How an epidemic begins and ends

Bobbi Campbell in 1983; Ryan White in 1989. | Bobbi Campbell photo: Courtesy of UCSF Archives and Special Collections,Bobbi Campbell Diary, MSS 96-33, Bobbi Campbell making a peace sign, ca. 1983; Ryan White Photo: MPI/Getty Images

What the fight against AIDS can tell us about the fight against opioids.

In 1981, a young nurse named Bobbi Campbell hung a poster in the window of the Star Pharmacy at the corner of 18th Street and Castro in San Francisco. The poster featured Polaroid photos of the purple spots on Campbell’s feet: Kaposi’s sarcoma, a once-rare skin cancer that would soon become well-known as a condition associated with HIV/AIDS.

“That I believe was the very first attempt at public education about the disease we now call HIV/AIDS in the entire world,” said Cleve Jones, a longtime activist and organizer in the city. “And within minutes of it being taped up there in the window, a small crowd of very anxious men had assembled on the sidewalk to look at these pictures.”

Nearly a decade later, Congress passed the first nationwide, coordinated response to the AIDS crisis: the Ryan White Care Act. In the years since, it’s dedicated billions of dollars to the fight against AIDS, and it revolutionized care for patients with this once-deadly disease. But by the time President George H.W. Bush finally signed it into law, hundreds of thousands of Americans were infected, and tens of thousands had died.

“You have to understand that people were dying every day,” Jones said. “We were in funerals every day. In our address books, we had entire pages where every name had been crossed out.”

Today, the United States is facing another public health crisis. Opioid overdoses killed more Americans in 2017 than HIV/AIDS did at the height of the epidemic, in the mid-1990s.

Senator and presidential hopeful Elizabeth Warren is using the Ryan White Care Act as a blueprint for her proposal to fight the opioid epidemic, with increased access to addiction treatment and overdose prevention. Her plan would cost $100 billion over 10 years, and addiction experts agree that this is the kind of money the United States needs to fight the opioid crisis.

Like the Ryan White Care Act, Warren’s proposal is an expensive idea, to help a deeply stigmatized population. How would a President Warren convince Congress, and the American people, to pass it?

The Impact’s first episode of its third season explores how an epidemic begins and how it ends, through the lives of two young men: Bobbi Campbell and Ryan White, who succeeded Campbell as a poster boy of the AIDS crisis. We find out what it took to get the federal government to finally act on AIDS, and what that means for Warren’s plan to fight the opioid crisis, today.

Further listening and reading:

• When We Rise: My Life in the Movement, Cleve Jones’s book about his work for LGBTQ rights and against AIDS
• And the Band Played On: Politics, People, and the AIDS Epidemic, by Randy Shilts
• Vox’s German Lopez on Elizabeth Warren’s plan to fight the opioid epidemic
• Vox’s guide to where 2020 candidates stand on policy