António Pais de Lacerda
Asignatura de Introducción a la Medicina, Facultad de Medicina de Lisboa, UCI Polivalente, Servicio de Medicina Intensiva, Hospital de Santa Maria, Lisboa (Portugal).
Correspondence: António Pais de Lacerda, Servicio de Medicina Intensiva, Hospital de Santa Maria 1649-035 Lisboa (Portugal)
Received 14 July 2006; accepted 24 July 2006
It was 25 years ago, in the summer of 1981, when society as a whole and particularly the scientific community was faced with an unknown disease that came later to be known as Acquired Immunodeficiency Syndrome (AIDS). Several films have sufficiently reflected the initial fears and uncertainty, the responses of the different social groups, the fight against ignorance, the urge of having access to treatment and the suffering of the infected individuals and their families that were due to this disease. Taking into account that these movies were filmed when these epidemics took place they can actually be considered as true historical documents that deserve being analysed by the generations to come. Films such as And The Band Played On; Long time Companion; Common Threads: Stories from the Quilt; Les Nuites Fauves; Angels in America; Yesterday and My Brother... Nikhil have marked 25 years of AIDS history that should not be forgotten by the world.
Keywords: AIDS, HIV, Antiretrovirals, History of Medicine, Cinema
"This is not a political issue. This is a health issue. This is not a gay issue. This is a human issue. And I do not intend to be defeated by it."
Roger Gail Lyon (And the Band Played On, 1993)
Positivist historians such as Charles Victor Langlois and Charles Seignobos who lived by the times of the early beginnings of cinema considered that history was based on documents”. The documents by that time were mainly written documents and by their means one could be able to reconstruct the historical facts from the past.
Therefore when workers leaving their factory were filmed in 1895 by the Lumière brothers, they not only registered the experience of the moment but also a new method for historical documentation became available to historians. From that moment on cinema became a constant companion of history.
Cinema has the ability of recreating images of events, ways of life or even feelings, may they be real or fictitious. But beyond this function, cinema can be a proactive art as it can shape mentalities and dominate hearts and minds. By doing so, it can become a transforming agent of social awareness and thus, contribute to the construction of history.
When films are aimed at recreating events from the past, the examination of the historical facts plays a valuable part in obtaining a reconstruction of the facts that is intended to be as accurate as possible. Films, however, also include elements of fiction that can actually be considered as critical reflections from the director, scriptwriters or producers that may be more or less determined by their own believes, ideologies or even by the current social trends. A number of films have recreated the life of prominent persons or important events in the History of Medicine. Among these are films such as The Story of Louis Pasteur (1935) by William Dieterle; Doctor Laennec (1949) by Maurice Cloche; Awakenings (1990) by Penny Marshall; Lorenzo’s Oil (1992) by George Miller or Kinsey (2004) by Bill Condon. These movies were all filmed once the real events had already taken place. Thus, particular attention was paid to the degree of historical coherence and objectivity that these films were supposed to exhibit. However this does not prevent from including various elements of fiction in these films.
Except for documentary films, it is still uncommon for films to show what a society thinks about a certain disease (evolutionary thoughts) and what active or medical responses are being undertaken in the context of the experienced reality.
When the Morbidity and Mortality Weekly Report journal published in June 5th., 1981 a report about the occurrence of Pneumocystis Carinii pneumonia in five previously healthy young men, the subjacent infection was still unknown1. It was the beginning of a new era that would be characterised by completely different experiences and personal relationships to the ones that used to exist. Although there was panic and grievance it was also a time of political and social challenge. It was in the summer of 1981 when the peak of the iceberg proved to be the beginning of what has become an enormous epidemic throughout the world.
In this case, however, there is no need for cinema to recreate the past. When talking about AIDS, cinema is constantly uncovering the present and it also shows the yearnings and hopes people have as well as the new ways of how they are experiencing love.
Films whose plots evolve around AIDS constitute living documents of the history of one of the most devastating epidemics in the contemporary medicine. An epidemic that will even have tragic consequences in the present century.
