publication in the gay weekly Body Politic of two articles: “Living with Kaposi’s” by Michael Lynch and “The Real Gay Epidemic: Panic and Paranoia” by Bill Lewis. In the first article, Lynch wrote an extensive profile of gay men living with Kaposi’s Sarcoma in New York City.  Lynch expressed his concern with the NYC community’s eager embrace of the medical community and its discourses of pathology. "Gays are once again allowing the medical profession to define, restrict, pathologize us," Lynch wrote in the November 1982 edition of Body Politic.  "What used to be a psychiatric pathology is now an infectious one ... This panic could never have set in so quickly and so deeply if within the hearts of gay men there weren't already a persistent anti-sexual sense of guilt ready to be tapped." In his article, Lynch called for a response to AIDS from people who were exclusively gay.  Lynch was an American-born English professor who settled in Toronto.  He would die of AIDS-related illness on July 9, 1991. His article in Body Politic was accompanied by a shorter piece by Bill Lewis which argued against panic and urged readers to look at the disease through a lens of science. "Until recently, the cause of the collapse of the immune system was baffling, and everything gay men did that straight men didn't was dragged forth as a possible cause," Lewis wrote.  "Abundant sex, poppers, fisting, drugs, ingestion of too much sperm, staying up too late -- all have been put forward as an explanation." Lynch said that these things failed to make sense as explanations, because none could explain cases of AIDS among nearly celibate gay men, hemophiliacs or children. According to This is Public Health: A Canadian History, CPHA's director of the AIDS Education and Awareness Program, David Walters, described Canada's initial public health response to HIV as "fragmented confusion." Canada was facing an economic recession and inadequate healthcare funding from different branches of government.  This, along with a lack of coordination efforts at the local level and a general resistance to anything involving the needs of the gay community, contributed to a reluctance by public health officials to take action in the early years of the epidemic. According to Walters, “There seemed to be no safe ground in talking about homosexuality, condoms and needles at national or provincial levels.  This reluctance resulted in foot-dragging and unclear messages about needed commitment to educational programs."

At the conference, scientists from the CDC recommended that blood banks begin implementing donor screening measures, such as questioning donors about risk behaviors and running blood donations through a series of tests.  Faced with daunting data and the same uncertainties, the blood banks and the plasma companies came away from the conference with different plans.. Playing down the extent of the risk, leaders of the blood banks would decide that the CDC's evidence did not show conclusively that HIV was a blood-borne disease, and they would decline to screen out potentially infected donors.  The blood bank physicians questioned the validity of the CDC data, which correlated of anti-HBc to AIDS cases among a cohort of homosexuals who attended an STD clinic. By contrast, the plasma companies concurred with the CDC that there was a good chance HIV was being transmitted by their products.  They moved very quickly to switch the source of their supply and introduced new methods to inactivate viruses in plasma derivatives.  However, they also decided to keep older product batches on the market, and commercial plasma ended up infecting more people than did donated blood. Getting blood or plasma out of one person and safely into another is a complex process.  Blood banks, such as the Red Cross, obtain almost all of their supply from voluntary donors.  They process and then distribute freely donated blood to hospitals, which they charge for their services. Every year, about 14 million units of blood are donated in the U.S.  The American Red Cross collects about 45% of the total, blood banks about 42%, hospitals 11%, and the small remainder is imported.  About 3.6 million people receive transfusions of these products every year. In the 1970s, blood collection and transfusion had a number of risks associated with it, in particular the prevalence of hepatitis in the supply.  In late 1982, when evidence began to show that a new disease might be spreading through blood products, things became more complicated. The blood bank scientists accepted that HIV/AIDS appeared to be a threat to the blood supply, but found it difficult to measure the risk.  U.S. surveillance systems were ill-equipped to identify diseases with a long incubation period such as AIDS. * * * * * * Sources: National Institutes of Health | National Library of Medicine, "HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking" (National Academies Press, 1995) The Emergence of HIV in the U.S. Blood Supply: Organizations, Obligations, and the Management of Uncertainty by Kieran Healy (Kluwer Academic Publishers, 1999)

