These are some of the most important events that occurred in the history of

AIDS up to 1986.

Dr. Conant and Dr. Volberding discussing Kaposi's Sarcoma

We do not know how many people developed AIDS in the 1970s, or indeed in
the years before.
"The dominant feature of this first period was silence, for the human
immunodeficiency virus (HIV) was unknown and transmission was not
accompanied by signs or symptoms salient enough to be noticed. While rare,
sporadic case reports of AIDS and sero-archaeological studies have
documented human infections with HIV prior to 1970, available data suggest
that the current pandemic started in the mid- to late 1970s. By 1980, HIV had
spread to at least five continents (North America, South America, Europe,
Africa and Australia). During this period of silence, spread was unchecked by
awareness or any preventive action and approximately 100,000-300,000
persons may have been infected." - Jonathan Mann 1
We also do not know for certain where the AIDS virus HIV originated, but it is
now generally accepted that the origin of AIDS can be traced back to Africa.
1981 History
Kaposi's Sarcoma (KS) was a rare form of relatively benign cancer that tended
to occur in older people. But by March 1981 at least eight cases of a more
aggressive form of KS had occurred amongst young gay men in New York. 2
At about the same time there was an increase, in both California and New York,
in the number of cases of a rare lung infection Pneumocystis carinii pneumonia
(PCP). 3 In April this increase in PCP was noticed at the Centers for Disease
Control (CDC) in Atlanta. A drug technician, Sandra Ford, observed a high
number of requests for the drug pentamine, used in the treatment of PCP:
"A doctor was treating a gay man in his 20s who had pneumonia. Two weeks
later, he called to ask for a refill of a rare drug that I handled. This was unusual
- nobody ever asked for a refill. Patients usually were cured in one 10-day
treatment or they died" - Sandra Ford for Newsweek 4
In June, the CDC published a report about the occurrence, without identifiable
cause, of PCP in five men in Los Angeles. 5 This report is sometimes referred to
as the "beginning" of AIDS, but it might be more accurate to describe it as the
beginning of the general awareness of AIDS in the USA.

A few days later, following these reports of PCP and other rare life-threatening
opportunistic infections, the CDC formed a Task Force on Kaposi's Sarcoma and
Opportunistic Infections (KSOI). 6
Around this time a number of theories emerged about the possible cause of
these opportunistic infections and cancers. Early theories included infection
with cytomegalovirus, the use of amyl nitrite or butyl nitrate 'poppers', and
'immune overload'. 7 8 9
Because there was so little known about the transmission of what seemed to
be a new disease, there was concern about contagion, and whether the disease
could by passed on by people who had no apparent signs or
symptoms. 10 Knowledge about the disease was changing so quickly that
certain assumptions made at this time were shown to be unfounded just a few
months later. For example, in July 1981 Dr Curran of the CDC was reported as
follows:
"Dr. Curran said there was no apparent danger to non homosexuals from
contagion. 'The best evidence against contagion', he said, 'is that no cases
have been reported to date outside the homosexual community or in women"
- The New York Times 11
Just five months later, in December 1981, it was clear that the disease affected
other population groups, when the first cases of PCP were reported in injecting
drug users. 12 At the same time the first case of AIDS was documented in the
UK. 13
1982 History
As the disease still did not have a name, organisations were referring to it in
different ways. The CDC generally referred to it by reference to the diseases
that were occurring, for example lymphadenopathy (swollen glands), although
on some occasions they referred to it as KSOI, the name already given to the
CDC task force. 14 15
In contrast some still linked the disease to its initial occurrence in gay men,
with a letter in The Lancet calling it "gay compromise syndrome". 16 Others
called
it
GRID
(gay-related
immune
deficiency),
AID
(acquired
immunodeficiency disease), "gay cancer" or "community-acquired immune
dysfunction". 17 18
In June a report of a group of cases amongst gay men in Southern California
suggested that the disease might be caused by an infectious agent that was
sexually transmitted. 19
By the beginning of July a total of 452 cases, from 23 states, had been reported
to the CDC. 20

Later that month the first reports appeared that the disease was occurring in
Haitians, as well as haemophiliacs. 21 22 This news soon led to speculation
that the epidemic might have originated in Haiti, and caused some parents to
withdraw their children from haemophiliac camps. 23
The occurrence of the disease in non-homosexuals meant that names such as
GRID were redundant. The acronym AIDS was suggested at a meeting in
Washington, D.C., in July. 24 By August this name was being used in
newspapers and scientific journals. 25 26 27 AIDS (Acquired Immune Deficiency
Syndrome) was first properly defined by the CDC in September . 28
By the beginning of July a total of 452 cases, from 23 states, had been reported
to the CDC.
An anagram of AIDS, SIDA, was created for use in French and
Spanish. 29 Doctors thought AIDS was an appropriate name because people
acquired the condition rather than inherited it; because it resulted in a
deficiency within the immune system; and because it was a syndrome, with a
number of manifestations, rather than a single disease. 30
Still very little was known about transmission and public anxiety continued to
grow.
"It is frightening because no one knows what's causing it, said a 28-year old
law student who went to the St. Mark's Clinic in Greenwich Village last week
complaining of swollen glands, thought to be one early symptom of the
disease. Every week a new theory comes out about how you're going to spread
it." - The New York Times 31
By 1982 a number of AIDS specific voluntary organisations had been set up in
the USA. They included the San Francisco AIDS Foundation (SFAF), AIDS Project
Los Angeles (APLA), and Gay Men's Health Crisis (GMHC). 32 In November 1982
the first AIDS organisation, the Terry Higgins Trust (later known as the Terrence
Higgins Trust), was formally established in the UK, and by this time a number of
AIDS organisations were already producing safer sex advice for gay men. 33
In December a 20-month old child who had received multiple transfusions of
blood and blood products died from infections related to AIDS. 34 This case
provided clearer evidence that AIDS was caused by an infectious agent, and it
also caused additional concerns about the safety of the blood supply. Also in
December, the CDC reported the first cases of possible mother to child
transmission of AIDS. 35
By the end of 1982 many more people were taking notice of this new disease,
as it was clearer that a much wider group of people was going to be affected.

"When it began turning up in children and transfusion recipients, that was a

turning point in terms of public perception. Up until then it was entirely a gay
epidemic, and it was easy for the average person to say 'So what?' Now
everyone could relate." - Harold Jaffe of the CDC for newsweek 36
It was also becoming clear that AIDS was not a disease that just occurred in the
USA. Throughout 1982 there were separate reports of the disease occurring in
a number of European countries. 37
Meanwhile in Uganda, doctors were seeing the first cases of a new, fatal
wasting disease. This illness soon became known locally as 'slim'. 38
1983 History
In January, reports of AIDS among women with no other risk factors suggested
the disease might be passed on through heterosexual sex. 39
At about the same time the CDC convened a meeting to consider how the
transmission of AIDS could be prevented, and in particular to consider the
newly emerged evidence that AIDS might be spread through blood clotting
factor and through blood transfusions. As James Curran, the head of the CDC
task force, said:
"The sense of urgency is greatest for haemophiliacs. The risk for others [who
receive blood products] now appears small, but is unknown." 40
The risk for haemophiliacs was so great because the blood concentrate that
some haemophiliacs used exposed them to the blood of up to 5,000 individual
blood donors.
In March, the CDC stated that,"persons who may be considered at increased
risk of AIDS include those with symptoms and signs suggestive of AIDS; sexual
partners of AIDS patients; sexually active homosexual or bisexual men with
multiple partners; Haitian entrants to the United States; present or past
abusers of IV drugs; patients with haemophilia; and sexual partners of
individuals at increased risk for AIDS."
The same report also said,
"each group contains many persons who probably have little risk of acquiring
AIDS... Very little is known about risk factors for Haitians with AIDS." 41
Nevertheless, the inclusion of Haitians as a risk group caused much
controversy. Haitian Americans complained of stigmatisation, officials accused
the CDC of racism, and Haiti suffered a serious blow to its tourism
industry. 42 43 Before long people were talking colloquially of a "4-H Club" at

risk
of
AIDS: homosexuals,
haemophiliacs,
heroin
addicts
Haitians. 44 45 Some people substituted 'hookers' for haemophiliacs. 46

and

In May 1983, doctors at the Institute Pasteur in France reported that they had
isolated a new virus, which they suggested might be the cause of AIDS.
In the UK there were public concerns about the blood supply with references in
newspapers to "killer blood". 47 The media more generally started to take
notice of AIDS, with the screening of a TV Horizon programme, "The Killer in the
Village", and a number of newspaper articles on the subject of the "gay
plague". 48 49
In May 1983, doctors at the Institute Pasteur in France reported that they had
isolated a new virus, which they suggested might be the cause of
AIDS. 50 Little notice was taken of this announcement at the time, but a
sample of the virus was sent to the CDC. 51 A few months later the virus was
named lymphadenopathy-associated virus or LAV, patents were applied for,
and a sample of LAV was sent to the National Cancer Institute. 52
But whilst progress was being made by scientists there was increasing concern
about transmission, and not just in relation to the blood supply. A report of AIDS
occurring in children suggested quite incorrectly the possibility of casual
household transmission. 53
AIDS transmission became a major issue in San Francisco, where the Police
Department equipped patrol officers with special masks and gloves for use
when dealing with what the police called "a suspected AIDS patient".
"The officers were concerned that they could bring the bug home and their
whole family could get AIDS." - The New York Times 54
And in New York: "landlords have evicted individuals with AIDS" and "the Social
Security Administration is interviewing patients by phone rather than face to
face." - Dr David Spencer, Commisioner of Health, New York City 55
There was considerable fear about AIDS in many other countries as well:
"In many parts of the world there is anxiety, bafflement, a sense that
something has to be done - although no one knows what." - The New York
Times 56
As anxiety continued, the CDC tried to provide reassurance that children with
AIDS had probably acquired it from their mothers and that casual transmission
did not occur:
"The cause of AIDS is unknown, but it seems most likely to be caused by an
agent transmitted by intimate sexual contact, through contaminated needles,

or, less commonly, by percutaneous inoculation of infectious blood or blood

products. No evidence suggests transmission of AIDS by airborne spread. The
failure to identify cases among friends relatives, and co-workers of AIDS
patients provides further evidence that casual contact offers little or no risk
[...] the occurrence in young infants suggests transmission from an affected
mother to a susceptible infant before, during, or shortly after birth." 57
Reports from Europe suggested that two rather separate AIDS epidemics were
occurring. In the UK, West Germany and Denmark, the majority of people with
AIDS were homosexual, and many had a history of sex with American nationals.
However in France and Belgium AIDS was occurring mainly in people from
Central Africa or those with links to the area. 58
Examples of this second epidemic included a number of previously healthy
African patients who were hospitalised in Belgium with opportunistic infections
(such as PCP and cryptosporidosis), Kaposi's sarcoma, or other AIDS-like
illnesses. All of these Africans had immune deficiency similar to that of
American AIDS patients. However they had no history of blood transfusion,
homosexuality, or intravenous drug use. 59 In light of such reports, European
and American scientists set out to discover more about the occurrence of AIDS
in Central Africa.
By this time, doctors working in parts of Zambia and Zaire had already noticed
the emergence of a very aggressive form of Kaposi's sarcoma. This cancer was
endemic in Central Africa, but previously it had progressed very slowly and
responded well to treatment, whereas the new cases looked very different and
were often fatal. 60 61
In September the CDC published their first set of recommended precautions for
health-care workers and allied professionals designed to prevent "AIDS
transmission". 62 In the UK, people who might be particularly susceptible to
AIDS were asked not to donate blood. 63
In October, the first European World Health Organisation (WHO) meeting was
held in Denmark. At the meeting it was reported that there had been 2,803
AIDS cases in the USA. 64
That meeting was followed in November by the first meeting to assess the
global AIDS situation. This was the start of global surveillance by the WHO and
it was reported that AIDS was present in the U.S.A., Canada, fifteen European
countries, Haiti and Zaire as well as in seven Latin American countries. There
were also cases reported from Australia and two suspected cases in Japan. 65
By the end of the year the number of AIDS cases in the USA had risen to 3,064
and of these 1,292 had died. 66

1984 History
At the CDC researchers had been continuing to investigate the cause of AIDS
through a study of the sexual contacts of homosexual men in Los Angeles and
New York. They identified a man as the link between a number of different
cases and they named him "patient 0". The research appeared to confirm that
AIDS was a transmittable disease, and the co-operation of "patient 0"
contributed to the study. 67
One of the researchers, Darrow, was to later change his original statement,
saying that he did not name the man as patient zero but rather he named him
patient O, for Out of California 68
"I called this guy Patient O... But my colleagues read it as Patient Zero."
- Darrow for Newsweek 69
Whatever Darrow did, or didnt say, in 1984 the myth of Patient Zero had
begun. 70 See the History of 1987 page for more about Patient Zero.

Margaret Heckler
On April 22nd, Dr Mason of the CDC was reported as saying:
"I believe we have the cause of AIDS."
He was referring to the French virus, LAV, and he was basing his opinion on the
findings made in the preceding weeks by the researchers at the Pasteur
Institute who had discovered the virus the previous year. 71
Just one day later, on April 23rd, the United States Health and Human Services
Secretary Margaret Heckler announced that Dr. Robert Gallo of the National
Cancer Institute had isolated the virus which caused AIDS, that it was named
HTLV-III, and that there would soon be a commercially available test able to
detect the virus with "essentially 100 percent certainty". It was a dramatic and
optimistic announcement that also included:
"We hope to have a vaccine [against AIDS] ready for testing in about two
years."
And it concluded with:
"yet another terrible disease is about to yield to patience, persistence and
outright genius". 72
The same day patent applications were filed covering Gallo's work, but there
was clearly a possibility that LAV and HTLV-III were the same virus. 73 74 The

scientific papers regarding Gallo's discovery of HTLV-III were published on 4th

May. 75 By 17th May, private companies were already applying to the
Department of Health & Human Services for licences to develop a commercial
test, which would detect evidence of the virus in blood, a test which it had
already been said would be used to screen the entire supply of donated blood
in the USA. 76 77
Meanwhile there was still concern about the public health aspect of AIDS. This
was particularly the case in San Francisco where all the gay bath houses and
private sex clubs were closed. Some gay men regarded the closures as an
attack on their civil rights. But Mervyn Silverman, Director of the San Francisco
Department of Public Health stated the public health view as follows:

"There are certain places where things are allowed and certain places where
they are not. You can't have sex at the McDonald's. You generally cannot have
sex in the pews of a church or in a synagogue. People don't feel their civil
liberties are being in any way abrogated because of that." 78
Researchers who had visited Central Africa in late 1983 reported they had
identified 26 patients with AIDS in Kigali, Rwanda, and 38 in Kinshasa, Zaire.
The Rwandan study concluded that, "an association of an urban environment, a
relatively high income, and heterosexual promiscuity could be a risk factor for
AIDS in Africa". 79 The Zairian study found there to be a "strong indication of
heterosexual transmission". 80
In light of these findings the Zairian Department of Public Health, in
collaboration with American and European scientists, launched a national AIDS
research programme called Project SIDA. 81
By the end of 1984, there had been 7,699 AIDS cases and 3,665 AIDS deaths in
the USA, and 762 cases had been reported in Europe. 82 83 In the UK there
had been 108 cases and 46 deaths. 84
1985 History
In January 1985 a number of more detailed reports were published concerning
LAV and HTLV-III, and by March it was clear that the viruses were the
same. 85 The same month the U.S Food and Drug Administration (FDA)
licensed, for commercial production, the first blood test for AIDS. The test
would reveal the presence of antibodies to HTLV-III/LAV, and it was announced
that anyone who had antibodies in their blood would not in future be allowed to
donate blood. 86
There were a number of social and ethical issues, as well as certain medical
matters, that had to be considered before the new test could be used even to

ensure the safety of the blood supply. And even more aspects needed to be
considered before the test could be more widely used. Concern particularly
centred on issues of confidentiality and the meaning of a positive test
result. 87 88
"Richard Dunne, director of the Gay Men's Health Crisis, said that the group
would not object to the wider availability of the procedure provided that certain
safeguards were assured: informed consent, good counselling and
confidentiality, 'which means anonymity,' he said. He stressed that the city
must prevent insurance companies, employers, schools and others from
gaining access to test results." - The New York Times 89
The first small-scale needle and syringe exchange project had been started in
1984 in Amsterdam, the Netherlands, but more projects were started in 1985
as a result of growing concerns about HTLV-III/LAV. 90
In April more than 2000 people attended the first international Conference on
AIDS held in Atlanta. Three major topics of discussion were the new HTLV-III/LAV
test, the situation with regards to AIDS internationally, and the extent of
heterosexual transmission. 91
"Some experts are sceptical that AIDS will spread as rapidly among
heterosexuals as it has among homosexuals. Yet other experts, taking their
cues from data emerging from preliminary studies from Africa showing equal
sex distribution among males and females, are less sure." - The New York
Times 92
Immediately after the conference, the World Health Organization (WHO)
organized an international meeting to consider the AIDS epidemic and to
initiate concerted worldwide action. 93
Meanwhile in many countries there was a separate "epidemic of fear" and
prejudice. 94
In the UK tabloid press, AIDS was the subject of many headlines and caused
alarm among the public. In some newspapers, the prejudice was obvious. The
haemophiliacs were seen as the "innocent victims" of AIDS whereas gay men
and drug-users were seen as having brought the disease upon
themselves. 95 The fear of AIDS caused firemen to ban the kiss of life, and
caused holidaymakers to cut their holiday short for fear of contracting AIDS
from an HTLV-III positive passenger on the Queen Elizabeth 2. 96 97 A 9-year
old HTLV-III positive haemophiliac was allowed to attend the local school, but
some of the pupils where kept home by anxious parents. 98

'This is not a setting for AIDS' poster

In the US, it was feared that drinking communion wine from a common cup
could transmit AIDS, and Ryan White, a 13-year old haemophiliac with AIDS,
was banned from school. 99 100
"In 1985, at 13, Ryan White became a symbol of the intolerance that is inflicted
on AIDS victims. Once it became known that White, a haemophiliac, had
contracted the disease from a tainted blood transfusion, school officials banned
him from classes." - Time Magazine 101
The CDC removed Haitians from their list of AIDS risk groups, in light of
information that suggested both heterosexual contact and exposure to
contaminated needles played a role in transmission. 102
On September 17th, President Reagan publicly mentioned AIDS for the first
time, when he was asked about AIDS funding at a press conference. At the
same press conference he was also asked a question whether he would send
his children if they were younger to school with a child who has AIDS.
"It is true that some medical sources had said that this cannot be
communicated in any way other than the ones we already know and which
would not involve a child being in the school. And yet medicine has not come
forth unequivocally and said, 'This we know for a fact, that it is safe.' And until
they do, I think we just have to do the best we can with this problem. I can
understand both sides of it." - Ronald W. Reagan 103
Drugs such as ribavirin, thought to be active against HTLV-III/LAV, were being
smuggled from Mexico into the USA. 104
The actor Rock Hudson died of AIDS on October 3rd 1985. He was the first
major public figure known to have died of AIDS. 105
All UK blood transfusion centres began routine testing of all blood donations for
HTLV-III/LAV in October. 106
For the Global Surveillance of AIDS, the WHO had initially used the definition of
AIDS as developed in the USA in 1982. But this definition was difficult to use in
developing countries where there was a lack of sophisticated laboratory tests.
So in order to help with the surveillance of AIDS, particularly in Africa, a new
WHO definition was adopted in October. This definition of AIDS became known
as the Bangui definition. 107
Towards the end of the year, Western scientists became much more aware of
the "slim disease" that had become increasingly common in South West
Uganda since 1982. Studies found that most cases were among promiscuous
heterosexuals, the majority of whom tested positive for antibodies to HTLVIII/LAV. The site and timing of the first reported cases suggested that the
disease arose in neighbouring Tanzania. Some scientists who studied slim

concluded: "Although slim disease resembles AIDS in many ways, it seems to

be a new entity." 108 However, others thought differently:
"[Evidence] suggests that slim disease cannot be distinguished from AIDS and
ARC [AIDS related complex] by extreme weight loss and diarrhea. Thus slim
disease may not be a new syndrome but simply identical with AIDS as seen in
Africa." 109
In December 1985, the Pasteur Institute filed a lawsuit against the National
Cancer Institute to claim a share of the royalties from the NCI's patented AIDS
test. 110
During the year, knowledge of transmission routes was to change again, when
it was reported that the virus had been transmitted from mother to child
through breast feeding. 111 The first case of AIDS was also reported in China,
and as a result, AIDS had been reported in every region in the world. 112
By the end of 1985, 20,303 cases of AIDS had been reported to the World
Health Organisation. 113 In the USA 15,948 cases of AIDS had been
reported, 114 and in the UK 275 cases. 115
1986 History