The aim of the article is to take a look at 25 years of AIDS in cinema. The exposed list of films where AIDS plays a significant role is not intended to be exhaustive as more complete listings of these films are available in other sources2. Whenever it is possible, films being analysed will be organized according to the period where action takes place. These are films that uncover some of the main medical, psychological or social aspects that can be considered as being representative of the first 25 years of this disease. These productions were filmed almost by the same time the events took place or slightly later. And links are also established to existing texts and events of the time or to problems of current interest (an account of all the historical facts related to AIDS can be found among the references 3 and 4). Considered as a whole, these films can be considered as an historical portrait of the first 25 years in the history of AIDS.
As one views these films they remind us of 25 years of our recent past. Meanwhile, we keep on trying to find new alternatives for a better future.
The number of AIDS cases that could have existed in the seventies remains unknown. The origin of the HIV is unknown but the disease appears to have been established in Africa, subsequently spreading to the Western Hemisphere. The oldest sample of infected blood goes back to 1959 (Leopoldville, Congo).
Woodstock (1970), a documentary film by Michael Wadleigh, is an arresting depiction of this legendary music festival that took place in 1969. While watching this film it is possible to understand the experiences lived by these outgoing and gregarious youngsters from the decades from the sixties and seventies. Another documentary film, Gay sex in the Seventies (2005), by Joseph f. Lovett, portrays the gay culture in New York before AIDS was recognised as a disease.
The unexplained occurrence of some cases of Karposi’s sarcoma in young gay males in New York (March, 1981), later followed by the publishing of reports dealing with new cases of Pneumocystis Carinii’ pneumonia in California and New York determined years of anxiety and suffering in these groups. They not only were taken aback by this deadly disease but, worst of all, they were bluntly rejected by society.
On November 11th, 1985, the American television network NBC presented the first television film about AIDS An Early Frost directed by John Erman. Considering that changes are difficult to bring about in reality, this production was carefully prepared during almost two years. Research was intended to avoid any misunderstanding that could offend the sensibility of the attendance. But, on the other side, this production was also aimed at stirring up the interest among spectators in a disease that otherwise they would have never suffered, neither physically nor emotionally. The provided information about the probable ways in which this disease comes about was correct: it also allowed to remove the baseless concerns about massive contamination and sudden deaths.
The film Longtime Companion (1990) by René Norman, whose screenplay was based on the homonymous play by Craig Lucas, opens with the news of a rare disease that affected young gay men”, published in The New York Times on July 3rd, 1981. In a world still free of AIDS, the idyllic images of happiness, innocence and freedom that existed in Fire Island shown at the beginning of the film are later followed by the story of the impact the disease has on the life of a group of young, apparently healthy and successful group of friends. The scene where Sean (Mark Lamos) is about to die, accompanied by his boyfriend David is a scene worth remembering by almost everyone. And regardless of the disease that has been responsible of the death of a beloved person, it is a lesson that everyone under similar circumstances should keep in his mind. From the medical point of view, all proceedings seen on the film were medically correct and in accordance to the state-of-the-art of the time. Although there were plenty of theories, little science proven findings were available.
There are two films that although they do not strictly deal with AIDS are worth remembering.
Parting Glances (1986), directed by Bill Sherwood, is a film that, regardless of the individual sexual options, narrates how complex interpersonal relationships can be. Set in Greenwich Village (New York) in the midst of the eighties, it narrates the story of the meeting between two persons, 24 hours before one of them journeys to Africa. AIDS was by that time already a reality. The own director, Bill Sherwood would die later of this disease. And this film was his one and only opera prima.
The trip (2002) by Miles Swain, deals with the social and political problems that existed from 1973 to 1984. It also deals with the love, honesty and courage that is needed to be in a hostile world that was not meant to be for fragile people. HIV infection is not only the hallmark of the film but also of the time where the action takes place.
In the first years several names were used to designate AIDS. Some of them were in close relationship to homosexuality; such is the case of Gay Compromise Syndrome, Gay Related Immunodeficiency (GRID) or Gay Cancer. Others, by contrast, were associated to their clinical characteristics as is the Community Acquired Immune Dysfunction. The acronym AIDS, that stands for Acquired ImmunoDeficiency Syndrome, was adapted in a meeting that took place in Washington in July 1982. The working definition was chosen by the Centre for Disease Control (Atlanta,USA) in September of the same year. In 1983, Luc Montaigner isolated the Lymphadenopathy virus (LAV) that came later to be known as HIV and later identified by Robert Gallo as being the causative agent of AIDS. The ways of transmission of this disease were also identified. While this stigmatised 4H disease (the capital H makes stand for the social groups among which the majority of the cases of AIDS have occurred: homosexuals, heroine abusers, Haitians and haemophiliacs, this last one was included in 1983) was initially confined to certain high-risk populations, it is now recognised throughout the world as a viral disease with its own epidemiology (1985).
