Newsday - June 7, 1988
Laurie Garrett

Michael Gottlieb at UCLA heard the whisper, but what he heard was so obvious that at first it seemed meaningless: Homosexual men were suffering from a number of diseases rarely seen in the general heterosexual population. On June 5, 1981, the UCLA researcher published word of five young gay men who had contracted pneumocystis pneumonia, or PCP. The disease was so rare in America that most doctors had to turn to old texts to jog their memories of PCP's brief mention in their medical school infectious-diseases classes.

It's been seven tumultuous and often frightening years since Gottlieb's report was published by the U.S. Centers for Disease Control. And with three major reports on AIDS released last week - and the fourth International Conference on AIDS scheduled to begin Sunday in Stockholm - it seems an appropriate time to take stock of the AIDS pandemic.

According to all three reports, our nation has reached a critical juncture in the AIDS epidemic. All three reports say the U.S. must be prepared to spend massive sums of money, overhaul its health-care system, draft anti-discrimination legislation to protect people infected with the AIDS virus, develop a strong national leadership in the AIDS war and face up to the bitter fact that neither a cure nor a vaccine for AIDS will be found in the near future.

One report, released Wednesday by the National Academy of Sciences, called for more than a tripling of federal expenditures for AIDS research, treatment and public education. Theodore Cooper, who chaired the academy panel that wrote the report, leveled tough criticism at the federal government, saying, "We have not yet emerged with a coherent national strategy for AIDS."

On Thursday, Adm. James Watkins, chairman of the Presidential AIDS Commission, released his final report. Although the commission exists at the behest of the White House, Watkins, too, was critical of the federal response to the epidemic. But, said Watkins, the size of the epidemic (now topping 63,000 in the United States alone) is simply too great to allow Americans to look backwards. "I don't think we've got time to be finger-pointing," said Watkins. "We've got to get in there and fix things now."

Taking a global view of the epidemic, the Londonbased Panos Institute, a leading think tank, released its second major international report on AIDS, focusing on the dynamics of racial and sexual discrimination in the AIDS epidemic. The Panos report found a widespread and disturbing international pattern of racial assaults and stigmatization against members of social groups that have higher incidences of the disease.

Finally, the entire leadership of the U.S. Public Health Service retreated to Charlottesville, Va., on Thursday for three days of meetings on AIDS. The sessions were closed to the press, but they reportedly involved occasionally heated discussions of future U.S. strategy in the war on AIDS. Morale within the health service is said to be low, and it is generally felt that there is little, if any, good news on the AIDS research front.

All of this may come as something of a surprise to many. After all, this year the federal government will spend $951 million on AIDS research, treatment and education. Next year federal AIDS spending will top $1 billion.

In addition, several states, notably New York and California, are spending hundreds of millions of dollars a year to combat AIDS. The World Health Organization will spend more than $60 million on AIDS research and education this year and plans to double that figure in the coming year.

Nevertheless, the AIDS toll is mounting. In parts of Africa AIDS is the leading cause of premature death for adults and rivals malaria as a pediatric problem. In New York City, AIDS has been the leading cause of premature death for young men since 1984. Today it ranks as the leading cause of premature death for New York's black and Hispanic adults, both male and female. About two out of every 100,000 Americans has AIDS, so while the United States leads the world in the actual number of reported AIDS cases, it ranks fifth in AIDS incidence. Bermuda ranks first in incidence, with an AIDS rate of 13 out of every 100,000.

How can it be that so much money and the collective genius of so many of the world's great doctors and scientists leaves humanity this severely threatened by a mere virus?

Dr. Harold Jaffee, chief of AIDS epidemiology at the U.S. Centers for Disease Control in Atlanta puts it simply:

"The easy part is over. All the simple questions have been answered. Now we're stuck."

The First Whispers

The earliest known cases of AIDS appeared in 1959 in Britain and the United States. At the time these were mysterious ailments, unexplained by medical precedent. Retrospectively, scientists have unearthed later cases during the 1960s in Europe, the United States and Africa.

