In this section, I will address the question, “What came first: the chicken or the egg? If HIV is the chicken, and AIDS is the egg, the egg came before the chicken. Yes, AIDS was identified several years before it was known that HIV was the cause of AIDS.
In late 1980 and 1981, medical experts in three United States cities--Los Angeles, San Francisco, and New York City described a rare crop of pneumonia cases in previously healthy young homosexual men in the three cities. A rare cancer, called Kaposi’s Sarcoma, was also noticed at the same time in the same group of men. The medical experts noticed that the men all had one important thing in common; they had low levels of a type of white blood cell called CD4 positive T-lymphocytes (also called CD4 cells or T-cells).
HIV officially became known to medical experts and the public on June 5, 1981. On that date, the United States Centers for Disease Control and Prevention (CDC) published a warning about this unusual type of pneumonia affecting young gay males in Los Angeles, California. The pneumonia was pneumocystis carinii (jirovecii) pneumonia (PCP) and was extremely rare in young healthy males. The cases of PCP along with the low CD4 counts in these previously healthy men gave experts the information that the men had an acquired immune system problem, rather than an immune system problem they were born with. The Associated Press and the LA Times reported this news on the same day. One month later, on July 4, 1981, the CDC reported on the unusual type of cancer hitting the young gay males.
By 1982, the CDC pulled enough information together from the cluster of cases to develop a definition of the new disease and put forth the words: Acquired Immune Deficiency Syndrome (AIDS). They looked at the population of people who were getting the disease, the signs and symptoms of the new disease, and the similarities in those people’s immune system. By this time, they knew that AIDS was being spread sexually and through contaminated blood. They identified four groups of people who were getting AIDS: gay men, heterosexual intravenous drug users, immigrants from Haiti, and those with the blood problem, hemophilia (hemophiliacs require blood transfusions).
Medical experts began to look hard at these four groups of people and noted these signs and symptoms were occurring: swollen lymph nodes on various parts of the body, thrush (white patches in the mouth), herpes zoster (shingles), low platelets (used for blood clotting), and weight loss. These people were noted to have low CD4 cells. Scientists later gave these signs and symptoms a name: AIDS-Related Complex, or ARC. Scientists believed that there some healthy people could “carry” whatever was causing AIDS, and have no symptoms at all.
On October 18, 1982, ABC World News Tonight reported that AIDS was spreading to many US states and that the cause of AIDS was unknown. Media and some scientists began to use the term “GRID” or “gay-related immune deficiency,” believing that this disease affected only gay males. In San Francisco and New York City, groups began to form to address the AIDS crisis. Congress held hearings to find out more about this strange new epidemic.
In 1983, AIDS was deemed a reportable disease in the US and the US Public Health Service presented recommendations of how to avoid spreading the disease. The CDC tried to squash public fear that AIDS could be spread by “casual contact” like hugging, kissing, and sharing eating utensils and urged people not to discriminate against those who had AIDS. The CDC now recognized a new group that was getting AIDS--female sex partners of males who had AIDS. National organizations began to form to address the AIDS crisis. The Orphan Drug Act, was passed, giving extra money to drug companies to quickly develop new drugs for rare diseases. A doctor in France, Luc Monagnier, discovered the virus that caused AIDS--he named it lymphadenopathy-associated virus (LAV). The name was later changed to human immunodeficiency virus (HIV). The first AIDS candlelight memorial was held.
In 1984, an American physician researcher, Dr. Robert Gallo, and his colleagues identified a virus called HTLV-III--later known as HIV-1--as causing AIDS. This virus was the same virus as the lymphadenopathy-associated virus discovered by Dr. Luc Monagnier the previous year. Frantic over the spread of this new disease, San Francisco officials ordered bathhouses to be closed, a move that angered many citizens. Several AIDS service organizations formed a new group called the AIDS Action Council. The CDC advised the public to stay away from intravenous street drugs and not to share street drug needles.
The World Health Organization (WHO) and the US Department of Health and Human Services (DHHS) hosted the First International AIDS Conference in 1985. At the conference, every region of the world, including China, reported at least one case of HIV/AIDS. In 1985, the US Public Health Service put forth recommendations to prevent a mother from giving HIV to her newborn child. The U.S Food and Drug Administration licensed the first HIV test. In the meantime, U. S. blood banks began to check the blood supply for the virus and military recruits were tested for the virus before they were allowed to join the armed services. Ryan White, a teenager with AIDS living in Indiana, was told to stay away from school. He would go on to become the face of HIV/AIDS and pave the way to ending some of the ignorance and discrimination against those with the virus. The actor, Rock Hudson, well-loved by many in the US and around the world, told the world he had AIDS and died several months later. This year was the beginning of the American Foundation for AIDS Research (amfAR) and Project Inform--an organization aimed at getting quicker approval for HIV drugs.
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In 1985, the Center for Disease Control and the World Health Organization met in Bangui, the capital of the Central African Republic. They talked about the problem of some countries not having HIV antibody tests. They developed a new definition of AIDS that was not based on lab results but on symptoms. For example, the symptom of continuous fevers would be given a score of “3.” If the symptom scores added up to “12,” the person was considered to have AIDS. This new way of defining who had AIDS received much criticism; however, the new definition did prove to be useful.