The film And the Band Played On” (1993) by Roger Spottiswood, is an excellent portray of this politically, scientifically and socially troubled period that was coincident with the Reagan Administration. Based on the homonymous book by Randy Shilts, it deals with the epidemiological field work with the sexual contacts of gay people in Los Angeles and New York (called patient O-out of California) that was needed to be done in order to identify the origin of the infection. Shilt was considering the possibility of the existence of a patient zero who would have been critical to the spreading of the disease in the USA. But tracing him back would demand being able to go back to the decade of the seventies.
The film also shows what pathways of investigation were followed by the pharmaceutical laboratories to identify the causative agent. But, besides, it also stresses the hidden rivalries that existed between the different groups and the search for personal glory that took place behind the scenes. This film remains being an important film as it shows how scientific research takes place and what issues are still posed to scientists in similar situations. What do we know about it? What facts need to be proven? These same questions that were posed to researchers in Atlanta might remain unanswered for a long time.
It was in 1985 when the first tests for screening blood supply for antibodies to HIV were marketed.
Together with the epidemic caused by this virus, two new epidemics came additionally, those due to panic and prejudice. In the meantime, the USA Administration focused its efforts on calming down the population by saying that the epidemic was limited to gay people and intravenous drug abusers. The truth, however, was that the disease was not only confined to these high-risk populations as the number of infected persons among heterosexuals, women and children was growing steadily.
The film The Fly (1986) by David Cronenberg can be regarded as a metaphor of AIDS as it portrays how patients loose control not only over their bodies but also over their spirit. Anything which causes structural changes in the brain may confuse their Egos and patients seem to favour a certain type of phobic symptoms about their disease. The film They Live (1988) by John Carpenter even poses the question: Could it be possible that by wearing special glasses one could be able to identify those who are carriers of this virus? In the film The Navigator. A Medieval Odyssey (1988) by Vincent Ward there is a consideration about what can be done in order to avoid the risk of acquiring the Black Death, a reflection aimed at establishing a metaphorical link between plague that occurred in the fourteenth century and the blight of AIDS in the twentieth century. Alien 3, by David Fincher is another metaphor of AIDS since the infection by an alien virus suffered by Ellen Ripley (Sigourney Weaver) is similar to the one produced by HIV as the alien’s behaviour is similar to that of the HIV virus. The film Zero Patience (1993), by John Grayson, is a rather radical and irreverent musical that shows how HIV is transmitted and what attitudes concerning this disease are existing.
The year 1985 reminds us of the death of Rock Hudson, a legendary actor who became the symbol of the victims who fell prey to this disease.
The nucleoside analogue zidovudine (AZT), the first active drug against HIV was introduced in September 1986 and licensed for treatment of patients with AIDS in 1987. AZT was initially synthesized in 1984 for the use as an antineoplasic drug but the results available from trials have confirmed its ineffectiveness. Thus started a new age in the history of AIDS, the age of antiretroviral therapy which implied a better survival of HIV-infected individuals.
By the end of that year, according to the World Health Organisation (WHO), formed by 85 countries, there were 38401 cases of AIDS, 83% of them in the USA.
Angels in America (2003) by Mike Nichols, is an adapted version for TV of two plays by Tony Kushner that debuted in 1990 and 1992. The series, aimed at the coming generations, conveys a genuine sense of the features of AIDS that existed by the beginnings of the eighties. Although these features, considered as a whole, have remained almost constant, the prognosis for the infected persons has now changed substantially. Although some sectors of the population have tried to play down the background of this disease, this 6-hour long film managed to blend reality and fiction thus stirring up great interest among young people and alert them to the danger of AIDS. News concerning AIDS have always shaken the emotions of young people, may it be in the present or in the past, and yet they are also easily forgotten.
