After the growth of the gay rights movement in the 1960s, the LGBTQ+ community had been making slow progress toward civil rights. However, that progress would come to a halt with the election of Republican presidential candidate Ronald Reagan in 1980. Segments of his party held very conservative social views, including intolerance toward sexual minorities. Gay rights activists knew their communities would have a hard time after Reagan’s victory. No one could have predicted the AIDS epidemic, though. The intolerance and indifference that came from the government in the wake of this outbreak needlessly allowed things to become much worse than they needed to.
THE HEROIN EPIDEMIC
A decade before the AIDS crisis plagued the United States, the nation was dealing with an epidemic of a different kind. Between 1969 and 1974, the National Institute on Drug Abuse estimated a rise in the number of heroin addicts from 242,000 to 558,000. In 1986, the New York Times estimated that there were 500,000 heroin addicts in the United States, with two hundred thousand of them in New York City.
One common way HIV is transmitted is by sharing a needle with an infected person. Today, programs that exchange intravenous drug users’ used needles for clean ones help prevent the spread of HIV and other diseases.
Many states attempted to discourage heroin use by passing laws making it illegal to own drug paraphernalia. These are objects used primarily for drug use. This law made it more difficult to acquire needles to inject heroin, causing drug users to often share the few needles they had. Sharing unsterilized needles was a perfect way to spread all kinds of infections. Doctors had already seen an epidemic of hepatitis B in injection drug users (IDUs).
As researchers from the CDC began to investigate what was killing gay men in the 1980s, they found that IDUs were also suffering similar ailments. Even though most heroin addicts told researchers they were not gay, the researchers initially assumed the men simply did not want to admit to taking part in a stigmatized lifestyle. As a consequence, medical institutions failed to see the link between the common ailments disproportionately affecting heterosexual IDUs and gay men.
Ronald Reagan formally accepts the nomination to become the Republican candidate in the 1984 presidential election in Dallas, Texas.
The life expectancy of heroin addicts with pneumocystis pneumonia (PCP) or Kaposi’s sarcoma (KS) was significantly shorter than that of gay men. Thus, even if doctors wanted to study addicts with this illness, they probably wouldn’t survive long enough for the doctors to make any meaningful discoveries.
IN REAGAN'S AMERICA
To many, the election of former actor and California governor Ronald Reagan signified a return to more traditional American values. The religious right, a political movement that consisted of Christians who did not believe in the separation of church and state, helped propel Reagan to power. They wanted the morals of their religion to dictate government policy. These values tended to favor the lives and wants of straight, white, male Christians over any other group. Reagan’s victory meant strong opposition to any measure that sought to protect or give sexual minorities civil rights.
Many Americans believed people could simply decide not to be gay. Those on the religious right saw same-sex attraction and acting on those feelings as an abomination. Considered a sin, same-sex attraction went against the religious beliefs of many. Some even considered homosexuality to be a contagious disease, fearing that it could spread to children. These beliefs led to discrimination in areas like employment and housing and even pushed people to commit violence. Many non-heteronormative people often didn’t feel it was safe to tell others in their community about their sexuality, so they remained in the closet.
But social conservatism wasn’t all Reagan offered to voters. He also campaigned on a platform of lowering taxes and cutting government spending to stimulate the economy. These money-saving tactics are called austerity measures. The Americans who saw tax cuts were generally wealthy and could afford to pay more taxes. Similarly, cutting government spending meant cutting back on services that were aimed at helping the most vulnerable Americans. One of the many government agencies that faced the harsh realities of spending cuts in 1981 was the CDC.
Although Reagan, the face of America at the time, disapproved of those who challenged heterosexual norms, the people of America—in some places more than others—were slowly learning more about their LGBTQ+ neighbors and, in turn, beginning to respect them. Certain cities, like San Francisco and New York, offered the LGBTQ+ community a safe haven, where they could live somewhat openly without fear of discrimination. Outside of these more tolerant areas, the rest of the country did not offer such acceptance. LGBTQ+ people often had to navigate one of two worlds, depending on where they were: one that was relatively accepting or one that was clearly intolerant.
