In the decade since AIDS was first described and named, medical science has made great progress against it. Doctors have identified its cause, the human immunodeficiency virus (HIV) that infects and destroys the T cells that are a key component of the immune system. They have devised reliable tests for the presence of HIV, thereby minimizing the risk of contracting it through contaminated blood transfusions. They have come up with drugs to slow the growth of the virus in the body and delay the onset of symptoms, and drugs to treat the complications of AIDS that actually kill (box). They have devised rules which, if everyone followed them, would virtually halt the spread of the virus among people who are not yet infected. But there is one thing they have not been able to do, even once: they have never cured it. Although there are reports of a few cases of spontaneous recovery (a highly controversial assertion, to be sure), for all practical purposes a person who has been infected with HIV is infected for life.
Accordingly, people in Johnson’s situation inhabit a kind of medical limbo, made possible by HIV’s remarkably long period of latency. Except for a brief flulike illness shortly after contracting the infection, people with the AIDS virus may feel completely healthy, as Johnson does, and exhibit no medical symptoms at all. They can continue like that indefinitely, while the virus erodes the immune system “the way the surf works on a beach,” according to Dr. Michael Gottleib, the Los Angeles immunologist who published the first clinical description of AIDS patients. Over time, symptoms may appear, such as weight loss or the night sweats that have been likened to a dousing with a bucket of cold water. Eventually a threshold is crossed. The immune system breaks down, the person gets sick with one of the distinctive infections that are markers for AIDS and his case is added to the 195,718 Americans who have been diagnosed with AIDS. Although some people get sick soon after infection, the median interval is between 10 and 11 years, and that includes statistics from the years before drugs such as AZT were available. The upper limit, if there is any, is unknown. That is the good news. The bad news is that once AIDS itself is diagnosed-the full-blown disease, not just the infection–the chance of surviving more than three years is around one in 10.
And, of course, from shortly after someone is infected until the day he dies, he can pass the virus on to someone else. It is precisely the long latency of the AIDS virus that has enabled it to spread so widely. Despite its lethality, AIDS is actually a very difficult disease to catch. The virus cannot survive for more than a few minutes outside the human body, and has been transmitted, as far as is known, only by infected blood, semen or vaginal secretions.
Hemophiliacs and surgery patients can get HIV via a contaminated transfusion of whole blood or blood products, although that is rare now that blood is routinely tested. Infants can get it from infected mothers, either in utero across the placenta or by contact in passing through the birth canal; the virus has also been found in breast milk and studies have shown that it can be transmitted that way. At least 40–and perhaps as many as several hundred– health workers have acquired the virus from the blood of patients, but transmission in the other direction almost never occurs. (The case of the Florida dentist who infected Kimberly Bergalis and four others of his patients was the only reported instance of its kind.) And the virus can spread among drug users who share needles, accounting for the second largest number of total AIDS cases in America.
And, of course, it can spread via unprotected sexual contact-usually, but not always, when the infected partner is a male. This is partly because more men than women have the virus in the first place. The early victims of the AIDS infection in America were mostly homosexual men, and although women are catching up, the rate of infection among men is still six times as great. But it also seems to reflect the medical phenomenon that men are more efficient at infecting their partners. Nancy Padian of the University of California, San Francisco, studied nearly 400 heterosexual couples in which one partner was originally infected with HIV. Of the 72 women who started out with the virus, only one appeared to have subsequently infected her lover. Of 307 HIV-positive men, roughly 20 percent passed the virus on to their partners. If Johnson indeed contracted the virus from a woman, he was very unlucky: only 2.2 percent of all AIDS cases in America were contracted in that way.
So it is not just a medical limbo that people with HIV find themselves in; it is an emotional and sexual one as well. The only sure way to avoid transmitting AIDS is to abstain from sexual intercourse entirely. A measure of safety is provided by condoms. Sometimes, though, the uninfected partners don’t consider a measure of safety safe enough. And certainly no HIV-infected man is advised to try to father a child, as Johnson unknowingly did. Although initial tests on his wife were negative, it can take months for an infection to show up, so she will need to be tested again.
