55 K. M. Rahman, and N. Islam, “Resurgence of Visceral Leishmaniasis in Bangladesh,†Bulletin of the World Health Organization 61 (1983): 113; and R. D. Pearson, “Leishmaniasis: The Pathologic Spectrum,†Hospital Practice, May 1984: 100e–100x.
56 W. Hammow, A. Rudnick, and G. E. Sather, “Viruses Associated with Epidemic Hemorrhagic Fevers of the Philippines and Thailand,†Science 131 (1960): 1102–3.
57 S. B. Halstead and C. Yamarat, “Recent Epidemics of Hemorrhagic Fever in Thailand: Observations Related to Pathogenesis of a ‘New’ Dengue Disease,†American Journal of Public Health 55 (1965): 1386–94.
58 D. M. Morens, “Dengue Fever and Dengue Shock Syndrome,†Hospital Practice, July 1982: 103–13; Halstead and Yamarat (1965), op. cit.; and S. B. Halstead, “Immunological Enhancement of Dengue Virus Infection in the Etiology of Dengue Shock Syndrome,†Third Asian Congress of Pediatrics, Bangkok, Thailand, 1974.
59 A. Morales, H. Groat, P. K. Russell, and J. M. McCown, “Recovery of Dengue-2 Virus from Aedes aegypti in Colombia,†American Journal of Tropical Medicine and Hygiene 22 (1973): 785–87.
60 G. P. Kouri, M. G. Guzmán, J. R. Bravo, and C. Triana, “Dengue Haemorrhagic Fever/ Dengue Shock Syndrome: Lessons from the Cuban Epidemic, 1981,†Bulletin of the World Health Organization 67 (1989): 375–80.
61 Centers for Disease Control, “Suspected Dengue—Laredo, Texas,†Morbidity and Mortality Weekly Report 29 (1980): 503.
62 D. J. Gubler, “Dengue Haemorrhagic Fever: A Global Update,†Virus Information Exchange Newsletter 8 (1991): 2–3.
63 According to the Centers for Disease Control, A. albopictus had, by mid-1987, taken hold in the states of Texas, Kentucky, Delaware, Maryland, Ohio, California, Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Louisiana, Mississippi, Missouri, North Carolina, and Tennessee.
10. Distant Thunder
1 Detailed accounts of these and other events in the nascent years of the New York gay liberation movement can be found in two sources: The Village Voice chronicled events closely, particularly as followed by reporters Lucian Truscott and Howard Smith. See also D. Teal, The Gay Militants (New York: Stein & Day, 1971); and M. Duberman, Stonewall (New York: Penguin, 1993).
2 Randy Shilts was the first openly gay reporter hired to work for a major American daily newspaper. The San Francisco Chronicle consciously put Shilts on staff to follow these historic developments. Out of that journalistic enterprise came two seminal books, each marking different extremes in recent U.S. gay history: The Mayor of Castro Street: The Life and Times of Harvey Milk (New York: St. Martin’s Press, 1981); and And the Band Played On (New York: St. Martin’s Press, 1987).
3 In reviewing the global sexually transmitted disease (STD) situation in developing countries, one group summarized the situation as follows:
Population shifts from rural to urban areas, where STD rates are higher, are proceeding rapidly in most parts of the world. Rural to urban migration generally results in an excess of men in urban areas and of women in rural areas. The sex ratio imbalances created in places of origin and places of destination may further increase STD risks. In addition, increasing educational opportunities in developing countries, particularly for women, may delay marriage, also increasing STD risks. Similar demographic changes have caused dramatic social changes contributing to high STD rates in the United States.
The differences between the values of youth and parents have been referred to as a generation gap. Many less developed countries are undergoing rapid social transition, with corresponding changes in values between generations … . Among the many new values adopted, altered sexual behaviors will place this population at greater risk for acquiring an STD. From S. T. Brown, F. R. K. Zacarias, and S. 0. Aral, “STD Control in Less Developed Countries: The Time Is Now,†International Journal of Epidemiology 14 (1985): 505–9.
4 J. E. Sutherland. V. W. Persky, and J. A. Brody, “Proportionate Mortality Trends: 1950 Through 1986,†Journal of the American Medical Association 264 (1990): 3178–84.