But the benchmark date often referred to as the beginning of the epidemic is June 5, 1981, when Michael Gottlieb's article on pneumocystis pneumonia was published.

Although from the beginning Gottlieb and his immediate colleagues suspected a new infectious agent was responsible for these bizarre cases of parasitic pneumonia, the U.S. CDC and researchers throughout the country first looked to other explanations. The strange new disease, which caused both pneumocystis pneumonia and a rare type of cancer known as Kaposi's sarcoma, seemed only to appear among young gay men. So most scientists initially asked what practices might be uniquely common to the homosexual community.

In retrospect, it's clear that nearly two years in the AIDS war were wasted arguing about the relative health risks of sexual stimulants such as amyl nitrite "poppers," such sexual acts as "fisting," and a number of diseases known to be endemic to the gay population, notably hepatitis B, cytomegalovirus and Epstein-Barr virus. Gottlieb claims his group was already considering the possibility in 1981 that a new sexually transmitted agent, probably a virus, was attacking gay men, but he couldn't convince other doctors to seriously consider the idea. "Initially," recalls Gottlieb, "all the idea got was ridicule."

In Atlanta, the members of the CDC's newly formed Task Force on Kaposi's Sarcoma and Opportunistic Infections - the syndrome was not yet known as AIDS - were busy attempting to sort out all the available information. Jaffee, one of the original members of the task force - led then, as it is now, by Dr. James Curran - remembers that there was a lot of denial going on, leading to pressure on the CDC "to constantly consider other causes. A lot of people in the gay community were having a hard time accepting the idea that there was a new sexual disease. And a lot of heterosexuals wanted to think it was some sort of gay plague."

In addition, a vital clue was overlooked. In late 1981, the CDC received a few reports of intravenous drug abusers in New York who were suffering from pneumocystis and severe immune deficiency. Jaffee says the patients were dead by the time the CDC was notified, "which made it impossible for us to rule out the possibility that these people had gotten the disease through sexual intercourse."

It wasn't until late 1982 that the CDC recognized that people were getting this strange new disease, finally dubbed AIDS (acquired immune deficiency syndrome), not only through homosexual intercourse, but from blood products and through the use of intravenous drugs. "Then we could be certain," says Jaffee, "that we were dealing with a transmissable agent of some kind, probably a virus."

The following year two key laboratories jumped into the AIDS game: the Pasteur Institute in Paris, and the U.S. National Cancer Institute. Both laboratories had been studying cancer-causing viruses and were intrigued by the ability of the mysterious AIDS agent to cause Kaposi's sarcoma. At the NCI, Dr. Robert Gallo headed a team determined to prove AIDS was caused by a virus, similar to two other viruses his laboratory had discovered in the previous decade. Luc Montagnier led the Pasteur group and was equally determined to find a new virus.

In early 1983, after more than 1,000 Americans had contracted AIDS, the National Institutes of Health awarded their first AIDS research grants, and Gallo was a key recipient.

The same year Drs. James Oleske in Newark and Ayre Rubenstein in New York City reported the first cases of what appeared to be mother-to-child transmission of the AIDS virus.

The CDC was increasingly alarmed about reports in 1983 of hemophiliacs' contracting the disease. It was obvious that whatever was responsible for AIDS had contaminated the nation's blood supply. Jim Curran spoke of a "nightmare time bomb ticking away in the blood supply," and privately the CDC began to put pressure on blood suppliers to consider ways to protect the public.

But there was little the blood banks could do until somebody discovered the cause of the disease.

The CDC's concern rose still higher when a San Jose, Calif., woman contracted AIDS as a result of sexual intercourse with her hemophiliac husband. The husband got the disease from contaminated blood. The wife clearly became ill as a result of vaginal intercourse.

Whatever fantasies the American people might have about seeing the disease "stay in the homosexual community" were clearly over.

The Virus Is Found

In late 1983 both the Montagnier team and Gallo's group published reports hinting they had found the virus responsible for AIDS. There was excitement in the air, because everybody, from the CDC to the Pasteur Institute, felt the mystery was about to be solved.

