Devyn Gilbert

JSIS 201

Bachman

2/29/24

When the first cases of AIDS in the United States appeared in 1981 among five young

gay men, little was known about the disease. The first human retrovirus, HTLV-I, had been

discovered only a year earlier and the multifaceted nature of HIV was unlike anything scientists

had seen in the past. In addition to the disease’s biological complexity, a preexisting stigma

against the groups that it impacted most, such as gay men, Haitians, and intravenous drug users,

led many to politicize the epidemic and discourage the use of government funds to research the

virus. As Ronald Reagan, the president of the U.S. at the time, ignored the pandemic for years on

end, the death toll only grew. Today, there is still no cure or vaccine for HIV, and even 40 years

after its onset, it’s evident that the legacy of the government’s failure to act during the AIDS

epidemic is still palpable in its public health policies today. But why did the U.S. fail so

spectacularly to prevent the deaths of hundreds of thousands of their citizens? Given the vast

array of firsthand evidence from the epidemic, it’s clear that the U.S. failed to respond efficiently

and effectively to the AIDS epidemic in its first decade due to poor political responses and prior

prejudice against gay men, intravenous drug users, and Haitians, as well as the biological

complexity of the virus.

Perhaps the most impactful constituent of why the U.S. failed to respond effectively and

efficiently to the AIDS epidemic during its first decade was the abysmal political response that

AIDS received from high-ranking government officials. Most notable of this trend was the
president of the U.S. during the first eight years of the epidemic, Ronald Reagan. For the first

four years of the AIDS epidemic, Reagan did not address the issue publicly at all (Boffey, 4).

This left the public in the lurch, with no major leader to help them understand the severity of the

epidemic or what they could do to protect themselves. With conflicting and biased news reports

alongside growing prejudice against people most likely to contract HIV, what people needed

most at the time was a well-known credible leader to inform them accurately and completely on

how to best protect themselves and others. Had the president spoken on the epidemic during its

earliest stages, it would have prevented the epidemic from spreading as widely by encouraging

people to follow the recommended guidelines of the CDC. Reagan failed to fulfill this roll, much

to the chagrin of many members and allies of the LGBTQ+ community.

One member of the LGBTQ+ community, in particular, spoke out on the negligence of

the federal government: the executive director of the National Gay Task Force, Virginia Apuzzo.

Apuzzo stated in her address to the Committee on Government Operations during a hearing on

the AIDS epidemic in August of 1983, “Further, if we take a look at the Federal Government’s

response to the AIDS crisis it leads unavoidably to the conclusion that within this administration,

there is a sharp contrast between the rhetoric of concern and the reality of response” (Federal

Response to AIDS: 1983, 17-18). She said this with reference to Secretary Heckler’s inability to

outline a plan to fight the epidemic as well as the flagrant federal underfunding of research into

AIDS, which forced the CDC to cut other programs to reallocate those funds to AIDS research.

In fact, in 1981, as the AIDS epidemic began to grow, the government cut the CDC’s budget by

20% (Federal Response to AIDS: 1983, 26), which showed how, from the very beginning, the

federal government wasn't invested in ending or preventing the epidemic and that their main

political response for the first four years was to ignore it in order to focus funds and time on
other, more widely sympathetic matters. Due to this political response, the fight against AIDS

was ill-fated from the start. Although Apuzzo made this statement in 1983, her point was further

proven by Reagan’s inaction prior to his 1985 news conference as well as his actions during the

conference.

After having remained silent on the matter for four years, Reagan referred to the

epidemic as a “top priority” during his news conference and stated that his administration had

supported research for AIDS since it had begun (Boffey, 7). Despite this claim, upon rebuttal

from a top scientist, who said that the budget was not nearly enough to take any significant

measures, Reagan dismissed his opinion, stating, “I think with our budgetary restraints and all it

seems to me that $126 million in a single year for research has got to be something of a vital

contribution” (Boffey, 8). If Reagan hadn’t ignored the warnings of scientists and their requests

for more funding, research would have progressed much more expediently as scientists would

have been able to afford a greater number of primate test subjects, and countless lives could have

been spared. Instead, Reagan not only undermined valid concerns and complaints from people

educated on the matter, but he also aided the spread of misinformation regarding how the virus

was contracted.

