Miami Herald - June 11, 2006
Jacob Goldstein, jgoldstein@MiamiHerald.com

For more than a year before the world's first AIDS cases were reported, doctors at Jackson Memorial Hospital in Miami treated patients who had failing immune systems and strange infections.

The initial report, published 25 years ago this month in the weekly bulletin of the Centers for Disease Control and Prevention, described cases in five gay men in Los Angeles. The authors postulated an association between the disease and "some aspect of a homosexual lifestyle."

In the months that followed, more reports of cases among gay men emerged, mostly in New York, San Francisco and Los Angeles. Some doctors referred to the unnamed disease as gay-related immune disorder. Headline writers called it the gay plague.

But the disease looked different in South Florida.

The first cases at Jackson appeared not only in gay men but also in straight men and women, many of whom were Haitian. In 1983, the CDC, a U.S. government agency, listed Haitians as a separate high-risk group for AIDS -- along with hemophiliacs, users of injected drugs and gay men.

LASTING DAMAGE

Haitians were removed from the high-risk list two years later, when officials recognized that people from Haiti acquired the disease the same way everyone else did -- through unprotected sex, intravenous drug use and infusions of tainted blood. But lasting damage had been done, and the alienation and stigmatization of Haitian Americans persisted.

By the mid-1980s, South Florida also began to show signs of the AIDS hysteria that moved across the country.

Broward County fired two county employees because they had AIDS. In Miami-Dade County, a set of triplets with AIDS was prohibited from attending kindergarten with other children. A Florida dentist believed to have transmitted the disease to several patients sparked a national panic, although no subsequent cases of provider-to-patient transmission were documented.

DURABLE DRUG

In the late 1980s, a University of Miami doctor, Margaret Fischl, was among the leaders in developing AZT, an early AIDS drug -- and she was vilified by some AIDS activists who believed that the side effects outweighed the benefits. But the drug outlasted the critics, and it continues to be widely prescribed to treat the disease.

With the development in the mid-1990s of multi-drug cocktails, AIDS became a manageable disease. The moment marked a dramatic split between the developed world, where patients could afford the drugs, and the developing world, where they could not.

The arrival of the drugs also led to less fear of the disease, and risky behavior began to increase. HIV, the virus that causes AIDS, continued to spread, especially among gay men and in the black community. In the United States, the rate of new HIV infections has remained constant since the 1990s, at 40,000 a year.

VACCINE IS ELUSIVE

The last few years have seen a massive influx of funds to counter the global pandemic. But the number of people with HIV has continued to rise and is now approaching 40 million. The promise of an effective vaccine -- the grail of the research world -- remains distant. New drugs continue to emerge, but they are able only to control the virus, not eliminate it.

The epidemic's early profile in South Florida foreshadowed what AIDS has become, nationally and globally: a disease of gay men, but also of heterosexual men and women, a pandemic that disproportionately affects the poor and people of color.

These vignettes are not intended to present a comprehensive portrait of the disease. They are, rather, an attempt to illuminate, with a few human stories, how the early days of the epidemic have resonated across a generation.

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