On April 23, 1984, former Secretary of Health and Human Services Margaret Heckler held a Washington press conference to announce "American scientists have discovered the cause of AIDS." At her side, beaming, was Robert Gallo. Heckler boldly predicted an AIDS blood test would be available in a matter of weeks, and "America will produce a vaccine against the disease within two years."

Days later Montagnier's group published word of another virus, also thought to cause AIDS. It was eventually determined that Montagnier and Gallo were looking at the same virus.

An intense nationalistic rivalry developed, with both the French and Americans claiming to have been first with the virus discovery. At issue were Nobel prizes, fame and millions - perhaps billions - of dollars in patent rights for products, such as blood tests, derived from the AIDS virus.

The Franco-American dispute was eventually sorted out through the diplomatic intervention of polio vaccine inventor Jonas Salk. But for two years the world's top AIDS research laboratories fought tooth and nail. The rest of the scientific community felt trapped, forced to take sides in order to obtain viral samples and other vital laboratory materials needed to do AIDS research.

Some critics charge that this rivalry slowed the battle against AIDS and still affects the research climate, but both Gallo and Montagnier deny there is any continuing animosity.

The Global Pandemic

In 1985 scanty reports leaked out of Africa alleging AIDS was overtaking parts of the continent. While most key African governments flatly denied these allegations, foreign reporters and international relief workers spread stories of the frightening African AIDS pandemic.

Rene Sabatier of the London-based Panos Institute says it is now obvious that African governments were initially reacting the same way gay men and American health officials had: with denial. Reaction to AIDS, says Sabatier, has been the same in every nation around the world. "It's always marked by what I call the Three D's: Denial, Denunciation and Distancing."

In Africa the denial led some governments to suppress information about the epidemic within their borders and even arrest or deport scientists and journalists. Scientists became very cautious, refused to speak to foreign reporters, and tried to cooperate closely with the African governments; in some cases they agreed to government censorship of research papers.

The Panos report released last week, entitled "Blaming Others," says that every society, once over its state of denial, begins to denounce others for creating the AIDS problem. Finger-pointing, says the Panos Institute, leads to racial and social stigmatization and nationalist outcries. "The explosions of accusation and blame which follow the advance of the AIDS virus across the globe," says the Panos report, "not only blur the vision of the blamer, but endanger those who are singled out for blame, all the while inhibiting AIDS prevention."

In the African context several things happened that, like the Franco-American rivalry, may have slowed the war on AIDS.

Perhaps most damaging was the very public argument, which persists today, over the origin of the AIDS virus. Harvard University's Max Essex developed a theory that the African green monkey was the original harbinger of the AIDS virus. The monkey virus, said Essex, mutated and moved into the African human population sometime in the 1950s. There it slowly spread until it reached explosive proportions sometime in the early 1980s.

To this day, Africans bitterly resent the concept that their continent is responsible for the epidemic, and although the Essex theory has now been thoroughly refuted by scientists around the world, tension remains. The tension has made many African governments suspicious of foreign scientists and relief organizations, and it has impeded the flow of information about the African epidemic.

But one fact from Africa is clear: AIDS can be a serious heterosexual, as well as homosexual, problem.

The Global Change of Heart

A turning point in the epidemic came in 1986, with the establishment of the World Health Organization's AIDS program. At first staffed by one scientist and a secretary, the program now commands a multi-million-dollar budget and offices around the globe. WHO AIDS director Jonathon Mann worked to overcome nationalist sensitivities, eventually gaining confidence of most world health leaders.

The health community officially acknowledged WHO's leadership in January at the London summit on AIDS. Health ministers from nations representing 95 percent of the world's population endorsed a strategy declaring it is highly unlikely a cure or vaccine for AIDS will be found before the year 2000, and, therefore, "the single most important component of national AIDS programmes is information and education."

The summit initiated new global cooperation, and recently innovative education programs from places like Rio de Janeiro, Copenhagen and Edinburgh have been tried in San Francisco, Los Angeles and New York.