The film dramatizes the story of two individuals that suffer from this disease, Prior (Justin Kirk) and Ray Cohn (Al Pacino). Fearing that he might acquire AIDS, Louis (Ben Shenkman) decides to veer away his former gay friend Prior. He comes to believe that he is going out of his mind when he experiences being visited by his forebears and is being chosen by the angels to be a prophet of humankind. Are these febrile hallucinations, hallucinations due to the drugs being taken or just plain reality? Ray Cohn was a prominent lawyer and an influential politician from the McCarthy era who died in 1986. His life was portrayed in the TV film Citizen Cohn (1992) by Frank Pierson. Hampered by the fear of this disease, he deliberately pushes his fears out of his consciousness pretending it does not exist. But instead, he comes to believe that he was actually suffering from an hepatic cancer. Being cared by Belize (Jeffrey Wright), an Afro-American gay male nurse and also friend of Prior and Louis, tries to manipulate him, too, as he always used to do as a politician. The parallel story narrates the drama being suffered by Harper (Mary-Louise Parker), Joe Pitt (Patrick Wilson) and Anna (Meryl Streep), mother of the latter, all members of a Mormon family who try to harmonize life and faith. In a world apparently derelicted by God, where there is so much rejection and mourning only through implication and compassion can experiences make sense. The proposal of Angels in America is therefore a radical change in concepts.
HIV infection was mainly affecting those who were less well informed about the disease. Therefore it became mandatory to supply the correct information and a rapid and easy access to the available treatments at the time. But, from the perspective of the infected individuals, advances in antiretroviral therapy investigation seemed to evolve at a slower pace than expected. Meanwhile, a new campaign had already started in the United Kingdom: “AIDS: Do not die out of ignorance. By the same time, the AIDS Coalition to Unleash Power (ACT-UP) was founded. This organization, whose motto was: “Silence equals to death”, intended to put an end to the crisis due to AIDS. Therefore, the cornerstones of this project were the access to less expensive drugs, education and behaviour modification of the population and the ban on any kind of discrimination against HIV-seropositive or those who already were suffering from the disease.
And the time was ripe for unveiling the many existing stories of pain and grievance. The first wall painting in remembrance of Martin Feldman was painted for the AIDS Memorial Quilt by Cleve Jones-later referred by K. Bishop on October 5th 1987 in the New York Times as a quilt of life. The documentary Common Threads: Stories from the Quilt showed the devastating effects that AIDS was having in that society. One could affirm that by facing the epidemic, it became more humane.
In 1987, the Cuban writer Reynaldo Arenas (1943-1990) presented some recognizable symptoms at the time of initial infection and was later diagnosed of AIDS. Harassed by the homophobic regime of Fidel Castro during the decades of the sixties and seventies, he was later forced into exile. In December 1990, deranged by his sufferings, he committed suicide in New York. The film Before Night Falls (2000) by Julian Schnabel, revolves around his life in the post-revolutionary Cuba, his years of imprisonment and the years of full-blown AIDS disease he suffered in New York. Taking into account that the film was based on the autobiography of the writer, it portrays his very personal perspectives that determined the existence of some historical mistakes and the due misconceptions of someone who lives and narrates his own life and the world he is experiencing.
In spite of activism, prevention could not stand the pace of the virus transmission. By the beginnings of the nineties there were approximately 500.000 cases of HIV-carriers in Europe and Asia. In addition, areas with the highest incidence included America with approximately two million cases and Africa with over than 5.5 million cases.
The play Angels in America. A Gay Fantasia on National Themes. Part One: Millenium Approaches, written by the Pulitzer Prize for Theatre- winning playwright Tony Kushner, was adapted for TV and the screen version debuted in San Francisco in 1991. Its second part: Perestroika (Angels in America: A Gay fantasia on National Themes. Part Two: Perestroika) debuted in 1992. By examining some social, political, racial, religious and sexual problems that existed during the Reagan Administration, these two films intended to take a look at the “state of the nation”. Meanwhile, the epidemic was spreading all over the country. The screen version was premiered eleven years later.
In the early years of the nineties, films dealing with AIDS used to portray personal stories that were aimed at achieving a better understanding among the general public of the reactions and experiences that the infected individuals were having. It is anything but easy to penetrate the thick layers of ignorance that have generated so much fear and rejection of the infected persons. They suffered righteous moral outrage even within their own families.
