Florence Revisited: America’s History of HIV Travel Restrictions

Scientists and protesters at 1991 International AIDS Conference in Florence

By Martha Henry

Over 18,000 people met in Durban, South Africa this July for the 21st International AIDS Conference. We look back to a time 25 years ago, when protesters at the 1991 meeting threatened a boycott because of severe U.S. restrictions for HIV-positive travelers.

The mood in Florence was combative. It was June 1991. Scientists, activists and reporters had gathered in Italy to share the latest findings at the International AIDS Conference. Unfortunately, there were no breakthroughs to announce.

Instead, press coverage featured protests by ACT UP (AIDS Coalition to Unleash Power) and others towards the U.S. policy to restrict immigration of people infected with HIV. Protesters threatened to boycott next year’s meeting, scheduled for Boston, unless the policy was changed. The situation put Max Essex, Chair of the Harvard AIDS Institute, in a difficult position. Essex, a prominent researcher, was also chair of the Boston meeting.

Most everyone at the Florence meeting, protesters and presenters alike, had lost partners, friends or colleagues to AIDS. Those who were HIV positive knew the likelihood of their being alive and able to attend next year’s meeting were slim. A million people in the U.S. were infected with HIV, 10 million worldwide. The triple-drug cocktail that would keep so many people from dying of HIV/AIDS was four years away.

The Legacy of Jesse Helms

The first mention of what would later be called AIDS was in a 1981 medical report. Five previously healthy gay men had been diagnosed with Pneumocystis pneumonia, a disease that usually strikes very sick people with a suppressed immune system. At the time of the report, two of the young men had died.

As AIDS spread in the 1980s and the number of deaths rose, so did panic and stigma. AIDS was labeled a gay disease. Hysteria was often mixed with homophobia.

Scientists worked hard to identify HIV, the virus that causes AIDS, and to understand how HIV is transmitted. Essex was one of the early AIDS researchers. He and his colleagues had made major contributions.

In 1987, Jesse Helms, a conservative senator from North Carolina, sponsored legislation that barred HIV-positive individuals from obtaining tourist visas or permanent residence in the U.S. without disclosing their status and then receiving special permission to enter the country.

Despite the law, the 1990 International AIDS Conference was held in San Francisco. When the World Health Organization (WHO) and other groups threatened to boycott the meeting, the first Bush administration agreed to issue special 10-day visas for foreigners to attend medical conferences. ACT UP members, led by Peter Staley from the conference floor, protested the U.S. travel restrictions throughout the San Francisco meeting.

Disorder in Florence

The theme of the 7th International AIDS Conference in Florence was Science Challenging AIDS, though Protesters Challenging Science and Government may have been more apt.

Max Essex opposed the U.S. travel restrictions and was sympathetic with protesters, despite the fact that they were, according to him, “threatening me in any way possible.” Canceling the Boston conference was a possibility.

Essex had a number of concerns. The conference was the main international forum for exchanging scientific information about HIV/AIDS. Though presentations were important, the meeting also provided researchers the opportunity to discuss ideas informally and meet potential collaborators. As chief sponsor, the Harvard AIDS Institute had borrowed hundreds of thousands of dollars from Harvard to secure hotels and meeting space. The deposits would likely be forfeited if the conference were canceled. Essex wasn’t sure how the money would be repaid.

A press conference was called on the fourth day, June 19. According to Jon Cohen’s account in The Washington Post, the panel featured Essex, along with other notable scientists including Jonas Salk, who developed the first polio vaccine; Paul Volberding, President of the International AIDS Society; and Jonathan Mann, former head of the WHO’s AIDS program. The scientists denounced the U.S. policy. Essex reiterated that unless U.S. policy changed by August, the 1992 conference could be canceled.

The protesters, who had arrived carrying “Boycott Boston” signs, were not appeased. Their goal was to stop the conference from being held in the U.S. According to Cohen, at one point the activists yelled “Murderers!” at the panel of scientists.

