The spot, continues Dr. Marcus Conant, 46, a dermatologist with the University of California Medical Center, may be a sign of Kaposi's sarcoma. A once obscure cancer (now 21 percent fatal) found usually in Italian and Jewish men in their mid-60s, it is a "marker" illness for a mysterious new malady that has become a killer, preying especially on the young male homosexual populations of New York and California. That killer is called acquired immune deficiency syndrome—better known by its cruel acronym, AIDS—and it has caused an alarming 381 deaths in 980 diagnosed cases. The disease breaks down its victims' immune systems, making them easy prey for Kaposi's sarcoma and a variety of life-threatening infections, particularly Pneumocystis carinii pneumonia.
Believed to be sexually transmitted, AIDS has thrown homosexual communities into near panic. It has also provoked their leaders' criticism of what they consider a sluggish response by the medical establishment to an epidemic that ranks with Legionnaires' disease and toxic shock syndrome. "There is a lot of concern," says Dr. Robert Bolan, a prominent member of the San Francisco homosexual organization Bay Area Physicians for Human Rights, "that if this kind of medical disaster were occurring in the straight community, the money for research would have been here yesterday."
In fact, AIDS has made its incursion into the non-homosexual community. It had been known since 1981 that intravenous drug users and Haitians were susceptible to the disease, but last year hemophiliacs were added to the list. And recently a 14-month-old baby in California was found to have a rare bacterium associated with AIDS. "The baby had been premature and had an Rh problem for which he received transfusions," says Dr. Arthur Ammann, director of pediatric immunology at Moffitt Hospital in San Francisco. "It turned out that one donor later died from a series of AIDS-related infections."
One result has been that the New York-based National Hemophilia Foundation has just called for a ban on homosexual and other high-risk blood donors, prompting the Coalition for Human Rights in San Francisco to condemn the move, comparing it to "miscegenation blood laws dividing black blood from white." Blood banks are divided on the matter. Says Dr. Herbert Perkins of the Irwin Memorial Blood Bank in San Francisco, "We are not going to be asking donors if they are gay." In Los Angeles, meanwhile, Alpha Therapeutic Corp., which manufactures plasma products, says it will buy no more plasma from blood banks unless the donors declare in writing that they are not male homosexuals, Haitians or needle-using drug addicts.
Easily the most temperate party to the controversy is James W. Curran of the Centers for Disease Control in Atlanta. "Think of yourself as a gay man in New York," he says. "You've been dealing with the problem for two years, worrying, seeing your friends die. All of a sudden there's one transfusion case and everybody's writing about it. You think, 'My God, there's one of them and 700 of us and nobody wrote about it then.' " Curran believes that AIDS is not going to be solved overnight and advises homosexuals to be patient. "We have to remember that this is a brand-new illness, first reported to the CDC in 1981," he says. "It is likely to become more common." He notes that a variety of theories try to account for AIDS. One school suggests that the villain is nitrite "poppers," used to enhance sex, and another theory says the immune system is simply worn down by homosexual promiscuity.
Whatever the cause, the fact is that no treatment tried so far will return the immune system to normal. Although a patient may recover from one AIDS-related disease through use of chemotherapy or other drugs, the immune system remains so weakened that the patient often succumbs to another ailment. Despite that, Curran adds, "It's a little early to be without hope."
Most experts believe that AIDS is caused by a "transmissible" agent, such as a virus. "We think of viruses," says Curran, "because they are known sometimes to affect the immune system and are associated with this kind of persistence and latency. Viruses that circulate in the blood can be transmitted sexually. For example, hepatitis B virus is present in blood, in semen and saliva. During sexual activity, there can be small abrasions that may result in the entry to the body of minute amounts of contaminated blood and semen." Curran theorizes that AIDS may be similarly transmitted.
Under Curran's lead, the CDC has established a task force of 20 full-time members, with 80 associates, and the National Institutes of Health has budgeted nearly $8 million to study AIDS in 1983. Physicians will welcome all the research they can get. Right now, says San Francisco's Bolan, "We're trying to educate ourselves with incomplete data." Meanwhile, he says, "I tell my patients that a large number of anonymous partners is unwise at this point. Even a single partner may transmit a potential agent, but the greater the number of different partners, the greater the risk."
Robert McQueen, editor of the Advocate, a California-based newspaper for homosexuals, reports 15 friends who either have AIDS or have died from it. "I see two major reactions," he says. "Some gays are terrified and are drastically altering their life-styles. But others don't want to hear of it. They are paying no attention." Indeed, when they learn they have Kaposi's sarcoma, some homosexual men in New York have even made provisions in their wills for disco funerals.
In San Francisco some patients participate in groups like the Shanti Project, which emphasizes counseling and mutual support. Says a Shanti member: "One technique is to hold hands and imagine a white light entering your body and healing it. But I visualize Pac-Man eating all those bad cells."
Most AIDS victims, however, rely more on doctors than Pac-Man. They are like San Francisco legal secretary Andrew Small, 30, who discovered last June that he had Kaposi's sarcoma. He had ignored a wart on his leg until it got "big and ugly." He recalls, "I was scared to death. I didn't come out of my fog until chemotherapy treatment started in August. Now I meet with a Shanti support group once a week here. I still think in terms of my mortality, but it's been an interesting process of reevaluating my priorities. My family's been very supportive, and so has my roommate. He's scared to death I'll die. Some friends have dropped me, and that sort of hurts. But there's nothing I can do about it." Tragically, there's little that medical science, to date, can do about AIDS either.
"You're 28 and gay and fairly bright. You've moved to San Francisco, and suddenly you find you have a disease with a high mortality rate. First you must tell your family—and perhaps confess you're a homosexual for the first time. Then you have to tell your employer you need four mornings each week for treatment of a cancer identified with homosexuals, and you must tell your lover you have a disease that may be transmissible. This can happen to a young man in one week after he sees a doctor about a red spot."