THT's 'AIDS is everyone's problem' awareness poster

In the UK the first needle exchange scheme started in Dundee 116 and
the AIDS charity AVERT was started.
In March in the UK, the government launched the first public information
campaign on AIDS, with the slogan "Don't Aid AIDS". There were a series of
advertisements in national newspapers. 117
At this time there was still disagreement about the name of the virus.
"The name of the virus had itself become a political football as the French
insisted on LAV (lymphadenopathy-associated virus), while Gallo's group used
HTLV-3 (human T-cell lymphotropic virus, type 3)." - Time Magazine 118
In May 1986, the International Committee on the Taxonomy of Viruses ruled
that both names should be dropped. The dispute was solved with a new name,
HIV (Human Immunodeficiency Virus). 119
At the opening speech of the International Conference in Paris, held from 23rd
to 25th June 1986, Dr H Mahler, the Director of WHO, announced that as many
as 10 million people worldwide could already be infected with HIV. 120

In August, the USA Federal Government accused an employer of illegal

discrimination against a person with AIDS for the first time. A hospital had
dismissed a nurse and refused to offer him an alternative job. This was seen as
a violation of his civil rights. 121
In September there was dramatic progress in the provision of medical
treatment for AIDS, when early results of clinical tests showed that a drug
called azidothymidine (AZT) slowed down the attack of HIV. AZT was first
synthesised in 1964 as a possible anticancer drug but had proved ineffective.
The AZT clinical trial divided patients into two groups: one received AZT and
the other received a placebo. At the end of six months, only one patient in the
AZT group had died, whilst there were 19 deaths among the placebo group.
The clinical trial was stopped early, because it was thought to be unethical to
deny the patients of the placebo groups a better chance of survival. 122
"The announcement set off a flurry of excitement and controversy. AIDS
hotlines and doctors' offices were flooded with calls, community leaders
warned about undue optimism, and doctors debated the ethical and medical
issues raised by the early cancellation of the AZT study." - Time Magazine 123
In the United States, the Surgeon General's Report on AIDS was published. The
report was the Government's first major statement on what the nation should
do to prevent the spread of AIDS. The "unusually explicit" report urged parents
and schools to start "frank, open discussions" about AIDS. 124
By this time, scientists had accumulated enough evidence to form an overview
of AIDS in Africa. Studies of medical records showed there had been marked
increases in a number of AIDS-related conditions during the late 1970s and
early 1980s. In particular:

Slim disease in Kinshasa, Zaire (late 1970s)

Slim disease in Uganda and Tanzania (early 1980s)

Esophagel candidiasis in Rwanda (from 1983)

Aggressive Kaposi's sarcoma in Kinshasa, Zaire (early 1980s)

Aggressive Kaposi's sarcoma in Zambia and Uganda (from 1982 and

1983)

Crypotococcal meningitis in Kinshasa, Zaire (late 1970s to early 1980s).

In conclusion:

"These studies suggested that while isolated cases of AIDS may have occurred
in Africa earlier, it was probably rare until the late 1970's and early 1980's, a
pattern similar to that in the United States and Haiti." 125
As in Western countries, AIDS in Africa was found to primarily affect young and
middle-aged people, especially those who were unmarried. The sex and age
distributions were seen to reflect other sexually transmitted diseases, and the
major transmission routes had been identified:
"Available data suggest that heterosexual activity, blood transfusions, vertical
transmission from mother to infant, and probably frequent exposure to
unsterilized needles account for the spread of HIV infection and AIDS in
Africa." 126
HIV and AIDS had also been detected in India among sex workers in the
southern state of Tamil Nadu, igniting fears that the disease would soon spread
across the subcontinent. In response, the Indian government decided to
increase the number of HIV testing centres and improve the screening of blood
donations. 127
By the end of the year, 85 countries had reported 38,401 cases of AIDS to the
World Health Organisation. By region these were: Africa 2,323, Americas
31,741, Asia 84, Europe 3,858, and Oceania 395. 128
See
more
1986.htm#sthash.BjR8o4L5.dpuf

at:

http://www.avert.org/history-aids-

1987 History
At the beginning of January the UK Secretary of State for Social Services,
Norman Fowler, visited San Francisco, and in a widely publicised visit shook
hands with an AIDS patient. It was suggested that Princess Diana should follow
his example, which she did later in the year. 1 2
A leaflet about AIDS was delivered to every household in the UK, and the British
Government also launched a major advertising campaign with the slogan
"AIDS: Don't Die of Ignorance", and with the secondary advice: 3 4
"Anyone can get it, gay or straight, male or female. Already 30,000 people are
infected." 5
In February there was a general media "AIDS week", which included numerous
TV and radio programmes about AIDS in the UK. 6 By this time, the World
Health Organisation had been notified of 43,880 cases of AIDS in 91
countries. 7

The first HIV case was officially recorded in the Soviet Union, and a massive HIV
testing programme was conducted. 8
Meanwhile in San Francisco, gay rights activist Cleve Jones made the first panel
for the AIDS Memorial Quilt in memory of his friend Marvin Feldman. 9
"The Names project is a campaign to provide memorials to those lives by
creating a huge quilt made up of individual panels, each 3 by 6 feet, that have
been made by families friends and co-workers of those who died. Each of the
nearly 3000 panels, which have come from all over the country, bears the
name of a victim of acquired immune deficiency." 10
In March the U.S. Food and Drug Administration (FDA) approved AZT as the
first antiretroviral drug to be used as a treatment for AIDS. 11
Around the same time the organisation ACT UP (the AIDS Coalition to Unleash
Power) was founded. ACT UP was committed to direct action to end the AIDS
crisis, and their demands included better access to drugs as well as cheaper
prices, public education about AIDS and the prohibition of AIDS-related
discrimination. On 24th March they held their first mass demonstration on Wall
Street. 12
Many of the placards used in ACT-UP's demonstrations carried the graphic
emblem "SILENCE=DEATH". Created in 1987 by a group of gay men calling
themselves the Silence=Death project, the emblem was leant to ACT-UP and
for many Americans it became the symbol of AIDS activism. 13
One ACT-UP committee used the emblem in a window display called "Let the
Record Show" at the New Museum of Contemporary Art in New York; afterwards
they regrouped as Gran Fury: 14
"a band of individuals united in anger and dedicated to exploiting the power of
art to end the AIDS crisis" 15
Over the next few years Gran Fury produced many high profile public projects
including the art banner announcing "Kissing doesn't kill: Greed and
indifference do" 16 and the poster "AIDS: 1 in 61" about babies born HIV
positive in New York City. 17
In Australia, the Grim Reaper education campaign was launched, with television
images of 'death' knocking down people in a bowling alley. Although widely
criticised at the time, the advertisements succeeded in ensuring widespread
discussion of AIDS. 18
"A bowling alley of death, haunted by decomposing grim reaper bowling over
men, pregnant women, babies and crying children was featured on national
television last night as the part of a $3 million AIDS education campaign, The

60-second commercial featuring the grim reaper, a macabre and dramatic

rotten corpse with scythe in one hand and bowling ball in the other, is
spearheading efforts by the National Advisory Committee on AIDS to educate
Australians about the incurable disease." 19
On 31st March, at a ceremony at the White House attended by President
Reagan, it was announced that an agreement had been reached regarding
ownership of the HIV antibody test patent. The Pasteur Institute agreed that it
would end its legal challenge, and would share the profits from the test with
the U.S. Department of Health and Human Services. 20 Although the
agreement officially resolved the question of who had invented the HIV
antibody test, it did not address the question of who had discovered HIV and
identified it as the cause of AIDS. It was generally agreed that:
"historians can decide who found the AIDS virus first." - Newsweek 21
But to many people it appears clear that HIV was isolated in Paris a year before
it was isolated in the USA. 22
The following day President Reagan made his first major speech on AIDS, when
he addressed the Philadelphia College of Physicians. Reagan advocated a
modest federal role in AIDS education, having told reporters the previous day
that he favoured teaching pupils about AIDS,
"as long as they teach that one of the answers to it is abstinence - if you say
it's not how you do it, but that you don't do it." 23
In England the first specialist AIDS hospital ward was opened by Princess Diana.
The fact that she did not wear gloves when shaking hands with people with
AIDS was widely reported in the press.
"she shook my hand without her gloves on. That proves you can't get AIDS
from normal social contact." 24
The WHO Global Programme on AIDS developed a Global AIDS Strategy, which
was approved by the World Health Assembly in May. The Global AIDS Strategy
established the objectives and principles of local, national and international
action to prevent and control HIV/AIDS. It included the need for every country
to have a "supportive and non-discriminatory social environment". 25
But on 31st May President Reagan gave a speech about AIDS at a dinner of the
American Foundation for AIDS Research and particularly focused on increasing
routine and compulsory AIDS testing. 26
The following day Vice President George Bush opened the 3rd International
Conference on AIDS in Washington and was booed by the audience when he
defended President Reagan's HIV testing proposals. Demonstrators against the

administration's policies were arrested outside the White House by police

wearing long yellow rubber gloves. 27
"On the nightly news broadcasts, the world saw pictures of demonstrators
being arrested by police wearing bright yellow, arm-length gloves. Although
research had by now proved that the AIDS virus could not be passed through
casual contact, the sight of the gloves served to reinforce the public's general
overestimation of the risk of HIV transmission." 28

Gran Fury HIV poster

In June the U.S. Public Health Service added AIDS to its list of diseases for
which people on public health grounds could be excluded from the
USA. 29 Subsequently in July the "Helms amendment" created by Senator Jesse
Helms added HIV infection to the exclusion list. 30 Few foresaw the implications
of the addition and it went virtually unnoticed. 31
In July the WHO reviewed the evidence and confirmed that HIV could be passed
from mother to child through breastfeeding. Nevertheless they recommended
that HIV positive mothers in developing countries should be encouraged to
breastfeed, as in many circumstances safe and effective use of alternatives
was impossible. 32
In light of more widespread HIV testing, the CDC revised their definition of AIDS
to place a greater emphasis on HIV infection status. 33
Prejudice against people with HIV continued in America. The Ray family, who
lived in Arcadia, Florida, had three sons, each of whom was a haemophiliac and
HIV positive. During 1986 the family was told their sons could not attend
school. In 1987 the family moved to Alabama, and once again they were
refused entry to school. Threats against the family grew louder and more
frequent, and on August 28th the Rays' small single-storey house was doused
with gasoline and torched. 34
In England, the UK Government expanded syringe exchange schemes to
prevent transmission of HIV through drug use, and also launched an advertising
campaign with the message 'Don't inject AIDS'. 35
In the autumn, a book by Randy Shilts called 'And the Band Played On' was
published, which chronicled the early years of the AIDS epidemic. 36 Shilts'
book made an important contribution to documenting the history of AIDS, but
his view of "the facts about AIDS", as well as his opinions, differ greatly from
others on a number of occasions. 37

Shilts was the first to identify a French-Canadian flight attendant called Gaetan
Dugas as 'Patient Zero'. (See the History of AIDS up to 1986 for an introduction
to 'Patient Zero'). Shilts claimed that Gaetan Dugas played a key role in the
early spread of AIDS in America, and the story of 'Patient Zero' was widely
publicised by the media. 38 But the claim has since been widely disputed:
"There's no Patient Zero. It's lots and lots of people moving around from New
York to San Francisco, and the rest of the world. If there ever was an original
Patient Zero, it would have been back in the mid-Seventies. But there isn't an
original Patient Zero." - Andrew Moss 39
In Africa, President Kaunda of Zambia announced that his son had died of AIDS,
and appealed to the international community to treat AIDS as a worldwide
problem. 40 In Uganda, 16 volunteers who had been personally affected by
HIV/AIDS came together to found the community organisation TASO. 41
In October, AIDS became the first disease ever debated on the floor of the
United Nations (UN) General Assembly. The General Assembly resolved to
mobilize the entire UN system in the worldwide struggle against AIDS, under
the leadership of the WHO. 42
The American scientist Dr. Peter Duesberg published a scientific paper in a
cancer journal that questioned the then dominant theory that viruses were
involved in cancer causation, and also queried the link between HIV and
AIDS. 43 In November, Channel 4 broadcast the documentary 'AIDS: the
Unheard Voices' to its British audience. In the documentary Duesberg and
others argued that HIV could not be the cause of AIDS. 44
By December, 71,751 cases of AIDS had been reported to the World Health
Organisation, with the greatest number reported by the USA (47,022).
Countries reporting over 2,000 cases included France (2,523), Uganda (2,369)
and Brazil (2,102). Five other countries reported more than 1,000 cases:
Tanzania (1,608), Germany (1,486), Canada (1,334), UK (1,170) and Italy
(1,104). 45
The WHO also reported that an estimated 5 to 10 million people were infected
with HIV worldwide, with 150,000 cases of AIDS expected to develop in the
following 12 months and up to 3 million within the next 5 years. 46
1988 History
As the global mobilisation against AIDS continued, a world summit of ministers
of health was held in London to discuss a common AIDS strategy. The summit
focused on programmes for AIDS prevention. Delegates from 148 countries
attended.

One outcome of the meeting was the London Declaration on AIDS Prevention,
which emphasised education, the free exchange of information and experience,
and the need to protect human rights and dignity. 47 The Director-General of
the World Health Organization chose this occasion to announce that the WHO
intended to promote an annual World AIDS Day, and the first such day would
be on 1st December 1988. 48

Gran Fury 'All people with AIDS are innocent' poster

The meeting was opened by the UK's Princess Royal, who upset many people
involved in AIDS education, as well as many people with AIDS, when she stated
that:
"the real tragedy concerns the innocent victims, people who have been
infected unknowingly, perhaps as a result of a blood transfusion but possibly,
worst of all, those babies who are infected in the womb and are born with the
virus." 49
If there are "innocent victims", then by implication there are also "guilty
victims". This was an unfortunate suggestion to be making at a world meeting
on AIDS prevention.
In May the United States finally launched a coordinated HIV/AIDS education
campaign. 50 The distribution took place of 107 million copies of
"Understanding AIDS", a booklet by Surgeon General C. Everett
Koop. 51 'Understanding AIDS' was the single most widely read publication in
the United States in June 1988, with 86.9 million readers. 52
The following month the American Medical Association urged doctors to break
confidentiality in order to warn the sexual partners of people being treated for
AIDS. 53
"We are saying for the first time that, because of the danger to the public
health and danger to unknowing partners who may be contaminated with this
lethal disease, the physician may be required to violate patient confidentiality.
The physician has a responsibility to inform the spouse or known partners. This
is more than an option. This is an professional responsibility."
In the USA frustration continued to grow over the slow progress in improving
access to drugs. When the Presidential Commission on the HIV Epidemic issued
its final report in June 1988, it declared that the FDA arrangements were "not
meeting the needs of people with AIDS". On October 11th more than 1,000
ACT-UP demonstrators virtually shut down operations at the FDA
headquarters. 54

Eight days after the ACT-UP demonstration the FDA announced new regulations
to speed drug approval. 55
The first official needle exchange was started in the US to prevent transmission
of HIV through drug use. 56 A limited experiment started in November in New
York City and, at about the same time, the Prevention Point opened in San
Francisco. 57 58 But Congress prohibited the use of federal funds to support
needle exchange programmes. 59
On December 1st, the first World AIDS Day took place, with the WHO asking
everyone to "Join the Worldwide Effort." 60
1989 History
On February 7th, the FDA announced that it was going to approve an aerosol
form of the drug Pentamidine for the treatment of PCP (a type of pneumonia) in
people with AIDS. 61 Much of the data that led to this approval was collected
by CCC, County Community Consortium of San Francisco, with further data
collected by another community research organisation called CRI, Community
Research Initiative of New York. 62
By March 1st, 145 countries had reported 142,000 cases of AIDS to the World
Health Organisation (WHO). The WHO regarded this as under-reporting, and
estimated the actual number of people with AIDS around the world to be over
400,000. It was predicted that this figure would rise to 1.1 million by 1991. It
was also estimated that 5-10 million people were already infected with HIV. 63
On April 2nd, Hans Verhoef, a Dutch man with AIDS, was jailed in Minnesota
under the federal law banning travellers with HIV from entering the USA. 64 In
June a protest against the law took place at the opening ceremony of the Fifth
International Conference on AIDS in Montreal, when 250 protesters with
placards stormed the stage. 65
In August, there were more developments with respect to treatment, when the
results were announced of a major drug trial known as ACTG019. ACTG019 was
a trial of the drug AZT, and it showed that AZT could slow progression to AIDS
in HIV positive individuals with no symptoms at all. The findings were
considered extremely exciting. On August 17th a press conference was held, at
which the Health Secretary, Louis Sullivan said:
"Today we are witnessing a turning point in the battle to change AIDS from a
fatal disease to a treatable one." 66
The result had enormous financial implications for the makers of the drug,
Burroughs Wellcome. The day after the press conference, the value of the
company's stock rose by 32 per cent. 67 The high price of AZT angered many

people; with a year's supply for one person costing about $7,000, Burroughs
Welcome were accused of "price gouging and profiteering". 68 69
In September, the cost of the drug was cut by 20 percent. 70
In October the second drug for the treatment of AIDS, dideoxyinosine (ddI), was
made available to people with AIDS, even though only preliminary tests had
been completed.
"It become clear that ddl was not just another drug in terms of need: it was a
life-and-death matter, said Richard L. Gelb, chairman of Bristol Myers." 71
1990 History
At the beginning of the year, it was reported that a large number of children in
Romanian hospitals and orphanages had become infected with HIV as a result
of multiple blood transfusions and the reuse of needles. Jonathan Mann, the
head of the WHO's Global programme on AIDS, noted that 'Eastern Europe is
the new frontier for the AIDS epidemic'. 72
In China, 146 people in Yunnan Province near the Burmese border were found
to be infected with HIV due to sharing needles. This shocked public health
officials in China. It was not known whether this was the first sign of an
epidemic or an isolated outbreak. 73
In New York city the needle exchange scheme was closed down. 74
Jonathan Mann resigned as the head of the WHO AIDS programme, in protest of
the failure of the UN and governments worldwide to respond adequately to the
exploding pandemic, and against the actions of the then WHO director-general
Dr. Hiroshi Nakajima. 75 During Jonathan Mann's leadership, the AIDS
programme became the