At the time, many parents felt concerned about the safety of sending their children to

school with other children who had AIDS. Reagan recognized this in his speech, explaining that

he understood the worries of parents and, simultaneously, felt compassion for children whom

others ostracized due to their diagnoses (Boffey, 12). Perhaps this would’ve been a comforting

sentiment to hear from a president who had taken no public notice of a strikingly deadly disease

for the past four years, had the CDC not announced two years prior that AIDS wasn’t spread

through casual contact, nor could it be spread through any activities that would likely happen at a
primary school (“Timeline of HIV”). So, instead of comforting those whom much of society had

designated as pariahs due to their diagnosis, Reagan’s comments worsened their situations by

lending credibility to the faulty arguments and stigma held by their oppressors. Because Reagan

did nothing to educate the public at the beginning of the epidemic and because of his later

reckless and misleading statements, few people understood how the virus spread, which allowed

social stigma to worsen and misinformation to run rampant. As a result, many people didn’t

know how to protect themselves or others, which allowed HIV to spread and thousands to die,

not to mention how his statements supported the proliferation of ignorance-based violence that

queer people, people living with AIDS, and Haitian people faced.

One notable outlier of this trend of inaction in Reagan’s administration was his surgeon

general, C. Everett Koop. Koop’s highly Christian conservative stance on a range of issues from

reproductive care to homosexuality made him appear to be the perfect candidate for surgeon

general of the Reagan Administration, whose voter base largely consisted of like-minded people.

However, in 1988, Koop proved America’s perceptions of him wrong. In a seven-page sex

education mailer, Koop was the one to finally step up and guide Americans through the AIDS

epidemic, telling them what the CDC had confirmed years earlier, but what some of the public

hadn’t quite come to believe: “You cannot get AIDS from social contact” (Lord). In addition, he

underlined the importance of using condoms, advice that everyone else in the Reagan

administration had been too afraid of moral backlash to say, but which was the only way to

effectively prevent AIDS at the time. In comparison, Reagan and other members of his

administration did their own campaign, which gave little scientific guidance or data on the

epidemic and opted, rather, to exclusively encourage abstinence. Koop wrote that other

conservative members of Reagan’s administration had “attempted to thwart [his] attempts to

educate the public about AIDS” (Lord), as was demonstrated by William Bennett’s, the secretary

of education’s, words on the matter. Calling Koop’s advice “morally bankrupt” (Lord), William

Bennett exemplified the consensus among much of the Christian right on how the conversation

about AIDS should be: non-existent, and if it must exist, adherent to Church tradition, even if it

cost people their lives, especially since the people who paid the highest price were gay men. As a

conservative, Reagan’s voter base consisted mostly of people who held this opinion, and as

support for him dwindled (Dionne), this social stigma made doing anything substantial to fight

AIDS absent from his agenda. While Koop did what he could to protect Americans, the most

important high-ranking government officials worked against him to preserve their standing

among conservative voters. Although poor political response was the most obviously impactful

part of the U.S.’s failure to respond effectively and efficiently to the AIDS epidemic, those

political responses wouldn’t have existed without the social stigma that triggered them.

Although Surgeon General Koop worked to educate the public on AIDS and how to stay

safe, he did it seven years too late. In those seven years, people had grown attached to their

prejudice. In 1982, a New York Times article was published with the title “New Homosexual

Disorder Worries Health Officials” (Altman). It referred to AIDS as GRID, or gay related

immune deficiency, even after recognizing that heterosexuals were just as able to contract AIDS

as gay people and that calling it AID, instead, was an option. The idea of AIDS being a “gay”

virus became more and more common as the media continued to present it as such, and the queer

community certainly felt its impacts. For example, in a 1983 ABC News report, Ken Ramsaur

discussed his experience as a patient with AIDS:

“Mr. Ramsaur: And one night I heard two of, I believe they were the nurse’s aides, not the

actual nurses, standing outside my door sort of laughing and I would almost say placing bets on,

now, how long is this one gonna last?

Rivera: What did they say, exactly?

Mr. Ramsaur: ‘I wonder how long the faggot in 208 is gonna last,’” (Federal Response to

AIDS: 1983, 82).