5 Center for Policy Studies, “The Federal Health Dollar, 1969–76,†Washington, D.C., 1977.
6 For an excellent history of the success—and failure—of America’s attempts to control sexually transmitted diseases, see A. M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880 (Oxford, Eng.: Oxford University Press, 1987).
7 H. H. Handfield, “Sexually Transmitted Diseases,†Hospital Practice, January 1982: 99–116; and Anonymous, “VD: Gonorrhea Incidence Put at 2 Million Annually in U.S.,†Hospital Practice, June 1971: 27–40.
According to the CDC, the reported numbers of sexually transmitted diseases between 1940 and 1982 were as follows:
8 S. A. Morse, A. A. Moreland, and S. E. Thompson, eds., Atlas of Sexually Transmitted Diseases (Philadelphia: J. B. Lippincott, 1990).
9 A. E. Washington, P. S. Arno, and M. A. Brooks, “The Economic Cost of Pelvic lnflammatory Disease,†Journal of the American Medical Association 255 (1986): 1735–38.
10 H. H. Handsfield, L. L. Jasman, P. L. Roberts, et al., “Criteria for Selective Screening for Chlamydia trachomatis Infection in Women Attending Family Planning Clinics,†Journal of the American Medical Association 255 (1986): 1730–34.
11 Centers for Disease Control, “Penicillinase-Producing Neisseria gonorrhoeae,†Morbidity and Mortality Weekly Report 25 (1976): 261.
12 I. Phillips, “Beta-Lactamase-Producing Penicillin-resistant Gonococcus,†Lancet II (1976): 656.
13 Centers for Disease Control, “Follow-up on Antibiotic Resistant Neisseria gonorrhoeae,†Morbidity and Mortality Weekly Report 26 (1977): 29–30.
14 P. F. Sparling, K. K. Holmes, P. J. Wiesner, and M. Puziss, “Summary of the Conference on the Problem of Penicillin-resistant Gonococci,†Journal of Infectious Diseases 135 (1977): 865–67.
15 Centers for Disease Control, “Follow-up on Penicillinase-Producing Neisseria gonorrhoeae—Worldwide,†Morbidity and Mortality Weekly Report 26 (1977): 153–54.
16 Centers for Disease Control, “Tetracycline-resistant Neisseria gonorrhoeae—Georgia, Pennsylvania, New Hampshire,†Morbidity and Mortality Weekly Report 34 (1985): 569–70; and Centers for Disease Control, “Plasmid-mediated Tetracycline-resistant Neisseria gonorrhoeae—Georgia, Massachusetts, Oregon,†Morbidity and Mortality Weekly Report 35 (1986): 304–5.
17 Centers for Disease Control, “Penicillinase-producing Neisseria gonorrhoeae—United States, 1986,†Morbidity and Mortality Weekly Report 36 (1986): 107–8; and H. Faruki, R. N. Kohmeschler, P. McKinney, and P. F. Sparling, “A Community-based Outbreak of Resistant Neisseria gonorrhoeae Not Producing Penicillinase (Chromosomally Mediated Resistance),†New England Journal of Medicine 313 (1985): 607–11.
18 L. Corey and P. G. Spear, “Infections with Herpes Simplex Viruses,†New England Journal of Medicine 314 (1986): 685–90.
19 A. J. Nahmias and B. Roizman, “Infection with Herpes-Simplex Virus 1 and 2,†New England Journal of Medicine 289 (1973): 667–74, 719–25, 781–89.
20 A. J. Nahmias, H. L. Keyserling, and G. M. Kerrick, “Herpes Simplex,†in J. S. Remington and J. O. Klein, eds., Infectious Diseases of the Fetus and Newborn Infant (Philadelphia: W. B. Saunders, 1983).
21 M. F. Goldsmith, “Possible Herpesvirus Role in Abortion Studied,†Journal of the American Medical Association 251 (1984): 3067–70.
22 Using sophisticated genetic mapping techniques for the first time, University of Chicago scientists showed in 1979 that most neonatal herpes cases came not from infected mothers but from other babies. Bernar
d Roizman and Timothy Buchman compared the genetic sequences of herpes viruses found in babies co-housed in intensive-care wards at several major U.S. urban hospitals with the strains seen in their mothers. They discovered that many of the mothers were uninfected, and the babies on any given hospital ward all had exactly the same viral strain in their bodies. The conclusion was that most pediatric herpes simplex in the United States was nosocomial in origin; that is, it was spread from baby to baby by the hospital medical staff. Presumably nurses tending a primary case of maternally derived herpes failed to observe sterile hygiene practices as they moved from patient to patient in the neonatal intensive-care wards. See B. Roizman and T. Buchman, “The Molecular Epidemiology of Herpes Simplex Virus,†Hospital Practice, January 1979: 95–104.