Ryan White (1971-1990) with his mother

largest single
importantly:

programme

in

the

organisation's

history. 76 But

more

"Jonathan's persistence and passion helped wake up the world." 77

and,
"Had it not been for Jonathan's unique contributions, the world's approach to
AIDS might very well have gone towards mandatory testing and
quarantine." 78

On April 8th Ryan White died in the United States. He was a haemophiliac
infected with HIV through blood products. He had become well known a few
years earlier as a result of his fight to be allowed to attend public
school. 79 Just a few months later the Ryan White CARE Act was passed by
Congress. The aim of the act was to provide grants to improve the quality and
availability of care for individuals and families with HIV. 80
In the UK and the US, discussion grew about whether there would ever be a
heterosexual epidemic because of the difficulty of female-to-male transmission
of HIV. 81 82 83
In June, a TV programme called 'The AIDS Catch' was screened in the UK, again
questioning whether HIV caused AIDS and whether AIDS was infectious. The
programme provoked a hostile response among the AIDS community and AIDSrelated organisations. 84 Some people felt that the programme was
sensationalist and contained factual inaccuracies. It was also felt the
programme caused significant distress among people with HIV and undermined
the efforts carried out in the field of HIV/AIDS prevention. 85
Protests against the ban on HIV positive people entering America continued.
Although there had been minor changes to the law, at the time of the 6th
International Conference on AIDS in San Francisco in June it was still considered
by many to be "discriminatory and medically unsupportable". 86 Consequently
there was a widespread boycott of the conference, and many people who spoke
at the conference took the opportunity to voice their views. One such person
was June Osborn, the Chair of the National Commission on AIDS, who said:
"How sorry I am, and how embarrassed as an American, that our country
whose tradition serves as a proud beacon for emerging democracies, should
persist in such misguided and irrational current policy." 87
Many demonstrations took place during the conference week, the most
significant being "A United Call to Action", in which activists, scientists, and
many others marched together to emphasise the importance of unified action
to end AIDS. 88
The International AIDS Society (IAS) announced that no further IAS sponsored
conference would be held in a country that restricted the entry of HIV infected
travellers. 89

ACT-UP protestors at the AIDS conference in San Francisco

In July the CDC reported the possible transmission of HIV to a patient during a
dental procedure. The dentist had been diagnosed with AIDS three months
before performing the procedure. The CDC investigation did not identify any

other risk factors or behaviours that could have put the patient at risk of HIV
infection. 90 A couple of months later the patient was named as 22-year old
Kimberly Bergalis and the dentist was named as David Acer. 91
"When she was diagnosed with AIDS we were in disbelief. All we could wonder
was whether something went wrong at the dentists. Health officials said no
way, it just can't happen. But Kimberly stuck by her guns and kept telling them
to look at the dentist. Eventually the CDC supported her conclusion." - George
Bergalis 92
In the UK, Prime Minister John Major announced that the Government would
pay 42 million compensation to haemophiliacs infected with HIV and their
dependants. 93
By the end of the year, over 307,000 AIDS cases had been officially reported to
the WHO, but the actual number was estimated to be closer to a million. It was
estimated that 8-10 million people were living with HIV worldwide, of whom
about 5 million were men and 3 million were women. 94
Area
Estimated HIV
Reported AIDS
Estimated AIDS
Africa
>5,500,000
77,043
>650,000
N America
1,000,000
156,658
200,000
S America
1,000,000
28,937
90,000
Asia
500,000
843
2,000
Europe
500,000
41,564
50,000
Oceania
30,000
2,334
2,700
Total
<9,000,000
307,379
<1,000,000
The 3 million HIV-infected women were estimated to have collectively given
birth to around 3 million infants, of whom over 700,000 were likely to have
become infected with HIV. 95
1991 History
At the beginning of 1991 the CDC published a report confirming that, in
addition to Kimberly Bergalis, two other patients had probably been infected by
the same dentist. 96 Such was the public concern that America's leading
medical and dental associations announced that HIV positive doctors and
dentists should warn their patients about their infection status or give up
surgery. 97 During the summer, in the midst of continuing public hysteria, the
CDC also recommended that infected health care workers should be barred
from certain procedures. 98 99
The largest peak in requests for HIV testing in the UK was observed in January
1991 when the character Mark Fowler, in the BBC television series EastEnders,
was diagnosed with HIV. 100

In the autumn, in a dramatic move, Kimberly Bergalis testified to the US

Congress. In what she called her "dying wish", she asked members of congress
to enact legislation for mandatory HIV testing of health care workers, to ensure
that: 101
"others don't have to go through the hell that I have."
But, overwhelmed by opposition from the medical profession, the CDC chose
not to recommend mandatory testing, and dropped its plans to list procedures
that should not be carried out by HIV positive health workers. Kimberly Bergalis
died a few days later. 102 103
During the summer, a third antiretroviral drug dideoxycytidine (ddC) was
authorised by the FDA for use by patients intolerant of AZT. 104
Also during the summer, a study was published showing that HIV was
transmitted much more easily through breast milk than had previously been
thought. 105 But despite admitting that the news was discouraging, WHO also
said that women in developing countries should continue to breastfeed, as the
threat to infant health from contaminated water was even greater than the
threat from AIDS. 106
The decision was taken to hold the 1992 international AIDS conference in
Amsterdam, rather than its planned location in Boston, following the American
administration's decision not to lift entry restrictions on HIV-infected
travellers. 107
In the USA Earvin (Magic) Johnson announced that he had tested HIV positive
and was therefore retiring from professional basketball, on the advice of his
doctors.
He said that he planned to use his celebrity status to help educate young
people about the disease. He also said:
"I think sometimes we think, well, only gay people can get it - it is not going to
happen to me. And here I am saying that it happen to anyone, even me Magic
Johnson." 108
A couple of weeks later in the UK, Freddie Mercury, lead singer of the rock
group Queen, confirmed that he had AIDS. Just one day later it was announced
that he had died. 109
In France, haemophiliacs who had become infected with HIV through blood
products sued leading medical and government officials. They accused the
blood transfusion centres of allowing the use of HIV-contaminated blood, even
though tests to screen blood for HIV and techniques to destroy the virus in
blood products were available. 110 111

The red ribbon became an international symbol of AIDS awareness during

1991. The organisation, Visual AIDS in New York, together with Broadway Cares
and Equity Fights AIDS, established the wearing of a red ribbon as a way of
signifying support for people living with HIV/AIDS. 112
As the end of 1991, about 450,000 AIDS cases had been reported to the Global
Programme on AIDS (GPA) / World Health Organisation (WHO). It was estimated
that 5-7 million men and 3-5 million women had been infected with HIV. Of
these 9-11 million HIV-infected adults, nearly 1.5 million were estimated to
have progressed to AIDS. 113
1992 History
The WHO set as a priority target for prevention that, by the year 2000, the
whole population at risk from HIV and AIDS in Africa and Asia should live in
communities where condoms were both readily available and affordable. 114
In the UK, the Department of Health made it an offence to sell, advertise or
supply HIV antibody testing kits to the public. 115
During 1992, a major UK newspaper ran a series of articles challenging the
orthodox view that HIV alone causes AIDS. 116
"But suppose the researchers are looking in the wrong place. Suppose HIV
doesn't equal AIDS. Then we will have witnessed the biggest medical and
scientific blunder this century." - The Sunday Times journalist Neville
Hodgkinson 117
Many other British newspapers joined the heated debate with journalists,
researchers, activists and organisations expressing their opinions about the
cause of AIDS. 118
"'But what if HIV does cause AIDS? What effect will such articles have on
attempts to inform the public on safe sex, or on the people who are suffering
from AIDS and taking anti-HIV drugs?" 119
Mary Fisher, an HIV-positive woman and member of the Republican party in the
USA, rebuked her partys negligence in the face of the growing HIV and AIDS
epidemic through a speech that was broadcast nationally: 120
We have killed each other with our ignorance, our prejudice, and our silence.
We may take refuge in our stereotypes, but we cannot hide there long,
because HIV asks only one thing of those it attacks. Are you human? - Mary
Fisher 121
Her address has since been considered one of the most significant American
speeches of the twentieth century. 122

Tennis star Arthur Ashe announced he had become infected with HIV as a result
of a blood transfusion in 1983. 123
Fearful that it was discouraging tourists, a new government in Thailand
threatened to scale down the country's extensive AIDS awareness campaign,
which had begun in 1991 and won international acclaim. However, the
government lost power within weeks and the campaign was restored. 124
The FDA approved the use of ddC in combination with AZT for adult patients
with advanced HIV infection who were continuing to show signs of clinical or
immunological deterioration. This was the first successful use of combination
drug therapy for the treatment of AIDS. 125
"This new drug is not a cure, said James Mason, M.D., assistant secretary for
health and head of the Public Health service, but it constitutes an important
addition to the expanding group of antiviral drugs currently available, including
AZT and DDI, for treating people with AIDS."
The CDC, under pressure from patients and doctors, decided to revise its
definition of AIDS. The previous list of illnesses that defined AIDS had been
criticised for some time because it did not include many of the conditions most
often seen in HIV positive women and injecting drug users. The new definition
would take effect from the start of 1993. 126 127
The VIII International Conference was successfully held in Amsterdam rather
than in its originally planned venue in Boston. 128
In France four health care officials were brought to trial accused of allowing the
distribution, between 1980 and 1985, of blood products known to be
contaminated with HIV. 129 130 The former director of the transfusion service,
Michel Garretta, was sentenced to four years in prison, as was Jean-Pierre
Allain, the former head of research at the transfusion centre. The third doctor,
Jacques Roux, was given a four-year suspended sentence, whilst the fourth
doctor was acquitted. 131
In response to rising HIV prevalence, the Indian government decided to allocate
$100 million to the National AIDS Control project over the next five years,
which amounted to more than 15 percent of the national health budget. Most
of this money would come from a World Bank loan. 132 Experts predicted that
within five years there might be more people affected by AIDS in India than in
any other country. 133
See
more
at:
1992.htm#sthash.DxQLsker.dpuf
History of AIDS: 1993-1997

http://www.avert.org/history-aids-1987-

'Europe against AIDS' flying condom poster

These are some of the most important events that have occurred in thehistory
of AIDS over the period 1993-1997.
1993 History
In January it was reported that some people with AIDS already had resistance
to the drug Zidovudine (AZT) even though they themselves had never taken
the drug.
"Some of the patients may have gotten the virus from other patients who have
been taking AZT and who are now transmitting the resistant virus."
Researchers said there was an urgent need to develop new drugs to combat
the epidemic. 1
On January 6th the Russian ballet star Rudolf Nureyev died. His doctor said that
"he died from a cardiac complication following a cruel illness", but it was widely
reported that he had died from AIDS. 2 3 He was buried in his evening clothes
with his medals and his favourite beret. 4
During January, 116 new cases of AIDS were reported in the UK, bringing the
cumulative total to 7,045. One in six of these new cases were acquired through
heterosexual intercourse. 5
In Romania, despite the progress made since the overthrow of the Ceausescu
regime, the number of children infected with HIV had increased. There were an
estimated 98,000 infected orphans. 6
China had reported one thousand cases of HIV infection, mostly in injecting
drug users, but it was believed that this greatly understated the scale of the
country's HIV epidemic. 7 8 The Ministry of Health in China announced that
soon only approved government blood donation centres would be able to
collect and sell blood. 9
In February the tennis player Arthur Ashe died, less than a year after
announcing that he had been infected with HIV. 10
In March, the House of Representatives in the USA voted overwhelmingly to
retain the ban on the entry into the country of HIV positive people. 11
In South Africa, the National Health Department reported that the number of
recorded HIV infections had grown by 60 percent in the previous two years and
was expected to double in 1993. A survey of women attending health clinics
indicated that nationally some 322,000 people were infected. 12

Princess Diana continued her HIV/AIDS advocacy work and spoke at the
opening address of the 2nd International Conference on HIV in Children and
Mothers in Edinburgh.
"By the year two thousand, only seven years from now - even the most
conservative estimates predict there will be more than thirty million people
worldwide with HIV - equivalent to more than half the population of the United
Kingdom." - Diana - Princess of Wales, 1993

Romanian children living with HIV

In the UK in March, there were a large number of rather hysterical stories in the
British press about the fact that a number of doctors in England had continued
to practise medicine whilst knowing they were infected with HIV. 13 The UK
government responded by issuing new guidelines, according to which health
care workers who believed that they had been exposed to HIV had to seek
medical advice and testing.14
Meanwhile scientists had found that HIV 'hides out' in lymph nodes and similar
tissue early in the course of infection. 15
The virus lies concealed for a decade or so, quietly seeding the destruction of
the immune system, the researchers found. The finding resoundingly solves a
mystery of AIDS: where does the virus secrete itself during the decade or so
after an initial infection when patients feel well and little virus can be detected
in their blood? 16
In early April the Ministers of Health and Finance from 39 countries met in Riga,
Latvia, and launched an initiative to contain the spread of HIV in Central and
Eastern European countries. 17 During the Eighties, many countries of Central
and Eastern Europe, the newly independent states, and the Russian Federation
had introduced large-scale screening for HIV infection, with in excess of 20
million tests being carried out in the Russian Federation during 1993. One
aspect of the Riga initiative was a refocusing of testing policies away from this
mass screening and towards voluntary testing. 18
The preliminary results were published of the large Anglo-French clinical trial of
AZT known as Concorde. 19 The results were interpreted as meaning that AZT
was not after all a useful therapy for HIV positive people who had not
developed symptoms. 20
In the UK the radio DJ and comedian Kenny Everett announced that he was HIV
positive, as did Holly Johnson, former lead singer with the group Frankie goes to
Hollywood. 21

The World Bank reviewed its HIV and AIDS activities Africa, and decided that
AIDS should not dominate its agenda on population, health and nutrition issues.
The World Bank believed that AIDS would have little demographic effect but
recognised that it was a serious threat to health and economic development.
With reference to blood screening, it was argued that this was costly and
"might not be cost-effective under all circumstances". 22
The ninth International AIDS meeting was held in Berlin, Germany. The general
feeling of the meeting was one of disappointment. The message conveyed by
the people who attended was once again to put more money and effort into
effective prevention of HIV and AIDS.
Dr. James W. Curran, who heads the AIDS Programme at the Centers for
Disease Control and Prevention in Atlanta, said he left the meeting 'dispirited
by the relentless assault of the virus'.23
At the beginning of the year the CDC had expanded the US definition of AIDS to
include people with certain opportunistic infections, as well as HIV infected
adults with a CD4 count of less than 200. The expert epidemiology group of the
European Centre for the Epidemiological Monitoring of AIDS together with the
WHO's Regional Office for Europe accepted the inclusion of the additional
indicator diseases but not the CD4 cell count criteria. 24
In mid-1993 six United Nations organisations, including the WHO, began to
seek agreement on forming a joint and cosponsored UN programme on
HIV/AIDS. 25
By this time it had been realised that HIV was also spreading rapidly in the Asia
and Pacific regions, home to more than half the world's population, where more
than 700,000 people were already believed to be infected. 26
The drug 3TC was authorised by the FDA in the USA and the Federal Health
Protection Branch in Canada, to be used in "compassionate" therapy in people
who had not responded to other AIDS treatment or who are not eligible for
clinical trials. 27 Those patients who had developed a resistance to AZT were
offered didanosine (ddI) and dideoxycytidine (ddC) - drugs that had been
extensively studied. A number of trials were underway comparing the
effectiveness of taking AZT on its own and in combination with ddI and ddC. 28
Despite the years of litigation and number of newspaper accounts of the
infection of haemophiliacs and transfusion recipients, no formal investigation of
what had happened in Germany was undertaken until the 'scandal' of October
1993. In October, the failure of a small German blood supply company called
UB Plasma to screen blood and plasma for HIV was made public. The
company's misconduct was discovered by the Federal Health Office by chance,
as a result of routine examination of positive HIV test results. 29 The Federal

Government also admitted that officials had covered up 373 cases of HIVcontaminated blood in the 1980s. 30
On World AIDS Day, 1st December, Benetton in collaboration with ACT UP Paris
placed a giant condom (22 metres high and 3.5 wide) on the obelisk in Place de
la Concorde in Central Paris in an effort to waken the world to the reality of the
disease. A symbolic monument to HIV prevention, it appeared on the covers of
newspapers worldwide. 31
At the end of 1993 the estimated number of AIDS cases worldwide was 2.5
million. 32
Region
Australasia
North America
Western Europe
Latin America & Caribbean
Sub-Saharan Africa
South and South-East Asia
East Asia and Pacific
Eastern
Europe
and
Central Asia
North Africa & The Middle
East
Total
1994 History

Estimated
infection
>25000
>1 million
500000
1.7 million
>9 million
2 million
>35000
>50000

Adult

HIV

Estimated adult AIDS

cases
5000
400000
125000
300000
1.7 million
>75000
>1000
4500

75000

12000

>14 million

>2.5 million

In the US the CDC launched a series of 13 bold and frank AIDS advertisements
breaking away from their previous low-key approach. The advertisements
focused on the use of condoms, which were rarely seen or even mentioned on
American television.
"One of the television ads, entitled Automatic, features a condom making its
way from the top drawer of a dresser across the room and into bed with a
couple about to make love. The voice-over says, 'it would be nice if latex
condoms were automatics. But since they're not - using them should be.
Simply because a latex condom, used consistently and correctly, will prevent
the spread of HIV.'" 33

Your pocket guie to sex - campaign

In the UK, the Department of Health vetoed an AIDS campaign promoting safer
sex and condoms, developed at a cost of 2 million, on the grounds that it was
too explicit. 34 The campaign was developed by the Health Education Authority

(a government funded body), who later in the year were banned by the
Department of Health from distributing the book, "Your Pocket Guide to
Sex". 35
In February the film maker Derek Jarman died of AIDS. He had written in the
preface of his autobiography:
"On 22nd of December 1986, finding I was body positive, I set myself a target:
I would disclose my secret and survive Margaret Thatcher. I did. Now I have my
sights on the millennium and a world where we are equal before the law." 36
Randy Shilts, author of the book 'And the band played on' also died in
February. 37
In March, the actor Tom Hanks won an Oscar for playing a gay man with AIDS in
the film Philadelphia. 38
Official statistics for Brazil, with a population of about 154 million, indicated
that some 46,000 cases of AIDS had been recorded, but estimates put the
actual number at anywhere between 450,000 and 3 million cases. Two thirds of
the known cases were in Sao Paulo state where AIDS was the leading cause of
death of women aged 20-35. 39
In France, on 7th April all the television networks, public and private, broadcast
'Tous contre le Sida' ('All against AIDS'), a special 4-hour AIDS programme. The
aim was to heighten awareness about HIV/AIDS and to raise money. 40 The
estimated audience for the program was 33 million. Some 32,000 cases of AIDS
had been recorded in France, with 15 deaths each day, and an estimated
150,000 people were thought to be infected. 41
During the summer, the AIDS Prevention Agency in Brussels, in collaboration
with the European Union, launched a campaign whose central image was 'the
flying condom'. This was intended to serve as a visual reminder to young
travellers of the risks of HIV infection. The logo was displayed in airports,
railway stations, popular holiday destinations and other places young people
visited during the summer. 42
A large European study on mother-to-child transmission showed that Caesarean
section halved the rate of HIV transmission. 43
Research indicated that Thailand had reduced its rate of HIV transmission. This
was largely due to action by the government, which had distributed condoms
to brothels and insisted that they were used consistently; establishments that
failed to comply were threatened with closure. Condom use in commercial sex
had risen from 14 percent in 1989 to 94 percent in 1993. 44