Les Nuits Fauves (1992) by Cyril Collard was the first film about the life of a patient with AIDS. Its script was based on its own novel “Les Nuits Fauves written by the director of this film. The role of the main character casts him as a victim of AIDS who narrates some of his own experiences. He wanted the public to realize how bad things were. By doing so, he not only was a filmmaker but also the courier of a cause. He stages his sexual adventures and although he knew that he was already infected by HIV, he dared to practice sexual intercourse without condom. Sex was easy to get at the “Rive du Seine”. Although he knowingly practiced high-risks behaviours, by no means pretends to be preachy or ask for forgiveness. He merely wants to bring his story to the screen. In his consideration, individuals increasingly live for today rather than tomorrow.
But, in order to understand the intended message, the film forces one to remove any unconscious roadblocks and detach from one’s own prejudices, concepts or, even , ideals. Prevention of the contagion of this disease is the only means to avoid being caught truly unprepared. The magazine “Cahiers du Cinema” considered the film Les Nuits Fauves as the most disturbing French film of the latest years.
The film was awarded the Cesar Prize of the French Cinema Academy for the best picture in 1993, but was also awarded for the best first film, for the best revealing actress (Romane Bohringer) and for the best editing. Meanwhile, in the annals of history of the Cesar prize, no other film has simultaneously won two prizes for the same film to date. Unfortunately, Cyril was not there. He died on March 5th. The setting of Cap Espichel where the final scenes of his movie take place was chosen by him to leave his final message. “The world is not only a static object that is external to me; I do take part in it. The world has also been offered to me. I might probably die out of AIDS. However, it is not my life anymore, life is already existing in me.”
The film Philadelphia (1993), by Jonathan Demme, winner of two Oscars portrays the homophobia and discrimination that the gay community in the USA suffered because of AIDS. However hard a task it may be, we should try to do it. The film was fortunately a hit movie and broad segments of the population became acquainted with the disease and its consequences. By that time AIDS was still a terminal disease and the discovery of AZT could not be hailed as a medical breakthrough since there were proven resistances to it. And discrimination was the hallmark of all those who fell prey to the disease.
However, concerning clinical data, the film has several shortcomings that need to be redressed. There is little reason to believe- and scant evidence to support- the notion that Karposi’s sarcoma is crucial to make the diagnosis of AIDS. Likewise, despite the fact that it is not a major mode of transmission, the film emphasizes the existence of sarcoma among female blood transfusions recipients. The same applies even more strongly to some of the dialogues being held in the film. Statements such as “heterosexuals need not worry about AIDS as only gay people are affected by this disease” or “ you are really at risk if you happen to have a sexual encounter with a gay person you do not know and you do not use any protection device” must therefore be considered as faulty and erroneous judgements.
As a matter of fact, Ron Vawter, who played the role of Bob Seidman, a lawyer who used to work together with Andrew Beckett (Tom Hanks) before he was forced out of his job, was suffering from AIDS while the movie was being filmed.
The British film Blue, directed by Derek Jarman (1942-1994) was premiered in 1993. The prime motivation of this impressive seventy-two minutes –long film seems to be the impact of the senses as the use of a blue background along with the use of voices and music are aimed at leading the attendance to a world of peacefulness and meditation. As part of his art legacy, Jarman left this abstract movie, full of pain, that was filmed when his disease was evolving to its final stages. Left blind by the Cytomegalovirus chorioretinitis, the power of his words speaks on the deepest human levels to transmit the experience of his disease and the sufferings it caused to him.
The Hindu film My Brother ... Nikki, (2005) by Onir, deals with the experience of being an HIV-seropositive person in Goa during the years 1987 to 1994. The public attending the Milan G&L Film Festival surprised everyone by giving its Best Film award to this homosexuality drama. For the first time in India, the film tries to address the issue of homosexuality considered as an expression of true love and tender feelings. It narrates the story of a young swimmer who experiences soaring moments when he manages to win the swimming championship. However, he knew that once the news was out, he would have a new label forever after: AIDS sufferer: But AIDS was contrary to the customs of his society and his life took a radical turn, being despised and bluntly rejected. This is an important film as it addresses the issues of the social response and the need for an adequate education. And it also is a reminder of a similar situation that had previously existed in Europe and America.
In the summer of 1994, the propaganda campaign: Europe against AIDS, aimed mainly at young people on a trip invaded the European walls with the logo of the flying condom.
