SCOURGE OF
THE GAYS
A rare
and dangerous disease whose victims are almost
exclusively homosexual and bisexual men has hit
Britain. Brian Deer explains why
the specialists are worried.
Time Out
(London) December 18 1981
Doctors released the worst possible news for gay
men last week with a report on the first death in
Britain from one of the extraordinary 'gay syndrome'
diseases which have stunned the US gay community
during 1981.
A
49-year-old gay man died from pneumocystis carinii
pneumonia (PCP) ten days after being admitted to the
Brompton Hospital. He had lost weight over three
months and suffered three weeks' general malaise and
progressive breathlessness.
His
case is identical to a series of puzzling US reports
collated by the federal Centers for Disease Control
(CDC) in Atlanta. Brompton Hospital doctors believe
it may be significant that their patient regularly
visited the States.
The
CDC is also studying a related outbreak, mostly in
New York and California, of Kaposi's sarcoma (KS) -
an extremely rare skin cancer hardly ever seen
outside parts of Africa. Its first symptoms are often
violet or blue lumps.
Both
diseases have risen dramatically during the year -
almost exclusively among homosexual and bisexual men.
By last week in the States the totals had reached: 75
of PCP, 77 of KS, 18 of both, and 13 cases of other
infections, like herpes, which had become
life-threatening.
Mortality
rates are over 50 per cent for PCP and 20 per cent
for KS. Early detection of the diseases is important,
although before national publicity their great rarity
caused many cases to be initially diagnosed as more
common ailments.
What
links the two diseases, apart from the lifestyle of
most victims, is not fully understood. Tests which
may show a connection with a generally rather minor
infection, cytomegalovirus, are incomplete.
Although
evidence of past or present cytomegalovirus shows in
all successful tests on PCP and KS patients, nearly
95 per cent of gay men and 50 per cent of the general
population will contract this at some time, so it
cannot be a full explanation.
Speaking
at a scientific conference in Chicago last month, Dr
James Curran, who leads a CDC task force dealing with
the problem, said: "Data suggests an epidemic of
immuno-suppression is occurring, primarily among
homosexual men."
What
this means is that the body's natural defences
against disease have been weakened. But this does not
of itself explain why gay men should be contracting
these very specific and rare complaints, which never
occurred in similar circumstances before 1979.
Dr
Harold Jaffe, a CDC task force member, agreed last
week that a "factor X" was still sought. He
said they were unable to explain the outbreak, but a
consensus of opinion was forming around two competing
hypotheses.
The
first is that the cause may be found among drugs -
either on prescription or off the street - used
extensively by gay men. Amyl or butyl nitrite
(poppers), used as stimulants, were especially strong
candidates.
Alternatively,
said Dr Jaffe, the epidemic may be due to a new and
previously unrecognised strain of an infectious agent
- possibly comparable with Legionnaires' disease.
This agent may or may not be a virus.
He
added: "We have no evidence at the moment that
it is transmitted from person to person, but this is
something we are concerned about."
In
recent months, British specialists have become
increasingly interested in US developments, and
current speculation in medical circles is about when,
rather than whether, further PCP and the first KS
cases will turn up here.
"We
have to be careful not to be alarmist," a London
doctor closely involved said last week. "The
numbers we are talking about are very small. But I
think this problem is going to become a large
one."
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