WHO says there is real urgency in this global education effort. By 1991 at least a million new cases of AIDS will be reported. And WHO estimates 5 million people are now infected worldwide with the virus.

Most disturbing is the recent spread of AIDS outside the Americas, Europe and Africa. Thailand, which until recently claimed no cases of AIDS, just completed a blood survey of Bangkok heroin users: 16 percent are infected with HIV (human immunodeficiency virus). About 3 percent of the city's male prostitutes are infected. Similar numbers have been reported recently out of the Philippines and Hong Kong.

The Poverty Component

Though AIDS first seemed to be unique to the American homosexual community, today more than half the cases worldwide are impoverished heterosexual adults and their children.

In the United States, the complexion of the epidemic has changed dramatically in recent years, from an overwhelmingly white, middle-class, gay phenomenon to an inner-city black and Hispanic problem. For white American adults the incidence of AIDS is currently 1.9 out of every 100,000 people; for blacks it is 5.8 per 100,000 and climbing fast.

San Francisco epidemiologist Andrew Moss says the gay AIDS epidemic is leveling off: "I bet we'll actually see a decline in gay cases next year. We're at the [peak] right now." On the other hand, he says, AIDS among heterosexual poor people who are IV-drug users, their sex partners or their children is rising rapidly. "The South Bronx," says Moss. "One quarter of all American heterosexual cases are there."

THE PANOS INSTITUTE says that, worldwide, AIDS "gravitates towards the least advantaged, most vulnerable sectors of society."

Newark pediatrician Jim Oleske says, "AIDS is a poor people's disease, and what's needed is a general attack on institutionalized poverty in America." Conquering AIDS, he adds, means recreating the War on Poverty, getting the inner-city poor out of "the cycle of despair that leads to drug abuse and prostitution."

Moss agrees, but is not terribly optimistic. "Look at how Americans deal with health care for the poor," he says. "Where is the public-health apparatus of the South Bronx? It's not there! Do you think we're going to do something about the South Bronx? Forget it! We never will. That's the real U. S. crisis."

The CDC's Harold Jaffee is equally concerned about the changing direction of the AIDS epidemic. "I think this is going to be an extraordinary problem," says Jaffee. "One where people may stand back and pity those poor people who are getting the disease, but disconnect themselves from the problem."

Rene Sabatier of the Panos Institute says the real challenge of the coming years will be providing health care and AIDS education to the world's poor: "There is a very real danger that we're going to end up as a society divided between those who were able to inform themselves first and those who were informed late. Those who have access, and those who don't. Those who are able to change, those who don't. There is a very very real danger of half of us turning into AIDS voyeurs standing around watching the other half die."

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Parasites in Gays Sent Up the First 'Red Flag'

IN THE FALL of 1980 a frail young man, coughing in uncontrollable fits, came into Michael Gottlieb's office at the University of California Medical School in Los Angeles. Gottlieb studied the man, took samples from his lungs and discovered something very odd: parasites.

This young man was the first of five patients Gottlieb would see in the next six months, all gay, all young and all infected with pneumocystis parasites, which cause a deadly form of pneumonia.

"In those days pneumocystis was extremely unusual in a young patient, without prior history of illness." In fact, pneumocystis was considered primarily a disease of terminally ill elderly hospitalized patients whose bodies were so wracked by other illnesses that they were vulnerable to the parasites.

"So the red flag for me," says Gottlieb, "was pneumocystis."

Gottlieb sent out an alert on the five cases in the form of a report, which appeared in the CDC's "Morbidity and Mortality Weekly Report" on June 5, 1981, seven years ago this week. In the halls of UCLA Medical School, the paper was greeted with a great deal of interest. There was a sense of excitement that a new discovery had been made.

Six months later Gottlieb published more information about the strange new disease affecting gay American men and hypothesized that it might be caused by a sexually transmitted agent, perhaps a virus. It wasn't until 1984 that the viral link was proven and the HIV virus discovered.

