Horizon (1964) s19e23 Episode Script
Killer in the Village
1 Archive programmes chosen by experts.
For this collection, Prof Alice Roberts has selected a range of programmes to celebrate Horizon's 50th anniversary.
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MUSIC: "Nipple To The Bottle" by Grace Jones # Colour and warmth Came into your world 'Girl dancers give a charity performance 'before an audience that contains a high proportion of homosexual men.
'Martyn Butler and his friends 'had seen the slow death of Terrence Higgins, 'one of the first British victims of a bizarre new disease.
'Now they're raising money 'to promote research and health education 'for those most at risk.
' # .
.
I won't do it tonight # I won't do it tonight No way, baby 'Among British gay men 'there's a strong admiration for all things American.
'There's a great deal of travel between the two countries, 'and in America this new disease has already become an epidemic.
'In New York, this is Greenwich Village.
'Centred in and around Christopher Street 'on the west side 'of this traditionally Bohemian district of Manhattan 'is a vast community of gay men, 'said to be hundreds of thousands.
'Here the killer disease has taken its greatest toll of death, 'and of fear among those who walk in its shadow.
'It's a world full of signals, 'such as which side a bunch of keys is worn 'to indicate a preference for the active or the passive sexual role.
'Some bars or bathhouses cater for extremes of promiscuity.
'This door leads to a private club of international reputation 'that occupies three floors of the large building behind it.
'In sharp contrast, 'some of the disease victims that we met claim to be monogamous.
' SINGING 'This is such a household, 'given over, it seems, to music and the arts.
'WC, the aspiring musician, 'had for nearly a year lived together happily with his boyfriend Kevin 'when disease struck the younger man down, 'savagely interrupting his career as a model 'and dashing his hopes 'of becoming a commercial artist and textile designer.
'With an impaired immune system, 'Kevin's resistance to disease is lowered.
'His condition is called A-I-D-S - AIDS.
'It lets in secondary diseases that can kill.
' I'd noticed these bumps on my skin and they looked a little suspicious.
They didn't hurt, but they were very strange and they were multiplying.
It started out with one, then the next day there were three and up to this point now, a month-and-a-half later, there's, like, close to 30.
'In fact, it's a cancer.
' I drew a picture about a week before we found out about it and Kevin said, "What is it?" and I said, "It's gay cancer.
" And we kind of laughed and then within a week he was in the hospital.
'With Kaposi's sarcoma.
' The tumours can be somewhat disfiguring, especially in a person as attractive as Kevin.
I was a little bit more in shock at the beginning of this than I am now.
It's been hard.
You know.
I'm very scared that I will come down with the Kaposi's at some point.
Well, I think it's definitely transmissible, just how I don't know.
Is it through blood, is it through saliva, is it through? I don't know.
'Kaposi's sarcoma starts with purplish-pink spots 'like blood blisters or mosquito bites 'that don't itch and don't hurt, 'but they don't clear up.
'Kaposi was a 19th-century Austrian doctor 'who saw it in elderly men of Jewish or Mediterranean origin.
'Medical students are taught that the cancer develops slowly 'and rarely causes death.
'But in these young Americans 'it develops rapidly in more and more sites - 'here, inside the rectum - 'until, without effective treatment, the patient will die.
'This is Kevin's last weekend before going into chemotherapy, 'but he knows that's only part of his problem.
'He has cancer because his immune system has broken down, 'and it's this underlying immune deficiency 'that others have called the "gay plague".
'That name, with its hints of divine retribution 'for a despised and segregated minority, 'is not popular among gay men.
'Homosexuality has been around a long time, 'so they see no reason why this immune deficiency 'should be so strongly represented in their community.
'Why here, and why now? 'Is the underlying syndrome infectious? 'How far will it spread? 'Can anything be done to stop it? 'WC and Kevin are putting on a brave show, 'but they'd like to know - can AIDS be cured, 'or will it put them at risk from other diseases, too?' How long have you had those stomach pains altogether? Actually they started a week ago Wednesday.
I see.
'The doctor suspects that John has an unusual form of pneumonia.
' What was the very first symptom? Loss of weight.
Mm-hm.
Was the first sign something was going on.
Just started losing weight for no good reason? I lost 30lb in one month.
In one month.
And how much weight have you lost altogether? About 60 Almost 60lb.
'John is the latest victim 'of a widespread epidemic of bizarre infections, 'all connected with AIDS.
' Are they high fevers? 'In fact, it was this rare pneumonia 'that first alerted the Centers for Disease Control in Atlanta, Georgia, 'that something very odd was going on.
'Usually it's people like transplant patients, 'whose immune system is artificially depressed, 'who sometimes get the pneumonia, 'and Sandy Ford controls all supplies of the best drug for it.
' I need your patient's name, age, sex and weight and the underlying reason for the immunosuppression.
'In 1981, there was a sharp increase in the number of requests.
' There's no underlying reason for the immunosuppression? 'The drug's restricted, and she's supposed to have a clear diagnosis.
' He's not on chemotherapy for any malignancy? 'Just checking - chemotherapy also hits the immune system.
'When this first happened 'all she could think about was her uncompleted paperwork, 'but then it happened again.
'And again.
'In a matter of months, 'the unsatisfactory forms began to pile up.
'The requests came mostly from around New York and from Los Angeles.
' How about WBC count? 'White blood cells.
' 2,000.
'That's low.
' Why is it that you're opting for pentamidine over more conventional therapy? 'Pentamidine is what they call an orphan drug.
'It's never been needed enough to make a profit 'and these days testing new drugs costs a fortune.
'So they call this experimental 'and hedge it around with paperwork.
'Instructions - "Dear Doctor, enclosed is not only the drug ' "but also a special note on what's known about it, ' "and a consent form for the patient to sign.
" 'As it happens, pentamidine is, or was until recently, 'made at Dagenham in England.
'And here at CDC is the whole world's supply, 'bought up by Sandy Ford.
'At the start, she didn't realise the importance of her evidence, 'that her records hold an answer to the question - 'is this disease really something new? 'To CDC's epidemiologists, 'the increased demand was a puzzle.
'They thought they'd better find out 'what happened to the drug Sandy was sending out.
'Some went to 'the University of California Los Angeles Medical Center.
' Very slowly.
'By mid '81, Michael Gottlieb had seen five patients 'with the rare pneumonia.
' Hi, James.
'Jim's a bartender who, for family reasons, 'prefers not to face the camera.
'Pentamidine has halted the pneumonia, 'but that's a secondary infection.
'It'll do nothing for the immune deficiency that underlies it.
' What's your understanding at this point of this condition? I really don't know much about it yet.
But you had heard about AIDS prior to your developing pneumocystis? Yes, I'd read about it in the gay trade papers and other newspapers.
'Gottlieb spotted and reported to CDC 'the crucial fact that it was gay men who were getting 'the pneumocystis carinii pneumonia parasite in their lungs and dying.
'Anyone could pick this up, 'but in a healthy population the effects are trivial.
'The second most common infection in the epidemic among gay men 'is a form of tuberculosis that's carried by birds, 'and it's highly unusual to see it in humans.
'It's yet another opportunistic infection.
'Alfred, too, lost weight.
'That was quite a while back.
' Just about a year.
'Again, there seems to be a deficiency 'in part of his immune system 'that would normally protect his body 'from organisms that are carried by other creatures.
'Reggie's problem is a very nasty form of diarrhoea.
' It varies.
Like, I go at least 20 times a day.
20 times a day? - Are they watery, or? - Watery.
How do you feel now? I don't want to say lousy, but - Yeah.
- Still alive, so 'Reggie may have an unusual disease with another obscure name, 'cryptosporidiosis.
' You lost 11lb, you never gained it back.
- No, I didn't.
- I see.
Reggie, did you bring me a specimen? Yes, I did.
Oh, let me see.
Show me your bottle.
I see, so this is all night, huh? OK, put it back.
All right.
'Reggie, who used to be a clerk on the stock exchange, 'had to borrow 30 for his stool test 'for a disease that's normally carried by cattle.
' - Take care.
- See you.
'In men with AIDS, the parasite lodges in the gut lining, 'causing it to weep, leading to dehydration and total exhaustion.
'And a speedy diagnosis may not help much 'since drugs don't seem to touch it.
'Reggie is lucky in one tiny way - 'most previous cases have been confirmed 'by surgically taking a specimen from the gut.
'At St Vincent's Hospital, New York, 'Pearl Ma's contribution to medical science 'is a non-invasive method of diagnosis.
' 'At the moment, cryptosporidium can take its toll over many months 'until some final collapse leads to death.
'But when a cure is found, 'it'll be essential to distinguish the spores of crypto 'from those of thrush, a common fungal disease, 'which, though serious in men with AIDS, can be treated.
'In this test, fungal spores take the green stain, 'while the cryptosporidium spores will remain red.
'And it's red for cryptosporidiosis, 'a disease that farmers can pick up from cattle, 'but which is normally self-limiting.
'Yet, it's now a deadly part of that same AIDS epidemic.
'To CDC in Atlanta came the reports - 'the pneumonias in Los Angeles, some cancers in San Francisco, 'with many more of both in New York, and all, it seemed, were gay.
'An epidemiologist from the Sexually Transmitted Disease Department 'was told to set up a task force and deal with it fast - Jim Curran.
' JIM: We liked to work on a project for three months and say that we saved x-thousands of lives.
I was the detail for three months in July of 1981 and now having moved into the permanent job, mid-1981, we were able to find that there had actually been cases diagnosed in isolated centres perhaps as early as 1978.
From 1979, there was an essential doubling of cases, approximately every six to nine months.
'And by early 1983, 'there were around three new cases every day.
' The disturbing thing was to realise that these three cases per day are occurring in relatively small segments of society and are at this time relatively contained among a few small-risk groups a few high-risk groups Additionally tragic about these illnesses are their economic and physical toll upon the people before they die and their occurrence in very young persons - the average age of victims is approximately 35 - and the average hospital bill often exceeds 100,000 prior to death.
'Bobbi Campbell, a nurse in San Francisco, 'was one of the earliest AIDS victims still alive.
'On a walking holiday, 'he'd found what looked like a blood blister on his foot.
'It didn't clear up so he showed it to a dermatologist who took a biopsy 'and diagnosed Kaposi's sarcoma.
' I was I was devastated, I was 29 years old and I had cancer, I had a cancer that had killed a number of gay men already in this country and in some other countries.
I felt like my death might be imminent even though I felt fine.
