And from a different perspective . . . had HIV disease been detected first in any other community in the US, the outcome likely would have been very different.
Harvey Milk was assassinated in 1978 causing the gay community to coalesce in a way they hadn’t before. A few short years later (1981) when the first cases of pneumocystis jiroveci pneumonia (PCP) were observed in San Francisco, the common denominator of the cases was being a gay male. As the community had come together as a result of Milk’s murder, there was a new type of coalition as a result of friends suddenly dying.
Because it was San Francisco and people were able to be more “out” than anyplace other than (maybe) New York, the doctors were able to see the pattern and these cases were reported in the CDC’s Morbidity and Mortality Weekly Report (MMWR) that set off alarms for doctors treating gay men in their practices. This clicked for doctors of some gay men in NY city who observed Kaposi’s sarcoma in their patients. Both of these conditions (PCP and KS) were symptomatic of severe immune dysfunction when seen in otherwise healthy young men.
The other relevant element was that the group of folks being impacted, while disenfranchised, were not poor. Some of their number were well connected. The community (lesbians and gay men) really came together to take care of friends who had been cast aside by their families. The overwhelming loss of so many loved ones really inspired a level of activism the community had not seen before.
HIV has always been an equal opportunity disease, but the fact that a pattern could be observed in gay men in the US meant that getting to the cause happened MUCH more rapidly than had the virus initially infected random others first—in fact, there is nothing to suggest that it didn’t impact random others in the US even earlier, but because no pattern could be recognized UNTIL there was a common denominator, who can guess how long HIV has been in the US. The earliest documented case was from 1969.
@JLeslie The “Patient Zero” notion was widely introduced in the movie, And the Band Played On, but he was not the index case for the disease, just the index case for a specific cluster of cases Don Francis of the CDC was studying.
So, why gay men? Well, in the 1970s, sexual exploration for men and women had changed rapidly as a result of the advent of the birth control pill. Among gay men, any STDs encountered at the time could be cured. Due to the lengthy incubation period, many gay men were likely infected years before they displayed the symptoms of end stage AIDS. In the absence of a test, all doctors could recognize was end stage disease. Once the pattern was observed, it took several years to identify the organism and to create a test to look for it—all the while more gay men became unwittingly infected.
When looking at statistics related to an epidemic, one has to consider incidence (new cases) and prevalence (existing cases). Due to the prevalence of HIV in the community of men who have sex with other men (whether they label themselves gay or not), the incidence of HIV among people who have sex with them is likely to increase exponentially. That is the benefit of the new medications on the market which, if taken consistently according to physician instructions, dramatically reduce transmission to sex partners.
In today’s epidemic, incidence is highest among young (age 13–29) men who have sex with men, particularly young men of color (Citation here). There are many possible explanations for this (including stigma around being “gay,” poverty, and limited access to healthcare).
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