By July 1994 the number of AIDS cases reported to the WHO was 985,119. The
WHO estimated that the total number of AIDS cases globally had risen by 60
percent in the past year from an estimated 2.5 million in July 1993 to 4 million
in July 1994. 45 It was estimated that worldwide there were three men infected
for every two women, but that by the year 2000 the number of new infections
among women would be equal to that among men. 46
At the end of July, it was announced that the WHO's Global programme on AIDS
would be replaced. The UN Economic and Social Council approved the
establishment of a new "joint and cosponsored UN programme on HIV/AIDS".
The separate AIDS programmes of the UNDP, World Bank, UN Population Fund,
UNICEF and UNESCO would have headquarters with the WHO in Geneva,
starting in 1996. 47Later in the year it was announced that Dr. Peter Piot, the
head of the research and intervention programme within the Global Programme
on AIDS, would be the head of the new UN program. 48
An exciting study, ACTG 076, showed that AZT reduced by two thirds the risk of
HIV transmission from infected mothers to their babies. 49 Some people
believed that ACTG 076 was:
the most stunning and important result in clinical acquired immunodeficiency
syndrome research to date. 50
And according to Dr Harold Jaffe of the CDC:
It is the first indication that mother-to-child transmission of HIV can be at least
decreased, if not prevented. And it will provide a real impetus for identifying
more HIV-infected women during pregnancies so that they could consider the
benefit of AZT treatment for themselves and their children. - The New York
Times - 51
In early August 1994, the Tenth International Conference on AIDS was held in
Yokohama, Japan. It was the first of the International Conferences to be held in
Asia. No major breakthroughs emerged, and it was announced that in future
the international conference would be held every two years. 52
Meanwhile in the Russian Federation, deputies in the Russian Parliament, the
Duma, voted at the end of October to adopt a law making HIV tests compulsory
for all foreign residents, tourists, businessmen and even members of official
delegations. 53
India by this time had around 1.6 million people living with HIV, up by 60
percent since 1993. Local and state governments were accused of underusing
and misusing HIV prevention funds. 54

Pedro Zamora, an HIV-positive reality TV show star

On 11th November AIDS killed the 22-year old Pedro Zamora. He had become
famous when he appeared on MTV's 'Real World' documentary about the real
lives of a group of young room mates. 55
In December, President Clinton asked Joycelyn Elders to resign from the post of
US Surgeon General, following her suggestion during a World AIDS Day
conference that school children should, amongst other things, be taught about
masturbation. Gay activists defended the Surgeon General and criticised the
president's record on AIDS. Fears were expressed that the president's action
would discourage other government leaders from speaking frankly about sex
education and AIDS. 56
1995 History
By 1st January 1995, a cumulative total of a million cases of AIDS had been
reported to the World Health Organisation Global Programme on AIDS. Eighteen
million adults and 1.5 million children were estimated to have been infected
with HIV since the beginning of the epidemic. 57
Later in the month the CDC announced that in the US, AIDS had become the
leading cause of death amongst all Americans aged 25 to 44.
The dramatic rise is due to the accumulating toll from AIDS and is almost
certain to continue because of AIDS deaths reflect infections from HIV, the AIDS
virus that were acquired several years earlier. - Dr. Harold W. Jaffe of the CDC
- 58
Two research reports provided important new information about how HIV
replicates in the body and how it affects the immune system. 59 60
Meanwhile in the USA, two reports by government scientists recommended
that the Clinton administration lift the ban on federal funding for needle
exchange programs, because the programmes had been shown to be effective
in reducing the spread of disease. 61 62
In March the VII International Conference for People Living with HIV and AIDS
was held in Cape Town, South Africa - the first time that the annual conference
was held in Africa. 63 The conference was opened by the deputy President,
Thabo Mbeki, who spoke about how:
"the impact has begun to cut deep. Those affected are from the young and
able-bodied work-force as well as young intellectuals." 64

The South African Ministry of Health announced that some 850,000 people - 2.1
percent of the 40 million population - were believed to be HIV positive. Among
pregnant women the figure had reached 8 percent and was rising. 65

Peter Piot - former UNAIDS executive director

The conference was also addressed by Dr Piot, the Director of the new Joint
United Nations Programme on AIDS (UNAIDS). Dr Piot confirmed his
commitment to involve people living with HIV/AIDS in the planning, shaping
and guiding of the global response to the epidemic. 66
In July, the US Senate voted to extend the Ryan White Care Act, which provided
care and support services to those affected by HIV and AIDS.67 As a result of
the first five years of the Act:
"in the place of activists there were now thousands of AIDS organisations
throughout the country - the AIDS "industry" made possible by the Ryan White
Care Act". 68
By the autumn of 1995, 7-8 million women of childbearing age were believed to
have been infected with HIV. The WHO spoke out about the 'inadequate
international response':
"The impact of the HIV/AIDS epidemic on women is not yet receiving
sufficient political awareness, commitment or enough action of programmes
responding to the specific needs of women."69
Also in August, researchers announced the results of a study in Tanzania, which
found that treating people for sexually transmitted diseases such as gonorrhea
substantially reduced their risk of becoming infected with HIV. 70
In September two clinical trials, the Delta trial and the ACTG175 trial, showed
that combinations of AZT with ddI or ddC were more effective than AZT alone in
delaying disease progression and prolonging life. 71
On 1st December, World AIDS Day, Nelson Mandela called on all South Africans
to
"speak out against the stigma, blame, shame and denial that has thus far been
associated with this epidemic." 72
The FDA approved the first of a potent new family of anti-AIDS medications.
The drug saquinavir belonged to a class of drugs called protease inhibitors. Its
approval in record time was said to be:
"some of the most hopeful news in years for people living with AIDS." 73

By December 15th, the World Health Organisation had received reports of

1,291,810 cumulative cases of AIDS in adults and children from 193 countries
or areas. The WHO estimated that the actual number of cases that had
occurred was around 6 million. Eight countries in Africa had reported more than
20,000 cases. 74
Other organisations estimated that by the end of 1995, 9.2 million people
worldwide had died from AIDS. 75
Worldwide during 1995, it was estimated that 4.7 million new HIV infections
occurred. Of these, 2.5 million occurred in Southeast Asia and 1.9 million in
sub-Saharan Africa. Approximately 500,000 children were born with HIV. 76
The WHO's Global programme on AIDS closed as planned on 31st December
1995. 77 They estimated that by the end of the century, 30 to 40 million
people would have been affected by HIV. 78
1996 History
The new Joint United Nations Programme on AIDS (UNAIDS), bringing together
six agencies belonging to or affiliated with the UN system (WHO, UNDP,
UNICEF, UNFPA, UNESCO and the World Bank), became operational on January
1st. 79
In February the heavyweight boxer Tommy Morrison was identified as HIV
positive after being tested prior to a fight. 80
"'I thought AIDS was something that happened to gays and drug addicts. A
macho guy like me who loves ladies and is superfit - he doesn't get
AIDS.' Tommy Morrison." 81
In March, a government appointed panel issued a report sharply criticising the
US government's domestic response to AIDS:
"The Government's $1.4 billion AIDS research program is uncoordinated, lacks
focus and needs a major overhaul to attract new scientific talent and spur
novel and imaginative ideas." 82
Meanwhile the effect of AIDS was continuing to be felt at a community level. In
the USA there had been a cumulative total of 81,500 AIDS cases in New York,
and:
"despite two world wars, the Depression and epidemics, nothing in this century
has affected the life expectancy for New Yorkers as greatly as AIDS." 83
In May the US Food and Drug Administration (FDA) approved the first 'home
sampling' system of HIV testing. Until then the FDA had insisted that all tests
for HIV (whether blood or oral fluid) had to be done under the supervision of

health professionals. Under the new system, someone would buy a sampling kit
from a shop or by mail order, collect a sample of their blood, send it to a
laboratory for testing, and receive their results by phone.
"'Too many Americans do not know their HIV status. Knowledge is power, and
power leads to prevention', said HHS Secretary Donna E. Shalala. 'The
availability of a home test should empower more people to learn their HIV
status and protect themselves and their loved ones.'" 84
Meanwhile in China it was estimated that the number of AIDS cases could be as
high as 100,000. Two thirds of the reported AIDS cases had occurred in the
southern province of Yunnan, where the use of heroin and the sharing of
needles had helped the spread of HIV. 85

Nevirapine
In June the FDA approved the drug Viramune (nevirapine), the first in a new
class of drugs known as non-nucleoside reverse transcriptase inhibitors
( NNRTIs). 86 Another treatment development that took place was the
introduction of the viral load test, which provided information about the risk of
disease progression. 87
Throughout 1996 there was excitement and optimism about the treatment of
HIV infected people. 88 The health of many improved enormously when they
started taking combination therapy. For some people, particularly those had
been ill in hospital and were then able to go home, the improvement in health
was so dramatic that it was referred to as the "Lazarus Syndrome". 89
At the start of the 11th International Conference on AIDS in Vancouver in July:
"the air was electric with excitement and anticipation about the findings on
combination therapies to be reported during the meeting." 90
Some scientists even declared that:
"aggressive treatment with multiple drugs can convert deadly AIDS into a
chronic, manageable disorder like diabetes." 91
One doctor suggested that giving combination therapy to patients in the first
few weeks of infection might mean that the virus could be completely
eliminated in two or three years. 92
However, Nkosazana Zuma, the health minister of South Africa, reminded the
conference delegates that:

"most people infected with HIV live in Africa, where therapies involving
combinations of expensive antiviral drugs are out of the question." 93
It was also reported that there were limitations on the use of the drugs, such as
severe side effects and the difficulty of taking large numbers of pills each
day. 94
"If you think the cure is here, think again. The cure is not here. We are a long
way from a cure, even for the rich who can afford the treatments." - Eric
Sawyer 95
The government of Brazil pledged to begin providing free combination
antiretroviral treatment by the end of the year. It said it would spend up to $45
million on protease inhibitors over the following twelve months. 96
In October, in Washington D.C., the AIDS Memorial Quilt was displayed in its
entirety for the last time, but it was also the first time that a display of the quilt
had been visited by an American president. 9798
"What it has done always in the past, and will continue to do, is to put a face
on this epidemic. It makes this epidemic human." - Anthony Turney 99
In December, the White House announced its first ever AIDS strategy. This
called, amongst other things, for sustained research to find a cure and a
vaccine; a reduction in new infections; guaranteed access to high quality care
for AIDS patients; and fighting AIDS-related discrimination.
"None of us can afford to sit by and watch this epidemic continue to take our
neighbors, friends and loved ones from us" - President Clinton in a letter
accompanying the AIDS plan 100
AIDS advocates said that much would depend on how the stategy was
implemented.
"It doesn't require rocket science to figure out what to do, what it requires is
the political will to back it up." - Paul Donato 101
New outbreaks of HIV infection were erupting in Eastern Europe, the former
Soviet Union, India, Vietnam, Cambodia, China and elsewhere.
"The epidemic is starting to skyrocket in Russia and the Ukraine where
transmission is from everything - injecting drugs, poor hygiene, and
heterosexual and homosexual intercourse." - Dr Peter Piot 102
At the end of the year UNAIDS estimated that during 1996 some three million
people, mostly under the age of 25, had become newly infected with HIV,
bringing to nearly 23 million the total number of infected people. In addition an

estimated 6.4 million people - 5 million adults and 1.4 million children - had
already died.
1997 History

Children at a school in Illinge, South Africa

Early in 1997 it was reported that, for the first time since the AIDS epidemic
became visible in 1981, the number of deaths from AIDS had dropped
substantially across the USA. 103 This was excellent news but:
"The decline in deaths leaves more people living with AIDS and HIV infection.
We do not want to be a wet blanket here, but we still need programs that
assure good access to treatment and care for infected people." - Dr John
Ward 104
In New York City the decline was even more dramatic, with the number of
people dying from AIDS falling by about 50 per cent compared to the previous
year. 105 The number of babies being born HIV positive had also declined
dramatically. 106
By the spring it was clear that although excellent for many people, the
antiretroviral drugs did have unpleasant and in some cases serious side effects.
Resistance could also occur, even when three drugs were being taken,
and adherence was an important issue as many pills needed to be taken each
day. 107
A number of treatment guidelines were published, and some doctors,
particularly in the UK, disagreed with the more aggressive approach taken by
the US guidelines. 108 109 Some doctors were particularly concerned about
the recommendations concerning the beginning of treatment when patients did
not have symptoms. 110 The US approach was sometimes referred to as
the "hit early, hit hard" 111 approach to treatment.
Later in the year a number of studies were published which showed that HIV
could not after all be eradicated by two or three years of treatment, even if
three drugs were taken and the treatment was strictly followed. 112
In May 1997 President Clinton set a target for the USA to find an AIDS vaccine
within ten years, so it could be the "first great triumph" of the 21st century. To
help attain this goal Clinton announced that a dedicated HIV vaccine research
and development centre would be established at the National Institutes of
Health.

"With the strides of recent years, it is no longer a question of whether we can

develop an AIDS vaccine - it is simply a question of when. And it cannot come a
day too soon." - President Clinton113
In July the CDC reported that it was likely that there had been a case of
transmission of HIV as a result of "deep kissing", although other routes of
transmission in this case could not definitely be excluded. The HIV positive man
had sores in his mouth and gums that regularly bled, and his female partner
also had gum disease with inflamed and sore areas in her mouth. 114
In August, at a UNAIDS-organised meeting in Nepal, an appeal was made for
urgent joint action by South Asian regional governments to check the spread of
the pandemic. Estimates of HIV/AIDS cases in India, Myanmar (Burma),
Bangladesh and Nepal were put at 3 million, 350,000, 20,000, and 15,000
respectively. 115
At the end of the year, UNAIDS reported that worldwide the HIV epidemic was
far worse than had previously been thought. More accurate estimates
suggested that 30 million people were infected with HIV. The previous year's
estimate had been 22 million infected people. 116
"The older estimates were based on data that came from a small number of
countries. It was assumed that one could extrapolate similar rates of
transmission for all countries in a particular regional factors would be pretty
much the same. It turns out that the assumption was wrong." - The New York
Times 117
It was also estimated that 2.3 million people died of AIDS in 1997 - a 50%
increase over 1996. Nearly half of those deaths were of women, and 460,000
were children under 15. UNAIDS said it was likely that, in terms of AIDS
mortality, the full impact of the epidemic was only just beginning.
Worldwide, 1 in 100 adults in the 15-49 age group were thought to be infected
with HIV, and only 1 in 10 infected people were aware of their infection. It was
estimated that by the year 2000 the number of people living with HIV/AIDS
would have grown to 40 million. 118
In Latin America and the Caribbean the disease was already having a major
impact. Earlier in the year a doctor in San Pedro Sula, Honduras had said:
"We will go from a city that is predominantly young to a city of old people and
children. We are in over our heads with AIDS cases. It is devastating us. And all
we can do here is watch people die, nothing more." 119
The United States Agency for International Development (USAID) said it
believed that 40 million children in developing nations would lose one or both
parents to AIDS by the year 2010.

"It is a crisis of staggering proportion, that is going to affect not only the future
of these countries, it is going to affect the entire global network of trade,
diplomacy and development. What we are talking about here is something that
has never been seen before, which is countries with one-sixth to one-quarter of
all children without one or both parents." 120
History of AIDS: 1998-2002

Gugu Dlamini's red ribbon memorial

These are some of the most important events that occurred in thehistory of
AIDS over the period 1998-2002.
1998 History
In Canada there was an outbreak of HIV infection amongst injecting drug
users in Vancouver. 1
Glaxo Wellcome cut the price of AZT by 75% after a trial in Thailand showed it
was safe and effective at preventing mother-to-child transmission of HIV in
developing countries. 2 However, even with this price cut it was expected that
the drug would still be far too expensive for use in many developing
countries. 3
The Clinton Administration refused to lift a ten-year ban on using federal funds
for needle exchange programmes
In some countries HIV positive people were returning to work, having recovered
their health as a result of combination antiretroviral drug treatment. However,
some people began to be affected by quite severe side effects of the drugs.
The emergence of negative reactions - which included a kind of fat
redistribution called lipodystrophy - cast doubt on the long term safety of
combination therapy. The reasons why lipodystrophy appeared in some people
taking anti-HIV drugs were unknown. Some reports linked the syndrome to drug
regimens that countained protease inhibitors. 4
"While fat disappears from some areas, for unknown reasons it redistributes to
build up in others. The back of the neck resembles a buffalo hump. Breasts
enlarge. A woman may have to buy a bra that is two sizes larger that the last
one. The abdomen swells producing a sometimes painful pot belly that is
dubbed 'a protease paunch'. A woman may look pregnant when she is not.
Exercise may not work it off." 5
In April, the Clinton Administration refused to lift a ten-year ban on using
federal funds for needle exchange programmes, despite concluding for the first

time that such exchanges prevent the spread of HIV and do not encourage drug
use. Leaders in the fight against AIDS condemned the unexpected decision,
which was announced by Health and Human Services Secretary Donna Shalala.
During her speech Shalala quoted NIH director Varmus as saying:
"An exhaustive review of the science indicates that needle exchange
programmes can be an effective component of the global effort to end the
AIDS epidemic. Recent findings have strengthened the scientific evidence that
needle exchange programmes do not encourage the use of illegal drugs."
But, without explanation, Shalala said the administration had "decided that the
best course at this time is to have local communities use their own dollars to
fund needle exchange programmes". 6
In the UK the London Lighthouse charity closed its residential unit. 7
In June, the company AIDSvax started the first human trial of an AIDS vaccine
using 5,000 volunteers from across the USA.
"It opened a new era in AIDS research, and led us toward the human trials. It
was like being in a room that was partially lit and getting darker and darker,
and suddenly the lights went on and you could see the pathway out." 8

Needle exchange services symbol

San Francisco started a pioneering Post Exposure Prophylaxis (PEP) program
giving HIV drugs to people that might have been exposed to HIV through sexual
contact or needle sharing during injecting drug use. The HIV drugs were given
to people at the earliest possible time after the risk exposure.
"The treatment really is to try, in case they've been exposed to HIV, to stop the
replication before it infects the cells and like a brush fire gets out of control." 9
The company AIDSvax started the first human trial of an AIDS vaccine using
5,000 volunteers
A study found that the combination of caesarean delivery and AZT reduced the
risk of HIV transmission from a mother to her baby to less than 1%. The study
also found that women who took AZT but delivered their babies by natural
childbirth had a higher risk (6.6%) of transmitting HIV to their babies. 10
In July, the 12th International AIDS conference was held in Geneva. The
challenge of this conference was not only to discuss the advantages available
for the treatment of HIV, but also to conquer overwhelming pessimism. The
mood of the meeting was in sharp contrast to the euphoria at the previous
AIDS meeting in Vancouver two years before.