All I had was spots on my feet, but I had this potentially fatal illness.
I went into a I think a very severe depression, I got drunk quite a lot, spent a lot of time on the phone telling everyone that I knew that I had this I felt that there were two ways that I could approach this, I could either keep it completely within myself and tell no-one, or I could tell everyone that would stand still long enough to listen.
I chose the latter option because first of all it enabled me to educate other people who were also at risk for this disease and it also earned me personal support in a time when I was really in crisis.
At that time I went on disability for my job, I didn't want to risk being around sick people.
It's still depressing, feeling that I have this chronic illness that could kill me.
In the year since I've been diagnosed, I've had three people that I know personally who have died and that each time it's a blow to the heart.
'The population of the city of San Francisco 'is 650,000 men and women.
'No-one knows how many gay men have come here, 'estimates range from 100,000 up.
'Gay newspapers here have emphasised the cancer 'and there's a Kaposi's sarcoma project 'in one of the University of California clinics.
' - Good morning.
How are you today? - Oh, hi, Bob.
- Hello.
- Ready to take my blood? Yes.
'Nurse Helen Schietinger gives her gay patients a sympathetic hearing.
' I guess it's been about a month now you've been on chemotherapy? - Yes, it has.
- You're finally coming back? Yes.
The biggest spots are going away, so that's nice.
Good, that's terrific.
'In more puritan communities, Bob might face intolerance or ridicule.
'He's escaped from that, but into a different kind of nightmare.
' At least you're used to this by now, with the blood-drawing for the chemotherapy.
You get used to lots of things you never used to think you would get used to.
- Good.
How's that? - That's fine.
'His blood is urgently needed for research.
'Already, there's one way to monitor his immune system.
' HELEN: Heart is doing the work just fine.
'In recent years, work on the body's immune defences has 'begun to uncover an extremely complex system 'that includes a wide range of specialised white blood cells.
'Some act as helpers, others as suppressors.
'Their job is to help protect our bodies from cancer 'or from certain invading organisms.
'A helper recognises the alien cells and sends for reinforcements.
'More white cells are produced and these attack 'and try to kill the invader.
'When the job is complete, 'the suppressor cells register the information 'and send a second message - 'close down production, the emergency is over.
'Normally, when we're healthy, we have more helpers than suppressors, 'maybe twice as many, 'but AIDS may increase suppressors and drastically cut back the helpers.
'One sign might be swollen glands.
'Take the ratio down further 'and some men become vulnerable to Kaposi's sarcoma.
'Further down still, and any of those bizarre infections that are around 'may take its toll.
'At worst, there may be so few left 'it's difficult to find enough to count.
'Now all kinds of disease can strike down the helpless victim.
'In Bob's case, the puzzle is that Kaposi's sarcoma set in 'so early in the downward pattern of the immune disease.
' - OK, now don't bend your arm back.
- OK.
Just leave it right like that.
Yeah.
I don't think I've developed any new spots, but at least it'll It'll give 'em a chance to check it.
'But a clue to that may also be found in the blood.
'Recent research implicates a genetically determined marker 'on the surface of each cell.
'Monoclonal antibody can be made to react with 'a sample of blood from anyone who has the marker.
'Men with the marker seem to be more susceptible to this cancer 'when they get AIDS.
'And at the present rate of progress, 'there are ten times as many men with AIDS every two years.
'Unless there's some dramatic change, 'that exponential growth will continue 'unless the disease is identified and stopped, 'or it weakens or resistance to it grows, 'or if there's a change in lifestyle which stops its transmission, 'or failing those, when everyone at risk has got it.
'Having seen so many of the earlier deaths, New York's Greenwich Village 'was a good place to begin a search for the causes of AIDS.
'In 1981, at nearby New York University, 'immunologist Al Friedman-Kien joined forces with Linda Laubenstein, 'who'd been treating gay Kaposi patients for nearly two years.
' By May of 1981, we had about eight cases of all young homosexual men in their 30s, who had this disseminated form of Kaposi's sarcoma.
They would tell us about the frequency of sexual encounters, they were extremely promiscuous.
They'd all had histories of multiple transmissible sexual diseases such as gonorrhoea, syphilis, giardiasis - which is a parasitic infection - and amebiasis, which is now considered a sexually transmitted disease among homosexual men, especially in New York.
'Outsiders were quick to attribute AIDS to the men's sexual activities, 'but what was new in that? 'Every possible variation had been around for thousands of years.
'But Al Friedman-Kien noted one activity 'that was new to this society.
' They had histories of taking what we call recreational drugs - marijuana, cocaine and especially amyl and butyl nitrite, which are used as sexual stimulants during sexual activity.
And they're sold under the names of things such as Thrust, Locker Room .
.
Poppers, old-fashioned fragrance.
Blackjack.
Bolt.
Hardware.
And Quicksilver.
And this particular agent was used by 100% of our patients and, initially, we were rather suspicious that there may in fact be a relationship between the use of this drug and the evolution of the Kaposi's sarcoma and the opportunistic infections which we've been seeing in homosexual men.
'The president of New York's Gay Men's Health Crisis showed us 'how nitrites are used although, to avoid problems in his job, 'wouldn't show his face.
' It's an inhalant and they block one nostril with their finger and inhale with the other nostril and you have an almost immediate high.
How long does a bottle like that last? Oh, one night in a disco.
Do people just keep? They pass it around a group, whoever is dancing together, it's passed around from person to person.
'But were these the cause of AIDS? 'If so, there'd be no need for big changes in lifestyle 'in the major gay communities.
'To the world outside, Hollywood is still the movie capital of the world, 'but to the people who live around here, 'it's also the centre of the gay district of Southern California.
'Around Los Angeles, 'there are thought to be 200,000 to 400,000 gay men.
'What is new in recent years, apart from nitrites, 'is the sheer numbers that have gathered together, 'plus the greater sexual openness and freedom 'that gay liberation has made possible.
'Did this contribute to the spread of AIDS? 'In their personal relationships, 'gay men are free from feminine restraints.
'In heterosexual relationships, the male traditionally is the hunter.
'When both are hunters, the effect is explosive.
'Some gay men can claim hundreds of tricks - 'that is new sexual contacts - each year, 'so sexually transmitted disease is commonplace - 'for many, an inevitable part of the lifestyle - 'and regular checkups 'guard against the health hazard of sexual overload.
'This is the clinic 'attached to the Gay and Lesbian Community Services Center 'in Los Angeles.
' Room one, first door on your left and you charge in at the desk.
Appointment number six, please.
'No lesbians - women have more stable relationships and less disease 'if they avoid men.
It's just men who come here, maybe 70 a night.
' - How you doing this evening? - Just swell(!) 'Around 15,000 a year.
' The doctor wants you to take tetracycline - one capsule, four times a day for the next ten days.
You should avoid sex for the next ten days, plus three days afterwards to see if your discharge returns.
'This clinic is run by gay volunteers.
'Other men go to private doctors who may also be gay, 'or to the county clinic.
' OK, you just came in for a routine screening, OK? There's no charge for routine screening, but I will ask you for a donation, OK? 'Most men here have something - gonorrhoea, syphilis, NSU, hepatitis, 'the list goes on.
'With so much existing disease, who needs a new one? 'And that was the idea behind another of the theories offered.
'Immune overload - 'an explosion of sexual activity leads to so much disease 'that the immune system is permanently damaged.
'However, that's never been seen before 'with other kinds of disease.
' .
.
So that means you do not have gonorrhoea, but you have nonspecific urethritis.
You take this pill, one pill, four times a day for ten full days, - drink lots of fluids - Mm-hm 'Compared with all the rest, AIDS is still quite new and so is this.
' AIDS hotline.
Yes, I'd be glad to give you the symptoms.
Low-grade persistent fever, night sweats, dry coughs that are not related to colds or smoking.
Weight loss of more than 10lb during a period of less than two months.
Enlarging lymph nodes 171! 'He's checking contacts - 'for the major infections, they want to know who else needs treatment.
'Should that be done for AIDS too? Linda Laubenstein.
' LINDA: As we gathered up more and more patients, as patients would meet each other in the office, it became apparent that many of the patients had had contact with one or two, or perhaps more, other people who had the syndrome, which began to suggest to us that perhaps there was a sexually transmittable a single sexually transmittable agent that was being passed around in the community.
'A virus, perhaps? 'At that time, only 19 cases had been recorded in Los Angeles.
'From their local office, they managed to track down just 13.
'Were they linked, did they know each other? David Auerbach.
' Of the 13 cases, or contacts of cases whom we interviewed, we found that there were histories of sexual connection between nine of those 13.
Those cases, those nine cases in Southern California are represented here.
These circles represent cases of Kaposi's sarcoma or pneumocystis carinii pneumonia, and here we have interconnections, histories of actual sexual contact between nine of these cases.
Included here to make these connections is one case, only one that was not from Southern California.
'An airline steward.
' This case has been found to have connections with 40 approximately 40 other cases of AIDS, mostly in New York City, but some from several other cities in North America.
We believe that this sort of cluster information does make it more likely that we are dealing with a communicable agent and we believe that because of that, laboratory resources should be more and more directed to looking for a communicable agent that the cases might have been exposed to.
'So nitrites seem to be out.
' - Yeah.
Look, though, the semen - All right, thank you.
'All over the States, the search is on for some organism 'that could transmit AIDS.
'Here they're looking in the diseased lymph nodes 'removed from AIDS victims.
'They also have a sample of seminal fluid.
'The idea they're working on 'is that it might be a sexually transmitted agent, 'rather like the virus for hepatitis B.
'But what they don't know is whether to look for something completely new, 'never seen before, or something that's common, 'thought of as harmless, 'but which has produced a new mutation 'which is doing all the damage.
'Dick Miner is one of several investigators on yet another track.
'Could it be the agent of some mild disease 'that's transmitted among gay men 'in a way that makes it specially dangerous, 'perhaps also promoting the cancer? 'He's been looking for evidence of cytomegalovirus - CMV.
'There's its signature - the dense body 'and several incomplete particles, 'just the coating.
'The lymph nodes of sexually active gay men are often loaded with CMV, 'but was it the cause of the disease or more likely 'just another opportunistic infection? 'Recently, interest has switched to a human T-cell leukaemia virus, 'and seminal fluid is a good place to look for a virus 'that's sexually transmitted.
' - Dick, how are you doing? - All right.
Do we have enough specimen to do the complete works on this one? Yeah, yeah.