In general, people who test positive for the AIDS virus are advised to get on with their lives, and most of them, after the initial shock, do just that. As a professional athlete, Johnson was unusual in having to give up his career. But many choose to change their jobs anyway, realizing, as John Lesnick did, that “the clock might not be ticking as long as I expected.” Lesnick, who was 31, quit his job as a graphics artist and went off to study printmaking, something he’d always wanted to do. Now, more than six years later, he’s back in New York, looking for work, a victim of the recession rather than illness. His regimen includes plenty of rest, good nutrition, AZT and three or four other medications, plus regular meetings of his HIV support group. “I wake up and say, ‘I’m alive one more day’,” Lesnick says. Then he takes his pills.
Many others end up building their lives around AIDS. Ii is a disease that lends itself to proselytizing, both because it is so easily prevented and the needs of its sufferers are so great. This year, for what is believed to be the first time, two openly gay and HIV-positive candidates ran for council seats in major cities. For a candidate to admit he has HIV takes courage; some voters won’t shake his hand much less let him kiss their babies. In Boston, Michael Cronin lost decisively, but in New York Tom Duane (running against a lesbian candidate in a district that includes Greenwich Village) won. The rigors of campaigning seem not to have complicated his health.
Bobby Smith, a research assistant at UCLA, discovered he was infected in 1986. Today, at 46, he is office manager at the AIDS Healthcare Foundation in Los Angeles, a living advertisement for life with HIV: “I have been infected over six years and my life has not changed. I exercise, I socialize, I work, I go on vacation. People can look at me and see I’m healthy.”
Yes, and Smith has a positive attitude, which helps him get through the bad times and may even contribute to his survival. “I can’t prove it,” says Gottlieb, “but my clinical experience suggests that a positive mental attitude can work to keep someone with this virus healthier.” Magic Johnson is not alone; there are many thousands of people with HIV who go to work each day, who greet each morning with gratitude and each evening with a warm glass of milk and have friends and lovers around them to keep their spirits up. Only one day, they know, they are liable to wake up with a cold, and it won’t go away. When all the press conferences and talk-show appearances are over, San Francisco journalist and AIDS chronicler Randy Shilts says, “the question is whether Magic Johnson will get AIDS and die.” There’s nothing wrong with Johnson that a cure for AIDS won’t fix.
Listen sympathetically to their worries and tell them Magic may have years to live.
Be prepared to counter misinformation they may have heard about AIDS and how the virus is and is not transmitted.
Use the opportunity to explain the facts about AIDS in an unemotional way.
Reassure very young children that they face almost no personal risk of AIDS.
Inform older kids about how they can avoid the deadly risks of unprotected sex and intravenous drugs.
People who have unprotected sex outside a stable, monogamous relationship.
People who have multiple sex partners, or partners whose HIV status is unknown.
Men and women who have unprotected sex with homosexual or bisexual men.
Men and women who have unprotected sex with IV drug users, or with the partners of IV drug users.
Male and female IV drug users who share their needles with others. This is the second-largest risk group.
AN ARSENAL FOR AN EPIDEMIC There is no cure, but research has produced several drugs that can slow the replication of the AIDS-causing virus. Other drugs can be used to treat the infections that mark the onset of full-blown AIDS.
The CDC estimates that as many as 1. 5 million Americans are currently HIV-positive.
By slowing the reproduction of the virus, these drugs delay the onset of full-blown AIDS.
The first anti-AIDS drug to receive FDA approval in 1987, AZT is standard therapy for HIV infection and AIDS.
Approved last July for patients who cannot tolerate, or who develop resistance to, AZT.
Some of the most common:
Pneumocystis carinii pneumonia, the most common life-theatening opportunistic infection in people with AIDS.
Infects virtually all AIDS patients. Can cause blindness, brain and colon infections.
Caused by a fungus that infects the brain and lungs.
The most common cancer in the HIV-positive, it results in blotchy skin lesions.
A newly emerging infection that most commonly affects the gastrointestinal tract.
Antimicrobials used to treat and prevent episodes of pneumonia.
Effective in treating infections of the retina.
Deters the yeastlike organism.
Approved only for AIDS patients with T-cell counts of fewer than 200.
Multidrug combination therapies that received FDA approval last month.