An American Red Cross interoffice memo blasts the CDC after its January 4 meeting, stating, “CDC is likely to continue to play up AIDS." The memo goes on to say;  "It has long been noted that CDC increasingly needs a major epidemic to justify its existence.  To the extent the [blood supply] industry sticks together against CDC, it will appear to some segments of the public at least that we have a self interest which is in conflict with the public interest, unless we can clearly demonstrate that CDC is wrong.” Donor screening issues arose in mid to late 1982, when cases of AIDS in hemophiliacs were first reported, including the first transfusion-associated AIDS case in an infant. Between December 1982 and December 1983, there were two critical events that presented opportunities for the blood services community to enact new donor screening and deferral policies to reduce the threat of HIV transmission through blood and blood products. The first, which occured on January 4, 1983, was at the Public Health Service meeting convened by the CDC.  This meeting was widely publicized, and over 200 people attended, including representatives of the FDA, NIH, the National Hemophilia Foundation, the National Gay Task Force, blood banks, and the plasma fractionation industry. This was where the blood services community first received data on the possibility of a transmissible agent within its blood supply.  CDC scientists recommended that blood banks implement specific donor screening measures (such as questioning donors about their risk behaviors and running blood donations through a series of tests). Some participants in the Atlanta meeting and others in key decision-making roles expressed reservations about the validity of the CDC data and indicated that they did not believe the CDC to be a credible source of information regarding AIDS.  Following the conference, American Red Cross officials would encourage colleagues to resist recommendations from the CDC. The ensuing resistance by blood banks to implementing the CDC's donor screening measures is now viewed as a critical failure on their part in the effort to limit transmission of HIV early on in the epidemtic. The second critical event would occur in December 15-16, 1983, when the Blood Products Advisory Committee of the FDA would convene a meeting to discuss all possible options of surrogate marker tests for HIV.  This meeting is notable for being the CDC's second attempt to address the need to implement blood screening as a means to implement safeguards to the blood supply. In the year between the two meetings, blood banks would continue to collect donations from unscreened members of the public. * * * * * * Source: HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking by the U.S. Institute of Medicine  Committee to Study HIV Transmission Through Blood and Blood Products (National Academies Press, 1995)

The following year, U.S. researcher Robert Gallo announced he had found the "probable" cause of AIDS, the retrovirus HTLV-III.  The two viruses -- HTLV-III and LAV -- turned out to be one and the same, and in May 1986 it became officially known as the human immuno-deficiency virus, or HIV. Barre-Sinoussi made her discovery while under French virologist Luc Montagnier, and both would go on to win the 2008 Nobel Prize in Physiology or Medicine for identifying the AIDS virus.  Barre-Sinoussi's discovery ultimately led to the development of anti retroviral medications that have turned AIDS from a death sentence to a manageable chronic disease. Barré-Sinoussi dedicated her career as a scientist and as an activist to halting the spread of AIDS.  Being on the front lines of the AIDS devastation was, she admitted, “very tough psychologically.” The pressure was so intense that, once antiretroviral therapy was discovered in 1996, Barré-Sinoussi fell into a depression, and pulled back from her public commitments. But she soon returned to the fight, often travelling around the world to meet with political leaders and healthcare providers seeking solutions to local epidemics. "Like everybody, I have some times in my life when I’m pessimistic," she said.  "I wonder whether I should continue … Then I go and have a trip to Africa or Southeast Asia and have a small meeting with people affected by HIV, and I forget my mood. I say, 'OK, let’s go on. Let’s continue. This is real life. Don’t think about yourself.'" She currently directs the Regulation of Retroviral Infections Unit at the Pasteur Institute, which is still looking for a vaccine or a functional cure. * * * * * * Sources: The Nobel Prize, "Women Who Changed Science: Francoise Barré-Sinoussi" CNN, "HIV discovery ‘will change your life forever’" by Jen Christensen, June 4, 2013 Nature magazine, "The discovery of HIV-1" by Sonja Schmid, November 28, 2018 PBS News Hour, "How the Discovery of HIV Led to a TransAtlantic Research War" by Dr. Howard Markel, March 24, 2020 Pastuer Institute | The Research Journal, "Françoise Barré-Sinoussi and Her Research on the HIV-1 VIrus," July 17, 2018

Ward 5B is the answer to a petition organized by psychiatric nurse Cliff Morrison, demanding compassionate, holistic care for AIDS patients in San Francisco.  By August, the ward's 12 beds are fully occupied. Run by Morrison and an all-volunteer team, Ward 5B allowed patients to create their own family made up of friends and partners. The nurses recognized that many of the patients were isolated from their families or had long-term, though not legal, partners. The ward was one of the first units in the country that allowed visitors at any time. * * * * * * Source:

