Dne of the most controversial ways the surgeon general and AIDS activists went about fighting the epidemic in the last half of the eighties was to advocate for harm reduction. Conservatives tried to teach people that they had two options: abstinence from sex and abstinence from drugs. By contrast, other people realized that these were not realistic goals and used harm-reduction methods to educate the public. Harm-reduction practices are based on the idea that if you can’t stop people from engaging in risky behavior, you can at least give them tools to make that behavior slightly safer.
NEEDLE EXCHANGE IN NEW YORK CITY
In 1987, Mayor Edward Koch of New York City started the first needle-exchange program. Even though New York had the most AIDS cases of any city in the United States, the mayor had largely ignored the epidemic. Many speculated that his inaction was because he did not want to be associated with the LGBTQ+ community. But with the Reagan administration finally acting, others had to as well.
Needle-exchange programs create places where injection drug users can turn in their used needles for clean ones and sometimes be given a safe place to inject. Advocates knew addicts would continue to share needles if they didn’t have ready access to clean ones, so they thought programs like these would curb the rates of new infections in injection drug users. Critics of the program thought that giving people access to clean needles would encourage drug use among children.
Even though the needle-exchange program was successful in lowering the rate of new infections, the program was made illegal shortly after Koch left office.
Needle-exchange programs often grappled with hostile laws that encouraged an all-or-nothing system. Under such laws, complete abstinence from drugs was the only acceptable way to avoid infection.
In 1990, members of ACT UP started an underground needle-exchange program of their own. It was located on the Lower East Side of Manhattan. Their plan was to challenge the law by breaking it, thus forcing a court case. Intentionally breaking the law is part of a tactic activists use called direct action. Eventually, after studies showed that needle-exchange programs didn’t cause drug use to rise, the laws were changed in 1992, and the exchange programs were brought back.
HARM REDUCTION IN SEXUAL EDUCATION
In an announcement that the New York Times called “unusually explicit,” the surgeon general made an impassioned plea for early comprehensive sex education in schools. In 1986, Koop wrote a report that outlined the type of education needed to help prevent the spread of HIV/AIDS. In the report, the surgeon general wrote,
Many people, especially our youth, are not receiving information that is vital to their future health and well-being because of our reticence in dealing with the subjects of sex, sexual practices and homosexuality. This silence must end. We can no longer afford to sidestep frank, open discussions about sexual practices—homosexual and heterosexual. Education about AIDS should start at an early age so that children can grow up knowing the behaviors to avoid to protect themselves from exposure to the AIDS virus.
Koop did state repeatedly that abstinence and monogamy were the best ways to protect oneself from infection. He also understood that these goals were not realistic for many. Members of the religious right, however, strongly believed that children should be taught only according to Christian morals when it came to sex education. They believed that even the discussion of sex would cause a rise in teen sexual activity. Beginning in the Reagan administration, the government began funding sex education that advocated only for abstinence, even though this went directly against the surgeon general’s recommendations. Later, in the 2000s, President George W. Bush significantly increased spending on these programs.
Abstinence-only sex education often received the criticism that it promoted the spread of misinformation to students. A 2011 study found these programs to be misleading students about the effectiveness of condoms and birth control. They also left out potentially lifesaving medical information.
A NEW DRUG
As researchers began to receive more funding, they started testing medications that already existed to see if anything would have an effect on the virus. In March 1987, the FDA announced the approval of an antiretroviral drug called Zidovudine (AZT) as a treatment for HIV/AIDS. The drug was originally intended to fight cancer, but it had failed at that purpose. It did, however, prevent HIV cells from spreading. Unfortunately, doctors at the time didn’t know that long-term AZT use is toxic because it also causes healthy cells to stop replicating. Many patients felt worse from the side effects of AZT than before they were treated.
AIDS IN POP CULTURE
As AIDS reached pandemic levels around the world, artists began to react in the way they knew best—through their art. During the late 1980s and early 1990s, many artists used their crafts to tackle the epidemic. Larry Kramer, who was a novelist and playwright before becoming an AIDS activist, wrote the play The Normal Heart in 1985. The play is a mostly autobiographical account of Kramer’s experiences becoming an AIDS activist.
