82) The Pandemic Of Our Time

Almost 7 million people have died so far from the coronavirus COVID-19 outbreak as of April 05, 2023, 13:57 GMT.

We constantly hear about COVID, but in reality HIV is the defining pandemic of our time.

The AIDS crisis, as we generally think of it, began in the 1980s. First as a mysterious illness primarily infecting gay men in urban areas in the United States. But that’s not really the beginning. Before the disease’s first mention in 1982 in the New York Times, people had been dying of AIDS for at least a decade, though probably not much longer. In Africa, HIV–the virus that causes AIDS–had jumped from chimpanzees to humans sometime early in the 20th century.

Like COVID’s suspected origination in bats, and many other mutated microorganisms that jump from animals to humans.  Over 30 new human pathogens have been detected in the last three decades, 75% of which have originated in animals.

But the AIDS virus didn’t make a random jump from chimpanzees to humans. It body slammed a particular population of people.

Like COVID. More than 81% of COVID-19 deaths occur in people over age 65 The number of deaths among people over age 65 is 97 times higher than the number of deaths among people ages 18-29 years.

A person’s risk of severe illness from COVID-19 increases as the number of underlying medical conditions they have increases.

Likewise, AIDS – the full blown disease – began and HIV – the latent infection – remains very much in the majority among the population of gay men.

Men who have sex with men (MSM) have been the population most impacted by the epidemic since the beginning. If current rates continue, it is estimated that 1 in 6 MSM will be diagnosed with HIV at some point in their lives.

  • MSM make up an estimated 2% of the US population, but accounted for 66% of new annual HIV infections in 2017.
  • As of 2019, 56% of people living with HIV in the US contracted it through male-to-male sexual transmission.
  • As of 2018, 1 in 6 MSM living with HIV was unaware of their status – and pass it on to unwitting partners.

The reason for this is the same as the elderlies’ higher risk for COVID –  vulnerability to infection due to reduced immune responses from the number of underlying infections already experienced.

Sexually transmitted diseases (STDs) are a major public health problem in the United States. Nearly 12 million Americans are infected with an STD annually; approximately 43 million have viral STDs, which cannot be cured and thus infect the individual for life.1 For virtually all STDs, the number of documented cases has increased in the last 10 years.2 The number of Americans infected with the human immunodeficiency virus (HIV), for example, has increased steadily since the 1980s, and in 1993, more than 40,000 U.S. residents died from AIDS-related illnesses.3 Further, STDs cost society more than $3.5 billion each year.

This alone constitutes a public health problem.

During the last century, extraordinary medical advances in the ability to diagnose STDs have not led to tremendous success in controlling them. For example, even though penicillin has been an important and effective part of the public health campaign against syphilis and gonorrhea for more than 40 years, these STDs continue to be significant health problems. In fact, in some subgroups of the population, the incidence rates of these infections have risen dramatically.5

STDs persist in the U.S. population largely because of the complex ways in which pathogens and their hosts interact with social and environmental factors that determine the mechanism of acquisition and the pattern of transmission of these diseases.6 For example, social changes, such as modified patterns of nonmarital sexual behavior, overwhelm the effects of medical treatments. The control and prevention of STDs thus calls for more than technological improvements or medical innovations: It requires an understanding of the social and behavioral linkages involved in the acquisition and transmission of infection…

Our examination of 20-39-year-old men’s sexual and health care behavior and behavior changes following the diagnosis of an STD confirm the role of behavioral factors in the persistence of STDs in the United States. To begin with, sizable proportions of the men in our sample continued to have sex while they were infected, did not tell their sex partners that they were infected, did not return to their doctor to be rescreened following therapy and did not change their sexual behavior or condom use in any way.

The reality of health care is that changing human behavior is the best preventive and cure for disease. Medicines can help, but they only work with a functional immune and metabolic system.


And yet government agencies blame society for failing to eliminate HIV and other STDs.

Despite the advancements in HIV prevention and care, the state of the epidemic today reminds us of the role stigma and discrimination play in increasing risk. There are many social, economic, and structural barriers that continue to prevent some people from accessing the care they need.

This LGBT-biased perspective is utterly biased against the barriers that prevent the majority of the population from protection against disease.

What truly boggles my mind are the barriers that government agencies’ discrimination in favor of LGBT freedom of action by the stark contrast in public health laws

  • minimizing the transmission of the COVID virus by demanding vaccinations for employment by health care workers, use of masks by the general public, and shut down of public services like schools and small businesses,
  • while knowingly increasing transmission of HIV by permitting HIV-positive persons unrestricted privacy in spreading a fatal disease into the public domain.