This one, small volume, but it's adequate.
'But a further problem - 'it's been found that if sperm are injected into the bloodstream 'of a mouse, 'that alone is enough to suppress its immune system.
'In New York, Alvin Friedman-Kien again.
' ALVIN: Our most exciting hypothesis, and the one that we're working on most right now is that with the multiple exposure to sperm that homosexual men have from a variety of sources, both through the rectal route or through the oral route, and possibly through tears in the mucosa or absorption through the mucosa, that the sperm is able to penetrate into the immune system or into the blood.
'In a survey of gay men in New York, 80% had an immune deficiency, 'but their average age was 35.
'To see how the deficiency is acquired, 'they need to study younger men.
'At UCLA, volunteers from the students' gay club 'were recruited by the dean of the School of Public Health, 'Roger Detels.
' We looked at the ratios of helpers to suppressors in this group of 89 young homosexuals and also looked at the absolute levels of suppressor cells and of helper cells.
We also did a detailed questionnaire on sexual practices.
'At that early stage of an active sex life, 'they often found a substantial increase in suppressor cells, 'but caused by what?' We found that there seemed to be an association with receptive anal sex and NOT with active anal sex.
If the organism is introduced, the hypothesised organism is introduced into the bloodstream of the individual through breaks in the rectal mucosa, the agent might be present in the sperm of the partner or it might be an inhabitant of the faeces of the individual himself and would gain access to his circulatory system because of the breaks in the rectal mucosa.
'And nitrites are implicated only because 'they help relax the muscles to receive anal sex.
'Highest risk? 'Men who receive a lot of anal sex from many partners, 'to which some gay men respond that it's not just them.
'Others get AIDS, too.
'Leandro injected heroin directly in his veins.
' Ugh, I feel terrible.
I feel pain in my stomach, my bones .
.
in all my muscles, I feel weak.
I think that's because I lost about 40lb, 42lb, something like that.
You feel very bad, dizzy.
'This is a complication in the story, 'but it's know that intravenous drug addicts can pass infection 'such as hepatitis B in traces of blood on dirty needles.
'Could an agent for AIDS be passed around like that?' I had a lot of diarrhoea, oh, about seven days with it.
INTERVIEWER: Diarrhoea? You're going to the lavatory a lot? Oh, boy, I've gone crazy with that, going to the bathroom all the time, all night long.
'His white blood cell count was lower than any we've yet seen.
' That's what they say I have.
My blood is so low that I can't find no You know, no matter how small the infection is .
.
I can't fight it.
'Leandro is NOT a homosexual.
' My wife come every day.
But they don't let the kids come on up.
They're, like, too small.
'Weakened by his addiction, 'he's fallen victim to an extreme form of AIDS, 'with a bewildering range of symptoms.
' I don't even know how to describe the way I feel.
'His doctor can describe it, listen not for the technical details, 'but simply for the number of diseases.
' DOCTOR: 'He presented with diffuse lymphadenopathy, 'profound diarrhoea of several months' duration, 'as well as 40lb of weight loss.
'He also had oral thrush, which is a candida infection of the mouth, 'and an unusual intestinal parasite called isospora, 'which we have not really seen in these patients before.
'He also has a hepatitis, some unusual eye lesions 'and lymphocytopenia with a reverse helper 'and suppressor cell ratio, 'which we've been seeing in the AIDS syndrome.
' So I don't know, what's it going to be? 'When a disease occurs in more than one group, 'epidemiologists seek a common cause, which, in principle, 'should become easier when a third distinct group is discovered.
' Hello, Mr Destine.
HE GROANS 'Destine, a Haitian, is very sick.
How are you feeling, otherwise? INDISTINCT REPLY 'But for a year after AIDS was first observed, no-one made the connection, 'this looked like a completely separate problem.
' Is your head still hurting you? Is there any pain in your head? No.
That's very good.
'He is wasting away, and a disease in the brain affects his speech.
' How's your strength otherwise? INDISTINCT REPLY 'He can't control one arm properly.
' Try to hold a fist for me.
'One medical scientist was busy writing a paper putting it down to 'a new form of syphilis 'brought in by the immigrants that was fatal in two to six weeks.
'After three such deaths at Miami's Jackson Memorial Hospital, 'pathologist George Hensley decided to take a look.
'His bet was tuberculosis, 'but among several less likely possibilities was 'a disease called toxoplasmosis.
'That's a parasite carried by lions and other felines, 'including domestic cats.
'In humans, it lodges in the brain 'but is held in check by the immune system.
' Well, yeah, I'm going to make the first slice 'It may form a microscopic cyst, but causes no further trouble.
'Today, Hensley knows exactly what he's looking for.
'Indeed, his research has led others to identify warning signs 'in brain scans.
Here's a ring of advanced toxoplasmosis 'spreading outward through the brain.
'This patient died within a few days.
'Syphilis and TB were out, but as more cases came to light' See the softening.
'.
.
there was a new problem.
'Was this a dangerous new strain of toxoplasmosis 'brought in by the Haitians? 'Hensley duly reported his findings to CDC, who promptly sent a team 'to follow every lead.
' What is causing it is this lesion within a necrotic, firm centre.
'Their first port of call was Krome North, 'a kind of concentration camp 'out on the edge of the swamps inland from Miami, 'where, at that time, thousands of Haitians 'were crowded together as illegal immigrants, 'pending a decision on what to do with them.
'The women, in their own compound, 'were investigated as carefully as their segregated menfolk.
'About a third of the toxoplasmosis patients were Haitian women.
'And CDC investigators wanted to know 'whether the supposed new and more virulent form of the disease 'was being carried here to become the focus of some new epidemic.
'And what they found in this whole overcrowded camp was nothing.
' SHE SPEAKS IN FRENCH 'Had they been on the wrong track all along? 'The idea began to grow 'that toxoplasmosis was simply AIDS once again, 'but disguised by an unfamiliar outcome.
'If so, they also had to ask - 'was it homosexuality among the segregated men? 'But among Haitians, homosexuality is taboo 'and that kind of question meets with blank incomprehension 'in Miami's Little Haiti.
'The investigators came here and learned what they could 'about the complexities of a society 'in which catholic and voodoo are mixed, 'where there's no word for "disease", 'and sickness is linked to spiritual state, 'and also where, by Miami's standards, 'there's very little crime - 'to the Americans, a strange and alien culture.
'But here again, no evidence was found 'that AIDS had been brought in by the immigrants.
'However, on the island itself, 'over 50 cases have been reported to visiting investigators, 'mostly among men but some in women, too, 'confirmed by the pneumonia, the cancer, 'as well as the cat disease, toxoplasmosis, 'which is more common in the tropics.
'It's been suggested that AIDS, too, came from Africa, 'where it could spread through children's open sores.
'And it's said that Haiti has been a popular holiday resort 'for gay men from America.
'Jose has AIDS and toxoplasmosis.
'He's a Spanish-American with no taboos about being gay.
'He's a teacher of classical ballet.
' CLASSICAL MUSIC PLAYS 'A surgeon has removed the cyst from his brain 'that had almost paralysed his right arm and leg.
'For Jose, the research among the Haitians 'may have saved both life and livelihood.
'It's gay men and heroin addicts 'who may unwittingly have created the link to the next group.
'In 1982, several haemophiliacs died 'and others, as yet unaffected, are worried.
'Steve Pasquale's haemophilia was diagnosed when he was six months old, 'but there was no treatment at all in those days 'and his life was always in danger, particularly from internal bleeding.
'He received plasma from the age of four 'then, at ten, a deep-frozen precipitate from plasma 'that helped to clot his blood.
'It was always given under medical supervision.
'He was tied to the hospital.
'But ten years ago, when Steve was 17, 'a new concentrate of the clotting agent, called factor VIII, 'revolutionised his life, 'because he could make it up himself when and where he needed it.
' Thank you.
'But now it looks as though some has been contaminated.
'Must Steve now give this up? 'He does it all himself, 'timing the infusion according to an increase in stiffness in the joints.
'He'd come to expect a full and normal life.
'He consults specialist Shelby Dietrich.
' Hello, Steve, how are you? Hello.
All right.
I would expect you've got some questions or feelings about this whole problem.
Yeah, it's a little, er you know, anxiety creating.
'There are 20,000 haemophiliacs in America 'and, by this day, 10 or 11 cases of AIDS reported and five deaths.
' - So they think it's in the factor? - Well, yes.
The point is, haemophiliacs absolutely have to be treated for their bleeding problems, and you know that, and I'm sure it raises all kinds of questions about, "What do I do now?" Whenever any of the haemophiliacs get together, it's a topic of conversation that always comes up.
I think everybody's a little scared.
"Is this the infusion that's going to give it to me?" I'm not ready to give up the benefits of concentrate yet.
'But if there were a problem with this batch, 'could it be traced back to its source?' Each lot of these clotting concentrates is pooled from over 2,500 donors each, so that haemophiliacs are exposed to literally tens of thousands of donors per year.
Tracking all of these donors back from a case is virtually impossible.
'How can we be sure that all blood products are safe? 'Stop gay men giving blood? 'Gay leaders say that's unacceptable.
'Everyone should have the same rights and the same obligations to society.
' Is that all right? .
.
on a kidney machine? No.
'In New York, volunteer donors are asked questions 'that should reveal some of the symptoms of AIDS.
' OK.
Have you lost a lot of weight recently? No.
Have you been exposed to any infectious diseases that you know of in the past three weeks? - No.
- OK.
'And there's an inspection for intravenous drug use.
' OK, thank you.
'But is this enough? 'In principle, a further possibility 'would be to screen the blood's helper/suppressor ratios, 'as it's tested here automatically for blood groups.
'But it would be expensive and would take time to develop.
'The contamination of blood and its products 'is not just an American problem.
'Half of the factor VIII used in Britain comes from the United States.
'And just how far can AIDS spread 'beyond the four main high-risk groups? 'To women, too? 'Among the early pentamidine requests, one was for a woman.
'Two Greenwich Village doctors, Joyce Wallace and Joe Sonnabend, 'have found that, among their gay patients, 'the number of sexual partners 'correlated remarkably well with immune deficiency.
'Joyce Wallace decided to see 'if that was true for New York prostitutes as well.
'Trading free checkups for their stories and for samples of blood, 'she found women with compromised helper/suppressor ratios.
'She felt this supported her belief in the immune overload theory.
'Again, it seemed to be related 'to the sheer number of different contacts.