"A series of reports about new problems with anti-HIV drugs and setbacks in
vaccine trials left many participants thinking that their best hope against the
epidemic was the strategy they had since it began: prevention." 11
A French court ordered the former French prime minister Laurent Fabius to
stand trial on charges of involuntary homicide for allowing HIV-tainted blood to
be used in transfusions. 12
The first case of a patient being infected with a strain of HIV resistant to the
most powerful new antiretroviral drugs was reported in San Francisco in July.
The mutated strain of HIV, seemingly impervious to protease inhibitors and
older drugs, was found in a newly infected patient at San Francisco General
Hospital.
"We may be seeing an emerging and dangerous edge to the epidemic." - Dr.
Frederick Hecht of the University of California at San Francisco 13
The United Nations issued new recommendations advising that HIV positive
women in developing countries should be counselled to make their own
decisions about how to feed their babies. This was interpreted as a major policy
shift towards endorsing the use of infant formula. At the same time the United
Nations decided to conduct pilot projects in eleven developing countries to
expand access to services to prevent mother-to-child transmission of HIV. 14
Jonathan Mann, the first director of the Global Program on AIDS, died in the
crash of Swissair flight 111, along with his wife the AIDS researcher Mary-Lou
Clements-Mann.
"It was always safe for scientists and institutions to think of AIDS as a virus, a
transmissible infection but Dr. Mann structured it as a human rights issue,
and a global rights issue. He really was a spiritual leader as well as scientific
leader." - Dr. James Curran 15
The FDA gave approval for various new drugs including Sustiva (efavirenz),
another drug in the NNRTI group. 16
In South Africa, Gugu Dlamini, an AIDS activist, was beaten to death by her
neighbours after revealing her HIV positive status on Zulu television. This
happened just a month after Deputy President Thabo Mbeki had called for
people to "break the silence about AIDS" in order to defeat the epidemic. 17
"It is a terrible story. We have to treat people who have HIV with care and
support, and not as if they have an illness that is evil." - Thabo Mbeki 18
The 1998 World AIDS Campaign 'Young People: Force for Change' was
prompted in part by the epidemic's threat to those under 25 years old, for as
HIV rates rose in the general population, new infections were increasingly

concentrated in the younger age groups. The campaign also had a special
representative, Brazilian footballer Ronaldo. 19
UNAIDS estimated that during the year a further 5.8 million people became
infected with HIV, half of them being under 25. 20
REGION
Estimated new HIV infections 1998
North America
44,000
Caribbean
45,000
Latin America
160,000
Western Europe
30,000
North Africa/Middle East
19,000
Sub-Saharan Africa
4 million
Eastern Europe/Central Asia
80,000
East Asia/Pacific
200,000
South Asia/South-East Asia
1.2 million
Australia & New Zealand
600
Global total
5.8 million
Sub-Saharan Africa was home to 70% of people who became infected with HIV
during the year. South Africa, which trailed behind some of its neighbouring
countries in HIV infection levels at the start of the 1990s was catching up fast.
It was estimated that one in seven new HIV infections in Africa were believed to
be occurring in South Africa. In Botswana, Namibia, Swaziland and Zimbabwe,
the estimates showed that between 20% and 26% of people were living with
HIV or AIDS. 21
1999 History
In the United States a doctor who injected his former lover with HIV infected
blood was sentenced to 50 years in prison. 22
A group of researchers at the University of Alabama claimed to have discovered
that a particular type of chimpanzee, once common in West Central Africa, was
the source of HIV. The researchers suggested that HIV-1 was introduced into
the human population when hunters became exposed to infected blood. 23

Former South African President, Thabo Mbeki

Reports started to emerge from South Africa of rape cases involving young
girls. It was suggested that a popular myth that sex with a virgin could cure
AIDS was the root cause of this increase in child rapes. 24Later on in the year,
the South African President Thabo Mbeki claimed that the anti-HIV drug AZT
was toxic and could be a danger to health.25
According to the annual World Health Report, AIDS had become the fourth
biggest killer worldwide, only twenty years after the epidemic began. 26

The Ugandan ministry of Health started a voluntary door-to-door HIV screening

programme using rapid tests in an effort to reduce the spread of HIV. This effort
was intended to make HIV screening services accessible to more people,
especially in rural areas where there were neither modern laboratories nor
electricity to run standard HIV tests. 2728 Since 1986 the Ugandan government
had implemented a number of successful initiatives, and whereas in 1992 it
was estimated that 30% of adults in Kampala were living with HIV, by 1999 the
figure had fallen to 12%. 29 However, HIV/AIDS was still a considerable health
problem in Uganda. It was estimated that 820,000 adults and children were
living with HIV/AIDS as at the end of 1999. 30
In the UK a judge ordered that a five-month-old baby girl should be tested for
HIV against her parents' wishes. The baby's parents refused to have their
daughter tested, contending that she was perfectly healthy and that they
should have the right to decide what was best for her.
"This case is not about the rights of the parents, and if, as the father has
suggested, he regards the rights of a tiny baby to be subsumed within the
rights of the parents, he is wrong, the judge said." 31
South Africa won the first round in its battle with the United States and
multinational pharmaceutical companies to force a cut in drugs prices. The
dispute concentrated on South African legislation that enabled local companies
to manufacture HIV/AIDS drugs that could be sold at a fraction of the price of
similar imported products. The US argued that the South African laws
undermined the patent rights of drug manufacturers. 32
Initial findings from a joint Uganda-US study identified a new drug regimen, a
single oral dose of the antiretroviral drug nevirapine, as being both affordable
and effective in reducing mother to baby transmission of HIV. This research
provided real hope that mother to child transmission could be effectively
reduced in developing countries. 33
"This extraordinary finding is the most recent in our efforts to bring an end to
AIDS, not only in the United States but in countries around the world." - Donna
E. Karala, the Health and Human Services Secretary
The UK Government announced that all pregnant women in Britain would be
offered an HIV test in an attempt to reduce the number of babies infected with
HIV. The Labour Government set a target of reducing the number of infant
infections by 80% by 2002. 34
Health officials rejected attempts to reopen the bath houses in San Francisco,
which were closed 15 years previously at the height of the epidemic in
1984. 35 A survey published in August found that growing numbers of gay men
in San Francisco were having unprotected sex. 36 The survey results provoked

concern and disappointment among public health authorities because, instead

of declining, the rate of new HIV infections had remained at about 500 per
year. 37

Injecting drug use (IDU) paraphernalia in Russia

Needle sharing among injecting drug users set off an explosive increase in HIV
infections in Russia. In Moscow, three times as many cases were reported in the
first nine months of 1999 as in all previous years combined. 38 39
"Russia is broke, and AIDS prevention programs are taking a back seat to
problems that appear more pressing, such as mass poverty, crime and Russia's
huge foreign debts." 40
In November, China broadcast its first ever television advertisement for
condoms in an effort to stop the spread of sexually transmitted diseases and
HIV/AIDS. 41 Shortly after the advertisement was seen by hundreds of millions
of people, it was banned by the State Administration of Industry and
Commerce. 42
'The River', a book by Edward Hooper, was published. There was a lot of debate
about the role of polio vaccines in the origin of the AIDS epidemic. 43
T-20, a member of a new class of AIDS drugs called fusion inhibitors, went into
clinical trials. 44
The Kenyan President Daniel arap Moi declared AIDS a national disaster and
ordered a National AIDS Control Council to be set up immediately.
"AIDS is not just a serious threat to our social and economic development, it is
a real threat to our very existence, and every effort must be made to bring the
problem under control." - President Moi 45
However the president also said that his government and Kenya's churches
would not advocate the use of condoms as a method of prevention because
this would encourage young people to have sex.
A research study published in November argued that male circumcision could
help to reduce HIV infection rates in Africa and Asia. 46
At the request of countries around the world eager to reach the age group at
highest risk, the 1999 World AIDS Day campaign, "Listen, Learn and Live!",
continued to focus on people under 25. 47
By the end of 1999, UNAIDS estimated that 33 million people around the world
were living with HIV/AIDS and that 2.6 million people worldwide had died of the

disease in 1999, more than in any other year since the epidemic began. 48 It
was also reported that for the first time more women than men were infected
with HIV in Africa. 49
"In 1992, a team headed by the late Dr. Jonathan Mann at the Harvard School
of Public Health, published estimates of HIV infections in sub-Saharan Africa
ranging from 20.8 million to 33.6 million by 2000. The World Health
Organisation criticized Dr. Mann's estimates as excessive. Now academic
scientists are criticizing the figures of Dr. Piot's Team. 'When we look at the
figures today, they are worse than the scenarios Jonathan had published,' Dr.
Piot" 50
The World Bank warned that the effect of AIDS in Asia could be to erase the
region's economic gains over the last two decades unless governments
maintained funding for social programs. The United Nations estimated that 7
million people in Asia were living with HIV/AIDS. 51
2000 History
In January, the Centers for Disease Control and Prevention (CDC) reported that,
for the first time, the rate of AIDS diagnoses among black and Hispanic gay
men had overtaken that among white gay men in the U.S. Statistics showed
that African Americans comprised 57% of all new HIV infections, even though
they made up just 13% of the U.S. population. 52 In order to publicise the
importance of HIV testing for African Americans, reverend Jesse Jackson
publicly took an oral HIV test. 53

Jesse Jackson publically taking an oral HIV test

UK national statistics revealed that 1999 had been the first year in which the
number of newly diagnosed HIV infections probably acquired through
heterosexual sex was higher than the number probably acquired through sex
between men. 54
Preliminary studies presented at the 7th Conference on Retroviruses and
Opportunistic Infections showed that, in some cases, temporarily stopping HIV
drug therapy might not lead to increased levels of virus or the development of
drug resistance. 55 This later became known as the structured treatment
interruption or drug holiday.
In February, the trial started of Bulgarian health workers charged in Libya with
deliberately infecting children with HIV. The Bulgarian medics - five nurses and
an anaesthetist - were detained in 1998 after almost 400 children were given
infected blood at a hospital in Benghazi, Libya's second largest city. Eight
Libyans and a Palestinian were also charged. 56 57

A more definitive study was published about the risk of transmitting HIV
through oral sex. Although earlier studies had identified oral sex as a means of
transmitting HIV, the new study was designed to find out the extent of HIV
transmission through oral sex among men who have sex with men. The
research suggested that oral sex accounted for about 7% of cases. 58
"I think it reinforces what we've said already - which is that condoms should be
used for whatever type of sex you have." - Dr. Robert Janssen, Director of the
Division of HIV/AIDS prevention at the CDC 59
Early in the year the South African government made a decision to invite a
panel of experts to pursue debate on questions relating to HIV/AIDS. 60 In
March it was reported that South African President Thabo Mbeki had consulted
two American 'dissident' researchers to discuss their claim that HIV was not the
cause of AIDS. 61
Israel lost one of its most successful singers, Ofra Haza, from what was
believed to be an AIDS-related complication. Following her death there was a
considerable increase in demand for helplines and anonymous HIV testing.
"Nevertheless, her death has brought the whole issue of AIDS out into the open
in Israel. This can only be a good thing for a country which has seven openly
HIV positive people - including myself - out of an estimated 10,000." - Aviram
Germanovitch, Director of the Israeli AIDS Task Force 6263
In April, President Mbeki sent a letter to world leaders explaining his views on
HIV/AIDS. In this letter Mbeki argued, amongst other things, that since HIV is
spread mostly through heterosexual contact in Africa, the continent's problems
are unique.
"Accordingly, as Africans, we have to deal with this uniquely African
catastrophe... It is obvious that whatever lessons we have to and may draw
from the West about the grave issue of HIV-AIDS, a simple superimposition of
Western experience on African reality would be absurd and illogical." 64 65
In Botswana, as many as one in four adults and four of every ten pregnant
women were estimated to be infected with HIV. 66 The president of Botswana,
Festus Mogae, announced that new contributions from donors including $50
million donated by the Bill and Melinda Gates Foundation would allow his
country to provide antiretroviral therapy to all HIV-infected pregnant women
and children born with the virus. 67
The Clinton Administration formally declared HIV/AIDS to be a threat to U.S
national security. The United States government believed that the global
spread of AIDS was reaching catastrophic dimensions that could topple foreign
governments, spark ethnic wars and undo decades of work building free-

market democracies abroad. It was the first time the National Security Council
was involved in fighting an infectious disease. 68 69
"We shouldn't pretend that we can give injections and work our way out of this.
We have to change behaviour, attitudes, and it has to be done in an organized,
disciplined, systematic way." - Bill Clinton 70
Later in the year, the U.S. Institute of Medicine released a report that sharply
criticised the Clinton Administration for failure to develop a comprehensive and
effective plan to combat the disease in the United States. 71
In May, at the opening of the first meeting of the presidential advisory panel on
AIDS in South Africa, President Mbeki offered his first detailed explanation of
why he had consulted the two American 'dissident' AIDS researchers. He also
explained why the 33-member presidential AIDS advisory panel contained
people who believed that HIV caused AIDS and others who did not.
"We were looking for answers because all the information that has been
communicated points to the reality that we are faced with a catastrophe, and
you can't respond to a catastrophe merely by saying I will do what is
routine." 72
Five pharmaceutical companies offered to negotiate steep reductions in the
prices of AIDS drugs for Africa and other poor regions. 73 A couple of months
later the United States offered sub-Saharan African nations loans to finance the
purchase of AIDS drugs and medical services. 74 The offer was not seen as
very helpful and was rejected by many African nations. 75
"Making drugs affordable is the solution rather than offering loans that have
interest." 76
According to the latest UNAIDS report, there were 34.3 million people infected
with HIV worldwide, of whom 1.3 million were children under the age of
15. 77 It was predicted that AIDS would cause early death in as many as half of
the teenagers living in the hardest hit countries of southern Africa, causing
population imbalances. In particular, it was predicted that two thirds of 15 yearold children in Botswana would die of AIDS before they reached 50. 78
Almost four million people were estimated to be living with HIV in India. This
meant that the country had the second largest HIV population in the world:
only South Africa had more people living with HIV.79
In July, the 13th International AIDS Conference was held in Durban, South
Africa. This was the first time that such a conference was held in a developing
country or in Africa. 80 Nkosi Johnson, an eleven year old HIV-positive boy,
gave a speech in the opening ceremony of the conference and called for the
government to give AZT to pregnant HIV-positive women. 81 82

Mbeki used his opening address at the conference to stress the role of poverty
in explaining the problems faced by Africa and compared the campaign against
AIDS with the struggle against apartheid. 83
"As I listened and heard the whole story told about our own country, it seemed
to me you could not blame everything on a single virus." 84

An HIV-positive woman marching at the Durban AIDS Conference, South Africa

To counter the comments made by president Mbeki, over 5,000 scientists
around the world signed the 'Durban Declaration' affirming that HIV is the
cause of AIDS. 85 86
Nelson Mandela, South Africa's former president, closed the AIDS conference
with a call for action to combine efforts and save people. 87
"History will judge us harshly if we fail to do so now, and right now."
At the conference, preliminary findings were reported from nonoxynol-9 studies
in Africa and Thailand. Scientists had hoped that nonxynol-9 would prove to be
the first effective 'microbicide' that could reduce the risk of HIV transmission
during sex, but the findings were quite the opposite. Women at high risk of HIV
infection were warned not to use the spermicide nonoxynol-9 because the
studies suggested it might increase the risk of transmission. 88
"If you use nonoxynol-9, you are either wasting your money or possibly wasting
your life." - Dr. Joseph Perriens 89
For some people these were not surprising findings, since the toxic effects of
nonoxynol-9 had been reported since 1989. 90
There were few other noteworthy scientific findings reported at the conference.
In September, the first phase of a new vaccine trial was launched in Oxford.
The trials were sponsored by the International AIDS Vaccine Initiative. 91 The
research into an AIDS vaccine was criticised by the World Bank for focusing on
a vaccine that could be marketed in western countries, despite the fact that
more than 90% of HIV infections were in the developing world. 92
It was reported that the number of people living with HIV in Brazil was less than
half that once predicted by health experts, and the number of AIDS deaths had
plummeted by as much as fifty per cent since the introduction of combination
antiretroviral therapy in 1996. The country's HIV prevention and treatment
programmes were seen as a model for other resource-poor countries to
emulate.

"It makes a lot of sense to look at what Brazil is doing... Something they're
doing is working." - Mbulelo Rakwena, South Africa's ambassador to Brazil - 93
Treatment provision remained non-existent in South Africa, and President Mbeki
stated in an interview with the Time Magazine that he did not think that HIV
alone caused AIDS.
"Clearly there is such a thing as acquired immune deficiency. The question you
have to ask is what produces this deficiency. A whole variety of things can
cause the immune system to collapse But the notion that immune deficiency
is only acquired from a single virus cannot be sustained. Once you say immune
deficiency is acquired from that virus your response will be antiviral drugs. But
if you accept that there can be a variety of reasons, including poverty and the
many diseases that afflict Africans, then you can have a more comprehensive
treatment response." 94
In October, President Mbeki announced his withdrawal from the scientific and
public debate on the causes of AIDS after admitting that he had created
confusion in South Africa. 95
There has been a lot of confusion about what Mbeki said and did not say during
the year. 96 It is clear that over a period of some months, particularly in April
and in September, Mbeki led many people to think that either 1) he does not
believe that HIV causes AIDS or 2) he does not believe that HIV causes AIDS on
its own.
It would seem that Mbeki may have believed that immune deficiency is caused
by a collection of factors such as poverty, nutrition and contaminated water as
well as HIV, rather than just HIV on its own:
"You cannot attribute immune deficiency solely and exclusively to a virus." 97
It is true that poverty related factors such as malnutrition will hasten the onset
of AIDS in people who are HIV-positive. Therefore, it is also true that provision
of food will slow down the progression of HIV. However improved nutrition is not
enough in itself to permanently keep people healthy. History provides evidence
of this. 98
2001 History
After years of denial, China finally admitted that HIV/AIDS threatened its public
health and economic security. China's most senior AIDS researcher stated that
China could soon have one of the world's largest populations of people living
with HIV. Infections were predicted to grow from about 600,000 to 6 million by
2005. 99 It was believed that nearly 75% of people living with HIV in China had
acquired the virus through injecting drug use or transfusion with contaminated
blood. 100

The Indian drug company Cipla offered to make AIDS drugs available at
reduced prices to the international aid organisation Medecins Sans Frontieres
(MSF). Cipla's offer to produce drugs at a price less than $1 per day put further
pressure on multinational drug companies. 101
The U.S. Government threatened Brazil with legal action over its production of
generic HIV drugs. 102The complaint was dropped later in the year and Brazil
promised to give the USA advance warning before changing its patent law for
drugs. 103
Thirty-nine pharmaceutical companies withdrew their case against the South
African government's efforts to lower drug prices. This victory was, however,
overshadowed by a statement by the health minister Manto TshabalalaMsimang, who said that the government already offered adequate treatment to
AIDS patients and that proposals to buy antiretroviral drugs were still being
considered. 104 The South African government released its annual HIV/AIDS
figures estimating that 4.7 million people were infected with HIV/AIDS and that
24.5% of pregnant women were HIV-positive in 2000. 105
According to a CDC study of six large U.S. cities, 30% of young gay black men
were infected with HIV. 106
"When people think 'gay', they think 'white'. But the people still at the greatest
risk are sexually active gay men, and that cuts across all races." - Helene Gayle
of the CDC 107
The CDC also reported that the rate of new HIV infections was increasing twice
as fast among people aged over 50 as among younger age groups.
"Officials have speculated that a more open society, people entering the dating
scene after the monogamy of marriage and the absence of a fear of pregnancy
is causing the alarming rise in sexually transmitted infections." 108
Zimbabwe's government announced that it would dissolve the board of the
National AIDS Council, after allegations of inappropriate political support and
mismanagement of funds. Zimbabwe had one of the highest HIV infection rates
in Africa. It was estimated in 2001 that AIDS had orphaned 1 million children
and 25% of Zimbabwe's 12 million population were HIV positive. 109
In April 2001, it was reported that the year 2000 saw by the far the largest
number of new HIV cases yet recorded in the UK. The Public Health Laboratory
Service (PHLS) recorded 3,435 new diagnoses in 2000. 110
"Many of those being diagnosed are people infected some years ago, but who
are now coming forward for testing. This is good news because once people
are diagnosed they can seek treatment." - Barry Evans 111