23 M. F. Goldsmith. “Sexually Transmitted Diseases May Reverse the ‘Revolution,’†Journal of the American Medical Association 255 (1986): 1665–72.
24 “There are many unanswered questions regarding sexually transmitted CMV infections,†noted H. Hunter Handsfield in 1982. “One of the most intriguing revolves around the markedly high prevalence of past or present CMV infection in homosexual men and the fact that these men probably have a higher than average risk of the rare malignancy, Kaposi’s sarcoma.†See H. H. Handsfield, “Sexually Transmitted Diseases,†Hospital Practice, January 1982: 99–106.
25 Morse, Moreland, and Thompson (1990), op. cit.; and G. P. Schmid, “The Treatment of Chancroid,†Journal of the American Medical Association, 255 (1986): 1757–62.
26 Handsfield (1982), op. cit.
27 A. DeSchryver and A. Meheus, “Epidemiology of Sexually Transmitted Diseases: The Global Picture,†Bulletin of the World Health Organization 68 (1990): 639–54.
28 R. K. St. John and S. T. Brown, eds., “International Symposium on Pelvic Inflammatory Disease,†American Journal of Obstetrics and Gynecology 138 (1980): Supplement.
29 O. Frank, “Infertility in Sub-Saharan Africa: Estimates and Implications,†Population and Development Review 9 (1983): 137–44.
30 S. K. Hira, “Sexually Transmitted Diseases: A Menace to Mothers and Children,†World Health Forum 7 (1986): 243–47; S. K. Hira et al., “Congenital Syphilis in Lusaka, II. Incidence at Birth and Potential Risk Among Hospital Deliveries,†East African Medical Journal 59 (1982): 306–10; and T. E. Watts et al., “A Case-Control Study of Stillbirths at a Teaching Hospital—Zambia 1979–1980: Serological Investigations for Selected Infectious Agents,†Bulletin of the World Health Organization 62 (1984): 803–8.
31 M. Callen, Surviving AIDS (New York: HarperCollins, 1990).
32 For a detailed discussion of this new ecology and the implications for microbial transmission, see “Biological and Social Conditions,†Chapter 14 in M. D. Grmek, History of AIDS: Emergence and Origin of a Modern Pandemic (Princeton, NJ: Princeton University Press, 1990).
33 Michael Callen summarized the mood beautifully in Surviving AIDS, op. cit.:
No one took heed of the warning signs that were all around us. No one asked what the cumulative consequences might be of continually wallowing in what was, to put it bluntly, an increasingly polluted microbiological sewer. Rumors that the [New York City] Health Department had been able to culture cholera and other exotic microbes from the greasy stair rails of the Mineshaft (a notorious Manhattan sex club) were dismissed as apocryphal.
We took each new disease in stride. I can even recall that the “invention†of a disease dubbed as “gay bowel syndrome†[E. histolytica] was, in some quarters, almost a matter of pride; now we even had our own diseases, just like we had our own plumbers and tax advisers. A whole new breed of physicians, affectionately known as “clap doctors,†grew rich treating our STDs. Many of these physicians could themselves be observed in the bathhouses and back rooms leading the same fast-lane life-style as their patients. Even if they had warned us, who would have listened?
34 T. J. John, G. T. Ninan, M. S. Rajagopalan, et al., “Epidemic Hepatitis B Caused by Commercial Human Immunoglobulin.†Lancet I, 8125 (1979): 1074.
35 S. C. Hadler, D. L. Sorley, K. H. Acree, et al., “An Outbreak of Hepatitis B in a Dental Practice,†Annals of Internal Medicine 95 (1981): 133–38.
36 A. L. Reingold, M. A. Kane, B. L. Murphy, et al., “Transmission of Hepatitis B by an Oral Surgeon,†Journal of Infectious Diseases 145 (1982): 262–68.
37 M. Carl, D. L. Blakey, D. P. Francis, and J. E. Maynard, “Interruption of Hepatitis B Transmission by Modification of a Gynaecologist’s Surgical Technique,†Lancet I, 8274 (1982): 731–33.
