The Relationship between the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome (Draft)

DRAFT
progressed to AIDS (Keet et al., 1994). In a study of 5 cohorts of homosexual men for whom
dates of seroconversion were well-documented, no statistically significant association was
found between HIV disease progression and sexually transmitted diseases, number of sexual
partners, use of AZT, alcohol, tobacco or recreational drugs (Veugelers et al., 1994).
These recent studies build on previous findings that showed no association between
drug use and the development of AIDS (Jaffe et al., 1983; Kaslow et al., 1989; Coates et al.,
1990; Lifson et al., 1990b; Robertson et al., 1990).
Also lacking is evidence of a temporal association between the onset of the AIDS
epidemic and behaviors such as the use of recreational drugs or sexual promiscuity. Such
behaviors have existed for decades -- in some cases centuries -- and have increased only in
a relative sense in recent years (Essex, 1992). For instance, widespread use of opiates has
existed since the middle of the 19th century (Courtwright, 1982); as many as 313,00
Americans were addicted to opium and morphine prior to 1914. Heroin use spread throughout
the country in the 1920s and 1930s (Courtwright, 1982) and the total number of active heroin
users peaked at about 626,000 in 1971 (Greene et al., 1975; Friedland, 1989). While cocaine
use increased markedly during the 1970s (Kozel and Adams, 1986), the use of the drug since
the 1880s in the United States is well-documented (Dale, 1903; Spotts and Shontz, 1980).
The recreational use of nitrite inhalants ("poppers") also predates the AIDS epidemic.
Reports of the widespread use of these drugs by young men in the 1960s were the impetus
for the reinstatement by the Food and Drug Administration of the prescription requirement for
amyl nitrite in 1968 (Israelstam et al., 1978; Haverkos and Dougherty, 1988). Since the early
years of the AIDS epidemic, the use of nitrite inhalants has declined dramatically among
homosexual men, yet the number of AIDS cases continues to increase (Ostrow et al., 1 990a;
Lau et al., 1 992b; ODO, 1 994a).
Historians and sociologists have documented extensive homosexuality dating from the
ancient Greeks to a thriving homosexual subculture in the United States in the 20th century

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