In the meantime, says Gottlieb, "the early years were hard going. And in the academic community there was a lot of curiosity and interest in the syndrome [of AIDS], and that was good. The patients, however, were regarded as a burden, potentially disruptive of what was perceived to be the academic mission. Curiously," he adds with a note of irony, "as the funding situation improved, previous reservations appear to have been overcome."

Some of Gottlieb's academic colleagues told him AIDS work was not "serious research" and turned their backs. "There were even snickers at lectures I gave because of the homosexuality involved with the disease. And until the AIDS virus was discovered and the scientific base of information expanded, there was very little legitimacy to AIDS work in academia."

About 18 months ago Gottlieb gave up the academic life, resigned from his UCLA position and turned to the private sector. He now conducts AIDS drug trials for a California pharmaceutical firm, has a private medical practice and serves as co-chair of the American Foundation for AIDS Research.

Gottlieb applauds last week's reports from the Presidential AIDS Commission and the National Academy of Sciences. "They have communicated clearly the seriousness of the problem and what should be done," he says. "Now it is up to the politicians to implement their carefully considerd recommendations and stop playing politics based on antiquated perceptions of public attitudes."

Gottlieb predicts history will not take a kind view of most Washington politicians when the AIDS epidemic has run its course. Of President Reagan, predicts Gottlieb, history will say he was "unwilling or unable to aggressively respond to a major domestic crisis. Too little too late."

Overall, Gottlieb feels the war against AIDS reminds him of his old days as an anti-Vietnam War activist. "It seems like we're in the AIDS era now, and the response to AIDS is a movement that was slow in getting started. A movement with all the characteristics of the Sixties' antipoverty programs and antiwar movement. It raises all the same questions about how people mobilize in a crisis."

In a pluralistic society, says Gottlieb, government must respond to all voices in a crisis, both rational and irrational. His hope is that the recent Presidential Commission report signals a government willingness to pay more heed to the voices of sane, yet urgent, response to the AIDS pandemic.

*****

The Realization 'Something Terrible' Was Happening

HAROLD JAFFEE is an expert on sexually transmitted diseases, and since the AIDS epidemic was first officially noted he has been one of the leaders of the anti-AIDS effort at the federal Centers for Disease Control in Atlanta.

Today he is one of a growing number of AIDS experts who travel around the world providing advice and gaining new insight about the epidemic.

But in 1981, Harold Jaffee was more concerned with other sexually transmitted diseases, such as syphilis, candida albicans and gonorrhea. When Michael Gottlieb's now-historic study on pneumocystis pneumonia among gay men appeared on Jaffee's desk he found it interesting. But not much more.

In June, 1981, shortly after Gottlieb's report reached the CDC, Jaffee attended a meeting of state health officials in California. Doctors from San Fransisco, New York and Los Angeles all described similar pneumonia cases among their gay patients. A month later Jaffee attended another health meeting and learned that a rare form of cancer, Kaposi's sarcoma, was turning up in young gay men around the country.

That, says Jaffee, is when he began to realize something terrible was taking place. "It happened in phases for me. By the end of the summer of 1981 we saw that whatever this was, it wasn't going to go away by itself. And it wasn't an isolated event."

By the middle of 1982 Jaffee and his colleagues at the CDC were convinced the new disease was sexually transmitted. And rumors of an AIDS-like disease among intravenous drug abusers were confirmed. The same year, Jaffee's team reported AIDS cases among hemophiliacs, and blood recipients were added to the CDC list of possible risk groups.

Since then Jaffee has noted a series of waves of public hysteria, each wave cresting higher than the last. And each crest, says Jaffee, seems to be fol- lowed by an apathetic or nonchalant dip in public concern about AIDS. "This would be a great subject for a sociologist," says Jaffee. "I'm not sure I completely understand why it's been so hard to get the public to take a middle ground in this epidemic."

Each time a new risk group has been added to the CDC list there has been, first, denial, then panic. "There's always some kind of fringe group on the edge of every social upheaval," says Jaffee. "It's just that in the case of AIDS the fringe elements seem to get more attention. And sometimes their denial or hysteria messages are dangerous."