In April, at the African Summit in Nigeria, United Nations Secretary-General Kofi

Annan called for spending on AIDS to be increased tenfold in developing
countries. 112 He suggested 'a war chest' of $7-10 billion to be spent annually
on a global campaign against AIDS - a massive increase on the $1 billion per
year that was then being spent. 113 A few weeks after, it was announced that
a new Global AIDS and Health Fund would not only target AIDS (as had at first
been suggested) but would also address tuberculosis and malaria. 114
"In this effort, there is no us and them, no developed and developing countries,
no rich and poor - only a common enemy that knows no frontiers and threatens
all people." - Kofi Annan at the G8 summit in Genoa 115
There were some concerns about how this new initiative was going to be
governed and implemented, and the U.S. government was criticised for
contributing only $200 million to the fund. Later on in the year, it was officially
named as The Global Fund to Fight AIDS, Tuberculosis and Malaria. 116 The
amount of money donated to the Fund was a disappointingly low $1.6
billion 117much less than the $10 billion that Kofi Annan had called for.
Newspapers all over the world marked the 20th anniversary of the first
published report on the disease that came to be known as AIDS.
"At the time, I read the report with great interest, but I never imagined I was
looking at the first sign of an epidemic, that in just 20 years would have
infected 60 million people, killed 22 million and achieved the status of the most
devastating epidemic in human history." - Peter Piot recalling the first mention
of AIDS 118
Ugandan president Yoweri Museveni opened a regional centre for treatment of
HIV-positive patients in Kampala. One of the main aims of the centre was to
train health workers from all over Africa.
"Our hope is that the hundreds trained here will train thousands who will treat
millions." 119
Kofi Annan appointed the Canadian Stephen Lewis as his 'Special Envoy for
AIDS in Africa'. 120
Kofi Annan opened the UN General Assembly Special Session (UNGASS) on
HIV/AIDS in New York. This was the first ever UN meeting devoted to a public
health issue. 121
During the UNGASS, representatives of all 189 members of the UN signed a
Declaration of Commitment on HIV and AIDS. This document contained many
significant pledges, including one to reduce HIV prevalence among young
people (aged 15 to 24) by 25% in the most affected countries by 2005, and to
reduce it by 25% globally by 2010. 122

There was a sudden explosion in HIV cases among injecting drug users in
Dublin, Ireland. It was reported that diagnoses jumped fivefold between January
1999 and June 2000. Diagnoses fell to a low of 12 in 1998, but in the next 18
months 96 people tested positive. Doctors blamed this on a sudden tightening
of regulations around the supply of the heroin substitute methadone, which
caused more people to start injecting street heroin. 123
Stephen Kelly was found guilty at Glasgow High Court of 'culpable and reckless
conduct' for having unprotected sex despite knowing that he had HIV. He
infected his girlfriend in 1994. Kelly was the first person to be tried under
Scottish law for this type of offence. It was feared that the threat of legal action
would make people more reluctant to be tested for HIV. 124
President George Bush appointed an openly gay man, Scott Evertz, as Director
of the Office of National AIDS Policy, but did not find any extra money in his
2002 budget for AIDS prevention or treatment. 125
The US Food and Drug Administration (FDA) issued a warning letter to
manufacturers of HIV/AIDS drugs, cautioning them to tone down the optimistic
tone of their antiretroviral drug advertisements. 126
"Examples of such images range from robust individuals engaged in strenuous
physical activity to healthy-looking individuals giving testimonials of a specific
drug's benefit. However, not all individuals have a response to ARV therapy; in
fact, some patients will still have disease progression despite ARV
therapy." 127
A former Japanese Health Ministry official was found guilty of negligence for
failing to stop the sale of untreated blood products. Over 1,800 haemophiliacs
had contracted HIV in Japan since the early 1980s from untreated blood and
more than 500 had died. 128

Publicity for the UN special session on HIV/AIDS in 2001

In August, AIDS activists took legal action against the South African health
ministry over its continuing refusal to supply antiretrovirals to prevent motherto-child transmission (MTCT) of HIV. 129 In December, it was ruled that the
South African government should give pregnant women free access to the drug
nevirapine. The judge ordered the government to set up a nationwide MTCT
programme with a deadline for an implementation report to be handed back to
the court by March 2002.130
Ministers meeting at the World Trade Organisation conference in Doha, Qatar,
agreed a new declaration on intellectual property rights. This made it easier for
developing country governments to license the production of drugs against

AIDS and other diseases without having to get permission from patent holders.
It was hoped that the new rules would help improve access to
antiretrovirals. 131
It was reported that some Asian countries had reduced the transmission of HIV
through widespread condom use. In Thailand, the rate of new infections had
plummeted from 143,000 in 1991 to 20,000 in 2000. 132 Meanwhile HIV was
spreading fastest in Eastern Europe and Russia. 133
A senior Iranian health official warned that the number of AIDS cases in the
country had risen dramatically. In the past, Iranian officials estimated the
number of HIV-positive people to be around 2,000, but the Deputy Health
Minister said that the real figure was more than 15,000. 134
2002 History
Ukraine became the first nation in Europe to have 1% of its adult population
infected with HIV. 135
Botswana became the first African country to begin providing antiretroviral
treatment through the public sector. It was estimated the programme would
cost $24.5 million in its first year and would reach 19,000 people. 136
The US Secretary of State Colin Powell strongly advocated condom use to
prevent the spread of AIDS and other sexually transmitted diseases, setting
himself apart from President Bush's views on sex education in an MTV
broadcast:
"In my own judgement, condoms are a way to prevent infection Therefore, I
not only support their use, I encourage their use among people who are
sexually active and need to protect themselves." 137
A new line of condoms carrying the logos of most important Brazilian football
teams went on sale. The campaign was helped by a TV advertisement in which
supporters wore caps with their team colours in the shape of a condom.
"The level of success was more than we had expected We are selling the
condoms in places not normally associated with this sort of product, such as
news stands and bakeries." 138
Later in the year, for the first time ever in Brazil, an HIV prevention campaign
was being aimed at male homosexuals. 139
A study showed that approximately 50% of Americans still believed they could
acquire HIV through everyday contact, and most supported the mandatory
testing of groups at highest risk of HIV infection.140

The Chinese Government announced a 17% jump in AIDS cases. The

government estimated that the number of people with full-blown AIDS was as
high as 200,000, of whom more than half were presumed already dead. It also
estimated that up to 850,000 people were infected with HIV by the end of
2001. These figures were still far below the estimates by experts at the UN and
the WHO, who said that as many as 1.5 million people could have been
infected in China. 141
The National Statistics Institute in Lisbon announced that there were 104.2 HIV
cases per one million Portuguese residents in 2000, compared with 88.3 cases
in 1999. This was the highest rate of HIV infection in the European Union. The
European average was just under 25 cases per million residents. Injecting drug
use was thought to be the main source of HIV infection in Portugal. 142
The board of directors of the Global Fund to Fight AIDS, Tuberculosis and
Malaria selected Richard Feachem to be its first leader. 143 In the first funding
round the Fund received applications for more than six times the amount they
had anticipated. During the year the Global Fund announced their first round of
payments of $600 million over a two-year period; the first $1 million was given
out in December. 144
The WHO published guidelines for providing antiretroviral drugs for treating HIV
infection in resource poor countries. They also released a list of 12 essential
AIDS drugs. These two moves were seen as "vital steps in the battle against
the AIDS pandemic [that] should encourage both industrialised and developing
country governments to make HIV treatment more widely available." 145
In April, the South African government promised to start providing nevirapine to
HIV-positive pregnant women and their babies to reduce the risk of HIV
transmission. It was also going to be possible to offer AZT as post-exposure
prophylaxis (PEP) to women who had been raped. 146
A World Bank report said that HIV was spreading so rapidly in parts of Africa
that it was killing teachers faster than the nations could train them. The report
noted that for example in parts of Uganda and Malawi, nearly a third of all
teachers were HIV-positive. 147
"With more than 113 million children not in school in the poorest countries
already presents a major challenge. However, HIV/AIDS makes this much
greater in those countries where the education system is already struggling to
grow, teachers are dying, or are too sick to teach. And every year more
children are losing their parents and the support that allows them to go to
school. Achieving education for all in a world of AIDS presents an
unprecedented challenge to the world education community." - World Bank
President James D. Wolfensohn 148

A report warned that Papua New Guinea was on the brink of an HIV/AIDS
epidemic and the country could face losing 13-38% of its working population by
2020. It was estimated that Papua New Guinea had between 10,000 to 15,000
people infected with HIV. In comparison, Australia with a population almost 5
times that of Papua New Guinea had less than 12,000 HIV positive people. It
was feared that HIV/AIDS could spread rapidly since 90% of infections were
transmitted through heterosexual sex. 149
A major Spanish study found that over 19,000 instances of unprotected oral
sex did not lead to a single case of HIV transmission among 135 HIV-negative
heterosexuals in a sexual relationship with a person with HIV. 150
The WHO warned that HIV could spread rapidly throughout Afghanistan due to
high levels of injecting drug use and unsafe blood transfusions. It also said that
refugees were especially vulnerable to HIV infection because of sexual abuse,
violence and lack of information and education. To learn more about this
problem, the WHO was funding the first survey of HIV/AIDS in Afghanistan. 151

Treatment activists at the International AIDS Conference 2002, Spain

In July, the 14th World AIDS Conference was held in Barcelona, Spain. Issues
around providing HIV treatment for resource-poor countries dominated the
mood and agendas of the conference.
"If we can get cold Coca Cola and beer to every remote corner of Africa, it
should not be impossible to do the same with drugs." - Joep Lange, the
President of the International AIDS Society speaking at the closing
ceremony 152
At the Barcelona conference, there were encouraging results from trials of T-20,
an injectable drug from a new class of treatments called fusion inhibitors. The
results provided good news for people who had become resistant to existing
drugs; the fusion inhibitors were called 'the most exciting advance since
protease inhibitors were introduced'. 153
The number of children orphaned by HIV/AIDS had risen three-fold in six years
to reach an all time high of 13.4 million. It was estimated that India had the
largest number of AIDS orphans of any country in the world, with an estimated
at 1.2 million in 2001; this was predicted to rise to 2 million in five years and
2.7 million in ten years. 154
"Children are taking the role of adults in many places affected by HIV because
a generation has disappeared. They can't go through normal development.
They have to work 40 hours a week. The very fabric of society is disappearing,
with family structures crumbling." - Peter Piot

Indonesia, the world's fourth most populous country, demonstrated how

suddenly HIV/AIDS epidemics could emerge. After more than a decade of low
HIV prevalence, the country was seeing rates increasing rapidly among
injecting drug users and sex workers, with as many as 40% of people in drug
treatment centres in Jakarta testing positive. 155
Swiss researchers reported the first fully documented case of HIV-positive man
who was additionally infected with a second strain of HIV through unprotected
sex more than two years after he was first infected. 156
Kami, a fluffy, mustard-coloured, HIV-positive character joined the cast of the
South African version of Sesame Street. Kami's name was derived from the
Tswana word for 'acceptance'. 157
In the U.S., the Food and Drug Administration for the first time approved a
rapid HIV test. It was hoped that this test, which could provide results in as
little as 20 minutes, would counter the problem of people not returning to
collect test results, and would also be useful for diagnosing pregnant women
during labour. 158
It emerged that several batches of cut priced drugs destined for Africa had
been illegally sold at full European prices in the Netherlands and Germany. The
drugs were supposed to be exported to Africa for 10% of the European
price. 159
"The face of HIV/AIDS has become that of a young African woman - seven of 10
people living with the disease are in sub-Saharan Africa, and 58% of infected
Africans are female. Of the 38.6 million adults living with the disease
worldwide, 19.2 million are women." 160
A study controversially suggested that more people in Africa may have been
infected with HIV through medical injections and treatments than was
previously thought. 161
"Our observations raise the serious possibility that an important portion of HIV
transmission in Africa may occur through unsafe injections and other unsterile
medical procedures." 162
In December the US Agency for International Development (USAID) announced
it was adopting a new approach to preventing sexual transmission of HIV
around the world, which would be known as "ABC" (Abstinence, Being faithful
and Condom use). USAID said its ABC approach was based on the strategies
adopted in Uganda, which it credited with reducing HIV prevalence in that
country. The decision to adopt the ABC approach came three months after
USAID hosted an experts technical meeting on behaviour change approaches
to HIV prevention. 163

The UN Secretary General, Kofi Annan, used World AIDS Day as a platform to
speak out against HIV-related stigma and discrimination. He said that, 'the
impact of stigma can be as detrimental as the virus itself,' and he urged people
to replace 'fear with hope, silence with solidarity'. He went on to say that, 'the
fear of stigma leads to silence and when it comes to fighting AIDS, silence is
death'. The use of phrase 'silence is death' was interesting, as it had been used
around the world for many years by AIDS activists, initially by the group ACT
UP. 164
History of AIDS: 2003-2006

AIDS vaccine development

These are some of the most important events that occurred in the history of
AIDS from 2003 to 2006.
2003 History
At the time, Botswana officially had the highest global HIV prevalence of 38.8
percent. However, in early January, Swaziland's Prime Minister Sibusiso Dlamini
said that HIV prevalence had risen to 38.6 percent from 34.2 percent in January
2002. Although prevalence in Swaziland remained slightly lower than
Botswana, reports in January suggested that HIV prevalence in Swaziland was
unofficially the world's highest, as the figures released were considered to be
already out of date. 1
Botswana was struggling to expand its antiretroviral treatment programme,
largely because of a shortage of health workers. The government had hoped to
provide drugs to 19,000 people by the end of 2002, but had enrolled only 3,200
by the end of January 2003. 2
Jerry Thacker, a controversial Christian extremist chosen by the White House to
sit on a presidential AIDS advisory panel and who once described the virus as
the 'gay plague', was forced to withdraw his name after protests
from gay rights groups. 3
In his State of the Union address on 28th January, US president George Bush
proposed spending $15 billion in combating AIDS in Africa and the Caribbean
over the next 5 years. He called the scheme 'a great mission of rescue'. 4
"This comprehensive plan will prevent 7 million new 'AIDS' infections, treat at
least 2 million people with life-extending drugs, and provide humane care for
millions of people suffering from AIDS, and for children orphaned by
AIDS." President Bush 5

Just two days later, US Health Secretary Tommy Thompson was elected as the
new chairman of the Global Fund for HIV, TB and Malaria. It was hoped this
move would prevent a conflict between the Bush administration and the
international health community. 6
In February, a rare case of female-to-female sexual transmission of HIV was
reported. Doctors suggested the woman may have been infected through
sharing sex toys after drug resistance tests found striking similarities between
the HIV strains in her and her female partner. 7
There had still been no dramatic increase in HIV transmission in Cuba since the
beginning of the epidemic. The rate of infection was 0.03% and thought to be
one of the lowest in the world. There had been virtually no transmission of HIV
through injecting drug use, blood transfusion or from mother to child. The
government had ensured that all HIV-positive mothers were treated with
prophylactic AZT therapy and that their babies were delivered by caesarean
section. The country had produced enough antiretrovirals to supply the
country's patients. 8
Globally the epidemic continued to expand, reducing world population
estimates by 0.4 billion to 8.9 billion for 2050.
"The long-term impact of the epidemic remains dire HIV/AIDS is a disease of
mass destruction and we do not see a vaccine coming soon."Joseph Chamie,
director of the UNPD - 9
An expert group reaffirmed that unsafe sexual practices were responsible for
the majority of HIV infections in sub-Saharan Africa. This announcement was a
response to claims made in 2002 that unsafe medical practices were to blame
for an important portion of HIV transmission in Africa. 10
Vaxgen announced that their AIDS vaccine had failed to reduce overall HIV
infection rates among those who were vaccinated. The vaccine showed a
reduction in certain ethnic groups, indicating that black and Asian volunteers
may have produced higher levels of antibodies against HIV than white and
Hispanic volunteers. However, many outside observers were sceptical of the
ethnic group part of the study. 11 12 In November, the AIDS vaccine also failed
in a clinical trial in Thailand.
"The outcome of this trial is one more reminder of how difficult it is to combat
HIV and how important it is for the international public health community to
redouble the effort to develop an effective vaccine."Donald P. Francis, Vaxgen
President - 13
Researchers warned that the number of women being diagnosed with HIV in
Europe was rapidly catching up with men. The researchers also noted that

initiatives supplying drug users with clean needles had been effective in
Europe. HIV transmission through injecting drug use was said to have been
almost eliminated in France, Germany and the UK, and significantly reduced in
Spain and Italy. 14
In March the Treatment Action Campaign (TAC) filed manslaughter charges
against the health minister and the trade and industry minister in South Africa.
The TAC held the ministers responsible for the deaths of 600 people a day
whose lives could have been saved if they had had access to antiretroviral
drugs. 15
Russia received an approval for a long delayed loan from the World Bank to
tackle HIV/AIDS and TB. For its part, the Russian Government promised to
match the loan with $134 million in new money over 5 years for HIV/AIDS and
TB. This contribution from the government signalled growing recognition that
both HIV/AIDS and TB epidemics represented a threatening crisis for Russia's
development. 16

The ARV drug Fuzeon, also known as Enfuviritide and T-20

The first of a new type of anti-HIV drug gained approval in the USA. Unlike all
previously approved drugs, Fuzeon (also known as enfuvirtide or T-20) was
designed to prevent the entry of HIV into human cells. The drug was not
available as a pill and had to be injected. It could be used as part of
combination treatment only by patients who had already become resistant to
other antiretroviral drugs. 17
In April the US Centers for Disease Control and Prevention (CDC) announced a
new initiative called Advancing HIV Prevention (AHP), designed to reduce the
number of new HIV infections in the US. For two decades before AHP, the CDC
mainly targeted its prevention efforts at persons at risk of becoming infected
with HIV. In contrast, the new initiative would focus mainly on people already
infected with the virus. AHP proposed making HIV testing a routine part of
medical care and putting more resources into partner tracing. The recentlylicensed rapid HIV test would play a key role in the new initiative. 18
The US Senate approved President Bush's international AIDS bill in May, setting
a timetable for spending $15 billion over five years. 19
A team of Belgian researchers reported on the probable origins of HIV-2. They
concluded that the virus had probably transferred from sooty mangabeys to
humans in Guinea Bissau during the 1940s. 20

South Korean Lee Jong-wook took office as the new Director-General of the
World Health Organisation (WHO) and named HIV/AIDS as his top priority in his
first speech. 21
Meanwhile concerns were mounting over the Global Fund's sustainability as it
faced a serious funding shortfall. 22
New HIV/AIDS figures were released in India in July, and it was estimated that
between 3.82 and 4.58 million Indians were HIV positive. 23
In September the WHO declared that the failure to deliver treatment to nearly
six million people with HIV/AIDS in developing countries was a global public
health emergency. Only about 300,000 people in developing countries received
the drugs at all, and in sub-Saharan Africa, where 4.1 million people were
infected, just over 1% or about 50,000 people had access to antiretroviral
treatment. 24
Vatican cardinal Alfonso Lopez Trujillo stated that condoms were not safe and
did not protect against the transmission of HIV.
"I simply wished to remind the public, seconding the opinion of a good number
of experts, that when the condom is employed as a contraceptive, it is not
totally dependable, and that the cases of pregnancy are not rare. In the case of
the AIDS virus, which is around 450 times smaller than the sperm cell, the
condom's latex material obviously gives much less security."Cardinal Trujillo
- 25
In response the WHO said that it was "totally wrong" to claim that condoms did
not protect against HIV and:
"It is quite dangerous to claim the contrary when you realize that today we are
facing an epidemic which has already killed 20 million people and 42 million
people are infected today." 26
There was a sharp rise in trafficking of heroin through central Asia. This caused
an increase in drug addiction and cases of HIV in many impoverished states
including Tajikistan. Since the fall of the Taliban, who had banned the growing
of opium poppies (the raw material for making heroin), production had
skyrocketed in Afghanistan. 27
In the US, estimates suggested there had been fewer than 100 AIDS
diagnosses among children during 2002, compared to nearly 1,000 in 1992.
The dramatic reduction was due to widespread use of antiretroviral drugs and
avoidance of breastfeeding. 28
South Africa approved the long-awaited provision of free antiretroviral drugs in
public hospitals