Furthermore, based on data collected, the World Health Organisation (WHO) report cites an increase of 60% in HIV7AIDS infection rates in the year 1994. Therefore it was absolutely mandatory to provide better information and prevention of HIV infection.
Considering that the infected mothers transmit the virus to their infants perinatally, it was important to know that the number of paediatric AIDS cases had dropped by at least 50% when delivery took place by caesarean sections. The use of AZT during pregnancy also reduces by 2/3 the risk of intrauterine transmission.
By January 1st.1995, the cumulative number of AIDS cases in the world had already reached 1 million infected persons.
The pharmaceutical industry was deploying its best scientific capabilities to discover new antiretroviral drugs and during that year the first of a new group of drugs, the protease inhibitors, made its appearance. It is hoped will lead to a new era it becoming a chronic manageable disease.
Prevention was increasingly being considered as the only means to control the spreading of the disease. Some consider it is advisable to abstain from sex, others prefer honesty as a mature expression of love but in most of the cases, the option was the correct use of condoms during intercourse. But, what about that phase of cognitive and emotional growth called adolescence? What masculine and feminine behaviours can be expected in this phase of growth?
The film Kids (1995) by Larry Clark is a portray of the social reality of young, urban people in the USA who knowingly practice high-risk behaviours. Some of the conclusions of the survey Youth Risk Behaviour Surveillance System, conducted by the Centre for Disease Control are shown in this film. The film goes on to say that “although adolescents show high levels of cognitive processing, this does not interfere with the practice of high-risk behaviours or neglect cautions such as driving cars under the effects of drug abuse, practice sexual intercourse without condoms or substance abuse. Adolescent girls seem to have a better assessment capacity of high-risk behaviours. By contrast, boys do not seem so scary about taking undue risks5.
The film Safe (1995) by Todd Haynes, is the diary of the empty life of the rich Californian housewife, Carol White (Julianne Moore) who suddenly develops a strange environmental disease. Her allergic response are due to external and internal allergens that seem to be present around her house. If one is looking for a cure for a disease that is either unexplained or for which there is no cure, is it possible to establish a metaphoric parallel between the psychosomatic disturbances and AIDS? To be sure, if one is willing to control his mind and body, is it necessary to go through loneliness and solitude?
In the film Boys on the side (1995) by Herbert Ross, the leading roles are played by three women, Jane (Whoopie Goldberg), Robin (Mary-Louise Parker) and Holly (Drew Barrymore). Mary-Louise Parker was the first actress to play the role of a supposedly heterosexual woman suffering from AIDS in a film from Hollywood. It is a story of brotherhood and solidarity between these three women who develop strong attachments to each other as they uncover the climate of unlove in which they have spent their lives.
In 1996 a new type of antiretroviral drug was marketed. The new drug was a non-nucleoside reverse transcriptase inhibitor. According to The Los Angeles Times from the 12th.of July, physicians attending the 11th. International Conference about AIDS celebrated in Vancouver were anxious to know about this new drug, according to which it would lead to it becoming a chronic manageable disease, just like diabetes. The recommended combined therapy changed the prognosis for infected individuals, causing prolongation of survival in AIDS patients but most of all, it allowed to improve their quality of life.
The film Alive and Kicking or Indian Summer (1996), by Nancy Meckler deals with the daily obstacles that existed when AIDS was the starting point of a future that had to be confronted with strength, courage and a will to live.
A River Made to Drown In (1997), by James Merendino and Alan Smitheenos, is an uneven film that revolves around the ravings of the romantic frustrations being suffered by an old lawyer, Thaddeus Mackenzie (Richard Chamberlain) a victim of AIDS who is about to die after undergoing treatment. Some of the dialogues may sound interesting and it also portrays some aspects of the male prostitution that existed during the nineties.
In 1999, there were about 20.000 cases of AIDS in Spain. By that time, Pedro Almódovar was making the film Todo sobre mi madre. The film is a complex story that can best be understood in terms of the history of the feelings of loss and love. The love life of a woman is her best psychological biography. Some feel it should remain sacred and beyond question. However, he challenges the pre-established concepts of family, sexuality and gender. Love is usually beset with stumbling blocks along the way but has the sufficient strength to deal with hazards such as different ways of being or thinking, errors committed in the past, desired sex or even the absence of the father. Rosa (Penelopé Cruz) is pregnant and infected by HIV. In her case, it was an heterosexually acquired AIDS and in almost 35% of the cases of infected women, the sexual contact has been the major mode of transmission of HIV.