Throughout much of early epidemiological history, isolation…was the primary method of halting the spread of pandemics

One of the earliest mentions of isolation is found in the Biblical book of Leviticus…the relevant chapters could have been written as early as the twenty-first century BCE…in response to a skin disease (most likely leprosy, caused by Mycobacterium leprae). Jewish Rabbis certainly had no knowledge of the bacteria, but they did know the value of isolation:

“The priest is to examine the sore on the skin, and if the hair in the sore has turned white and the sore appears to be more than skin deep, it is a defiling skin disease… he shall pronounce them ceremonially unclean [isolated from crowds / public interaction]. If the shiny spot on the skin is white but does not appear to be more than skin deep and the hair in it has not turned white, the priest is to isolate the affected person for seven days [only]. On the seventh day the priest is to examine them, and if he sees that the sore is unchanged and has not spread in the skin, he is to isolate them for another seven days.”

Quarantine differs greatly from isolation; it requires a theoretical knowledge about the causes and methods of disease transmission…first postulated in the mid-nineteenth century…by the work of Louis Pasteur…

An important offshoot of germ theory…is the incubation period of disease. Anyone who carries a pathogen responsible for a disease is considered infected, though not all carriers may be symptomatic.

Isolation is established when those people who belong in the red circle are restricted in their movements. Quarantine occurs when those people who belong in the yellow circle have their movement restricted as well.

Isolation is established when those people who belong in the red circle are restricted in their movements.
Quarantine occurs when those people who belong in the yellow circle have their movement restricted as well.1

1. Centers for Disease Control and Prevention,
“Quarantine and Isolation.”
Last modified October 24, 2011.
Accessed December 5, 2011.

In 2023 while I was working in a state mental hospital one of my patients became symptomatic and tested positive for COVID.

  • That patient was confined to his/her room.
  • Everyone else on the unit was quarantined by blocking access to the patient.
    • There was no common space for the patients to interact in the patient’s room, shared bathroom, or day room.
    • Staff donned full body hazmat suits before entering the patient’s room, stripped off the disposables before re-entering the common area and disinfected the non disposable face masks.
    • No visitors or non-essential staff were allowed on the unit, only essential health care personnel.
    • Testing of all patients and staff was conducted periodically.

This is the standard procedure for any hospitalized patient testing positive for TB or C difficile diarrhea.

However, this alone did not prevent the spread of the disease.

Pathogenic bacteria take time to grow and multiply within their host. Until they do so in sufficient numbers, they are often overlooked by the immune system. The time between when a pathogen enters the body and when it first causes symptoms is the incubation period.

The sequence of events during a simple, directly transmitted disease. The dynamics of the disease are shown in A and the dynamics of infectiousness in B. The victims may cease to be infectious before the end of the symptomatic period.

“The sequence of events during a simple, directly transmitted disease.
The dynamics of the disease are shown in A and the dynamics of infectiousness in B.

1. Susan Scott and Christopher Duncan, Biology of Plagues:
Evidence from Historical Populations,
(Cambridge, United Kingdom: Cambridge University Press, 2001), 22.

I had visited the patient face to face for a routine check prior to her becoming symptomatic of COVID, i.e. during her latent period. Five days later I became symptomatic. Following Infection Control guidelines,

  • my illness was linked to my contact with our Patient Zero,
  • to prevent transmitting infection to other persons I was not allowed to return to work as soon as I felt symptom-free, I had to remain quarantined from the hospital for 10 days to ensure full clearance of the infectious agent from my body.

Essential Components of a Public Health…Prevention, Control, and Elimination Program

July 31, 2020

This works.

But that is only for tuberculosis and COVID.

Despite being The Epidemic Of Our Time, HIV is the only disease not subject to monitoring under these strategies.

That is specifically WHY HIV became The Epidemic Of Our Time.

Legal protection of patient privacy and confidentiality depends on whether or not public health concerns outweigh the interest in preserving the doctor-patient privilege. The balancing of these interests is a particular challenge when it comes to privacy concerns associated with HIV status…

Partner notification is critical so that individuals know they are at risk, receive HIV counseling and testing, and get appropriate medical care. One of the most controversial issues is whether physicians may disclose the HIV status of their patients to known contacts and, further, whether failure to do so may give rise to liability if the known contact becomes HIV-positive…

In other contexts, physicians have faced liability for not warning third parties of foreseeable harm…case law contains legal precedent that justifies dissemination of information to prevent third-party harm. Yet, to date, attempts to create a duty for physicians to protect endangered third parties in HIV cases have been unsuccessful. In 2 such cases, the…parties sued, alleging intentional infliction of emotional distress[by the physician] because of their fear of contracting AIDS…

Furthermore, punitive damages have been allowed for wrongful disclosure of a plaintiff’s HIV status in violation of a confidentiality statute…

However, the AMA Code of Medical Ethics Opinion 5.05 states that information disclosed to a physician by a patient is confidential but subject to certain exceptions that are ethically and legally justified because of overriding societal considerations…

The Code also notes that communicable diseases should be reported as required by applicable law. This utilitarian approach fulfills the physician’s duty to be an agent of the individual patient but in the context of the potentially greater good of the society in which he or she practices.