Keith Haring was a popular painter and sculptor in the 1980s. Many of his paintings touched upon themes of frustration, fear, and isolation that were common in artistic portrayals of the epidemic. Haring lost his life to AIDS-related complications on February 16, 1990.
Perhaps one of the most famous pieces of art to come from the AIDS epidemic is the musical Rent by Jonathan Larson. The musical is a somewhat glamorized portrayal of life in New York’s economically distressed Lower East Side. The majority of characters in the musical are HIV positive or have AIDS. The play was praised for its uplifting and positive portrayals of queer characters and people with AIDS. Larson died of an aortic dissection on the morning before Rent’s first Broadway preview performance. The show went on to win the Pulitzer Prize for Drama and three Tony Awards, while the song “Season of Love” became a pop hit that is often played at graduation ceremonies. Rent gained a cult following and became one of the longest-running shows on Broadway.
Rent is not the only well-known theatrical work to address HIV/AIDS. Tony Kushner (left) wrote Angels in America, a play about people from all walks of life coping with the AIDS crisis. A huge success, it won two Tony Awards and a Pulitzer Prize for Drama.
It turned out that the initial dosages of AZT that were prescribed to patients were much too high. The severity of the side effects was partially caused by the high doses. The dosages also caused patients to develop drug resistance sooner. When doctors realized their mistake, they lowered the doses and patients responded better. AZT was by no means a perfect drug, but it was the only drug available then. In 1987, AZT treatment usually added about a year to the life of a person with AIDS, but patients would take as much time as they could get.
LAZARUS EFFECT
As scientists continued searching for a cure, they finally reached a major medical breakthrough in 1996. Doctors combined several types of antiretroviral drugs into what would colloquially become known as the AIDS cocktail. The medical names for the treatments were highly active antiretroviral therapy (HAART), combination antiretroviral therapy (cART), or antiretroviral therapy (ART). Each of these names stand for the same thing, prescribing a patient a combination of drugs based on where the patient is in the virus’s progression. The main goal of this treatment is to prevent the virus from becoming drug resistant while also lowering the patient’s viral load, or the amount of the virus detectable in a patient’s blood.
MAGIC JOHNSON
Earvin Magic Johnson Jr. is awarded a gold medal as a member of the US men’s basketball team at the 1992 Olympics. His announcement that he was HIV positive helped fight the stigma against HIV.
Earvin “Magic” Johnson Jr. was an incredibly popular basketball player for the Los Angeles Lakers. He had a promising career ahead of him when he stunned the nation by announcing that he was HIV positive and would be retiring from basketball. He contracted the disease by having unprotected heterosexual sex.
Even though he had retired, he was still chosen to play for the United States in the 1992 Olympics. He did play, and he led his team to winning the gold medal.
Johnson became an AIDS activist after his retirement. He hoped to help educate others about the disease. His openness about his illness helped to dispel some of the stigma surrounding the disease. The straight ballplayer used his influence to show that AIDS could affect anyone, no matter their sexuality.
The AIDS cocktail consists of nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs). These all prevent HIV from replicating. There are two other drugs in the cocktail, and these prevent the virus from entering cells. They are known as entry/fusion inhibitors and integrase inhibitors.
This 1985 photo shows AZT in capsule form. It was also made available in syrup form. Like many pharmaceutical drugs, AZT came with a plethora of side effects.
Although the side effects of these drugs can be hard for patients to handle, 1996 was the year that AIDS went from being a fatal disease to a manageable chronic disease. The treatment worked so well that it was referred to as the Lazarus effect because patients who had previously been wasting away were now much healthier. AIDS was no longer a death sentence for many. In fact, for the first time, people could say they were “living with AIDS.” But this wasn’t true for everyone, AIDS medications were, and in some cases still are, prohibitively expensive. AIDS became a “disease of poverty” because only those who could afford treatment would survive.