In the twentieth anniversary of AIDS (2001), while remembering the first known cases, Peter Piot manifested that: I could have never been able to imagine that I was in front of the first signal of an epidemic that along these twenty years has infected more than 60 million people, killed 22 million people and has been able to reach the status of the most devastating epidemic that has ever existed6.
Up to the present there are no safe and effective vaccines for HIV but new treatments are now under development. In 2003 a new antiretroviral drug called Enfurtivide from access of HIV into the human cells was marketed.
The mean rate of infection for HIV in the EU is of 25 cases among 1 million inhabitants. In Portugal, however, the rate rises up to 104,2 cases/million inhabitants. This high rate is mainly due to the practice of high-risk behaviours among intravenous drug users. The proven efficacy of programs based on the change of syringes and the use of methadone, when compared to the year 2000, has led to a decline in the number of new cases of AIDS.
The increase of number of new cases experimented in Asia can be attributed not only to the dissemination of heroin traffic but also to the huge migratory movements that have taken place in recent years. Such is the case of Israel where the massive migratory movements that took place in 1991determined an increase by 4 times of the annual rate of new cases of infection.
The documentary film Gan or the Garden (2003), directed by Adi Barash and Ruth Shatz, later presented in the Sundance Cinema Festival of 2004, addresses the issue of men prostitution in areas of Tel Aviv. The film evolves around the story of young Palestinians and Israelis whose despairing day-to-day life desperately cries out for a better living, leads them to forget about the conflicts and substitute them for “buyed” sex.
The Global Coalition On Women and AIDS that was created in 2004 by UNAIDS has reported that there is a pattern of a dramatic increase in HIV infections among women. Therefore efforts should be displayed in order to implement new strategies that are adequate to the needs of women.
The film Yesterday (2004) by Darrell James Roodt portrays some of the most relevant aspects of AIDS that exist in areas that are under development. Issues such as inadequate health education, insufficient medical assistance and the inherent vulnerability of women -due to the social and sexual dependency they suffer- to infection, are all addressed in this film. Unable to meet their targets on poverty reduction, they are compelled to migrate thus increasing the sexual contacts and, hence, the spreading of the epidemic. The epidemic of AIDS in South Africa is among the most severe worldwide and there are no indications of a decline in the number of new cases7. About ready for delivery, Yesterday (Leleti Khumalo) becomes aware that she is infected by HIV. Her husband (Kenneth Kambule) works in a far away place and she is willing to inform him about how urgent it is to undergo the tests for this disease. On her way, she is brutally beaten up. Her husband returns home later as there was no place for him at the hospital. Yesterday will take care of him until the moment of his death. But, in spite of all, she is willing to live up to the moment where her daughter Beauty (Lihle Mvelase) can go to school.
Despite of all the displayed preventive efforts, the number of new cases steadily increases. In the year 2005 there have been 4.900.000 cases of new infections7. Although it might sound absurd, the mode of transmission of HIV is closely related to certain attitudes, behaviours and feelings. In borderline situations, it is hard to bring people to their senses.
First recognized 25 years, AIDS is still a disease who stigmatises those who suffer from it. This situation is responsible not only for the delays in diagnosis and treatment of the disease but it also determines that public health programs are insufficiently funded.
Although there has been a number of epidemiological, sociological and psychological studies, campaigns based on traditional values or (pseudo values) still remain easier to promote. Such measures are, however, inadequate if one thinks in terms of the dynamic societies of the 21st. century where individualism is dominant, experiences are lived in the flair of pleasure and there is a constant restructuring of individual and social ethical values.
It has been estimated that by December 2005 there were 38,6 (33,4-46) millions of persons infected by HIV (and among these are 2,3 millions of children that are less than15 years of age)7.
It is absolutely necessary to stop the epidemic! It can no longer be accepted that whole communities are still being affected by this disease.
All the movies that have been commented in this article make reference to the historical reality of an epidemic that has already lasted 25 years. While watching these films they should reminds us of how important it is to be more aware of the consequences of our individual and social actions.
The author thanks Ricardo Varga, M.D., resident in Anaesthesiology at the Hospital de Santa María in Lisbon for his helpful translation into Spanish from the original in Portuguese.