'There's no evidence as yet 'of any transmission from prostitutes to their clients.
'But her next patient, not a prostitute, 'seems to confirm the transmissible agent theory.
'This woman was simply married to a heroin addict 'and now she, too, has been treated for the pneumonia 'and other secondary diseases.
'She was an hour late for this appointment.
' I'm a little bit tired, as usual.
I haven't been, er, having the fevers or the chills lately, but, um, it's been hard getting around, still.
I don't travel on the trains because I'm afraid of fainting and, you know, dizzy spells.
So, not really 'Joyce Wallace believes that Dolores's story is reliable, 'although it contains one very curious detail.
'Her first symptoms of AIDS appeared 'over a year after she left her husband.
'Can AIDS hide in the body for so long?' I have Septra for the pneumonia, and, um, Tagamet.
'Joyce Wallace also believes 'that for every woman like Dolores, whose AIDS is reported, 'there are six more with lesser complications.
'The disease CAN reach women.
'But babies, too? 'Eight cases have been reported from one town alone.
'The population of Newark, New Jersey, includes 22,000 Haitians, 'gay men who can't afford the prices of Manhattan, 'and drug addicts.
'Most of the high-risk factors are bundled up together.
'At Newark's St Michael's Hospital, 'Jim Moleski has treated eight babies with AIDS.
' Because of the wheezing he had in his chest 'The eldest of the eight is Ramir.
'This is a checkup prior to his release from hospital.
'Of the other seven babies, all under eight months, 'four died from the pneumonia or cytomegalovirus.
'Only one of the eight had received blood 'but one was a haemophiliac and two were Haitians.
'One had a drug addict father with an uncle living in who was gay.
' RAMIR CRIES DOCTOR: I know, I know.
'Ramir's doctor believes 'that he was infected while in the womb.
'His mother was one of several who were intravenous drug addicts.
'From today, he'll be in the care of his aunt.
' All right, I'm here.
'A biopsy to confirm the pneumonia left the upper scar.
'That below is where the lung was drained.
'Ramir's first symptoms did not appear until well after he was born.
'The same was true for most of Newark's other baby victims.
'Is this another sign of a slow, hidden incubation? 'The strongest and most disturbing evidence of that 'comes from those jails in New York State where AIDS has been reported.
'In principle, prisons provide a unique opportunity 'to monitor the progress of the disease, 'especially if it develops when the man's already inside.
'But there are problems.
'It's well known that there's homosexuality in prisons 'and prisoners' own statements are notoriously unreliable, 'but in every case investigated, 'the man claimed to be strictly heterosexual 'while all or most, it seemed, had been on heroin outside.
'And that was supposedly stopped when they arrived in jail.
' OK.
'Investigating such cases, CDC man John Hanrahan.
' Do you remember when you first felt ill? How long after you were in prison did you start feel ill? Well - I went to Sing Sing - Yes.
- Um, in March.
- Yes.
And I started getting sick on, like, um .
.
the beginning of April.
You know, between March and April.
'From a year's investigation, 'John Hanrahan's tentative conclusion is this.
' JOHN: 'The bulk of their drug use, if not all, 'occurred prior to them feeling imprisoned.
' What that allows us to do is to try to establish a minimum incubation period, from the time they stopped drug use, which is coincident with the time they entered the prison system, and the time they developed symptoms of AIDS.
And for the ten inmates that we have data on so far who have had AIDS, nine of those, the only risk factor we know for them is IV drug use before being incarcerated.
And their symptoms developed anywhere between three and 36 months after they were incarcerated and after their drug use stopped, the average being about a year-and-a-half.
That tells us that the incubation period of AIDS in this group, and maybe in all groups, is quite extensive - on the order of many months to even years.
'Characteristically, the former addicts 'had developed pneumonia after a considerable delay.
'Three had already died in jail.
'Four others remained very ill.
' - Hello, Mrs Castronova.
- Hi.
Go right on talking to your husband.
I know your time is limited here.
Yeah 'Prisoner Castronova's speech is affected.
'He may have toxoplasmosis as well as the pneumonia.
'This is one of his better days.
' MRS CASTRONOVA: You look a lot better.
He looks good today.
And if it wasn't for my wife .
.
I don't know what I'd be doing.
She's been there with me every day - intensive care I was in intensive care.
Er, I left here for, what, four months? - Mm-hm.
- Went back to prison .
.
and they shot me right back here.
And they have no cure for it at all.
What's rough now is, I don't know if I'll ever see my kids again.
You know? Like a walking time bomb.
You know? But that's what they said.
"You're like a walking time bomb.
" Aww.
- Huh? - No, they'll find a cure for it.
Some day, but it might be too late.
You know? So you people that are out there shooting dope - give it up.
Because I'll never make it through.
You know, if you've got any value for your life .
.
give it up.
'Soon after that day, Castronova died.
'All these cases have strengthened fears 'that there may be a year or two of hidden disease 'already in the pipeline before anyone at risk is off the hook.
'There are more secondary diseases, too.
' We've recently recognised that additional cancers and additional serious disorders such as, um, deficiency in platelets are part of the syndrome and it's quite likely that for every case of reported illness, there are anywhere from 10 to 100 more cases of mild illness.
'Could it be caught early? 'At the Jules Stein Eye Institute, Los Angeles, 'Gary Holland has observed small, white patches - 'they call them cotton-wool spots - on the retinas of men 'who later developed the more obvious symptoms of AIDS.
' Look to the left.
'They don't affect vision 'and they're precursors to other diseases, too - 'high blood pressure or diabetes could cause them.
'But here, six months later, 'that same retina was overwhelmed by cytomegalovirus.
'The diagnostic method that's normally used 'is to measure the white blood cell helper/suppressor ratio 'and machines like this should soon be able to do it in a few minutes.
'By previous methods, 'one technician can process only about ten cases a week.
'But more serious is the scientists' limited understanding 'of the normal range and behaviour of the immunological system 'and how it can be corrected when something goes wrong.
'Being able to measure it at all is still a scientific novelty 'and, on the day we filmed this machine, 'the final calculation of the ratio was made on paper.
'But where the immune system is already suppressed, 'is there any cure?' Excuse me, Jim, I'm going to insert the needle now.
'One possibility is to inject some substance 'that promotes the growth of the white cells that are missing.
'At the Sloan Kettering Memorial Hospital, New York, 'Jim was very happy to be given the chance to try out interluekin-2.
'A day's supply, extracted from 50 pints of blood, costs 1,000.
'From the box, it's pumped in near a lymph node in the groin.
'It won't repair the defective immune system 'but it's already given Jim relief from his secondary infections.
' This interleukin-2, which some people also call T-cell growth factor, does just that - it makes T-lymphocytes grow.
What I should mention is that, in the test tube, your cells didn't make any interleukin-2, but when we added in the interleukin-2, behaved just like normal cells.
'And it did seem to work, 'until the expensive experimental supply ran out.
'Later, he developed Kaposi's sarcoma 'and joined other patients in a larger trial.
'This is interferon, which has its problems, too, 'for a dozen different kinds have been identified in man.
'Should you use a lot or just a little? And of which? 'Several new synthetic interferons are ready to be tested 'and, in San Francisco General, Scott was one of the first to get it.
'His weakened immune system might be damaged even more by chemotherapy, 'while interferon might prod it into action.
'It's a gamble.
' I was just discussing with the doctor the experimental factor.
I haven't seen enough results to be too encouraging, and I wondered if I have been wasting valuable time not being on chemotherapy.
So, I do have my reservations but I'm going to follow through with the entire treatment plan and, er, I'll see what happens then.
I really don't know.
My mind is not made up on that point, as to how I feel about the whole treatment plan.
If I were seeing remarkable results, of course, I'd be ecstatic.
And I'd have no questions or reservations whatsoever.
But, er, that's not the case.
'In these trials, the results so far have been patchy.
'Perhaps, for Scott, any effect so far has been overlaid by shock.
' The shock was so great.
I stopped smoking marijuana, I stopped smoking cigarettes, I've stopped drinking.
I've stopped, er, sexual contact, I've stopped I stopped, basically.
'There are still no absolutely certain answers 'to the most important questions.
' - How do you get it? - Yeah, how do you get it? Is there any cure for it? Can there be some way you can put it stop to it? - Or medicine? - Medicine? Shots or something? 'They're talking to a gay health counsellor.
' COUNSELLOR: What if I told you that the diseases that are going around now have no cure, and they lead to death within a year? Oh, I'd move.
HE WHISTLES IN AWE That you can catch it through sexual contact, and that the more sexual contacts you have with people, the higher your risk of catching it? What would you do now? Oh, that's tough.
COUNSELLOR: Assuming I told you the more times you have sex with different people, the higher your chances of coming down with this.
Yes, I would stop having sex with people.
- Oh, definitely.
- Very definitely.
'Changes in sexual behaviour should halt the spread of AIDS.
'But that can be difficult.
' It's very difficult in relationships.
In my primary relationship, I had a boyfriend for a year prior to becoming ill and when I became sick and it became clear that I had something that was very serious and was possibly transmissible, the question arose as to whether or not I should remain with this man.
Um, on the other hand On the other hand, the doctors were saying that it was better to stay with a single partner than to go and be with someone who had not been previously exposed, presumably this man, Ron, whom I had been with, had already been exposed to any viruses that I might have had.
So it put tremendous pressure on the relationship.
It's like, "I have to be with you or there's no possible option for me - "I have no outlets except for you.
" Large numbers of people have become chaste, are no longer seeking sexual are no longer seeking sexual satisfaction with other people, period.
And these people are not sick, they are living in terror that they are going to develop this disease that I have.
So I-I don't know what to make of it.
What I do know is that because I'm immunosuppressed, I am I believe that other people are more dangerous to me than I am to them.
'True - doctors and nurses who work close to patients 'don't seem to be at risk.
'And of those at greatest risk, still over 70% are gay.
'To survive, what course does Bobbi Campbell recommend?' It would seen to be healthful at this time, in order to protect oneself, to limit the number of sexual partners.
In part, that reduces your risk of disease of any type, even gonorrhoea, which at this point is beginning to look like garden variety.
But to limit the number of sexual partners and to limit the frequency of use of recreational drugs I think is certainly a wise recommendation.
MUSIC: "Nipple To The Bottle" by Grace Jones 'The British gay community 'is no longer just watching on the sidelines.
'There have been deaths here, too.
'AIDS has already arrived in Britain.
'Do we already have the hidden seeds of an epidemic here?'
