For Edie Lou Skoog on the Maine island of Vinalhaven, it was the panel of a quilt friends and family made for her son, Lennie, after he died. For physician Donald Abrams in San Francisco, who first noticed swollen lymph nodes in his patients 10 years ago, it was the government's about-face on speeding up approval of experimental drugs. For Doug Nelson of Milwaukee, it was when so many mothers started volunteering to be "buddies" for those diagnosed with AIDS, taking them to the doctor, helping them find housing, easing their way to a lawyer to make a will or fight discrimination.
A decade into the epidemic, AIDS has come of age -- for these three Americans and millions of others who have been touched by the disease. No longer a new and mysterious infection, the lethal virus has become a permanent feature on the medical landscape. But more than a health problem, AIDS is a political issue. And like wars past that consume resources and public passions, the politics of this disease is fueled by the body count: more than 136,000 cases so far in the U.S.; more than 83,000 deaths.
The toll falls short of the scaremongering predictions of the mid 1980s, when AIDS was compared to the Black Death of the Middle Ages that wiped out a third of Europe's population. But if the public over-reacted to these initial alarms, it now shows signs of complacency. With all the other hazards of modern life, some wonder, why care about AIDS?
In part, that question will be addressed at the Sixth International Conference on AIDS that opens tomorrow in San Francisco, where as many as 12,000 researchers, physicians, public health officials, social workers and gay activists will debate the science and policy of AIDS in the '90s.
In part, that question has already been answered by the thousands of Americans who have been touched by the disease: patients, relatives, friends, nurses, doctors, dentists, emergency medical technicians, major corporations. Why AIDS?
Because it remains a fatal disease. While scientists are more optimistic about the chances of developing a vaccine -- and a range of drugs have been designed to fight the Human Immunodeficiency Virus and AIDS-related diseases -- there is still no cure.
Because it is growing. The rate of new cases is slowing, but the toll continues to rise. An estimated 1 million Americans are infected with HIV, and health officials project that as many as 480,000 cases will be diagnosed by the end of 1993. AIDS is also a global epidemic with an estimated 650,000 cases worldwide and a projected 6.5 million infected with HIV.
In the U.S., the disease is shifting from gay men to intravenous drug users and their families, making AIDS a hallmark of a swelling medical underclass. Meanwhile, AIDS is spreading from the two coasts into the nation's heartland, where small-town pride and prejudice exacerbate the problems of adequate medical care and social support.
Because it is preventable. Scientists know a lot about HIV and how it spreads: largely through sex and drug use. But containing the epidemic involves much more than medicine. First are the social and economic underpinnings of the disease. Second is the role of personal behavior.
Both facets of the disease demand money and attention from society as a whole. As Nelson, executive director of the Milwaukee AIDS Project said: "People have read the stories on what is happening on the East and West coasts and they say -- we don't want that to happen here."