The Expansion of Risk
Sensitive to the fact that gay doctors and activists criticized the informal "GRID" designation, the CDC came up with an official name for the epidemic in May 1982 and first used the term in print in September of that year. This name was chosen specifically for its neutrality—Acquired Immunodeficiency Syndrome, or AIDS: "acquired" to distinguish it from congenital defects of the immune system; "immunodeficiency" to describe the underlying problem, the deterioration of immune system functioning (and specifically, a decline in the numbers of helper T cells, causing the body to lose most of its capacity to ward off infection); and "syndrome" to indicate that the condition was not a disease in itself, but rather was marked by the presence of some other, relatively uncommon disease or infection (like PCP or Kaposi's sarcoma), "occurring in a person with no known cause for diminished resistance to that disease." This was strictly a "surveillance" definition, for epidemiological reporting purposes: it did not imply any knowledge about what AIDS "really was." But in the absence of a lab test for a known cause, this definition at least allowed the CDC a crude measure of the scope of the problem.
The newly defined syndrome would, over the course of 1983, achieve the status of a "Worldwide Health Problem," as the headline of one of Lawrence Altman's articles in the New York Times labeled it in November. By that time, AIDS cases would be reported "in 33 countries and all inhabited continents." Though most cases were in the United States or Europe, the most striking aspect of the epidemic's spread was the discovery of AIDS in equitorial Africa. In April the Washington Post summarized reports appearing in both Lancet and the New England Journal that described cases of AIDS in European countries, but among patients who had immigrated from or traveled in countries such as Zaire and Chad. Of twenty-nine such cases in France, six patients had become ill before June 1981—that is, before the epidemic was first reported in the United States. Immediately
scientists and reporters in the West picked up on the notion that Africa "could have been the breeding place" for the epidemic.
Despite the globalization of the epidemic and the formal change in terminology, the "gay disease" formulation, in various guises, continued to undergird medical investigation of the syndrome through the first half of 1982. For example, an editorial in the Annals of Internal Medicine by Dr. Anthony Fauci, a distinguished scientist who would later become the head of the AIDS program at the National Institutes of Health (NIH), laid out a number of etiological possibilities: "Is there a new virus or other infectious agent that has expressed itself first among the male homosexual community because of the unusual exposure potential within this group? Is this an immunosuppressed state due to chronic exposure to a recognized virus or viruses? Is this illness due to a synergy among various factors such as infectious agents, recreational drugs, therapeutic agents administered for diseases that are peculiar to this population such as the 'gay bowel syndrome' …?" But what Fauci never doubted was that the "critical questions" were: "why homosexual men and why occurrence or recognition only as recently as 1979?"
Suddenly, this whole framework for understanding the epidemic was dramatically challenged. On July 9, the CDC reported thirty-four cases of Kaposi's sarcoma or opportunistic infections among Haitians living in five different states in the United States. None of those interviewed reported homosexual activity, and only one gave a history of injection drug use. The following week the agency reported three cases of PCP in people with hemophilia, all of them recipients of a blood product called Factor VIII, "manufactured from plasma pools collected from as many as a thousand or more donors." The CDC refrained from drawing conclusions, but noted that the occurrence of the hemophilia cases "suggests the possible transmission of an agent through blood products." Since bacteria were screened out of Factor VIII in the production process, while smaller particles such as viruses could potentially escape the screen, the "agent" in question would almost certainly have to be a virus.
Mass, writing in the Native, quickly noted the significance of these findings: of all the existing etiological hypotheses, "only that of viruses would seem able to provide a unitary hypothesis that could explain the sudden appearance of AID [the Native's term at that time] in a growing number of distinct populations." But he also acknowledged the alternative possibility: Perhaps, he suggested, "we are dealing with
a number of superficially similar epidemics, each with its own primary etiology."