For this collection, Prof Alice Roberts has selected a range of programmes to celebrate Horizon's 50th anniversary.
More Horizon programmes and other BBC Four Collections are available on BBC iPlayer.
MUSIC: "Nipple To The Bottle" by Grace Jones # Colour and warmth Came into your world 'Girl dancers give a charity performance 'before an audience that contains a high proportion of homosexual men.
'Martyn Butler and his friends 'had seen the slow death of Terrence Higgins, 'one of the first British victims of a bizarre new disease.
'Now they're raising money 'to promote research and health education 'for those most at risk.
' # .
.
I won't do it tonight # I won't do it tonight No way, baby 'Among British gay men 'there's a strong admiration for all things American.
'There's a great deal of travel between the two countries, 'and in America this new disease has already become an epidemic.
'In New York, this is Greenwich Village.
'Centred in and around Christopher Street 'on the west side 'of this traditionally Bohemian district of Manhattan 'is a vast community of gay men, 'said to be hundreds of thousands.
'Here the killer disease has taken its greatest toll of death, 'and of fear among those who walk in its shadow.
'It's a world full of signals, 'such as which side a bunch of keys is worn 'to indicate a preference for the active or the passive sexual role.
'Some bars or bathhouses cater for extremes of promiscuity.
'This door leads to a private club of international reputation 'that occupies three floors of the large building behind it.
'In sharp contrast, 'some of the disease victims that we met claim to be monogamous.
' SINGING 'This is such a household, 'given over, it seems, to music and the arts.
'WC, the aspiring musician, 'had for nearly a year lived together happily with his boyfriend Kevin 'when disease struck the younger man down, 'savagely interrupting his career as a model 'and dashing his hopes 'of becoming a commercial artist and textile designer.
'With an impaired immune system, 'Kevin's resistance to disease is lowered.
'His condition is called A-I-D-S - AIDS.
'It lets in secondary diseases that can kill.
' I'd noticed these bumps on my skin and they looked a little suspicious.
They didn't hurt, but they were very strange and they were multiplying.
It started out with one, then the next day there were three and up to this point now, a month-and-a-half later, there's, like, close to 30.
'In fact, it's a cancer.
' I drew a picture about a week before we found out about it and Kevin said, "What is it?" and I said, "It's gay cancer.
" And we kind of laughed and then within a week he was in the hospital.
'With Kaposi's sarcoma.
' The tumours can be somewhat disfiguring, especially in a person as attractive as Kevin.
I was a little bit more in shock at the beginning of this than I am now.
It's been hard.
You know.
I'm very scared that I will come down with the Kaposi's at some point.
Well, I think it's definitely transmissible, just how I don't know.
Is it through blood, is it through saliva, is it through? I don't know.
'Kaposi's sarcoma starts with purplish-pink spots 'like blood blisters or mosquito bites 'that don't itch and don't hurt, 'but they don't clear up.
'Kaposi was a 19th-century Austrian doctor 'who saw it in elderly men of Jewish or Mediterranean origin.
'Medical students are taught that the cancer develops slowly 'and rarely causes death.
'But in these young Americans 'it develops rapidly in more and more sites - 'here, inside the rectum - 'until, without effective treatment, the patient will die.
'This is Kevin's last weekend before going into chemotherapy, 'but he knows that's only part of his problem.
'He has cancer because his immune system has broken down, 'and it's this underlying immune deficiency 'that others have called the "gay plague".
'That name, with its hints of divine retribution 'for a despised and segregated minority, 'is not popular among gay men.
'Homosexuality has been around a long time, 'so they see no reason why this immune deficiency 'should be so strongly represented in their community.
'Why here, and why now? 'Is the underlying syndrome infectious? 'How far will it spread? 'Can anything be done to stop it? 'WC and Kevin are putting on a brave show, 'but they'd like to know - can AIDS be cured, 'or will it put them at risk from other diseases, too?' How long have you had those stomach pains altogether? Actually they started a week ago Wednesday.
I see.
'The doctor suspects that John has an unusual form of pneumonia.
' What was the very first symptom? Loss of weight.
Mm-hm.
Was the first sign something was going on.
Just started losing weight for no good reason? I lost 30lb in one month.
In one month.
And how much weight have you lost altogether? About 60 Almost 60lb.
'John is the latest victim 'of a widespread epidemic of bizarre infections, 'all connected with AIDS.
' Are they high fevers? 'In fact, it was this rare pneumonia 'that first alerted the Centers for Disease Control in Atlanta, Georgia, 'that something very odd was going on.
'Usually it's people like transplant patients, 'whose immune system is artificially depressed, 'who sometimes get the pneumonia, 'and Sandy Ford controls all supplies of the best drug for it.
' I need your patient's name, age, sex and weight and the underlying reason for the immunosuppression.
'In 1981, there was a sharp increase in the number of requests.
' There's no underlying reason for the immunosuppression? 'The drug's restricted, and she's supposed to have a clear diagnosis.
' He's not on chemotherapy for any malignancy? 'Just checking - chemotherapy also hits the immune system.
'When this first happened 'all she could think about was her uncompleted paperwork, 'but then it happened again.
'And again.
'In a matter of months, 'the unsatisfactory forms began to pile up.
'The requests came mostly from around New York and from Los Angeles.
' How about WBC count? 'White blood cells.
' 2,000.
'That's low.
' Why is it that you're opting for pentamidine over more conventional therapy? 'Pentamidine is what they call an orphan drug.
'It's never been needed enough to make a profit 'and these days testing new drugs costs a fortune.
'So they call this experimental 'and hedge it around with paperwork.
'Instructions - "Dear Doctor, enclosed is not only the drug ' "but also a special note on what's known about it, ' "and a consent form for the patient to sign.
" 'As it happens, pentamidine is, or was until recently, 'made at Dagenham in England.
'And here at CDC is the whole world's supply, 'bought up by Sandy Ford.
'At the start, she didn't realise the importance of her evidence, 'that her records hold an answer to the question - 'is this disease really something new? 'To CDC's epidemiologists, 'the increased demand was a puzzle.
'They thought they'd better find out 'what happened to the drug Sandy was sending out.
'Some went to 'the University of California Los Angeles Medical Center.
' Very slowly.
'By mid '81, Michael Gottlieb had seen five patients 'with the rare pneumonia.
' Hi, James.
'Jim's a bartender who, for family reasons, 'prefers not to face the camera.
'Pentamidine has halted the pneumonia, 'but that's a secondary infection.
'It'll do nothing for the immune deficiency that underlies it.
' What's your understanding at this point of this condition? I really don't know much about it yet.
But you had heard about AIDS prior to your developing pneumocystis? Yes, I'd read about it in the gay trade papers and other newspapers.
'Gottlieb spotted and reported to CDC 'the crucial fact that it was gay men who were getting 'the pneumocystis carinii pneumonia parasite in their lungs and dying.
'Anyone could pick this up, 'but in a healthy population the effects are trivial.
'The second most common infection in the epidemic among gay men 'is a form of tuberculosis that's carried by birds, 'and it's highly unusual to see it in humans.
'It's yet another opportunistic infection.
'Alfred, too, lost weight.
'That was quite a while back.
' Just about a year.
'Again, there seems to be a deficiency 'in part of his immune system 'that would normally protect his body 'from organisms that are carried by other creatures.
'Reggie's problem is a very nasty form of diarrhoea.
' It varies.
Like, I go at least 20 times a day.
20 times a day? - Are they watery, or? - Watery.
How do you feel now? I don't want to say lousy, but - Yeah.
- Still alive, so 'Reggie may have an unusual disease with another obscure name, 'cryptosporidiosis.
' You lost 11lb, you never gained it back.
- No, I didn't.
- I see.
Reggie, did you bring me a specimen? Yes, I did.
Oh, let me see.
Show me your bottle.
I see, so this is all night, huh? OK, put it back.
All right.
'Reggie, who used to be a clerk on the stock exchange, 'had to borrow 30 for his stool test 'for a disease that's normally carried by cattle.
' - Take care.
- See you.
'In men with AIDS, the parasite lodges in the gut lining, 'causing it to weep, leading to dehydration and total exhaustion.
'And a speedy diagnosis may not help much 'since drugs don't seem to touch it.
'Reggie is lucky in one tiny way - 'most previous cases have been confirmed 'by surgically taking a specimen from the gut.
'At St Vincent's Hospital, New York, 'Pearl Ma's contribution to medical science 'is a non-invasive method of diagnosis.
' 'At the moment, cryptosporidium can take its toll over many months 'until some final collapse leads to death.
'But when a cure is found, 'it'll be essential to distinguish the spores of crypto 'from those of thrush, a common fungal disease, 'which, though serious in men with AIDS, can be treated.
'In this test, fungal spores take the green stain, 'while the cryptosporidium spores will remain red.
'And it's red for cryptosporidiosis, 'a disease that farmers can pick up from cattle, 'but which is normally self-limiting.
'Yet, it's now a deadly part of that same AIDS epidemic.
'To CDC in Atlanta came the reports - 'the pneumonias in Los Angeles, some cancers in San Francisco, 'with many more of both in New York, and all, it seemed, were gay.
'An epidemiologist from the Sexually Transmitted Disease Department 'was told to set up a task force and deal with it fast - Jim Curran.
' JIM: We liked to work on a project for three months and say that we saved x-thousands of lives.
I was the detail for three months in July of 1981 and now having moved into the permanent job, mid-1981, we were able to find that there had actually been cases diagnosed in isolated centres perhaps as early as 1978.
From 1979, there was an essential doubling of cases, approximately every six to nine months.
'And by early 1983, 'there were around three new cases every day.
' The disturbing thing was to realise that these three cases per day are occurring in relatively small segments of society and are at this time relatively contained among a few small-risk groups a few high-risk groups Additionally tragic about these illnesses are their economic and physical toll upon the people before they die and their occurrence in very young persons - the average age of victims is approximately 35 - and the average hospital bill often exceeds 100,000 prior to death.
'Bobbi Campbell, a nurse in San Francisco, 'was one of the earliest AIDS victims still alive.
'On a walking holiday, 'he'd found what looked like a blood blister on his foot.
'It didn't clear up so he showed it to a dermatologist who took a biopsy 'and diagnosed Kaposi's sarcoma.
' I was I was devastated, I was 29 years old and I had cancer, I had a cancer that had killed a number of gay men already in this country and in some other countries.
I felt like my death might be imminent even though I felt fine.