In November the UN World Food Programme said it would shift its humanitarian
aid effort in southern Africa from traditional emergency food supply to a greater
response to HIV/AIDS including providing nutritional support, awareness
campaigns, food baskets and other services to HIV-positive people. 29
Many drug manufacturers lowered their prices of antiretroviral drugs in
resource-poor countries during 2003. Although these price reductions were
welcomed by many countries and organisations, it was understood that 'lower
price medicines alone will not deliver treatment'. What was also needed was
the ability of countries to deliver these drugs, building of stronger health
systems and training of more health care workers in resource-poor
countries. 30
South Africa approved the long-awaited provision of free antiretroviral drugs in
public hospitals in November. The cabinet instructed the Department of Health
to proceed with implementation of the plan, which envisaged that within a year
there would be at least one service point in every health district across the
country, and within five years, one service point in every local municipality. 31
UNAIDS warned that the efforts to stem the world's AIDS epidemic were
'entirely inadequate'. It was estimated that around 14,000 people became
infected with HIV each day in 2003. It was estimated that 40 million around the
world including 2.5 million children were living with HIV/AIDS. 32 33
Meanwhile India's health minister said that there would never be a widespread
AIDS epidemic in the country.
"I will prove all experts wrong. We are taking on the disease from all fronts. We
are tackling it very bravely."Sushma Swaraj - 34
On World AIDS Day the WHO announced a new plan called '3 by 5', which
aimed to provide 3 million people in resource-poor countries with antiretroviral
treatment by 2005. This target was seen as a step towards achieving the
ultimate goal of universal access. 35
"Nothing close to this has ever been tried. It's not like finding babies with
diarrohea and treating them for a week, or adults with tuberculosis and
treating them for six months - both of which have been major efforts by the
WHO in recent decades... HIV infection is a chronic disease. The 3 million - and
the millions who will come after them - will have to take their medicine for
years, until they die." 36
Also on World AIDS Day, Wen Jiabao became the first Chinese premier to shake
the hand of an AIDS patient. Mr Wen's handshake broadcast in close-up was the
most dramatic of a series of government moves that demonstrate a new
determination to fight AIDS.

"This was like breaking the ice It's something that a lot of people working in
the AIDS field inside China and outside have been hoping for and waiting
for."Joel Rehnstrom, the co-ordinator in China for UNAIDS - 37
The Chinese government announced a policy of 'Four Frees and One Care',
which promised free antiretrovirals to poor city dwellers and to everyone in the
countryside; free voluntary counselling and testing; free drugs to prevent
mother-to-child transmission; free schooling for AIDS orphans; and care and
economic assistance to the households of people living with HIV/AIDS. 38
According to new estimates, the number of people infected with HIV in the UK
increased by almost 20 percent between 2001 and 2002, from 41,700 to
49,500, of whom 31 percent were undiagnosed.
"World AIDS Day reminds us that the problems we face with HIV are not going
away, despite it being a disease that is largely preventable."Kevin Fenton, a
public health consultant - 39
2004 History
In January Brazil's government reached a deal with pharmaceutical companies
to reduce the price of HIV/AIDS drugs by around a third. It was believed that
the deal saved the government about $100 million in 2004 and cut the average
treatment cost per patient to a new low of $1,200. 40 Also, 10 million free
condoms were given out to people in Brazil during the carnival season as part
of an AIDS-prevention campaign. 41
In parts of Russia and Eastern Europe, HIV was spreading faster than anywhere
else in the world.
In February, President Bakili Muluzi of Malawi announced that his brother had
died from AIDS. This was intended to highlight issues of stigma and
discrimination related to HIV/AIDS. President Muluzi made the announcement
as he launched the first AIDS policy in a country where an estimated 15 percent
of the 15 million population were HIV-positive. 42
The Global Fund to Fight AIDS, Tuberculosis and Malaria suspended payments
to three HIV/AIDS programmes in Ukraine, citing concerns over slow progress
and management problems. It was the first time in its history that the Global
Fund had stopped funding to a scheme that it had supported. 43
In parts of Russia and Eastern Europe, HIV was spreading faster than anywhere
else in the world. A survey by the United Nations Development Programme
estimated that almost one in 100 Russians were HIV-positive and that AIDS
could claim up to 20.7 million lives by 2045. 44 The head of the UN
Development Programme, Mark Malloch Brown, criticised Russia's efforts to
combat the virus:

"President Putin mentioned it last May, but one speech is not enough and one
reference in a speech is not enough." 45
Stephen Lewis, the UN special envoy for HIV/AIDS in Africa warned that the
WHO's attempt to get three million people onto treatment by the end of 2005
was compromised by lack of financial support from the world's richest
countries.
"There has never been a more determined plan of action If 3 by 5 fails, as it
surely will without the dollars, then there are no excuses left, no
rationalizations to hide behind, no murky slanders to justify indifference. There
will only be the mass graves of the betrayed."Stephen Lewis, UN Special Envoy
for HIV/AIDS in Africa - 46
In March, the US Food and Drug Administration approved the first oral fluid
rapid HIV test. 47
South Africa began a programme to give out free HIV/AIDS drugs after years of
confusion and delays. The program started in South Africa's richest province,
Gauteng, where five major hospitals, including Chris Hani Baragwanath, the
largest in Africa, were selected to administer the drugs. 48
"To me, it means a lot," said the frail man, whose girlfriend and 2-year-old
daughter have also tested positive for HIV. "I have a child to raise... I want to
take her to her first day of school, and I can only do that if I am healthy."27year-old HIV-positive South African man 49

An educational sign promoting abstinence at a Ugandan school

A study found that the HIV prevalence rate in Uganda had been reduced by 70
percent since the early 1990s. It was estimated that half a million Ugandans
were HIV positive in 2004, compared with 1.5 million a decade before. It was
believed that the reduction in HIV prevalence was due to people having fewer
sexual partners as well as to effective prevention efforts in local
communities. 50
"In Uganda people became engaged with the epidemic at the community level.
Local care groups, religious movements, non-governmental organisations and
care networks all spread the message. Families, friends and neighbours began
talking about HIV prevention and care, and sexually transmitted diseases
stopped being a taboo subject."
A survey of US media coverage of the AIDS epidemic revealed that the number
of AIDS-related stories peaked in 1987 and rapidly declined in the early 1990s,

despite these being the peak years for AIDS deaths. The stories increased
slightly in 1991, when Magic Johnson spoke publicly about his HIV status. The
number of stories revived again in 1996-7 with the introduction of combination
therapy. 51
In May, five Bulgarian nurses and a Palestinian doctor accused of deliberately
infecting children with HIV were sentenced to death by a Libyan court. The
medical staff had been detained in 1998 and the trial had started in 2000. 52
The US porn industry was hit by fears of HIV outbreak among its stars. By May,
five porn actors had been found to be HIV-positive. 53 54
President Bush's $15 billion initiative to combat the global AIDS pandemic, by
now known as PEPFAR (President's Emergency Plan For AIDS Relief), began full
implementation in June, having received its first funding in January. PEPFAR was
to concentrate on fifteen focus countries, all of them in Africa except Guyana,
Haiti and Vietnam (which was a late addition to the list). The initiative set a
goal of providing AIDS treatment to 200,000 people living in the focus countries
by June 2005. 55
A new UNAIDS report estimated that 37.8 million people were living with HIV at
the end of 2003, including 17 million women and 2.1 million children under 15
years old. It was estimated that there were nearly 8,000 AIDS deaths per day
during 2003. These were slightly lower than previous estimates because
improvements had been made to the estimation process, but without doubt the
epidemic was still expanding. The number of AIDS orphans had risen to 15
million, of whom 12.1 million lived in sub-Saharan Africa. 56
The WHO announced that, by the end of June, 440,000 people in developing
and transitional countries were receiving antiretroviral treatment, an
improvement of 40,000 since the end of 2003. 57
The Bill and Melinda Gates Foundation announced that it would donate $50
million to the Global Fund, bringing its total Fund contributions so far to $150
million. 58
The South African Treatment Action Campaign and its leader, Zackie Achmat,
were jointly nominated for the 2004 Nobel Peace Prize, but were not chosen to
win. 59
In November the Global Fund said that it would delay launching its fifth round
of grants for five months because of a funding shortfall. Some commentators
said the US was not providing enough support for the Global Fund because it
preferred its own PEPFAR initiative. 60
Botswana's antiretroviral treatment programme, which had made dramatic
progress during 2004, was providing medication to around 36,000 and 39,000

people by the end of the year - around half of the number who needed the
drugs. 61
Women, Girls, HIV and AIDS was chosen as the theme of World AIDS Day 2004.
Events to mark the occasion took place around the world, including in China,
where Premier Wen Jiabao called for "unremitting efforts" against the epidemic,
and the Executive of the Global Fund warned of catastrophic consequences
should such efforts fail. 62 63 64
"Today the face of AIDS is increasingly young and female... We will not be able
to stop this epidemic unless we put women at the heart of the response to
AIDS."Peter Piot, head of UNAIDS, on World AIDS Day 65
2005 History

A London Stop AIDS campaign bus for World AIDS Day, 2005
At the start of the year, UNAIDS published a report predicting the future of the
global AIDS epidemic. Three very different scenarios highlighted how much
would depend on the responses of governments, donors and civil society. 66
Also in January, both the WHO and PEPFAR published figures detailing numbers
of people receiving AIDS drugs. PEPFAR said it had helped to provide treatment
to nearly 155,000 people in its fifteen focus countries by end of
September. 67 The WHO said that the total number receiving treatment in all
developing and transitional countries had risen to 700,000 by the end of 2004,
meaning that the 3 by 5 initiative had achieved its latest target. 68
The US Food and Drug Administration (FDA) for the first time approved a
generic AIDS drug made by a foreign company. PEPFAR had decided not to trust
any drug that had not been approved by the FDA, which meant that all PEPFARfunded programmes had had to stick to the more expensive brand-named
products. However in January the FDA gave its approval to two drugs made by
the South African company Aspen Pharmacare. This came just weeks after a
product of the US company Barr Laboratories had become the first ever FDAapproved generic, and was predicted to mark a turning point in providing
cheaper treatment in Africa. 69
Nelson Mandela announced that his eldest son Makgatho had died of AIDS,
aged 54.
"Let us give publicity to HIV/AIDS and not hide it, because [that is] the only way
to make it appear like a normal illness."Nelson Mandela 70

Publication of death certificate data from South Africa revealed that the total
number of reported deaths had increased by 57 percent between 1997 and
2002. Among those aged 25-49 years, the rise was 116 percent in the same six
year period. 71 Based on an analysis of a sample of death certificates, the
South African Medical Research Council estimated that nearly two-thirds of
deaths related to AIDS had been misclassified (wrongly attributed to other
causes) during 2000-2001. 72
In April, the US Institute of Medicine published the results of an extensive
review of data relating to the use of the drug nevirapine. It found that the drug
was a safe and effective way to prevent mother-to-child transmission of HIV,
and that news stories suggesting otherwise had distorted the facts.
"It is conceivable that thousands of babies will become infected with HIV and
die if single-dose nevirapine for mother-to-infant HIV prevention is withheld
because of misinformation."National Institute of Allergy and Infectious Diseases
- 73
Brazil turned down $40 million offered by PEPFAR because it refused to agree to
a declaration condemning prostitution. The director of Brazil's HIV/AIDS
programme said the government had taken the decision "in order to preserve
its autonomy on issues related to national policies on HIV/AIDS as well as
ethical and human rights principles". 74
A new set of international treatment figures were published by the WHO in
June. They revealed that the 3 by 5 initiative was a long way off track, because
only 970,000 people (15% of those in need) were receiving treatment,
compared to a target of 1.6 million. The WHO admitted that it would be unlikely
to achieve its goal of 3 million by the end of the year. 75
PEPFAR said it had exceeded one of its own targets by helping to provide
treatment to 235,000 people in its focus countries by the end of March. 76 The
figure given for Botswana was disputed by the country's health officials. They
said the US was claiming credit for helping thousands of people whose
treatment had in fact been funded overwhelmingly by the Botswanan
government. 77
Speaking at the 2005 National HIV Conference, the acting director of the CDC
announced a new estimate of HIV prevalence in the USA. The CDC had
calculated that between 1.039 million and 1.185 million Americans were living
with HIV at the end of 2003, of whom 47 percent were black. One in four HIVpositive people did not know they were infected. Other studies presented at the
conference showed that new infections among African Americans were rising,
and the total number of new cases was remaining stable at around 40,000 per
year. 78

In the UK at least, 2005 had been hailed as the Year of Africa - the year in
which real progress would be made towards relieving poverty and disease in
that continent. The UK held the presidency of the European Union for the
second half of the year, and in July the UK hosted the G8 (Group of Eight)
summit of world leaders in Gleneagles, Scotland. Prime Minister Tony Blair
promised that the main themes of the summit would be Africa and climate
change. The meeting was preceded by massive "Live8" pop concerts around
the world, and other events associated with the Make Poverty History
campaign.
At the summit the leaders promised to double aid to Africa by 2010, and to
cancel the debts of 18 poor countries, but no progress was made in improving
trade justice, which many groups considered to be the most important issue.
However, the leaders were praised for pledging to ensure as near as possible to
universal access to antiretroviral treatment worldwide by 2010. 79
South Africa's latest antenatal clinic survey showed that 29.5 percent of
pregnant women were HIV positive at the end of 2004. According to the report,
the total number of people living with the virus had risen to an estimated 6.29
million - far more than in any other country. 80
The Global Fund to Fight AIDS, TB and Malaria in August suspended all grants to
Uganda following concerns about possible corruption within the country's
health ministry. Uganda's suspension was lifted in November, after an
agreement was reached with the ministry over better financial management.
Meanwhile the Fund announced its global AIDS programmes had exceeded
targets for 2005. 81 82 83
By August, nine generic antiretroviral drugs had been approved by the
American Food and Drug Administration (FDA). However several African
countries refused to allow the drugs to be imported until they had also been
approved by the WHO. 84 PEPFAR would not begin distributing generic drugs
until near the end of the year. 85
PEPFAR's approach to HIV prevention (described as "ABC") came under
increasingly heavy fire from commentators who said it was motivated by
ideology, and was focusing too much on abstinence until marriage while
downplaying the role of condoms. Among the fiercest critics were Professor
Duff Gillespie, a public health expert and former senior USAID official, who
called PEPFAR's policies "outrageous and stupid", and Stephen Lewis, the UN
Special Envoy for HIV/AIDS in Africa, who said the approach to HIV prevention
would "cause a significant number of infections which should never have
occurred". Two prominent US medical associations, the IDSA and the HIVMA,
were also critical. However PEPFAR officials maintained that their approach to
HIV prevention was balanced and based on evidence of effectiveness. 86 87 88

At the UN World Summit in September, the General Assembly followed the

example set by the G8 leaders, by committing themselves to:
"Developing and implementing a package for HIV prevention, treatment and
care with the aim of coming as close as possible to the goal of universal access
to treatment by 2010 for all those who need it" 89
Russian President Vladimir Putin promised that his country would allocate at
least 20 times more money to fight HIV and AIDS in 2006 than it did in 2005.
The President said that AIDS in Russia was a "serious problem", and that
current spending of $5 million per year was "practically nothing for Russia on
the scale of things". 90 91
In September the antiretroviral drug zidovudine (AZT) reached the end of its
patent period in the US. This meant that any pharmaceutical company could
now produce the drug legally and cheaply for the US market without having to
pay royalties to the patent owner, GlaxoSmithKline. The FDA immediately
approved four generic forms of AZT for sale within America. 92
Zimbabwe, one of the countries worst affected by AIDS, was suffering from a
severe economic crisis made worse by droughts and the government's
controversial land redistribution programme. One consequence was a sharp
rise in the price of AIDS drugs in the public sector, from $7.70 per month in July
to $46 per month in October. At the same time the state-run treatment
programme was handicapped by a lack of foreign assistance, due to Western
opposition to land reform and reported violence and intimidation during
elections.
"People are giving up [their] drugs - they have to choose between feeding and
educating their kids or taking ARVs" 93
Zimbabwean President Robert Mugabe was accused of further worsening the
AIDS crisis in his country through his slum clearance campaign, which left
thousands of families homeless. But UNAIDS announced that Zimbabwe's HIV
prevalence rate had fallen over the previous five years, from around one in four
to around one in five infected. 94 95
In 2005 skepticism about the cause of AIDS was still thriving in South Africa.
The Democratic Alliance gave a list of the country's twelve most influential
"AIDS dissidents" (people who question the theory that HIV causes AIDS),
whom it said had an "ongoing and bizarrely powerful" influence on national
HIV/AIDS policy. The list was headed by attorney Anthony Brink, the convenor
and national chairperson of the Treatment Information Group and spokesperson
for the Dr Rath Health Foundation, an organisation dedicated to promoting the
use of vitamin supplements rather than antiretrovirals to treat AIDS. Also

featured were President Thabo Mbeki and Health Minister Manto TshabalalaMsimang.
"South Africa has become a safe haven for AIDS denialists and is the AIDS
denialist capital of the world... Were it not for the influence of dissidents, South
Africa would long ago have been able to take the steps that countries like
Brazil and Thailand have taken to stop new AIDS infections, provide
appropriate education and offer meaningful treatment to those already
infected."Democratic Alliance health spokeswoman, Dianne Kohler-Barnard - 96
By late 2005, it was clear that the World Health Organisation's 3 by 5 plan
would fail to achieve its goal of 3 million people on treatment in resource-poor
countries by end of the year. With refreshing honesty, the head of the WHO's
HIV/AIDS programme admitted as much and apologised.
"All we can do is apologise. I think we just have to admit weve not done
enough and we started way too late."Dr Jim Yong Kim
However, Dr Kim said the initiative should certainly not be deemed a failure:
"Before Three by Five, there was not an emphasis on saving lives... Many
leaders in the world were saying we just have to forget about this generation of
people who are infected, we're really thinking about the next generation... So
something has happened that's extraordinary." 97
The WHO estimated that expanded access to treatment had saved between
250,000 and 350,000 lives during 2005. However, their estimates also revealed
there were more new HIV infections and more AIDS deaths in 2005 than in any
previous year.
"2005 is likely to be remembered more for the 3 million deaths and almost 5
million new infections it heralded than for the 300 000 lives saved through
treatment for HIV"Front cover of The Lancet Volume 366 Number 9500 98
2006 History

The Lancet's Red edition, August 2006

In January, the rock star Bono announced the creation of a new commercial
brand designed to help raise money to fight AIDS in Africa. Product RED
originally involved four large companies (Armani, Gap, American Express and
Converse), each of which would sell special red products and donate a portion
of the profits to the Global Fund. The first merchandise would become available
in the UK in March. 99