Unbridled homophobia such as this was exceedingly prevalent during this period, and it

influenced who cared about the epidemic. Presenting HIV as a virus that only killed gay people

and drug users reduced its importance to many conservative homophobes. They didn’t care that

AIDS research was underfunded or that AIDS killed more and more people each year because

they wanted those people to die anyway. In Virginia Apuzzo’s words, “Because of its mysterious

nature, and I submit, because of the groups associated with it, AIDS has generated something

just short of a public panic. A good deal of panic that has been fostered by homophobes bent on

turning a public health crisis into an opportunity to attack the gay and lesbian community,”

(Federal Response to AIDS: 1983, 19). According to the New York Times, even many doctors,

the people who were meant to protect and help people living with AIDS, refused to treat AIDS

patients, supposedly because they didn’t want to put themselves at risk (“When Doctors Refuse

to Treat AIDS”). This argument is nonsensical, though, because if they followed CDC

guidelines, being the doctor of an AIDS patient would put them in no danger whatsoever. In

truth, it’s likely that doctors were simply prejudiced against AIDS patients. They saw them as

“dirty” or “infected”, a view that was already commonly held about queer people who weren’t

living with AIDS.

 This view wasn’t restricted to gay people and AIDS patients. Haitians, as the third

highest percentage of people living with AIDS in 1983, suffered similarly. Employers across the

United States fired Haitians en masse. According to Jean-Claude Compas, “In one particular

instance, a Haitian maid presented herself to work on a Monday morning, only to find all of her

belongings in the street and to be told through a closed door that as all Haitians were sick she

would not receive her salary directly but by mail” (“Federal Response to AIDS: 1983”, 47). He

reported that parents refused to allow their children to play with Haitian children and some

apartments advised them to prohibit intermingling of Haitian children with others. The panic and

ignorance that the AIDS epidemic brought with it led to severe discrimination against those most

impacted by AIDS in all groups, but it was most potent among conservatives. This flourishing

social stigma heavily influenced the government’s actions during the epidemic as they fought for

public approval. No conservative politicians wanted to talk about AIDS because it would’ve

meant having to recognize that gay people, Haitians, and IV drug users deserve to live, which

often didn’t suit the beliefs of their voters.

While the failure to minimize the spread of HIV was largely the fault of the U.S.

government, it should also be considered that retrovirology simply wasn’t developed enough in

1981 to quickly create a cure or vaccine for HIV. Prior to 1977, all research in retrovirology

revolved around mice and chickens, and the first human retrovirus wasn’t discovered until 1980

(Coffin). This meant that, a year later when HIV began to spread throughout the U.S., scientists

were severely behind the research curve. They knew little about how HIV spreads, they didn’t

know about the connection between HIV and AIDS, and they didn’t even discover that HIV was

a retrovirus until 1984 (Vahlne). It didn’t help that retrovirology is a tremendously complex

field. For context, a retrovirus is a virus that encodes itself into a cell’s genome, allowing it to
highjack the cell for reproduction in a process that eventually kills the cells that it takes place in.

The new viruses that it produces infect other cells and repeat the process. Additionally, HIV

DNA can remain dormant for years before it begins to rapidly replicate itself and spread the virus

to other cells. This ability to quickly reproduce makes a varied culture of different clades, or

types, of the virus (“HIV Cure”).

The lack of any significant related prior research combined with the biological intricacies

of retroviruses meant that researchers had no hope early on of curing HIV, especially since doing

that would require one of two things: being able to kill all cells that contained the HIV DNA, or

the capability to edit DNA. Scientists of the early 80’s didn’t have the resources to do either of

these things. They didn’t have a drug that would activate all cells containing HIV DNA (“HIV

Cure”), which would then allow them to kill all infected cells, including those that had

previously been hidden by their dormancy, and they certainly didn’t have the tools to edit human

DNA (Carroll, 653), which could disinfect cells by cutting out the HIV-producing gene.

Additionally, vaccines weren’t an option because the wide variety of clades of the virus would

have made them ineffective. A new vaccine would need to be made for every clade and the virus

produced new clades faster than new vaccines could be developed. To put it bluntly, it wasn’t

possible to effectively and efficiently respond to the AIDS epidemic using a cure or vaccine in

the early years of the epidemic.