All I had was spots on my feet, but I had this potentially fatal illness.
I went into a I think a very severe depression, I got drunk quite a lot, spent a lot of time on the phone telling everyone that I knew that I had this I felt that there were two ways that I could approach this, I could either keep it completely within myself and tell no-one, or I could tell everyone that would stand still long enough to listen.
I chose the latter option because first of all it enabled me to educate other people who were also at risk for this disease and it also earned me personal support in a time when I was really in crisis.
At that time I went on disability for my job, I didn't want to risk being around sick people.
It's still depressing, feeling that I have this chronic illness that could kill me.
In the year since I've been diagnosed, I've had three people that I know personally who have died and that each time it's a blow to the heart.
'The population of the city of San Francisco 'is 650,000 men and women.
'No-one knows how many gay men have come here, 'estimates range from 100,000 up.
'Gay newspapers here have emphasised the cancer 'and there's a Kaposi's sarcoma project 'in one of the University of California clinics.
' - Good morning.
How are you today? - Oh, hi, Bob.
- Hello.
- Ready to take my blood? Yes.
'Nurse Helen Schietinger gives her gay patients a sympathetic hearing.
' I guess it's been about a month now you've been on chemotherapy? - Yes, it has.
- You're finally coming back? Yes.
The biggest spots are going away, so that's nice.
Good, that's terrific.
'In more puritan communities, Bob might face intolerance or ridicule.
'He's escaped from that, but into a different kind of nightmare.
' At least you're used to this by now, with the blood-drawing for the chemotherapy.
You get used to lots of things you never used to think you would get used to.
- Good.
How's that? - That's fine.
'His blood is urgently needed for research.
'Already, there's one way to monitor his immune system.
' HELEN: Heart is doing the work just fine.
'In recent years, work on the body's immune defences has 'begun to uncover an extremely complex system 'that includes a wide range of specialised white blood cells.
'Some act as helpers, others as suppressors.
'Their job is to help protect our bodies from cancer 'or from certain invading organisms.
'A helper recognises the alien cells and sends for reinforcements.
'More white cells are produced and these attack 'and try to kill the invader.
'When the job is complete, 'the suppressor cells register the information 'and send a second message - 'close down production, the emergency is over.
'Normally, when we're healthy, we have more helpers than suppressors, 'maybe twice as many, 'but AIDS may increase suppressors and drastically cut back the helpers.
'One sign might be swollen glands.
'Take the ratio down further 'and some men become vulnerable to Kaposi's sarcoma.
'Further down still, and any of those bizarre infections that are around 'may take its toll.
'At worst, there may be so few left 'it's difficult to find enough to count.
'Now all kinds of disease can strike down the helpless victim.
'In Bob's case, the puzzle is that Kaposi's sarcoma set in 'so early in the downward pattern of the immune disease.
' - OK, now don't bend your arm back.
- OK.
Just leave it right like that.
Yeah.
I don't think I've developed any new spots, but at least it'll It'll give 'em a chance to check it.
'But a clue to that may also be found in the blood.
'Recent research implicates a genetically determined marker 'on the surface of each cell.
'Monoclonal antibody can be made to react with 'a sample of blood from anyone who has the marker.
'Men with the marker seem to be more susceptible to this cancer 'when they get AIDS.
'And at the present rate of progress, 'there are ten times as many men with AIDS every two years.
'Unless there's some dramatic change, 'that exponential growth will continue 'unless the disease is identified and stopped, 'or it weakens or resistance to it grows, 'or if there's a change in lifestyle which stops its transmission, 'or failing those, when everyone at risk has got it.
'Having seen so many of the earlier deaths, New York's Greenwich Village 'was a good place to begin a search for the causes of AIDS.
'In 1981, at nearby New York University, 'immunologist Al Friedman-Kien joined forces with Linda Laubenstein, 'who'd been treating gay Kaposi patients for nearly two years.
' By May of 1981, we had about eight cases of all young homosexual men in their 30s, who had this disseminated form of Kaposi's sarcoma.
They would tell us about the frequency of sexual encounters, they were extremely promiscuous.
They'd all had histories of multiple transmissible sexual diseases such as gonorrhoea, syphilis, giardiasis - which is a parasitic infection - and amebiasis, which is now considered a sexually transmitted disease among homosexual men, especially in New York.
'Outsiders were quick to attribute AIDS to the men's sexual activities, 'but what was new in that? 'Every possible variation had been around for thousands of years.
'But Al Friedman-Kien noted one activity 'that was new to this society.
' They had histories of taking what we call recreational drugs - marijuana, cocaine and especially amyl and butyl nitrite, which are used as sexual stimulants during sexual activity.
And they're sold under the names of things such as Thrust, Locker Room .
.
Poppers, old-fashioned fragrance.
Blackjack.
Bolt.
Hardware.
And Quicksilver.
And this particular agent was used by 100% of our patients and, initially, we were rather suspicious that there may in fact be a relationship between the use of this drug and the evolution of the Kaposi's sarcoma and the opportunistic infections which we've been seeing in homosexual men.
'The president of New York's Gay Men's Health Crisis showed us 'how nitrites are used although, to avoid problems in his job, 'wouldn't show his face.
' It's an inhalant and they block one nostril with their finger and inhale with the other nostril and you have an almost immediate high.
How long does a bottle like that last? Oh, one night in a disco.
Do people just keep? They pass it around a group, whoever is dancing together, it's passed around from person to person.
'But were these the cause of AIDS? 'If so, there'd be no need for big changes in lifestyle 'in the major gay communities.
'To the world outside, Hollywood is still the movie capital of the world, 'but to the people who live around here, 'it's also the centre of the gay district of Southern California.
'Around Los Angeles, 'there are thought to be 200,000 to 400,000 gay men.
'What is new in recent years, apart from nitrites, 'is the sheer numbers that have gathered together, 'plus the greater sexual openness and freedom 'that gay liberation has made possible.
'Did this contribute to the spread of AIDS? 'In their personal relationships, 'gay men are free from feminine restraints.
'In heterosexual relationships, the male traditionally is the hunter.
'When both are hunters, the effect is explosive.
'Some gay men can claim hundreds of tricks - 'that is new sexual contacts - each year, 'so sexually transmitted disease is commonplace - 'for many, an inevitable part of the lifestyle - 'and regular checkups 'guard against the health hazard of sexual overload.
'This is the clinic 'attached to the Gay and Lesbian Community Services Center 'in Los Angeles.
' Room one, first door on your left and you charge in at the desk.
Appointment number six, please.
'No lesbians - women have more stable relationships and less disease 'if they avoid men.
It's just men who come here, maybe 70 a night.
' - How you doing this evening? - Just swell(!) 'Around 15,000 a year.
' The doctor wants you to take tetracycline - one capsule, four times a day for the next ten days.
You should avoid sex for the next ten days, plus three days afterwards to see if your discharge returns.
'This clinic is run by gay volunteers.
'Other men go to private doctors who may also be gay, 'or to the county clinic.
' OK, you just came in for a routine screening, OK? There's no charge for routine screening, but I will ask you for a donation, OK? 'Most men here have something - gonorrhoea, syphilis, NSU, hepatitis, 'the list goes on.
'With so much existing disease, who needs a new one? 'And that was the idea behind another of the theories offered.
'Immune overload - 'an explosion of sexual activity leads to so much disease 'that the immune system is permanently damaged.
'However, that's never been seen before 'with other kinds of disease.
' .
.
So that means you do not have gonorrhoea, but you have nonspecific urethritis.
You take this pill, one pill, four times a day for ten full days, - drink lots of fluids - Mm-hm 'Compared with all the rest, AIDS is still quite new and so is this.
' AIDS hotline.
Yes, I'd be glad to give you the symptoms.
Low-grade persistent fever, night sweats, dry coughs that are not related to colds or smoking.
Weight loss of more than 10lb during a period of less than two months.
Enlarging lymph nodes 171! 'He's checking contacts - 'for the major infections, they want to know who else needs treatment.
'Should that be done for AIDS too? Linda Laubenstein.
' LINDA: As we gathered up more and more patients, as patients would meet each other in the office, it became apparent that many of the patients had had contact with one or two, or perhaps more, other people who had the syndrome, which began to suggest to us that perhaps there was a sexually transmittable a single sexually transmittable agent that was being passed around in the community.
'A virus, perhaps? 'At that time, only 19 cases had been recorded in Los Angeles.
'From their local office, they managed to track down just 13.
'Were they linked, did they know each other? David Auerbach.
' Of the 13 cases, or contacts of cases whom we interviewed, we found that there were histories of sexual connection between nine of those 13.
Those cases, those nine cases in Southern California are represented here.
These circles represent cases of Kaposi's sarcoma or pneumocystis carinii pneumonia, and here we have interconnections, histories of actual sexual contact between nine of these cases.
Included here to make these connections is one case, only one that was not from Southern California.
'An airline steward.
' This case has been found to have connections with 40 approximately 40 other cases of AIDS, mostly in New York City, but some from several other cities in North America.
We believe that this sort of cluster information does make it more likely that we are dealing with a communicable agent and we believe that because of that, laboratory resources should be more and more directed to looking for a communicable agent that the cases might have been exposed to.
'So nitrites seem to be out.
' - Yeah.
Look, though, the semen - All right, thank you.
'All over the States, the search is on for some organism 'that could transmit AIDS.
'Here they're looking in the diseased lymph nodes 'removed from AIDS victims.
'They also have a sample of seminal fluid.
'The idea they're working on 'is that it might be a sexually transmitted agent, 'rather like the virus for hepatitis B.
'But what they don't know is whether to look for something completely new, 'never seen before, or something that's common, 'thought of as harmless, 'but which has produced a new mutation 'which is doing all the damage.
'Dick Miner is one of several investigators on yet another track.
'Could it be the agent of some mild disease 'that's transmitted among gay men 'in a way that makes it specially dangerous, 'perhaps also promoting the cancer? 'He's been looking for evidence of cytomegalovirus - CMV.
'There's its signature - the dense body 'and several incomplete particles, 'just the coating.
'The lymph nodes of sexually active gay men are often loaded with CMV, 'but was it the cause of the disease or more likely 'just another opportunistic infection? 'Recently, interest has switched to a human T-cell leukaemia virus, 'and seminal fluid is a good place to look for a virus 'that's sexually transmitted.
' - Dick, how are you doing? - All right.
Do we have enough specimen to do the complete works on this one? Yeah, yeah.
