Last summer (1981) a very disturbing and unexpected outbreak of Pneumocystis carinii pneumonia and Kaposi’s Sarcoma (a cancer) began to be documented amoung young gay men. According to a recent editorial in the New England Journal of Medicine (Dec. 10, 1981) “more than 160 examples are now being analyzed by CDC (Center for Disease Control – Atlanta) and 5 or 6 new cases are being reported each week.” More than one-third of the patients at the CDC have died.
Neither of these diseases is new to the medical world. The pneumonia is usually only seen in this country in very debilitated people frequently kidney transplant patients or other very compromised individuals. The cancer occurs in young. Africans (accounting for 9% of all cancers in parts of Africa) and elderly Americans. The fact that apparently healthy young gay men are coming down with these maladies is new and distressing!
The initial impression of some of those researching this outbreak is that it is a truly new syndrome and not something that has plagued homosexual men from antiquity. So why us and why now?
Quoting again from the New England Journal “…we must suspect that some new factor may have distorted that host-parasite relation. So called ‘recreational’ drugs are one possibility…the leading candidates are the nitrites (poppers), which are commonly inhaled to intensify orgasm. Users of amyl nitrite(poppers) are more likely than non-users to have had hundreds of sexual partners and to contact venereal diseases. Preliminary data indicates that this ‘liberated’ group may be at highest risk for immunosuppression.” Immunosuppression meaning roughly that your natural defenses are depleted for some reason or combination of reasons and you are therefore more susceptable to catching and/or becoming sick from bugs/diseases that ordinarily wouldn’t make you ill. So what is being implied here at least in the New England Journal article is that the host (you and me) becomes immunusuppressed and then these opportunistic diseases – Kaposi’s Sarcoma and this pneumonia move in taking, advantage of the situation. In the quote above an accusing finger is being pointed at poppers as being a possible causative factor in the iramunospuressive process.
Another possible culprit causing immunosupression is Cytomegalovirus (CMV) – which is already known to cause immunosuppression in mice and human beings. Infection with Cytomegalovirus is very common among gay men.
Quoting again, this time from Medical World News (Nov.-. 23. 1981), New York City Internist Daniel C. Williams doesn’t think its either drugs or CMV: “I suspect these men are suffering immunological overload – that rapidly sequential or concurrent infections with many pathogens may be paralyzing their immune systems.” Dr*. Williams believes that the venereal diseases so commonly prevalent among gay men may be reaching levels that could “account for the sudden emergence of opportunistic infections and perhaps an oncogenic virus.” Kaposi’s Sarcoma and the pneumonia being two such oppotunistic diseases.
There are numerous other possible causative factors that are being pursued by researchers. If you are interested in some further information I suggest you start by reading The New England Journal of Medicine editorial from the December 10, 1981 issue and an article titled “Health Hazards of Homosexuals” from the November 23, 1981 issue of Medical World News. Copies of both articles are available at the GLCCC.
It’s perhaps best to insert a world of caution here before we indulge in our propensity/love for hysteria and freak out about all of this. The New England Journal article emphasizes that all this speculation on cause is just that at this point – speculation. From the Medical World News article: Dr. Yehudi M. Felman, New York City’s V.D. control chief says he wishes the speculation would stop…in his view, the media spotlight should be illuminating the more common-and treatable-health problems of homosexuals rather than a rare and still inexplicable syndrome.”
So are any of us here in Colorado coming down with Kaposi’s or pneumocystis? According to G. Barry Gaspard, epidemeologistt at the State Health Department, have no documented cases of Kaposi’s Sarcoma* among gay men in Colorado. The pneumonia is apparently a bit more difficult to pin point but it has not been found to be afflicting any gay men to date here either.
Since the cause of these diseases among gays is certainly unknown at this time it becomes difficult to offer advice on prevention! Based on my research and discussion with Mr. Gaspard a worthwhile first step would be to get a better handle on the rampant number of sexually transmitted diseases (STD’s) currently ravaging our community for which there are treatments available -syphilis, gonorrhea and the various intestinal parasites to name a few. Whether or not these common STD’s are part of the causative miliwe* for Kaposi’s and pneumocystis doesn’t matter really – they are ravaging our health now as it is!
The Bay Area Physicians for Human Rights along with the National Coalition for Gay STD Services have recently issued an education pamphlet soon to be available here in Denver if we can scrounge up the money to print it! Among their suggestions:
“Always exchange your name and phone number to facilitate contact in case signs or symptoms of an STD are later discovered.”
“Casually inspect (a prospective partner) for growth, sores or rashes, especially around the genitals. If no reasonable explanation is given postpone the encounter.”
“Rimming except in an exclusively monogamous relationship should be eliminated from the activities of everyone who is not interested in getting amebiosis, giardiases, shigellosis, Campylobacter bowel infections or hepatitis A or B.”
Closing with one further bit of advice. If you aren’t receiving your health care from a physician currently knowledgable (and preferably gay him/herself) about the peculiarities of gay male health needs you are doing yourself a real disservice. Call the GLCCC (831-6268) today for the name of a physician if you need one!