Specifically with regard to HIV-infected patients, exceptions to confidentiality do exist. As stated in Opinion E-2.23:

If a physician knows that a seropositive individual is endangering a third party, the physician should, within the constraints of the law (1) attempt to persuade the infected patient to cease endangering the third party; (2) if persuasion fails, notify authorities; and (3) if the authorities take no action, notify the endangered third party.16

As a policy matter, the AMA strongly recommends that all states adopt requirements for confidential HIV reporting to appropriate public health authorities for the purpose of contact tracing and partner notification…

The AMA encourages…public health departments…to address, through the Council on Ethical and Judicial Affairs, the patient confidentiality and ethical issues raised by known HIV-positive patients who refuse to inform their sexual partners or modify their behavior.

The AMA also supports legislation on the physician’s right to exercise ethical and clinical judgment regarding whether or not to warn unsuspecting and endangered sexual or needle-sharing partners of HIV-infected patients and promulgates the standard that a physician attempt to persuade an HIV-infected patient to cease all activities that endanger unsuspecting others and to inform those whom he or she might have infected…

That was written in 2005. Nothing has been done since.

AIDS Exceptionalism

By late February of 1982, 251 Americans had been diagnosed with AIDS and 99 had died. (The disease at that time was labeled GRID gay related immune deficiency.) Although the pathogen responsible had not been identified, experts were convinced that they were dealing with a disease caused by a virus and transmitted by semen and blood, and that the gay bathhouses were a likely venue for transmission, since many of the first victims could be linked to these establishments…

By 1985, the pathogen that causes AIDS had been identified, the modes of transmission known, and a test developed to identify those infected. The standard public health procedures used for other STDs…should have been immediately instituted. Instead, spokesmen for the gay community objected to any form of mandatory or routine testing…No one should be tested unless they wanted to be. All testing information should be absolutely confidential to avoid outing gay men. The names of the infected should not be reported. There should be no routine testing, no contact tracing, and no notification of possibly infected persons. No one had a moral responsibility to tell their sexual partners they were HIV positive…

The gay AIDS establishment defended the right of infected persons…to conceal their contagious condition from others, including sexual partners and healthcare personnel…

For gay activists, the proper goal of AIDS prevention was defense of the gay sexual revolution, and since gay liberation was founded on a “sexual brotherhood of promiscuity … any abandonment of that promiscuity would amount to a communal betrayal of gargantuan proportions…”

The motivations for high-risk behavior included…eroticization of behavior that is considered taboo…

June [2021]marks the 40th anniversary of the first scientific report describing pneumocystis pneumonia, which later became known as acquired immune deficiency syndrome (AIDS). More than 32 million people have died worldwide from AIDS and 38 million people are living with HIV, the virus that causes AIDS, according to the Centers for Disease Control and Prevention.

“The last 40 years of the HIV epidemic have given us an in-depth look at society, science, medicine, and socioeconomic impacts of disease on communities and countries…

No kidding.


Unfortunately, the AIDS crisis of the 1980s was steeped in…discrimination, especially against gay men who were disproportionately affected by the disease. Much progress has been made since that time, but there is still more work to be done. 

July 23, 2022: The World Health Organization on Saturday declared the international monkeypox outbreak a global emergency. This is the highest level of alert the WHO can issue, in order to pressure governments into action and to provide resources including funding dedicated to this. More than 16,500 cases of monkeypox have been reported in 74 countries.

“In short, we have an outbreak that has spread around the world rapidly through new modes of transmission about which we understand too little,” WHO Director General Tedros Adhanom Ghebreyesus told reporters Saturday.

Oh yes they understand!

overwhelmingly concentrated in men who have sex with men…

The WHO director general emphasized that any containment measures should respect the “human rights and dignity” of gay and bisexual men.

“Stigma and discrimination can be as dangerous as any virus,” Tedros said.

Seriously? How can we ignore the innocent victims who are infected because society and medical care discriminated against their need to know to protect themselves?

The goal of mandatory testing, contact tracing, partner notification, and universal treatment would be to identify and treat all those infected and shrink the time between infection and treatment—the time when the HIV-positive person is highly infectious. While some AIDS activists still argue that universal testing and treatment would violate civil rights, such arguments should not guide public health policy. HIV/AIDS should be treated like any other serious contagious disease. No one has a civil right to spread disease.

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