For example, some members of the gay community and a handful of scientists continue to insist that HIV (human immunodeficiency virus) is not the virus that causes AIDS. The more strenuously Jaffee insists HIV is the lethal virus, the more vociferously these individuals denounce him and the CDC as conspirators and liars. Jaffee sighs, "I don't know what you can do about that. I really don't."

On the the other extreme are individuals like William Masters and Virginia Johnson, whose recent book claims, among other things, that people can get AIDS from a contaminated toilet seat. Jaffee was pleased to see the public reject such scientifically inaccurate hysteria, and he says it proves progress has been made. "Two years ago most of the press and public probably would have lapped that stuff up."

Nevertheless, at times, says Jaffee, he envies his friends at the CDC who worked on Legionnaires disease and toxic shock syndrome. "They reached a point where they could look back, say there was a problem, and we solved it. And with AIDS you never feel that way." Jaffee's voice sounds thoroughly spent as he adds, "We may never be able to look back and pat ourselves on the back about AIDS. It's very disheartening."

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The Frustrating Struggle for Research Funds

IN LATE 1981 Andrew Moss had a conversation that changed his life. A friend at the U.S. Centers for Disease Control in Atlanta told Moss about some strange new diseases seen among homosexual men. "He convinced me I ought to get into this [AIDS] thing, and at first my involvement was really quite naive."

Moss is a British-born epidemiologist, an expert on how people pass disease to one another. Today Moss works at San Francisco General Hospital, on the AIDS ward.

Back in 1981 Moss' friend at the CDC argued it was logical for him to get into the AIDS problem; after all, an estimated 55,000 openly gay men lived in San Francisco at the time and the city was considered a social mecca for homosexuals throughout the world.

The CDC wanted to know how prevalent the newly identified disease was among homosexuals but didn't have the resources to study the problem. For Andrew Moss AIDS was a made-to-order problem that satisfied both his scientific curiosity and his longstanding commitment to politically renegade causes. In those days, says Moss, AIDS was definitely a politically renegade cause.

"So we did this study that was really quite simple," recalls Moss. "In 1982 we sat down and studied gay men in San Francisco to find out what the incidence [of the disease] was." Because there was no AIDS test in 1982 Moss had to use physical examination and interviews to determine which men might have the strange new disease. "And we came out with - I still remember the number because it startled me - 287 out of 100,000. It was a big number. That's about three out of every one thousand gay men who already had the disease in 1982. And I thought, Christ! This is big!"

Moss showed the data to colleagues all over the country, and the reaction from all quarters was the same: panic. "That's when I began to have fits, visceral fits, of paranoia, in the fall of '82. We plotted a curve, demonstrating where the epidemic was going, and showed it rocketing up. When we showed it to people in a room you could hear everybody go OOOOOOH!"

Despite the frightening curve of epidemic growth Moss and his epidemiology colleagues throughout the country had a hard time getting government funds for research on the epidemic. Moss describes the 1982-84 period as a nightmare: "I was saying 'Look, look, the sky is falling,' but nobody was listening."

Moss says it was particularly hard to get Washington's ear long-distance from San Fransisco. "I like to think of it as being like a trying to talk to a brontosaurus." The giant dinosaur had a pea-sized brain and a very slow nervous system. A good metaphor, says Moss, for the federal government's response to the early AIDS epidemic. "We were whacking away at the dinosaur's tail out here in San Francisco every day, and finally after two years the message gets through to the brontosaurus' brain."

Funding for AIDS research on homosexuals jumped in 1984, and Moss says today it's not terribly difficult to get grants to study gay men at risk for the disease. "But that brontosaurus thing is happening all over again now with intravenous drug abusers." Moss has shifted his research to what he considers the most crucial arena in the current American epidemic, and finds the government unable to come to terms with drug abusers. Once again Moss is locked into daily battles for funding.

