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The Anatomy of an Epidemic

contact tracing to stem the virus's spread, as they do for other sexually transmitted diseases.

Today, a few months shy of his 90th birthday but still active as senior scholar of the Koop Institute at Dartmouth, Koop continues to be a relentless advocate for public health and health education.

Reaching around the world
Dr. C. Fordham von Reyn, DMS '69: now
a professor of medicine (infectious disease) at Dartmouth Medical School and chief of the infectious disease section at Dartmouth-Hitchcock Medical Center

In the early 1980s, AIDS was exploding in the nation's cities. But it was also quietly making its way to rural New Hampshire and Vermont, too.

"The earliest patients we saw with AIDS in New Hampshire were gay men who had moved back from urban areas and were dying of the disease, and hemophiliac men who were living locally and had been receiving concentrated blood products from hundreds of donors," says infectious disease expert Fordham von Reyn. "I saw my first patient in 1983. He came back from New York City almost terminally ill. At this point, the stigma was tremendous. His family, who owned a local business, didn't want to be taking him out of the house. I made house calls. I didn't have anything much to offer other than treating complications and symptoms and trying to provide some comfort.

"It was wonderful in the late '80s when we had the first drug to treat HIV," von Reyn continues. "But unfortunately we treated people with serial monotherapy—one drug at a time. When one failed, we switched to another, and later realized that this was an ideal recipe for introducing resistance. So when multiple-drug treatment became the standard in the 1990s, then we really saw a tremendous difference in how people did. Patients who were sick in bed, dying, . . . perked up, gained weight, went back to work," after taking what came to be known as the AIDS "cocktail." By that time, for patients in the U.S., AIDS was no longer a death sentence but a manageable chronic disease.

Yet no one predicted that AIDS would spread the way it has—that Africa and the Indian subcontinent would see infection rates well into the double digits and that heterosexual men, women, and children would far outnumber gay men in the ranks of the HIV-positive. Today, the typical

"We learned as much about AIDS in six years as we learned about the hepatitis virus in over 40 years," former Surgeon General Koop says. "Largely that was because we had done so much bench science on cancer."

AIDS patient is a young, married, monogamous woman in Africa. But the disease continues to have social, medical, and economic implications for developed and undeveloped nations alike.

"None of us realized at the beginning that this would become a worldwide pandemic," says von Reyn. Today, he's turned over the care of local AIDS patients to colleagues and is attacking the disease on a far broader front. He is one of the leaders of the DARDAR Project, based in the central African nation of Tanzania. The HIV infection rate in Tanzania is 10% in adults and 30% in pregnant women. DARDAR, a collaboration between Dartmouth Medical School and Tanzania's Muhimbili University College of Health Sciences (MUCHS), includes a clinic for children with HIV/AIDS, a trial for a tuberculosis vaccine (tuberculosis being a common complication of AIDS), and a program to train Tanzanian researchers.

The term DARDAR was drawn from the first three letters of "Dartmouth" and "Dar es Salaam," the city where MUCHS is located. In addition, the acronym is similar to the Kiswahili word "dada," which means "sister." The close relationship between the two institutions—and their commitment to address AIDS together—was broadened six months ago to be a Dartmouth-wide project called the Global Health Initiative. Von Reyn expects to focus on those efforts for some time to come.

Investigating implications
Dr. Andrew Saykin: now a professor of psychiatry and of radiology at Dartmouth Medical School

In 1984, Andrew Saykin was a junior faculty member at the University of Pennsylvania when he was offered the opportunity of a lifetime—to work on a mysterious new disease. Dr. Robert Janssen, a CDC neurologist who had trained at Penn, asked for Saykin's help in assessing the neurological effects of


  • U.S. Food and Drug Administration (FDA) approves zidovudine, AZT, the first antiretroviral for the treatment of AIDS.
  • Entertainer Liberace dies of AIDS.
  • The AIDS Memorial Quilt is started in San Francisco (it comes to Hanover in 1991).
  • Princess Diana shakes hands with AIDS patients without gloves to show the disease can't be spread by normal contact.
  • AIDS is the first disease ever debated on the floor of the UN General Assembly. The body resolves to mobilize the UN against AIDS, under WHO leadership.


  • A summary of Surgeon General Koop's report, Understanding AIDS, is mailed to every U.S. household.
  • WHO declares the first World AIDS Day.
  • U.S. NIH establishes the Office of AIDS Research as a separate agency.
  • The U.S. bans discrimination against federal workers who are HIV-positive.


  • More celebrities die of AIDS, including choreographer Alvin Ailey and photographer Robert Mapplethorpe.
  • Congress passes a resolution to create the National Commission on AIDS.
  • A drug trial shows that AZT can slow the progression of AIDS. U.S. Secretary of Health Louis Sullivan calls this "a turning point in the battle to change AIDS from a fatal disease to a treatable one."


  • The Americans with Disabilities Act is passed; it prohibits discrimination based on disability, including HIV/AIDS.
  • Ryan White dies and Congress approves the Ryan White CARE Act to provide community-based AIDS care.
  • The CDC reports the possible transmission of HIV to a patient during a dental procedure. The dentist had been diagnosed with AIDS three months before performing the procedure.

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