Activists knew the fight for civil rights would be long, but many were basking in the tolerance they received in cities like New York and San Francisco, where they could openly find romantic partners and date in ways that were completely unavailable to people like them in the rest of the country.
AN OUTBREAK
The heterosexual community experienced a sexual revolution spurred by the birth control pill. Although the LGBTQ+ community has little fear of unwanted pregnancy, they experienced their own sexual revolution. Since they could not legally marry, ideas about abstaining from sex until marriage were irrelevant. Many LGBTQ+ people engaged in unprotected sex and had active sex lives with multiple partners.
Suddenly, in 1980, gay men started to become sick. Doctors in New York and San Francisco noticed a handful of patients, all young men who were otherwise healthy, coming down with Kaposi’s sarcoma (KS). This purple lesion-causing cancer had previously been seen in elderly men only. It was particularly notable how sick it seemed to make the young men. Usually, KS was not fatal and was easily treated.
Along with skin cancer, some young men also came down with pneumocystis carinii pneumonia (PCP), a severe lung infection caused by a small parasite. While it is likely that most people have been infected by this parasite, the majority don’t get sick. These young men, however, were dying-— and dying fast.
Doctors had never seen so many patients fighting multiple diagnoses. Diseases that their immune systems normally would have suppressed were overcoming their bodies’ efforts to suppress them. Doctors refer to the array of illnesses these patients came down with as opportunistic infections, or illnesses that could only take advantage of an immune system that had been weakened.
THEY CALLED IT GAY PNEUMONIA
Although most doctors have encountered illnesses they can’t diagnose, it took just five patients with similar health issues for immunologist Michael Gottlieb and general practitioner Joel Weisman to notice that they were dealing with an outbreak. The CDC published a report Gottlieb wrote on the initial findings on those five patients. Soon, Gottlieb noticed that each patient lacked T cells, a part of the immune system that had recently been discovered.
BABIES IN THE BRONX
In the early 1980s, Dr. Arye Rubinstein, an immunologist who specialized in pediatrics, noticed more and more infants coming in with mysterious immune system issues. His office was located in the Bronx, a borough of New York City with a lot of poverty. The parents of many of Rubinstein’s patients were either injection drug users or had partners who were. He noticed that some of the mothers were also showing signs of immunodeficiency that matched those of the gay men he had heard of who were getting sick, but other doctors ignored this trend. Rubinstein diagnosed his patients with the same disease that gay men were getting, but other doctors would remove the diagnosis from the children’s charts. Clearly, they thought, babies couldn’t get a gay disease. The articles Rubinstein submitted to medical journals about his patients would be rejected on similar grounds.
Dr. Michael Gottlieb was a prominent early AIDS researcher. In late 1980, he began to work with patients exhibiting symptoms of the disease that came to be known as AIDS.
When doctors research a new disease, they must uncover the similarities between infected people. Finding these similarities is important when it comes to determining if people are being made sick by something in their environment or from something like a virus. One of the few circumstances each patient shared was sexuality. All the men Gottlieb and Weisman treated were homosexual, a term often used pejoratively at this time by people who were hostile to gay people. Initially, the doctors thought that a bad batch of an illegal drug popular in some segments of the gay community called poppers could be the cause. If the cause was an infectious disease, the doctors knew it could signal the start of a public health crisis. The rate at which people were being diagnosed and dying from this mysterious illness revealed that this wasn’t a contained crisis. Doctors soon realized that time was not on their side.
As a select few in the medical community began trying to spread the word about a new disease initially referred to as gay pneumonia or gay cancer, they ran into problems at every turn. The first problem was the lack of answers and explanations doctors had about the condition. No one knew how to alert the public about the disease without causing panic or more discrimination. How could they warn people about a possible infection if they didn’t know how it spread?
As the CDC began to look into the disease, researchers learned that the Reagan administration budget cuts meant there was almost no money with which to do the research. The health of the LGBTQ+ community was not a major priority for medical professionals or politicians at the time, so gaining financial support would happen at an infuriatingly slow pace.