"I'm pretty sick of it, to tell you the truth," says Moss. "Sometimes I wonder how much longer I can hang in there. I mean it's just not enough to be altruistic in this thing. You can't be. The disease is too horrible. And on top of it to have to fight for every research dollar you get is just too much."

Last month Moss learned his latest research grant application was turned down by the National Institute on Drug Abuse. He says NIDA is as confused about AIDS today as the CDC was seven years ago.

*******

At a Newark Hospital the Time Bomb Has Exploded

JIM OLESKE SEEMS the archetypical pediatrician: cheerful, always ready to babble infant vernacular, boyish-looking and energetic. When Oleske agreed to set up an allergy and immunology center at Children's Hospital in Newark he dreamed that one day he might have a chance to perform exotic procedures such as bonemarrow transplants.

But Newark's Children's Hospital isn't Massachusetts General, and Oleske's patient population, largely impoverished black and Hispanic children, suffered from far more immediate problems than those that could benefit from exotic surgery. Oleske had barely hired a staff nurse when, in 1978, he faced his first case of a mysterious immune deficiency.

The patient was a little girl, recalls Oleske, "that frustrated me because she died of an unusual type of pneumonia, had liver involvement and a number of other symptoms. In 1978, that was a total mystery to me. Nowadays a medical student could identify that as AIDS."

In 1982 Oleske saw another child whose entire disease-fighting, or immune, system seemed to have collapsed. The child's illness reminded him of the 1978 case and sent up alarms for Oleske. "And then six months later I tested the father of this child for the same thing. He was a drug user, and eventually both he and the child died of AIDS. That made me feel the frightening reality was children were getting AIDS from their parents."

In that case, he said, the child got the disease from his mother, during pregnancy. And the mother became infected through sexual intercourse with her heroin-using husband. "That's when we started asking all the right questions," says Oleske, "like who in the family is using drugs and so on. That's when we understood what we were dealing with."

In early 1983, Oleske published news of his cases in a pediatric journal, hypothesizing that whatever caused AIDS could be passed from mother to child during pregnancy. Three months later a similar report from researchers at Albert Einstein School of Medicine appeared in the Journal of the American Medical Association.

Although the public was clearly alarmed, says Oleske, members of the medical community were initially very skeptical. "And that made it difficult," he says, "because if people did not believe it could happen, then funding agencies wouldn't come through. So it was very hard to get credibility and funding for pediatric AIDS."

Children's Hospital received absolutely no AIDS-related funding until Christmas, 1984, when the Lifer's Association of New Jersey prisoners sent Oleske a check for $1,000. The following year AIDS threatened to bankrupt the hospital. It was saved at the eleventh hour by a special bail-out from the New Jersey govenor's office. "It wasn't until 1987 that our program got a dime of federal money, and even that isn't supposed to be used for treating these kids."

Meanwhile Oleske's patient population has exploded in size, from two pediatric AIDS cases in 1982 to 250 cases between January and June of this year. Nearly all the cases involve black and Hispanic babies born with the disease. In most cases one or both of the parents are impoverished inner-city intravenous drug abusers.

"AIDS is a maternal-child health problem," says Oleske, "and its main promoter is poverty. All us doctors can splash around in the water all we want trying to save drowning people, but until we stop the guy that is throwing them off the bridge we're not going to get anywhere. And the guy throwing them off is poverty." Poverty, says Oleske, that drives Newark's most desperate citizens to lives of prostitution, teen pregnancy and drug abuse.

Oleske says there are days when the enormity of Newark's AIDS problem, the lack of funding and the desperate poverty of his patients overwhelms him. "I just want to walk away. But I can't, because there is nobody to fill the void. That's the tragedy of it, there isn't anybody else."

To console himself Oleske watches old reruns of the "Star Trek" TV show, reads science fiction, and gives AIDS lectures to PTA groups. "I used to appeal to their compassion for these people, but that doesn't work. Forget compassion. Now I appeal to their self-interest. I tell them the time bomb is ticking. It already went off in Newark, and we're just picking up the pieces here. It will eventually - perhaps not for a decade or so - go off in everybody else's communities unless we take action now."
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