This one, small volume, but it's adequate.
'But a further problem - 'it's been found that if sperm are injected into the bloodstream 'of a mouse, 'that alone is enough to suppress its immune system.
'In New York, Alvin Friedman-Kien again.
' ALVIN: Our most exciting hypothesis, and the one that we're working on most right now is that with the multiple exposure to sperm that homosexual men have from a variety of sources, both through the rectal route or through the oral route, and possibly through tears in the mucosa or absorption through the mucosa, that the sperm is able to penetrate into the immune system or into the blood.
'In a survey of gay men in New York, 80% had an immune deficiency, 'but their average age was 35.
'To see how the deficiency is acquired, 'they need to study younger men.
'At UCLA, volunteers from the students' gay club 'were recruited by the dean of the School of Public Health, 'Roger Detels.
' We looked at the ratios of helpers to suppressors in this group of 89 young homosexuals and also looked at the absolute levels of suppressor cells and of helper cells.
We also did a detailed questionnaire on sexual practices.
'At that early stage of an active sex life, 'they often found a substantial increase in suppressor cells, 'but caused by what?' We found that there seemed to be an association with receptive anal sex and NOT with active anal sex.
If the organism is introduced, the hypothesised organism is introduced into the bloodstream of the individual through breaks in the rectal mucosa, the agent might be present in the sperm of the partner or it might be an inhabitant of the faeces of the individual himself and would gain access to his circulatory system because of the breaks in the rectal mucosa.
'And nitrites are implicated only because 'they help relax the muscles to receive anal sex.
'Highest risk? 'Men who receive a lot of anal sex from many partners, 'to which some gay men respond that it's not just them.
'Others get AIDS, too.
'Leandro injected heroin directly in his veins.
' Ugh, I feel terrible.
I feel pain in my stomach, my bones .
.
in all my muscles, I feel weak.
I think that's because I lost about 40lb, 42lb, something like that.
You feel very bad, dizzy.
'This is a complication in the story, 'but it's know that intravenous drug addicts can pass infection 'such as hepatitis B in traces of blood on dirty needles.
'Could an agent for AIDS be passed around like that?' I had a lot of diarrhoea, oh, about seven days with it.
INTERVIEWER: Diarrhoea? You're going to the lavatory a lot? Oh, boy, I've gone crazy with that, going to the bathroom all the time, all night long.
'His white blood cell count was lower than any we've yet seen.
' That's what they say I have.
My blood is so low that I can't find no You know, no matter how small the infection is .
.
I can't fight it.
'Leandro is NOT a homosexual.
' My wife come every day.
But they don't let the kids come on up.
They're, like, too small.
'Weakened by his addiction, 'he's fallen victim to an extreme form of AIDS, 'with a bewildering range of symptoms.
' I don't even know how to describe the way I feel.
'His doctor can describe it, listen not for the technical details, 'but simply for the number of diseases.
' DOCTOR: 'He presented with diffuse lymphadenopathy, 'profound diarrhoea of several months' duration, 'as well as 40lb of weight loss.
'He also had oral thrush, which is a candida infection of the mouth, 'and an unusual intestinal parasite called isospora, 'which we have not really seen in these patients before.
'He also has a hepatitis, some unusual eye lesions 'and lymphocytopenia with a reverse helper 'and suppressor cell ratio, 'which we've been seeing in the AIDS syndrome.
' So I don't know, what's it going to be? 'When a disease occurs in more than one group, 'epidemiologists seek a common cause, which, in principle, 'should become easier when a third distinct group is discovered.
' Hello, Mr Destine.
HE GROANS 'Destine, a Haitian, is very sick.
How are you feeling, otherwise? INDISTINCT REPLY 'But for a year after AIDS was first observed, no-one made the connection, 'this looked like a completely separate problem.
' Is your head still hurting you? Is there any pain in your head? No.
That's very good.
'He is wasting away, and a disease in the brain affects his speech.
' How's your strength otherwise? INDISTINCT REPLY 'He can't control one arm properly.
' Try to hold a fist for me.
'One medical scientist was busy writing a paper putting it down to 'a new form of syphilis 'brought in by the immigrants that was fatal in two to six weeks.
'After three such deaths at Miami's Jackson Memorial Hospital, 'pathologist George Hensley decided to take a look.
'His bet was tuberculosis, 'but among several less likely possibilities was 'a disease called toxoplasmosis.
'That's a parasite carried by lions and other felines, 'including domestic cats.
'In humans, it lodges in the brain 'but is held in check by the immune system.
' Well, yeah, I'm going to make the first slice 'It may form a microscopic cyst, but causes no further trouble.
'Today, Hensley knows exactly what he's looking for.
'Indeed, his research has led others to identify warning signs 'in brain scans.
Here's a ring of advanced toxoplasmosis 'spreading outward through the brain.
'This patient died within a few days.
'Syphilis and TB were out, but as more cases came to light' See the softening.
'.
.
there was a new problem.
'Was this a dangerous new strain of toxoplasmosis 'brought in by the Haitians? 'Hensley duly reported his findings to CDC, who promptly sent a team 'to follow every lead.
' What is causing it is this lesion within a necrotic, firm centre.
'Their first port of call was Krome North, 'a kind of concentration camp 'out on the edge of the swamps inland from Miami, 'where, at that time, thousands of Haitians 'were crowded together as illegal immigrants, 'pending a decision on what to do with them.
'The women, in their own compound, 'were investigated as carefully as their segregated menfolk.
'About a third of the toxoplasmosis patients were Haitian women.
'And CDC investigators wanted to know 'whether the supposed new and more virulent form of the disease 'was being carried here to become the focus of some new epidemic.
'And what they found in this whole overcrowded camp was nothing.
' SHE SPEAKS IN FRENCH 'Had they been on the wrong track all along? 'The idea began to grow 'that toxoplasmosis was simply AIDS once again, 'but disguised by an unfamiliar outcome.
'If so, they also had to ask - 'was it homosexuality among the segregated men? 'But among Haitians, homosexuality is taboo 'and that kind of question meets with blank incomprehension 'in Miami's Little Haiti.
'The investigators came here and learned what they could 'about the complexities of a society 'in which catholic and voodoo are mixed, 'where there's no word for "disease", 'and sickness is linked to spiritual state, 'and also where, by Miami's standards, 'there's very little crime - 'to the Americans, a strange and alien culture.
'But here again, no evidence was found 'that AIDS had been brought in by the immigrants.
'However, on the island itself, 'over 50 cases have been reported to visiting investigators, 'mostly among men but some in women, too, 'confirmed by the pneumonia, the cancer, 'as well as the cat disease, toxoplasmosis, 'which is more common in the tropics.
'It's been suggested that AIDS, too, came from Africa, 'where it could spread through children's open sores.
'And it's said that Haiti has been a popular holiday resort 'for gay men from America.
'Jose has AIDS and toxoplasmosis.
'He's a Spanish-American with no taboos about being gay.
'He's a teacher of classical ballet.
' CLASSICAL MUSIC PLAYS 'A surgeon has removed the cyst from his brain 'that had almost paralysed his right arm and leg.
'For Jose, the research among the Haitians 'may have saved both life and livelihood.
'It's gay men and heroin addicts 'who may unwittingly have created the link to the next group.
'In 1982, several haemophiliacs died 'and others, as yet unaffected, are worried.
'Steve Pasquale's haemophilia was diagnosed when he was six months old, 'but there was no treatment at all in those days 'and his life was always in danger, particularly from internal bleeding.
'He received plasma from the age of four 'then, at ten, a deep-frozen precipitate from plasma 'that helped to clot his blood.
'It was always given under medical supervision.
'He was tied to the hospital.
'But ten years ago, when Steve was 17, 'a new concentrate of the clotting agent, called factor VIII, 'revolutionised his life, 'because he could make it up himself when and where he needed it.
' Thank you.
'But now it looks as though some has been contaminated.
'Must Steve now give this up? 'He does it all himself, 'timing the infusion according to an increase in stiffness in the joints.
'He'd come to expect a full and normal life.
'He consults specialist Shelby Dietrich.
' Hello, Steve, how are you? Hello.
All right.
I would expect you've got some questions or feelings about this whole problem.
Yeah, it's a little, er you know, anxiety creating.
'There are 20,000 haemophiliacs in America 'and, by this day, 10 or 11 cases of AIDS reported and five deaths.
' - So they think it's in the factor? - Well, yes.
The point is, haemophiliacs absolutely have to be treated for their bleeding problems, and you know that, and I'm sure it raises all kinds of questions about, "What do I do now?" Whenever any of the haemophiliacs get together, it's a topic of conversation that always comes up.
I think everybody's a little scared.
"Is this the infusion that's going to give it to me?" I'm not ready to give up the benefits of concentrate yet.
'But if there were a problem with this batch, 'could it be traced back to its source?' Each lot of these clotting concentrates is pooled from over 2,500 donors each, so that haemophiliacs are exposed to literally tens of thousands of donors per year.
Tracking all of these donors back from a case is virtually impossible.
'How can we be sure that all blood products are safe? 'Stop gay men giving blood? 'Gay leaders say that's unacceptable.
'Everyone should have the same rights and the same obligations to society.
' Is that all right? .
.
on a kidney machine? No.
'In New York, volunteer donors are asked questions 'that should reveal some of the symptoms of AIDS.
' OK.
Have you lost a lot of weight recently? No.
Have you been exposed to any infectious diseases that you know of in the past three weeks? - No.
- OK.
'And there's an inspection for intravenous drug use.
' OK, thank you.
'But is this enough? 'In principle, a further possibility 'would be to screen the blood's helper/suppressor ratios, 'as it's tested here automatically for blood groups.
'But it would be expensive and would take time to develop.
'The contamination of blood and its products 'is not just an American problem.
'Half of the factor VIII used in Britain comes from the United States.
'And just how far can AIDS spread 'beyond the four main high-risk groups? 'To women, too? 'Among the early pentamidine requests, one was for a woman.
'Two Greenwich Village doctors, Joyce Wallace and Joe Sonnabend, 'have found that, among their gay patients, 'the number of sexual partners 'correlated remarkably well with immune deficiency.
'Joyce Wallace decided to see 'if that was true for New York prostitutes as well.
'Trading free checkups for their stories and for samples of blood, 'she found women with compromised helper/suppressor ratios.
'She felt this supported her belief in the immune overload theory.
'Again, it seemed to be related 'to the sheer number of different contacts.