The publication lasts for two years, until mainstream scientific journals begin expediting publication for articles on AIDS. * * * * * * Source:

In the CDC Report “Current Trends Update: Acquired Immunodeficiency Syndrome (AIDS) -- United States,” CDC identifies all major routes of HIV transmission — and rules out transmission by casual contact. * * * * * * Source:

Dr. Arthur J. Ammann traveled from San Francisco to New York City for an immunology conference hosted by the New York Academy of Science to report his research on pediatric AIDS patients, which discovered that HIV/AIDS can also be transmitted in utero - from mother-to-infant, and through blood transfusions. Some conference attendees responded to Dr. Ammann’s presentation with indifference and rejection. Dr. Ammann said, “People just don’t want AIDS to affect infants, they just don’t believe it.” Included in the nay-sayers was his former mentor, Robert A. Good, M.D., who had served as president of the American Association of Immunologists and more recently as director of the Sloan-Kettering Institute for Cancer Research. "Bob Good got up and said that he didn't think that we were seeing AIDS in children, that he had seen this immunodeficiency with CMV [cytomegalovirus virus] before," Dr. Ammann recalled for the San Francisco AIDS Oral History Series.  "I quickly responded, because I had looked up all the literature. I said, 'If it's been seen before, no one's ever reported it.'" Dr. Ammann said his early theory about pediatric AIDS was reinforced by a meeting he had with Arye Rubinstein, M.D., a New York City immunologist working with pediatric patients, who told him that he was receiving the same immediate resistance to his own case reports. As the lead pediatric AIDS practitioners on the West Coast and East Coast, respectively, Drs. Ammann and Rubinstein did not let the initial rejection from the medical community deter them from their work.  In fact, both would be later recognized for their important discoveries. Dr. Ammann would serve as director of research for the Pediatric AIDS Foundation, a board member and President of amfAR, and on the Presidential National AIDS Task Force on Drug and Vaccine Development.  In 1997, he would found Global Strategies for HIV Prevention to address the inequity of HIV prevention services provided around the world.

In a 1988 article for The San Francisco Chronicle, Dr. Ammann would draw nationwide attention to the issue of pediatric AIDS when he predicts that at least 20,000 children will contract AIDS in the next four years.  Sadly, his prediction would be borne out.  By 1992, about 5,000 cases of pediatric AIDS would be reported to the CDC, with the actual number of HIV-infected children to be estimated at about 20,000.

In 2017, Dr. Ammann would publish a first-person account of the pediatric HIV/AIDS crisis, Lethal Decisions: The Unnecessary Deaths of Women and Children from HIV AIDS.  Dr. Ammann would die four years later, in San Rafael, California on August 15, 2021, at the age of 85.

Dr. Arye Rubinstein would also dedicate his life to the care of children and women with HIV. The National Institutes for Health would award a grant to Dr. Rubinstein for the  first study of AIDs in women and children. In 1986, he established that transmission of AIDS can occur in utero, and he published his findings in the journal Clinical Immunology and Immunopathology. By 1985, Dr. Rubinstein would estimate that he had treated about 100 children with the AIDS virus at his practice based out of Albert Einstein College of Medicine in the Bronx. At the time, New York public health policy dictated that pediatric AIDS patients be confined to hospitals, so misunderstood was the nature of the virus.  So Dr. Rubinstein decided to open a day care center at Albert Einstein College for the families of pediatric AIDS patients, and successfully petitioned the City of New York for the funding to build it. He would take personal risks to come to the defense of his pediatric patients' parents, many of whom had a history of drug use and sex work, and were not equipped to navigate the backlash of fear and anger directed at them. “I was almost assaulted after testifying in court in Brooklyn,” recalled Dr. Rubinstein in an 2011 edition of Einstein Magazine. “The parents in one school wanted to remove children who were infected, but I testified that HIV was not transmitted through casual contact.  The parents got very upset, to the point where I had to be hauled out of the courtroom through a back door.” In 1986, Dr. Rubinstein and colleagues would show that IV gamma globulin helps prevent infections and T-cell attrition in children with AIDS, significantly improving survival rates.  Later the same year, he would demonstrate that in pregnant women with HIV, transmission of the virus often occurs in utero and not just at delivery or through breast-feeding. In the April 1987 edition of Pediatric Research, he would co-author a paper about the increase in AIDS cases of women whose only known risk factor was heterosexual contact with HIV-positive men.  In another pediatric publication, he would report that the leading cause of death in 1987 for women between the ages of 24 and 35 was AIDS. In 1989, Dr. Rubinstein would launch a summer camp in the Catskills for children with HIV and their families (many more similar camps would open in the 1990s).  He currently is chief of the Division of Allergy & Immunology at Children's Hospital in Montefiore and Professor of Pediatrics at Albert Einstein College of Medicine.