Although they couldn’t cure HIV, scientists quickly found effective ways to prevent the

spread of HIV, i.e. condoms. Through examining trends in infection, members of the National

Gay Task Force and the CDC discovered within the first three years of the epidemic that HIV is

sexually transmitted and could be prevented using condoms (Jaffe, et al, 35-49). This meant that,

while it wasn’t possible to save those who had already contracted HIV, it was possible to
diminish the propagation of the virus until it was no longer of epidemic proportion. However,

this required people to understand that they needed to use condoms, and in turn, that the

government tell them as such. By the time that the government had fulfilled this requirement,

much of the damage had already been done. Although the late start in retroviral research was no

one’s fault, the U.S. government was entirely culpable for the failure to adequately fund research

after the beginning of the epidemic, as well as for the failure to alert the public of these possible

preventative measures outlined by scientists to stop or slow the spread of the virus.

Many factors led to the U.S.’s failure to respond to the AIDS epidemic. Science couldn’t

cure AIDS or make a vaccine, and the Evangelist right didn’t care that gay people, IV drug users,

or Haitians were dying, and, in line with his voter base, neither did Reagan or many main

political actors at the time. This led to a secondary plague of misinformation, causing the deaths

of about 700,000 Americans, as of 2018 (“The HIV/AIDS Epidemic”). But now Americans have

access to PrEP, and an HIV diagnosis is nowhere near the death sentence it once was (that is, for

Americans. Many people in the global South don’t have access to the necessary care to survive

HIV, and hundreds of thousands of people still die every year of AIDS (Roser and Ritchie)).

Given the reduced threat of AIDS today, why is it still important to consider why the U.S. failed

to respond to the AIDS epidemic? In addition to helping us grasp the importance of safe injection

sites in the continued fight against AIDS, it's also crucial to consider because it is exemplary of

the dangers of politicizing a public health crisis, which will be an important lesson for political

leaders long after AIDS has been cured. These dangers were thoroughly demonstrated in the

Trump administration’s treatment of the Covid-19 pandemic.

Donald Trump approached the pandemic in the same way Reagan approached the AIDS

epidemic: ignoring it, and for similar reasons. Acknowledging the pandemic would’ve meant, to
an extent, admitting to his shortcomings in containing the pandemic as soon as it entered the

U.S., which would’ve bruised his ego and his reelection chances. Instead, he repeatedly denied

the severity of the pandemic and insisted that “We’re prepared, and we’re doing a great job with

it. And it will go away. Just stay calm. It will go away” (Wolfe and Dale). It absolutely did not

go away. He made that statement on March 10, 2020, and the number of new cases every day

only grew from there. However, he continued to insist that, eventually, it would just disappear.

This decision to ignore the problem and hope that it just goes away was exactly what Reagan did

for the first four years of the AIDS epidemic, and the results were similar: countless people died

(“CDC Covid Data”). People didn’t understand the severity of the pandemic and didn’t think it

would kill them, so they didn’t follow the guidelines recommended by the CDC, much like

during the AIDS epidemic. This decision ultimately killed not just the people who made that

decision, but also some of the people around them. Had Trump been educated on the example of

the politicization of the AIDS epidemic and understood how that can kill people, perhaps he

wouldn’t have undermined Covid-19's severity as he did, and fewer people would have died.

Trump made yet another mistake similar to that of the Reagan administration: associating

the virus with a marginalized group. While the Reagan administration didn’t start the association

of AIDS with gay men, they certainly let it work in their favor. By not correcting this false

association, Reagan gave himself an excuse in the eyes of his voters to use government funds

that could’ve been spent on research for other endeavors. Similarly, Trump actively participated

in the process of associating Covid-19 with China and Chinese people by referring to it as the

“China Plague” (Wolfe and Dale) and the “Kung Flu” (Hwang, 331). Trump’s statements

directly correlated with and likely caused a rise in anti-Asian-American violence during the

pandemic. For example, “In March, the Cung family—including their two children, a two-year-
old and a six-year-old— were attacked and stabbed at a Midland, Texas, Sam’s Club by a

perpetrator who thought they were Chinese and thus carrying the virus” (Hwang 331). Blaming

China and Chinese people for the epidemic did nothing to stop it, but perhaps Trump felt it took

some of the blame off him. Either way, the only result of his decision to politicize the epidemic,

much like the result of Reagan’s decisions, was more death and more violence. As bacteria and

viruses evolve and new epidemics and pandemics happen, new politicians will need to decide

how to handle them. It’s crucial that politicians learn from the mistakes of the past, especially

such a travesty of public health as the U.S.’s failure to respond effectively and efficiently to the

AIDS epidemic in its first decade.