38 W. L. Heyward, T. R. Bender, A. P. Lanier, et al., “Serological Markers of Hepatitis B Virus and Alpha-fetoprotein Levels Preceding Primary Hepatocellular Carcinoma in Alaskan Eskimos,†Lancet II, 8304 (1982): 889–91.
39 N. E. Reiner. F. N. Judson, W. W. Bond, et al., “Asymptomatic Rectal Mucosal Lesions and Hepatitis B Surface Antigen at Sites of Sexual Contact in Homosexual Men with Persistent Hepatitis B Virus Infection,†Annals of Internal Medicine 96 (1982): 170–73.
40 According to CDC statistics amassed by Dr. Miriam Alter, the more easily transmitted hepatitis A dominated all reported cases of the liver disease until 1983, when it was surpassed by hepatitis B. The increase was largely in gay Caucasian males. Between 1966 and 1983, hepatitis A rates declined, as surely as B rates escalated.
41 R. H. Purcell, “The Viral Hepatitides,†Hospital Practice, July 1978: 51–63.
42 M. Robertson, “Joining the War Against Hepatitis B,†San Francisco Chronicle, February 5, 1982: A24.
43 Laws governing drug paraphernalia and possession vary widely around the world and from state to state within a country. In Amsterdam, for example, it is legal to purchase both the narcotic drugs and sterile equipment for injection. In the United States narcotics use is governed at both the state and federal levels. In general, the commerce or business end of narcotics—import, transport, and distribution—falls under federal law, while the consumer end—use and possession—is under state law. The exceptions relate to quantities, with federal jurisdiction coming into play where the amount of drugs in one’s possession is large. A cogent review of the complexities of U.S. narcotics laws can be found in L. Gostin. “The Interconnected Epidemics of Drug Dependency and AIDS,†Harvard Civil Rights-Civil Liberties Law Review 26 (1991): 114–84.
44 In 1975, Newsday and reporters Les Payne, Knut Royce, and Bob Greene won the Pulitzer Prize for their series of reports tracing the deaths of suburban Long Island, New York, residents back through international crime networks all the way to the poppy fields of Turkey. The series was republished as a book: The Heroin Trail (New York: Holt. Rinehart and Winston, 1974). The author has drawn liberally from their work in describing heroin distribution during the 1970s.
45 Heroin was first marketed internationally by the Bayer Chemical Company of Germany, which sold the compound in 1898 as a cough suppressant. By 1906 the product had become so popular that the American Medical Association officially recommended its use as a painkiller.
But by 1924 some 200,000 Americans and an unknown number of Europeans were cough syrup addicts. That year the U.S. Congress outlawed further importation of the Bayer cough syrup and all other heroin-containing products.
The second international heroin marketing effort came on the heels of World War II, reaching the lucrative urban centers of Europe and North America during the 1950s. From its outset, the second heroin marketing efforts, which was entirely illegal, was run by well-established, traditional organized crime elements in each country.
In 1961 the Mafia distributors who controlled the U.S. heroin trade created increased consumer demand and profits by manufacturing a false drug panic. H
eroin was deliberately held off the market, causing tens of thousands of addicts, most of them then living in New York City and nearby cities such as Newark, to experience the physical pangs of withdrawal. Once the desired pressure had been exerted, the wholesalers released drugs diluted still further, setting the standard of 90 to 95 percent dilution that would remain in place for years. To maintain the high to which they had become accustomed, addicts had to purchase more heroin. On the other hand, the diluted formulation seemed less threatening to potential new consumers.
46 Meanwhile, there was one city on the planet in which nearly pure heroin crystals could be purchased relatively cheaply at the retail level: Saigon. The heroin was of such strength that the thousands of U.S. soldiers stationed in the city who indulged in the drug refrained from injecting the substance because they obtained a powerful high from merely smoking the Saigon product.
The congressional Subcommittee on Public Health heard testimony that at least 12,000 returning GIs were severely addicted and in need of detoxification and treatment. A U.S. medical officers’ survey put that figure higher, estimating that 25,000 to 37,000 GIs had become heroin addicts during the Vietnam War. See “The Drug Abuse Problem in Vietnam,†Report to the Office of the Provost Marshal, U.S. Military Assistance Command Vietnam, 1971; and New York Times, May 16, 1971: A16.
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