At the December 15-16 meeting, the FDA's Blood Products Advisory Committee facilitates a discussion of the options for HIV surrogate marker tests.  This conference is a follow-up to the one held in January 1983, where blood bank scientists remained unmotivated to begin blood screening. After the January meeting, an American Red Cross interoffice memo stated, “CDC is likely to continue to play up AIDS.  It has long been noted that CDC increasingly needs a major epidemic to justify its existence.” In the year between the two meetings, blood banks would continue to collect donations from unscreened members of the public.  The initial resistance by blood banks to implement the CDC's donor screening measures is now viewed as a critical failure on their part in the effort to limit transmission of HIV early on in the epidemtic. At the December 1983 meeting, industry representatives proposed the creation of a task force to deliberate the details of a recommendation made at the meeting by Dr. Dennis Donohue, director of the FDA's Division of Blood and Blood Products.  Dr. Donohue proposed that hepatitis B anti-core testing be incorporated for routine plasma screening, since it would identify 90% of all potentially infectious or high-risk donors. While Dr. Donohue was not enthusiastic about the task force approach, which was generally seen as the industry's way to delay screening requirements, he agreed to it.

Dr. Fauci, who previously reported that the disease struck primarily gay men, tells his colleagues: "There is increasing evidence, particularly from Zaire, that the virus can be spread by heterosexual contact." Dr. Fauci's presentation is accompanied by a paper co-authored with Henry Masur, M.D.; Edward Gelmann, M.D.; Phillip Markham, Ph.D.; Beatrice Hahn, M.D.; and H. Clifford Land, M.D. In the paper, the scientists summarize the results of their research into the treatment of opportunistic infections. "Attempts at immune reconstitution with lymphocytes and lymphokines have resulted in some transient improvement in immune function but without clinical effect, indicating the need for specific antiretroviral therapy in combination with immune reconstitution," the paper states.

The report includes the following "recommendations for the individual" judged most likely to have an HTLV-III infection:

More than 2,000 researchers gathered at the conference to share information and assess prospects for controlling the disease, not yet realizing that the worst was yet to come. The Atlanta conference featured 392 presentations and generated considerable excitement among participants eager to learn about how this new disease was playing out within specific populations in the U.S. Much of the news was discouraging, however, as presenters introduced new data that showed that many of those dying in 1985 had been infected before 1981, and that within especially vulnerable populations, the epidemic was becoming entrenched. At a side meeting before the day the conference opened, gay activists protested Reagan administration proposals to implement mandatory HIV testing policies, arguing that this would do little to halt the spread of the disease and would only intensify discrimination against vulnerable groups.

At a two-day convening in Geneva, Switzerland of representatives from WHO's global centers on AIDS, health officials reviewed the epidemiologic status of AIDS world wide: more than 15,000 cases were reported in 40 countries, with 13,000 of the cases coming from the U.S. WHO officials estimated that the number of cases in the U.S. would double to 26,000 in 1986, according to the Morbidity & Mortality Weekly Report issued by the U.S. Centers for Disease Control and Prevention on November 8, 1985. WHO organized the meeting to review information presented at the International Conference on AIDS, held in Atlanta in April 1985, and assess the global implications. According to The Fourth Ten Years of the World Health Organization, a key outcome of the WHO meeting was the decision to develop a comprehensive AIDS program in which WHO's AIDS-focused collaboration centers would take an active part.  WHO officials attending the meeting also decided to set up additional collaborating centers that focused on AIDS, in an effort to lay the surveillance groundwork needed for the proposed program. WHO Director-General Halfdan Mahler expressed concern regarding AIDS, but in separate comments to the media, he said he considered other diseases to be top priority outside the U.S. “AIDS is not spreading like a bush fire in Africa,” Mahler said in widely reported accounts. “It is malaria and other tropical diseases that are killing millions of children every day.”