The biggest news of 1986 was a new drug to treat AIDS: AZT (Zidovudine or Retrovir) was found to be effective against AIDS and would be tested in humans. Some US cities began to give out clean syringes to drug addicts. Someone handy with a sewing needle put together the first block of the AIDS memorial quilt, representing someone who had died of AIDS. (The project would take off like wildfire and later be composed of 46,000 individual blocks, honoring 91,000 dead. The quilt now stays in a warehouse in Atlanta, Georgia, weighs approximately 108,000 pounds, and covers 1,293,300 square feet. It would take someone more than 33 days to view the entire quilt, spending one minute on each individual square.)
This same year, 1986, nine year-old Ricky Ray, the oldest of three brothers all with hemophilia and HIV, was not allowed to attend his Florida school. The next year, arsonists set fire to his family home. The Robert Wood Johnson Foundation founded the AIDS Health Services Program which provided money to cities which were hit hard by the AIDS epidemic. The program was the forerunner to the Ryan White Care Act. The US Surgeon General, C. Everett Koop, called form more education about HIV/AIDS and more condom use.
The next year, 1987, marked big news. The first HIV drug, AZT (zidovudine or Retrovir) was approved for use. The approval for this drug was the fastest in US history. The US Congress provided $30 million in emergency funds directly to states so that they could buy the drug. Again, the US Center for Disease Control expanded the list of criteria that identified AIDS to include those with an AIDS-disease, even without lab results. International groups began to form to address the AIDS crisis. The first human tests of an HIV vaccine began. A history of the early years of the HIV/AIDS epidemic was published by Randy Shilts. The book was called “And the Band Played On; Politics, People, and the AIDS Epidemic.” (Randy Shilts would later die of AIDS himself in 1994, at the young age of 42.) The great pianist, Liberace, died of AIDS in 1987. The U. S. began testing all immigrants who wished to come to the U. S.; those with HIV were forbidden entry. The AIDS memorial quilt, now made up of 1,920 blocks and larger than a football field, was displayed in Washington, D. C. National groups were formed to address the impact of HIV/AIDS on U. S. minorities.
December 1, 1988, was named the first World AIDS Day by the World Health Organization. For the first time, the number of women in the African region south of the Sahara Desert with HIV/AIDS was more than the number of men with the disease. The International AIDS Society (IAS) was formed. The number of AIDS cases, according to the World Health Organization, jumped 56%. Major research groups were formed. A U. S. schoolgirl with AIDS was told she could only attend classes if she was enclosed behind a glass window. Ironically, the same year, the U. S. Department of Justice changed their policy and said that those with HIV/AIDS could not be discriminated against.
In 1989, the U. S. Center for Disease Control put forth new guidelines for preventing pneumocystis carinii pneumonia (PCP), a common serious disease in those with AIDS. If you recall, PCP was the disease that was first noticed in June 1981 and marked the beginning of the AIDS epidemic. New policy allowed those with AIDS who were not eligible for clinical trials access to new experimental treatments.
Ryan White, the boy who was prohibited from attending school, died on April 8, 1990. He was just 18 years old. The next day, the U. S. Congress enacted the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990. This act gave federal dollars to U. S. communities for the care and treatment of those with HIV or AIDS. The first year, more than $220 million dollars was given out. The drug AZT was now approved for use in children. This year marked the American Disabilities Act--HIV or AIDS was now considered a disability and those with HIV or AIDS could no be discriminated against. A woman in Florida believed she got HIV from her dentist, who may have used contaminated dental tools.
In 1991, the famous basketball player, Magic Johnson, announced that he had HIV. The U. S. Congress enacted the Housing Opportunities for People with AIDS (HOPWA) Act. This act provide federal money to cities and states to assist those with HIV/AIDS to have adequate housing. The U. S. Center for Disease Control recommended that HIV positive health care workers stay away from certain types of health care procedures that could expose patients to the health care worker’s infected blood. The red ribbon was introduced at the annual Tony Awards and quickly became the international symbol of AIDS awareness.
Ricky Ray, the child who was barred from school and home was burned by arsonists, died in 1992. He was just 15 years old. (His HIV positive brother, Robert, would die 8 years later, at age 22; the third HIV positive brother, Randy, remains alive and is taking HIV medicines.) The International AIDS Conference, now in it’s eighth year, was moved from Boston to Amsterdam due to strong feelings against the U. S. banning HIV positive immigrants.
The next year, 1993, marked “the year of the HIV positive woman.” A new female condom hit the U. S. marketplace in 1993. Researchers received federal money to study women with HIV/AIDS. Women and minorities were now to be included in all HIV/AIDS research. The CDC came up with a new broader definition of AIDS--adding invasive cervical cancer, pulmonary tuberculosis, recurrent pneumonia, and a CD4 count less than 200 (or CD4 percentage less than 14) as new criteria to define AIDS. Federal money would now be aimed at preventing HIV. Immigrants with HIV were now officially forbidden entrance into the US.