The scientists felt unfairly attacked. Many of them had spent almost a decade working 100-hour weeks to find treatment or a cure. They shared many of the activists’ frustrations about inadequate government funding and the slow drug-approval process.

The next day, June 20, ACT UP issued a press release insisting that Boston conference be shut down. Part of the release read, “If the organizers of next year’s conference and if the Board of Directors of Harvard University attempt to hold this conference in Boston, or any other city in the United States of America, while these discriminatory laws stand against those of us infected with HIV, we’ll give them a Tea Party they’ll never forget!”

Essex was scheduled to give the closing speech the next day. He stayed up all night in a hotel room with several close colleagues, working out what he would say. In the middle of the night, he called John Shattuck, who at the time was in charge of public affairs at Harvard, to ask his advice. According to Essex, Shattuck told him that the decision was his—Essex should do what he thought was right and not worry about the money.

Christopher Sands helped Essex with the speech. Sands, after graduating from Harvard in 1979, became a successful Hollywood producer. He was also a member of ACT UP LA. As the AIDS crisis worsened, he became increasingly disenchanted with Hollywood. He left in 1990 to help develop a communications strategy for the Harvard AIDS Institute.

Max Essex in Florence after staying up all night to write the closing speech at the International AIDS Conference in Florence, 1991.
Max Essex, after staying up all night to write the closing remarks, Florence, 1991. Richard Marlink is in the background.

According to Essex, “He [Sands] was a writer par excellence. He gave a lot of the oomph to the talk.” Sands remembers helping Essex stress the importance of “not mistaking allies for enemies.” “The hope was that we would help divert some of the hostility towards the appropriate target,” said Sands.

On the last day of the Florence meeting, Essex looked exhausted when he adjusted the microphone to address the room. He got straight to the point. “There will be no international AIDS conference in Boston next year unless all American travel and immigration restrictions against people infected with the AIDS virus are lifted.” There were scattered cheers throughout the crowd.

“As a scientist,” continued Essex, “I never expected to be so preoccupied with the issue of national politics. I admit I was naive. But I know that the world will be ill-served by the loss of international communication without another meeting. If the Bush administration does not change its misguided and discriminatory travel and immigration policies, the cooperation necessary among countries to fight this global epidemic will be blocked. That will be a major setback for all of us.” Read full text of speech.

After the closing remarks, more than a 1000 delegates and protesters, including Essex, marched to the U.S. consulate in Florence to protest the travel restrictions.

After Florence

By August of 1991, when it was clear that the Bush administration wouldn’t alter its policy, Harvard called a press conference to announce that the 1992 Conference would not be held in Boston. Essex resigned as conference chair to focus on research. Jonathan Mann replaced him as conference chair. In mid-September, Mann announced that the 1992 conference would be held in Amsterdam.

Harvard was sued by Boston hotels for canceling the conference. In a twist, activists who had shouted down Essex in Florence testified on Harvard’s behalf, confirming that they would certainly have shut down the Boston conference if it had taken place.

The travel restrictions persisted through the Clinton and George W. Bush administrations. After 22 years, the restrictions were finally lifted on January 5, 2010, by President Barack Obama. “If we want to be a global leader in combating HIV/AIDS, we need to act like it,” he said.

The International AIDS Conference did not return to the U.S. until 2012, when Washington, D.C. hosted the event.

Though HIV/AIDS is less in the spotlight today, recent outbreaks of Ebola and Zika raised fears in America, as well as several calls for imposing travel restrictions.

“The public and the government have a great tendency to overreact to anything they hear of as infectious,” said Essex recently in his Harvard office, where he continues to conduct HIV/AIDS research.

“People took so long to listen to the activists,” he said. “In retrospect, a lot of the serious protests that happened were necessary to wake people up.”

Title photo: ACT UP members protest panel of scientists at the 1991 International AIDS Conference in Florence, Italy. Max Essex is seated and holds the microphone.

About HAI

The Harvard T.H. Chan School of Public Health AIDS Initiative (HAI) is dedicated to research, education and leadership to end the AIDS epidemic in Africa and developing countries.