A reasonable surmise is that, about 50 years ago, in east and central Africa, some hunters and their families who ate monkeys became infected with a low-virulence (and for a long time quiescent) progenitor of what is now known to be the virus that causes AIDS.
Its dynamics have now led some researchers to an encouraging conclusion: In America, the disease is largely concentrated in perhaps 30 neighborhoods nationwide. Change behavior in those places and the epidemic will recede.AIDS has been particularly disconcerting because the nation had come to believe that it was no longer vulnerable to mass infectious disease. But modernity actually abetted the epidemic. In Uganda and Tanzania it was spread by roadside prostitutes whose clients were truckers and soldiers traveling on the modern road system. Africa has been increasingly integrated into the world flow of transportation, commerce, tourism and traveling students. This is a century of global interconnections, so pandemics - infectious diseases spread globally - are now more possible than ever.
Furthermore, AIDS, like lung cancer, coronary artery disease and motor vehicle accidents, is a characteristic 20th century epidemic: It is closely related to current behavior. Related, in fact, to voluntary, conscious and intimate behavior, that involving sex and drugs. And much of the high-risk behavior is highly concentrated in a few small areas.
Last Sunday, Gina Kolata, a science writer for The New York Times, reported that some experts now believe that the AIDS epidemic in America "can be all but stamped out," without a vaccine or wonder drug. The strategy would involve concentrating on prevention of risky behavior that is particularly prevalent in 25 to 30 neighborhoods nationwide, in such cities as New York, Miami, Los Angeles, San Francisco, Houston, Newark and Camden, N.J. However, Kolata says, among the measures public health officials want to concentrate in those neighborhoods are some that many conservatives oppose, including free distribution of clean hypodermic needles, many more drug treatment programs and explicit sex education "adapted to the language and mores of affected neighborhoods."
However, the political impediments to rational AIDS policies involve much more than just conservatism. AIDS in America has been associated with stigmatized and illegal behavior and has been concentrated among marginalized groups - homosexuals and inner-city poor - that feel vulnerable to oppression. So there has been a concerted effort to "democratize" the disease. The politically correct message has been that everyone is vulnerable - "AIDS does not discriminate." And there has been resistance to targeting the risky behavior of particular groups.
The primary public health task in an epidemic is to protect the uninfected. Until there is an arsenal of AIDS medicines, the epidemic will remain less a medical challenge than a test of political will.