Bibliography

Altman, Lawrence K. “New Homosexual Disorder Worries Health Officials.” The New York
Times, 11 May 1982, p. 45–50.

Boffey, Philip. “Reagan Defends Financing for AIDS.” The New York Times, 18 Sept. 1985, p. 7,
https://www.nytimes.com/1985/09/18/us/reagan-defends-financing-for-aids.html.

Carroll, Dana. “Genome Editing: Past, Present, and Future.” The Yale journal of biology and
medicine vol. 90,4 653-659. 19 Dec. 2017.

“CDC Covid Data Tracker.” Centers for Disease Control and Prevention, U.S. Department of
Health & Human Services, 27 Nov. 2023, covid.cdc.gov/covid-data-tracker/#datatracker-
home.

Coffin John M., et. al. Retroviruses. Cold Spring Harbor Laboratory Press, 1997.

Coulson, Morgan. “Why Don’t We Have an HIV Vaccine?” Johns Hopkins Bloomberg School of
Public Health, Johns Hopkins University, 29 Nov. 2022, publichealth.jhu.edu/2022/why-
dont-we-have-an-hiv-
vaccine#:~:text=We%20traditionally%20have%20used%20live,%2C%20or%20clades%2
C%20of%20HIV.
Dionne, E. J. “Poll Shows Reagan Approval Rating at 4-Year Low.” The New York Times, 3
Mar. 1987, p. 1, https://www.nytimes.com/1987/03/03/us/poll-shows-reagan-approval-
rating-at-4-year-low.html.

Federal response to AIDS: hearings before a subcommittee of the Committee on Government

Operations, House of Representatives, Ninety-eighth Congress, first session, August 1 and
2, 1983. (1983). U.S. G.P.O., 1983.

“HIV & AIDS Trends and U.S. Statistics Overview.” HIV.gov, U.S. Department of Health &
Human Services, 7 Jan. 2023, www.hiv.gov/hiv-basics/overview/data-and-
trends/statistics/.

“HIV Cure.” Science of HIV, scienceofhiv.org/wp/cure/.

Hwang, Roland, et al. Being Human during COVID. University of Michigan Press, 2021, pp.
329-335, https://doi.org/10.3998/mpub.12136619.29.

Jaffe, Harold W., et al. Dispatches from the AIDS Pandemic: A Public Health Story. Oxford
University Press, 2023, https://doi.org/10.1093/oso/9780197626528.001.0001.

Lord, Alexandra M. “As AIDS Epidemic Raged, a Rogue Reagan Official Taught America the
Truth.” The Washington Post, The Washington Post, 8 June 2023,
www.washingtonpost.com/history/2023/06/04/aids-epidemic-reagan-everett-koop/.

Rogers, Katie, et al. “Trump Defends Using ‘Chinese Virus’ Label, Ignoring Growing
Criticism.” The New York Times, 18 Mar. 2020,
https://www.nytimes.com/2020/03/18/us/politics/china-virus.html.

Roser, Max, and Hannah Ritchie. “HIV / AIDS.” Our World in Data, Global Change Data Lab,
Dec. 2023, ourworldindata.org/hiv-
aids#:~:text=Causes%20of%20death%2C%20World%2C%202019&text=According%20t
o%20the%20Global%20Burden,number%20of%20deaths%20from%20malaria.

“The HIV/AIDS Epidemic in the United States: The Basics.” KFF, KFF, 7 June 2021,
www.kff.org/hivaids/fact-sheet/the-hivaids-epidemic-in-the-united-states-the-basics/.

“Timeline of the HIV and AIDS Epidemic.” HIV.Gov, Minority HIV/AIDS Fund, 15 Nov. 2023,
www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline/#.

Vahlne, Anders. “A historical reflection on the discovery of human retroviruses.” Retrovirology

vol. 6 40. 1 May. 2009, doi:10.1186/1742-4690-6-40

“When Doctors Refuse to Treat AIDS.” The New York Times, 3 Aug. 1987, p. 16,
https://www.nytimes.com/1987/08/03/opinion/when-doctors-refuse-to-treat-aids.html.
Wolfe, Daniel, and Daniel Dale. “All of the Times President Trump Said Covid-19 Will
Disappear.” CNN, Cable News Network, 31 Oct. 2020,
edition.cnn.com/interactive/2020/10/politics/covid-disappearing-trump-comment-tracker/