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Emerging Infections: Microbial Threats to Health in the United States
emerged: intravenous substance abusers. The introduction of crack cocaine in the United States in the mid-1980s added another component to the complex epidemiology of HIV infection. Many persons who abuse crack cocaine use sex as a currency to support their habit. The result has been a striking rise in heterosexually transmitted syphilis, chancroid, and HIV infection. Although in the United States, HIV infection occurs predominately in male homosexuals and intravenous substance abusers, the rate of infection among non-substance-abusing heterosexuals is increasing.
The fact that HIV first established itself in the United States mainly among gay men has both negative and positive repercussions. On the negative side, rapid emergence was facilitated among those individuals who engaged in anal intercourse with multiple partners. On the positive side, unusual diseases related to HIV infection initially occurred in a specific subpopulation, and that specificity probably hastened recognition of the syndrome and its infectious nature. Had the first cases of AIDS occurred in a more diverse population, it is likely that discovery of the exact nature of the problem would have been slowed. Once the disease was recognized as a new entity with the potential for epidemic spread, the biomedical research community began a concerted effort to identify the etiologic agent. Collaborations were established between health care workers, who provided blood samples from patients, and researchers, who in turn isolated and defined properties of the virus so that blood tests could be generated and the development of drugs and vaccines could begin.
Unfortunately, the U.S. political sector was not as responsive to the crisis and by its slow response may have contributed to the explosive growth of the epidemic. A major reason for this hesitancy appeared to be the antipathy of some federal officials to the behaviors of those persons initially affected by HIV disease: gay men and substance abusers. In some instances, federal officials thwarted efforts to curtail the epidemic. For example, former Surgeon General C. Everett Koop has stated, "Even though the Centers for Disease Control commissioned the first AIDS task force as early as June 1981, I, as Surgeon General, was not allowed to speak about AIDS publicly until the second Reagan term. Whenever I spoke on a health issue at a press conference or on a network morning TV show, the government public affairs people told the media in advance that I would not answer questions on AIDS, and I was not to be asked any questions on the subject. I have never understood why these peculiar restraints were placed on me. And although I have sought the explanation, I still don't know the answer" (Koop, 1991).
More detrimental, however, was the government's continued resistance to proposed sex education programs designed to interrupt transmission of HIV (Koop, 1991). The federal government's recent revocation of funding for an approved five-year study of teenage sexual behavior (Marshall,