In 1994, the U.S. Public Health Service recommended that all pregnant women receive the drug AZT, as the drug had been shown to drastically decrease a mother’s chances of giving HIV to her newborn baby. There was now an HIV test that could use saliva instead of blood. AIDS was now the leading cause of death of all young Americans, age 25 to 44.
AIDS continued to be the leading cause of death in young U. S. adults in 1995. Fortunately, a new class of drugs, called protease inhibitors, was available and would breathe new life into AIDS sufferers. The first protease inhibitor, Saquinavir, was rushed through the drug approval process--the drug would not be used alone, but with other HIV medicines. This marked the beginning of the use of 3-drug HIV regimens--also called “HIV cocktails.” The proper term is highly active antiretroviral therapy, or HAART. The U. S. Center for Disease Control issued guidelines to prevent certain types of infections (called opportunistic infections or OIs) in those with AIDS.
The next year, 1996, heralded the arrival of another new class of drugs, called non-nucleoside reverse transcriptase inhibitors (NNRTIs). Nevirapine (Viramune) was the first NNRTI to be approved. The “viral load” test, a test which measures the amount of HIV in the blood, became available. HIV could now be detect in urine so one could test for HIV in the comfort of one’s own home. For the first time since 1981, new AIDS cases began to decrease. AIDS was no longer the leading cause of death in all young adult Americans but was still the leading cause of death in young adult African Americans.
In 1997, AIDS deaths markedly declined, due to the effects of the 3-drug HIV regimens (HAART). By 1998, AIDS was hitting the U. S. black community hard and African American leaders declared this “a state of emergency.” The Minority AIDS Initiative was created to address the prevention and treatment of HIV/AIDS in the nonwhite community. The first national guideline on the use of HIV medications became available. Large-scale human trials of an HIV vaccine were begun.
The years 1999 to 2000 marked numerous national and international efforts aimed at providing HIV treatments, decreasing the cost of HIV medicines, and giving money and resources to those with the disease. In 1999, the Center for Disease Control (CDC) Division of HIV/AIDS prevention gave money to five U. S. nonprofit groups known as the Community Capacity Building Coalition. In 2000, the Ryan White Care Act was reauthorized.
On February 23, 2001, the first annual National Black HIV/AIDS Awareness Day was held in the US. (The event was permanently switched to February 7 the next year.) United States drug companies agreed to allow generic drug manufacturers in developing countries to make and supply HIV drugs to their people. United States Secretary of State, Colin Powell, said that HIV was a threat to the national security.
In 2002, HIV/AIDS killed more adults aged 15-59, around the world, than any other cause of death and women made up one half of the cases. A new HIV test could detect HIV antibodies with just a jab of a needle to a finger.
The first annual National Latino AIDS Awareness Day was held in the US on October 15, 2003. A new HIV medication treatment program was begun in South Africa. President Bush put forth a new plan: The President’s Emergency Plan for AIDS Relief (PEPFAR) would give $15 billion over 5 years to 15 countries suffering large amounts of HIV/AIDS, tuberculosis, and malaria.
The year 2004 marked the year that international policy-makers called for better efforts to find a vaccine for HIV and for more focus on HIV/AIDS in females. As part of PEPFAR, the US Food and Drug Association put forth a new plan allowing drug companies outside the US to receive quick approval to produce HIV medicines. The companies could submit an application to make single or combined HIV drug products that had already been approved by the FDA, even if other drug companies still held the patent or exclusive market protection. By the end of this year, over 700,000 HIV positive people in developing countries had received HIV medications.
The first annual National Asian and Pacific Islander HIV/AIDS Awareness Day was celebrated on May 19, 2005. An Indian drug company received US FDA approval to produce generic HIV medicines for the international organization, PEPFAR, in 2005.
By 2006, the CDC recommended all adults age 13-64 visiting any type of health care clinics, for any cause, be tested at least once for HIV. They recommended that those in high-risk groups be tested yearly thereafter. The first annual National Women and Girls HIV/AIDS Awareness Day was held in the US on March 10, 2006. For the third time, the Ryan White Care Act was reauthorized.
In 2007, international HIV/AIDS organizations recommended males be circumcised as a way to control the spread of HIV. The next year, 2008, PEPFAR was given $48 billion and given five more years to accomplish their goal of helping poor countries deal with HIV/AIDS, malaria, and tuberculosis. This year, HIV positive immigrants would no longer be banned from entering the US. The CDC’s new count of those in the US with HIV was worse than expected.
On October 30, 2009 United States President Obama signed paperwork officially ending the 22-year-old HIV travel and immigration ban. The International AIDS Conference, now in its eighteenth year, said that now that the travel ban was gone, the conference could now be held in the US. (The 2012 International AIDS Conference will be held in Washington, DC.) Another change in policy allowed the US federal government to provide clean needles to drug addicts. President Obama placed PEPFAR into his Global Health Initiative--$63 billion over 6 years was authorized to help poor countries deal with contagious diseases.
The next year, 2010, US President Obama put forth the first National HIV/AIDS Strategy. I'll add more history later.
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