Appearance of AIDS in hæ­¯philiacs

The first case of AIDS was recognised in a person with hæmophilia in the United States in January 1982, although it is now clear that a small number of cases had gone unrecognised as far back as 1979 in the United States. Despite this report, it took almost three years for public health authorities to act to safeguard the supply of clotting factor in some countries, resulting in thousands of infections which might have been avoided by the prompt introduction of heat treated Factor VIII, a process already recognised to reduce the hazard of hepatitis B infection. Even though the causative agent had not been isolated in 1983 and 1984, there were enough parallels between the incidence of hepatitis B and AIDS in different populations to make heat treatment a reasonable precaution.

For over a year and a half physicians debated whether Factor VIII was indeed the source of the agent which caused AIDS, and waited for action upon the blood banks which gathered the blood from which Factor VIII is isolated. Most seroconversions occurred in 1983 and 1984 in the United States and Europe, and infected blood products continued to be distributed until the end of 1985 in France. As a result half of all hæmophiliacs in France were infected, whilst in the UK one quarter of hæmophiliacs were infected. In general, those with the most serious hæmophilia were most likely to have been infected owing to their greater intake of Factor VIII; those who received greater quantities of imported blood were also at greater risk (see HIV transmission through blood transfusions and blood products for further details of these findings).

Appearance of AIDS in blood transfusion recipients

The first case of AIDS in a person with no other risk except for blood transfusion was diagnosed in a New York hospital in the summer of 1982. Amazingly, the report of this case was rejected for publication by several medical journals, and it was not until December 1982 that the first case of AIDS due to blood transfusion was officially recognised by the US Centers for Disease Control.

During this period the blood banks refused to accept that a clear public health risk existed in the United States, although the British Blood Transfusion Service began to ask individuals from high-risk groups (gay men and drug users) to refrain from giving blood in August 1983. As one historian has commented, the CDC 'moved with great consideration for the institutions in question'. The blood banks objected to demands for screening on the grounds that there was still no proof that AIDS had a transmissible cause, whilst gay groups objected on civil rights grounds to calls for gay men to refrain from donating blood. When the CDC proposed that the antibody test for hepatitis B be used as a surrogate test for those at risk for AIDS (88% of those diagnosed with AIDS at the beginning of 1983 had antibodies to hepatitis B) the blood banks objected on the grounds of cost. They estimated that it would cost around $100 million a year to test for hepatitis B, and this outlay was for a route of transmission that remained unproven, they argued.

The key problem in the US was the for-profit nature of blood donation. In contrast to the voluntary, unpaid donation system run largely by non-profit organisations in Europe, the United States had a system of paid donors, and blood banks in turn sold the blood to hospitals. The paid donor system was particularly abused by injecting drug users who donated blood frequently in order to obtain money.

It was not until March 1984 that an antibody test for HIV became available for commercial use in the United States. In the UK all blood donated since November 1985 has been screened for antibodies to HIV.

AIDS in children

The first case of AIDS in a child was identified in late 1981 at Albert Einstein Hospital in New York; several more were to follow in the next year. All were children of mothers who injected drugs. In May 1983 a report of AIDS in children in the Journal of the American Medical Association sparked mass panic after one of the reporting physicians speculated that AIDS had developed as a result of casual household contact. His views were echoed by Dr Anthony Fauci of the National Institutes of Health, who said 'If routine close contacts can spread the disease, AIDS takes on an entirely new dimension'.

In fact, the claim that the cases were a consequence of casual household contact was strongly disputed by other doctors reporting cases of AIDS in children in the same issue of the journal. For neither the first nor the last time, accuracy in AIDS reporting was sacrificed for sensationalism.

There had been little evidence of panic over casual transmission of AIDS before this report. It triggered a panic which is still being dealt with by health educators. Although it is often argued that fears of contagion accompany any new disease, it is also arguable that clear guidance by public health authorities can allay such fears. The unwarranted speculation of public health officials and their exaggeration by the media was to prove a huge obstacle to future education efforts.

Further reading

Randy Shilts: And the band played on: Politics, people and the AIDS epidemic, Penguin, 1987.