'There's no evidence as yet 'of any transmission from prostitutes to their clients.
'But her next patient, not a prostitute, 'seems to confirm the transmissible agent theory.
'This woman was simply married to a heroin addict 'and now she, too, has been treated for the pneumonia 'and other secondary diseases.
'She was an hour late for this appointment.
' I'm a little bit tired, as usual.
I haven't been, er, having the fevers or the chills lately, but, um, it's been hard getting around, still.
I don't travel on the trains because I'm afraid of fainting and, you know, dizzy spells.
So, not really 'Joyce Wallace believes that Dolores's story is reliable, 'although it contains one very curious detail.
'Her first symptoms of AIDS appeared 'over a year after she left her husband.
'Can AIDS hide in the body for so long?' I have Septra for the pneumonia, and, um, Tagamet.
'Joyce Wallace also believes 'that for every woman like Dolores, whose AIDS is reported, 'there are six more with lesser complications.
'The disease CAN reach women.
'But babies, too? 'Eight cases have been reported from one town alone.
'The population of Newark, New Jersey, includes 22,000 Haitians, 'gay men who can't afford the prices of Manhattan, 'and drug addicts.
'Most of the high-risk factors are bundled up together.
'At Newark's St Michael's Hospital, 'Jim Moleski has treated eight babies with AIDS.
' Because of the wheezing he had in his chest 'The eldest of the eight is Ramir.
'This is a checkup prior to his release from hospital.
'Of the other seven babies, all under eight months, 'four died from the pneumonia or cytomegalovirus.
'Only one of the eight had received blood 'but one was a haemophiliac and two were Haitians.
'One had a drug addict father with an uncle living in who was gay.
' RAMIR CRIES DOCTOR: I know, I know.
'Ramir's doctor believes 'that he was infected while in the womb.
'His mother was one of several who were intravenous drug addicts.
'From today, he'll be in the care of his aunt.
' All right, I'm here.
'A biopsy to confirm the pneumonia left the upper scar.
'That below is where the lung was drained.
'Ramir's first symptoms did not appear until well after he was born.
'The same was true for most of Newark's other baby victims.
'Is this another sign of a slow, hidden incubation? 'The strongest and most disturbing evidence of that 'comes from those jails in New York State where AIDS has been reported.
'In principle, prisons provide a unique opportunity 'to monitor the progress of the disease, 'especially if it develops when the man's already inside.
'But there are problems.
'It's well known that there's homosexuality in prisons 'and prisoners' own statements are notoriously unreliable, 'but in every case investigated, 'the man claimed to be strictly heterosexual 'while all or most, it seemed, had been on heroin outside.
'And that was supposedly stopped when they arrived in jail.
' OK.
'Investigating such cases, CDC man John Hanrahan.
' Do you remember when you first felt ill? How long after you were in prison did you start feel ill? Well - I went to Sing Sing - Yes.
- Um, in March.
- Yes.
And I started getting sick on, like, um .
.
the beginning of April.
You know, between March and April.
'From a year's investigation, 'John Hanrahan's tentative conclusion is this.
' JOHN: 'The bulk of their drug use, if not all, 'occurred prior to them feeling imprisoned.
' What that allows us to do is to try to establish a minimum incubation period, from the time they stopped drug use, which is coincident with the time they entered the prison system, and the time they developed symptoms of AIDS.
And for the ten inmates that we have data on so far who have had AIDS, nine of those, the only risk factor we know for them is IV drug use before being incarcerated.
And their symptoms developed anywhere between three and 36 months after they were incarcerated and after their drug use stopped, the average being about a year-and-a-half.
That tells us that the incubation period of AIDS in this group, and maybe in all groups, is quite extensive - on the order of many months to even years.
'Characteristically, the former addicts 'had developed pneumonia after a considerable delay.
'Three had already died in jail.
'Four others remained very ill.
' - Hello, Mrs Castronova.
- Hi.
Go right on talking to your husband.
I know your time is limited here.
Yeah 'Prisoner Castronova's speech is affected.
'He may have toxoplasmosis as well as the pneumonia.
'This is one of his better days.
' MRS CASTRONOVA: You look a lot better.
He looks good today.
And if it wasn't for my wife .
.
I don't know what I'd be doing.
She's been there with me every day - intensive care I was in intensive care.
Er, I left here for, what, four months? - Mm-hm.
- Went back to prison .
.
and they shot me right back here.
And they have no cure for it at all.
What's rough now is, I don't know if I'll ever see my kids again.
You know? Like a walking time bomb.
You know? But that's what they said.
"You're like a walking time bomb.
" Aww.
- Huh? - No, they'll find a cure for it.
Some day, but it might be too late.
You know? So you people that are out there shooting dope - give it up.
Because I'll never make it through.
You know, if you've got any value for your life .
.
give it up.
'Soon after that day, Castronova died.
'All these cases have strengthened fears 'that there may be a year or two of hidden disease 'already in the pipeline before anyone at risk is off the hook.
'There are more secondary diseases, too.
' We've recently recognised that additional cancers and additional serious disorders such as, um, deficiency in platelets are part of the syndrome and it's quite likely that for every case of reported illness, there are anywhere from 10 to 100 more cases of mild illness.
'Could it be caught early? 'At the Jules Stein Eye Institute, Los Angeles, 'Gary Holland has observed small, white patches - 'they call them cotton-wool spots - on the retinas of men 'who later developed the more obvious symptoms of AIDS.
' Look to the left.
'They don't affect vision 'and they're precursors to other diseases, too - 'high blood pressure or diabetes could cause them.
'But here, six months later, 'that same retina was overwhelmed by cytomegalovirus.
'The diagnostic method that's normally used 'is to measure the white blood cell helper/suppressor ratio 'and machines like this should soon be able to do it in a few minutes.
'By previous methods, 'one technician can process only about ten cases a week.
'But more serious is the scientists' limited understanding 'of the normal range and behaviour of the immunological system 'and how it can be corrected when something goes wrong.
'Being able to measure it at all is still a scientific novelty 'and, on the day we filmed this machine, 'the final calculation of the ratio was made on paper.
'But where the immune system is already suppressed, 'is there any cure?' Excuse me, Jim, I'm going to insert the needle now.
'One possibility is to inject some substance 'that promotes the growth of the white cells that are missing.
'At the Sloan Kettering Memorial Hospital, New York, 'Jim was very happy to be given the chance to try out interluekin-2.
'A day's supply, extracted from 50 pints of blood, costs 1,000.
'From the box, it's pumped in near a lymph node in the groin.
'It won't repair the defective immune system 'but it's already given Jim relief from his secondary infections.
' This interleukin-2, which some people also call T-cell growth factor, does just that - it makes T-lymphocytes grow.
What I should mention is that, in the test tube, your cells didn't make any interleukin-2, but when we added in the interleukin-2, behaved just like normal cells.
'And it did seem to work, 'until the expensive experimental supply ran out.
'Later, he developed Kaposi's sarcoma 'and joined other patients in a larger trial.
'This is interferon, which has its problems, too, 'for a dozen different kinds have been identified in man.
'Should you use a lot or just a little? And of which? 'Several new synthetic interferons are ready to be tested 'and, in San Francisco General, Scott was one of the first to get it.
'His weakened immune system might be damaged even more by chemotherapy, 'while interferon might prod it into action.
'It's a gamble.
' I was just discussing with the doctor the experimental factor.
I haven't seen enough results to be too encouraging, and I wondered if I have been wasting valuable time not being on chemotherapy.
So, I do have my reservations but I'm going to follow through with the entire treatment plan and, er, I'll see what happens then.
I really don't know.
My mind is not made up on that point, as to how I feel about the whole treatment plan.
If I were seeing remarkable results, of course, I'd be ecstatic.
And I'd have no questions or reservations whatsoever.
But, er, that's not the case.
'In these trials, the results so far have been patchy.
'Perhaps, for Scott, any effect so far has been overlaid by shock.
' The shock was so great.
I stopped smoking marijuana, I stopped smoking cigarettes, I've stopped drinking.
I've stopped, er, sexual contact, I've stopped I stopped, basically.
'There are still no absolutely certain answers 'to the most important questions.
' - How do you get it? - Yeah, how do you get it? Is there any cure for it? Can there be some way you can put it stop to it? - Or medicine? - Medicine? Shots or something? 'They're talking to a gay health counsellor.
' COUNSELLOR: What if I told you that the diseases that are going around now have no cure, and they lead to death within a year? Oh, I'd move.
HE WHISTLES IN AWE That you can catch it through sexual contact, and that the more sexual contacts you have with people, the higher your risk of catching it? What would you do now? Oh, that's tough.
COUNSELLOR: Assuming I told you the more times you have sex with different people, the higher your chances of coming down with this.
Yes, I would stop having sex with people.
- Oh, definitely.
- Very definitely.
'Changes in sexual behaviour should halt the spread of AIDS.
'But that can be difficult.
' It's very difficult in relationships.
In my primary relationship, I had a boyfriend for a year prior to becoming ill and when I became sick and it became clear that I had something that was very serious and was possibly transmissible, the question arose as to whether or not I should remain with this man.
Um, on the other hand On the other hand, the doctors were saying that it was better to stay with a single partner than to go and be with someone who had not been previously exposed, presumably this man, Ron, whom I had been with, had already been exposed to any viruses that I might have had.
So it put tremendous pressure on the relationship.
It's like, "I have to be with you or there's no possible option for me - "I have no outlets except for you.
" Large numbers of people have become chaste, are no longer seeking sexual are no longer seeking sexual satisfaction with other people, period.
And these people are not sick, they are living in terror that they are going to develop this disease that I have.
So I-I don't know what to make of it.
What I do know is that because I'm immunosuppressed, I am I believe that other people are more dangerous to me than I am to them.
'True - doctors and nurses who work close to patients 'don't seem to be at risk.
'And of those at greatest risk, still over 70% are gay.
'To survive, what course does Bobbi Campbell recommend?' It would seen to be healthful at this time, in order to protect oneself, to limit the number of sexual partners.
In part, that reduces your risk of disease of any type, even gonorrhoea, which at this point is beginning to look like garden variety.
But to limit the number of sexual partners and to limit the frequency of use of recreational drugs I think is certainly a wise recommendation.
MUSIC: "Nipple To The Bottle" by Grace Jones 'The British gay community 'is no longer just watching on the sidelines.
'There have been deaths here, too.
'AIDS has already arrived in Britain.
'Do we already have the hidden seeds of an epidemic here?'