"The Reagan administration was openly hostile to addressing the issue, and openly hostile to the groups traditionally associated with the issue, which meant the gay community," Neilson said. "That did lead to a climate of fear. In a climate of fear, there are very few people who are willing to step forward and be tested. They are afraid of the repercussions."
As the disease progressed amid an atmosphere of discrimination, efforts to encourage widespread testing were also hindered because there was no effective treatment for the disease, and thus no self-interested reason for people to find out if they harbored the virus. So the testing ethos that emerged from HIV/AIDS's early days in San Francisco and New York focused on civil liberties. As Africa is sundered by the disease – and with statistics showing that India will likely be the next country devastated by the epidemic – the emphasis should shift to public health.
"San Francisco led the world in battling – and continues to lead the world in battling – the most deadly disease of all time. But the initial notions of how to address the epidemic 20 years ago obviously need to evolve, particularly now that we have access to drugs," Neilson said. "We need to adjust the way we look at testing."
To get another perspective on the testing dilemma, I called a publicist who had just moved from a San Francisco AIDS group to a New York AIDS nonprofit. She recommended I speak with someone from a third AIDS group, where I was sent to a fourth, the San Francisco AIDS Foundation, which pioneered testing back in the 1980s. The SFAF does not currently focus on testing, a spokesman told me, and it would be best if I spoke to another group.
The silence is typical, Neilson said. Testing dredges up touchy issues many groups would rather not address.
"For leaders in the AIDS community in San Francisco, their involvement in the testing issue globally would be very useful. They're the ones who were involved back when it was happening. They should be speaking to the WHO, to UNAIDS, to the global decision-makers on this issue, giving their assessment of what the best way to address the lack of access to testing would be," Neilson said. "They have two decades of experience in this issue. It might inject a dose of reality on the difference between 1980s San Francisco and modern Botswana."
It might also help rescue some of us from Inside-Out World, so we start paying attention to the planet's real problems again.