The final results of the 3 by 5 initiative were revealed in March. By the end of
2005, only around 1.3 million people in low- and middle-income countries had
been receiving antiretroviral treatment less than half of the 3 million target.
Though this result was highly disappointing, the WHO stressed that it still
represented a more than three-fold increase within two years. Of the 152
countries involved in the initiative, only 18 met the target of 50 percent
treatment coverage. Among the worst performers were Russia and India, and
among the best was Botswana, where coverage had reached around 85
percent.
"Two years ago, political support and resources for the rapid scale-up of HIV
treatment were very limited. Today 3 by 5 has helped to mobilize political and
financial commitment to achieving much broader access to treatment. This
fundamental change in expectations is transforming our hopes of tackling not
just HIV/AIDS, but other diseases as well."WHO Director-General, Dr Lee Jongwook 100
PEPFAR announced that it was helping to provide treatment to 401,000 people
in its fifteen focus countries, 101 but this news was soon overshadowed by yet
more criticism of the plans HIV prevention policies. A report by the
Government Accountability Office revealed that, by allocating one third of its
prevention budget to programmes promoting abstinence and fidelity, PEPFAR
was forcing countries to cut funding for efforts to help high-risk groups and to
prevent mother-to-child transmission. 102
A new study suggested that the rate of new HIV infections in Southern India
might have declined between 2000 and 2004, perhaps because of changes in
sexual behaviour. One of the authors, Professor Prabhat Jha, said their results
contradicted previous assumptions:
There have been many predictions, mostly based on guesswork, that India's
AIDS problem will explode as it did in southern Africa but we now have
direct evidence of something positive. 103
Reports that an HIV-positive orphan, Isaiah Gakuyo, had been violently
murdered by his uncle sparked protest marches in Kenya. Before his death, the
teenager had been mistreated and isolated by his relatives because of his
infection.
The boy was facing violence on a daily basis. We don't want this to happen
again.March organiser, Inviolata Mwali M'Mbwari - 104
Dr Lee Jong-wook, Director General of the WHO, died after undergoing
emergency surgery in May. Dr Lee had led the 3 by 5 initiative, and was
especially passionate about achieving universal access to HIV/AIDS prevention,
treatment and care. 105

At the end of May, twenty-five years after doctors first became aware of AIDS,
UNAIDS published an especially comprehensive report on the global epidemic.
Although the number of people living with HIV was still rising, there was new
evidence of HIV prevalence declines in Kenya, as well as urban areas of Burkina
Faso and Haiti. 106
The UNAIDS report also revealed that funding for the response to AIDS in lowand middle-income countries had risen from $300 million in 1996 to $8.3 billion
in 2005, yet was still a long way short of what was required for meaningful
action. Of the $18.1 billion that would be needed in 2007, only $10 billion was
likely to be available. 107
June also contained the fifth anniversary of the UNGASS declaration, in which
UN member states had set ambitious targets for combating HIV and AIDS
worldwide. Another High-level Meeting was therefore convened to agree a new
Declaration of Commitment on HIV/AIDS, which would guide the global
response over coming years. The final document was criticised by some
campaigners for being vaguely worded, and for omitting any definite spending
commitments.
I wish we could have been a bit more frank in our declaration about telling the
truth that some groups like sex workers, drug users and men who have sex
with men are more at risk This is not a time for embarrassment, this is
about telling it straight because it is about saving people's lives. Openness,
honesty, frankness, giving people enough information, not being squeamish
and telling the truth is really, really, important.Hilary Benn, UK International
Development Secretary 108
The Vatican sparked excitement among AIDS campaigners when it suggested it
was planning a review of its stance on condom use as a method of HIV
prevention. However, it soon became clear that a major change in policy was
unlikely, and that the Catholic Church would probably continue to oppose
condom use in all circumstances. 109
The Gates Foundation the worlds largest private source of funding for HIV
and AIDS received a substantial boost to its finances in June, when the
billionaire Warren Buffet promised to donate $31 billion over ten years. Bill
Gates announced that he would step down as head of Microsoft to concentrate
on the work of the Foundation. 110
The first one-a-day pill for effectively treating HIV infection was approved for
sale in the USA. A result of unprecedented cooperation between two major
pharmaceutical companies, the pill, called Atripla, combined three types of
drug widely used in first-line treatment. The advent of once-daily treatment
represented great progress since the mid-1990s, when people with HIV usually
had to take several pills every few hours. 111

President Bill Clinton and Bill Gates at the International AIDS Conference in
Toronto, 2006
In August, attention turned to the XVI International AIDS Conference in Toronto.
One major talking point was how to accelerate the expansion of antiretroviral
therapy worldwide, and in particular how to alleviate dire shortages of
healthcare workers in the most needy countries. Delegates also discussed the
pros and cons of routine HIV testing, whereby everyone attending medical
settings is offered an HIV test, regardless of symptoms. The WHO and others
suggested that wider use of this approach would increase take-up of treatment
and help to counter stigma.
The conference provided a platform for critics of the South African
governments response to AIDS. Activists protested at the countrys exhibition
stand, which was dominated by unproven nutritional remedies, with almost no
reference to effective medication. Conference co-chair Mark Wainberg said it
was unconscionable that South Africas leaders would not talk openly about
AIDS. 112 Stephen Lewis (UN Special Envoy for HIV/AIDS in Africa) went further
in his closing speech:
South Africa is the unkindest cut of all. It is the only country in Africa whose
government is still obtuse, dilatory and negligent about rolling out treatment. It
is the only country in Africa whose government continues to propound theories
more worthy of a lunatic fringe than of a concerned and compassionate state...
The government has a lot to atone for. I'm of the opinion that they can never
achieve redemption. 113
Shortly after the conference, more than 80 prominent international scientists
wrote an open letter to South African President Thabo Mbeki calling on him to
sack health minister Manto Tshabalala-Msimang, whom they blamed for
disastrous, pseudo-scientific policies on HIV/AIDS. 114 Instead, the South
African government set up a new inter-ministerial committee to take charge of
the national AIDS response, to be headed by the deputy president, thus
seeming to sideline the controversial health minister. 115
To coincide with the Toronto conference, medical journal The Lancet produced a
special issue with a red cover to help promote the Product RED brand. The 130page journal was entirely devoted to AIDS-related articles, and included
prominent adverts for Product RED merchandise. 116 The Independent, a
British newspaper, had been the first publication to produce a RED edition in
May; it would repeat the stunt in September and December. 117

In September, the WHO issued an emergency warning to health care

professionals to be on the lookout for a new strain of tuberculosis, against
which most existing drugs were ineffective. The WHO had been aware of XDRTB (extreme drug-resistant tuberculosis) for several years, and it had been
recorded in Asia, Eastern Europe and the United States. The alarm was raised
when doctors reported 53 new patients in South Africa, 52 of whom died within
25 days. It was thought that most, if not all, of these people had been coinfected with HIV. Experts were concerned that they might be seeing the
beginning of a devastating new epidemic.
There is no point in investing hugely in [AIDS treatment] programmes if
patients are going to die a few weeks later from extreme drug-resistant
tuberculosis This is raising the spectre of something that we have been
worried about for a decade the possibility of virtually untreatable TB.Dr Paul
Nunn of the WHO 118
In the USA, the Centers for Disease Control and Prevention (CDC) issued new
guidelines recommending routine HIV testing for all adults and adolescents
attending healthcare services. Routine testing had already proved highly
successful in identifying HIV among pregnant women; the CDC hoped that
more general use of this approach would help to cut the rate of new infections
and would result in more people receiving treatment before becoming very
ill. 119
Product RED was launched in the USA in October, by which time Apple and
Motorola were also supporting the brand. 120
Kevin De Cock, director of the World Health Organisation's HIV/AIDS
department, expressed growing concern about HIV in Papua New Guinea. Adult
HIV prevalence in this Pacific nation was estimated to be 1.8 percent - a level
not usually seen outside Africa. The country's health minister said that some
isolated pockets could have rates as high as 30 percent.
Papua New Guinea probably is somewhat in a class of its own in this
region.Dr. Kevin De Cock 121
In December, South Africas deputy health minister Nozizwe Madlala-Routledge
decided to speak out against her own government, admitting there had been
denial at the very highest level over the countrys AIDS crisis. She also
acknowledged that leaders had created confusion about treatment by
appearing to promote nutrition as a viable alternative. Activists greeted these
statements as a defining moment in the countrys response to HIV and
AIDS. 122 123
The most important scientific announcement of the year was made in
December, when the US National Institutes of Health revealed the results of

two African trials of male circumcision as an HIV prevention method. The

studies were halted early for ethical reasons because they had already
provided clear evidence that the intervention reduced HIV transmission by
around 50 percent. The WHO and other organisations suggested they would
soon begin promoting male circumcision in areas with severe HIV epidemics.
However, they also stressed that there were many difficulties associated with
this intervention, including acceptability, demands on resources, and infections
resulting from unsafe operations. Furthermore, it was clear that the benefit
would be lost if circumcised men became over-confident, and began to engage
in more risky sexual behaviour. 124
At their second trial within two years, five Bulgarian medics and a Palestinian
doctor were again found guilty of deliberately infecting 426 Libyan children
with HIV, and were again sentenced to death. This verdict was condemned by
the USA, the European Union and the UN human rights office. Leading experts
in HIV and genetic testing had declared that the healthcare workers were
almost certainly innocent, and that poor hygiene had led to the children
becoming infected. 125
History of AIDS: 2007-2010

President Yahya Jammeh of The Gambia

These are some of the most important events that occurred in the history of
AIDS between 2007 and 2010.
2007 History
A large-scale international microbicide study was halted in January after
preliminary results found that the product was not achieving its aims of
preventing HIV infection in women. In fact, trials of the drug in some sites
found that there was a higher infection rate amongst women who used the
cellulose sulphate vaginal gel, compared to the placebo group. 1UNAIDS
regarded the news as a disappointing and unexpected setback as [t]he need
to continue research to find a user-controlled means of preventing HIV infection
in women is urgent. 2
Also in January came the dramatic announcement by President Jammeh of The
Gambia that he had found a cure for AIDS.
I can treat asthma and HIV/AIDS and the cure is a days treatment. Within
three days the person should be tested again and I can tell you that he/she will
be negative... 3

Jammehs claim was soon revealed to be unfounded. A scientist who conducted

the tests rebutted the studys findings, saying that none of the trial patients
could be described as cured. 4Despite the negative outcomes of the trial, the
president continued in his belief of his treatment plan, which was also endorsed
by the Gambian health ministry and administered in state hospitals. The
President of the International AIDS Society Dr. Pedro Cahn called the Gambian
presidents claims shocking and irresponsible 5, not only for providing false
hope, but also for risking peoples lives by taking them off potent combination
antiretroviral therapy.
Good news came to South Africa in March when the government finally
developed an ambitious and comprehensive plan to try and tackle the epidemic
after years of inaction. Headed up by the deputy president, Phumzile MlamboNgcuka, and the deputy health minister Nozizwe Madlala-Routledge, the plan
aimed to try and reduce the number of new infections by fifty percent, and
bring treatment care and support to at least eighty percent of all HIV-positive
people and their families. 6The new plan was welcomed by national and
international health experts, although it was made clear that in order for the
new goals to be realised there needed to be a fast track restructuring of the
health care system.
Also that month came the first publication by the World Health Organisation
(WHO) and the Joint UN Programme on HIV/AIDS (UNAIDS) regarding
recommendations on circumcision and HIV. The guidance came three months
after trials in Uganda and Kenya provided conclusive evidence that
circumcision reduces the risk of transmission from women to men by around
50-60%. The publication stressed that men should be taught that circumcision
provides only partial protection against HIV, to prevent them developing a false
sense of security, and should only be provided as part of a comprehensive HIV
prevention package. It also stressed that well-trained practitioners working in
sanitary conditions should perform the procedure only after obtaining informed
consent. 7
In April, it was revealed by the WHO that at the end of 2006 two million HIVpositive people in low- and middle-income countries were accessing
antiretroviral treatment. This means that around 28% of those in need of the
life-saving drugs were receiving them. The speed of expansion remained too
slow to meet the global AIDS treatment targets agreed by the G8 summit. 8
By June the G8 had revised its universal treatment pledge to give every person
in need of HIV treatment access by 2010. Instead, it proposed a new weaker
target stating that the G8 would, over the next few years aim to ensure
access for approximately five million people. 9The weakening of the original
G8 pledge caused anger, as it was felt that a commitment had been broken
which had been at the very heart of the fight against AIDS for the past two

years. 10Although it was acknowledged that universal treatment by 2010 was

more idealistic than feasible, many people believed that having such a
demanding target put pressure on country governments to get as many people
as possible into treatment programmes and highlighted the scale and urgency
of the task.
In July, it was revealed that new methods of sampling led to a massive
reduction in the estimated number of people living with HIV in India. Previous
estimates had suggested that there were around 5.7 million people living with
HIV in India, giving it the largest HIV caseload in the world. The new figures
suggested that the actual total was somewhere between 2 and 3.1 million
people - around 60% lower than the original estimate - and placed India third
after South Africa and Nigeria for countries with the highest HIV infected
populations. The previously inflated HIV numbers for India were due to figures
being obtained in areas of particularly high HIV prevalence and taken from
samples from surveillance sites visited mainly by pregnant women, injecting
drug users and prostitutes. 11
Today we have a far more reliable estimate of the burden of HIV in India, said
the Indian Health Minister, Anbumani Ramadoss. He did however warn of
complacency, as in terms of human lives affected, the numbers are still large,
in fact very large. 12
Later in July, there were reports of counterfeit antiretroviral drugs (ARVs)
flooding the market in Zimbabwe, potentially putting many lives at risk. The
adverse economic and political conditions in Zimbabwe meant that supplies of
government-funded ARVs dried up in many parts of the country, leaving those
with HIV at serious risk of developing AIDS. This left the door open for dealers
to sell fake or illegally obtained pills to HIV positive people desperate to
maintain their health. A spokesperson for the Medicines Control Authority of
Zimbabwe (MCAZ) said Such medicines may be counterfeited, adulterated and
contaminated, thus rendering them ineffective and sometimes dangerous. 13
As July drew to a close so to did the eight-year ordeal of the six Bulgarian
medics facing the death sentence in Libya for allegedly infecting hundreds of
children with HIV. They had always denied the claim, saying their confessions
were extracted under torture. Expert evidence from various scientists claimed
that the infections began long before the medics had arrived in the country,
and that they were due to poor hygiene and the reuse of equipment and
needles. 14The Libyan authorities finally agreed to release the medics to spend
the rest of their sentences in Bulgaria, but on arrival, they were pardoned by
the Bulgarian President and returned home to their friends and families. 15

Protest in South Africa against the sacking of the Deputy Health Minister

Optimism regarding South Africas response to the AIDS crisis was short lived
after it was announced in August that the Deputy Health Minister Nozizwe
Madlala-Routledge had been fired. After years of denial and inaction in the
country it was felt that Madlala-Routledge was a government member who
finally recognised the seriousness of the epidemic and was determined to take
effective action. The official reason for Madlala-Routledges dismissal was cited
as her inappropriate labelling of infant deaths at Frere Hospital as a national
emergency and accusations of her attendance at an AIDS conference in Spain
without the Presidents permission. But it was felt that the underlying motive
for her dismissal was her ongoing conflict with Tshabalala-Msimang, the Health
Minister, and in particular their contrasting opinions on how to confront
AIDS. 16
It was revealed that the African nation of Botswana had managed to
dramatically reduce rates of mother to child HIV transmission. Botswana, with
one of the highest HIV prevalence rates in the world, set up a comprehensive
treatment and care programme, to ensure that all women were being tested for
HIV in pregnancy and offered appropriate drugs to prevent HIV being passed to
their babies. Without intervention, around one in three babies born to HIV
positive mothers will become infected with HIV themselves; but by
implementing this programme, Botswana successfully cut the mother-to-child
transmission rate to under 4%. 17
In August, the U.S. Food and Drug Administration (FDA) granted accelerated
approval to the new HIV drugs maraviroc (Selzentry) and raltegravir (Isentress).
These two new drugs offered hope to patients infected with virus strains
resistant to almost all other classes of drugs designed to fight AIDS.
In October, it was revealed that hundreds of South Africans who had been
involved in an AIDS vaccine trial might have an increased risk of HIV infection
as a result. The trial, which was being conducted by the Merck pharmaceutical
company, had been halted in the previous month after initial results showed
the vaccine to be ineffective, an outcome that was described by leading
vaccine researcher Dr. Gary Nabel as a big blow to the field. 18It was
revealed that the infection rate was higher among people who received the
vaccine than among those given a placebo. Experts said the vaccine itself
could not have caused HIV infection, but it may have increased the risk of
transmission by affecting immune responses. 19
The biographer of Thabo Mbeki revealed in November that the South African
President remained unconvinced that HIV caused AIDS. Mbeki had previously
stepped back from the AIDS debate in South Africa in 2000 after causing much
controversy. 20
2008 History

At the beginning of 2008 the Swiss Federal Commission for HIV/AIDS published
the findings of four studies, showing that people living with HIV who take
effective antiretroviral therapy cannot pass on the virus through unprotected
sex, as long as they adhere to the drugs, have an undetectable viral load for at
least six months, and have no other sexually transmitted infections. It was not
possible to prove conclusively that transmission is impossible, however the
commission reported that scientific evidence showed the risk to be negligibly
small. 21
The Swiss statement was met by immediate controversy, with questions over
the reliability of its conclusions coming from HIV/AIDS advocacy groups as well
as scientists. Concerns focused on the fact that the research was based solely
on heterosexual couples and therefore neglected to include anal sex 22.
UNAIDS and the WHO quickly issued a statement stressing that consistent use
of condoms was still the safest protection against HIV. 23

Michel Sidib, the Executive Director of UNAIDS

In April, the Executive Director of UNAIDS, Peter Piot, announced that he would
be stepping down at the end of the year. An editorial in The Lancet praised Piot
for having raised the profile of HIV/AIDS so successfully that the epidemic has
remained a high priority on health, political and security agendas". 24Later in
the year it was announced that Michel Sidib would be Piots successor. 25
In June, a team of scientists in South Africa were tried and found guilty by a
South African court for conducting unauthorised medical trials and selling
unregistered vitamin supplements as a treatment for AIDS. One of the
supervisors of the illegal trials, Matthias Rath, was already widely criticised for
his promotion of vitamins as a substitute for antiretroviral drugs. The South
African court halted the medical trials and banned Rath from advertising his
natural AIDS remedies. It also highlighted the responsibility of the South African
government and its failure in not preventing Rath from distributing his
products. 26
The American PEPFAR funding program was renewed on 30th July, committing
$48 billion to HIV/AIDS, malaria and tuberculosis for fiscal years 20092013. 27This was triple the amount of money that the fund had distributed in
its initial five years, and was commended by international HIV/AIDS activists
and organisations. However, they stressed that the bill only authorised the
expenditure and the money would still need to be appropriated each year. 28
The Reauthorization Act 29also repealed a policy that had received substantial
criticism: the requirement that one third of funding be spent exclusively on the
promotion of sexual abstinence. However, it was replaced with a reporting

requirement for recipients who spend less than 50 percent of prevention funds
on abstinence-only programmes. It was argued that this perpetuated bias in
PEPFAR spending.
The political and economic climate in Zimbabwe worsened dramatically in
2008, exacerbating an already severe AIDS epidemic. A cholera outbreak that
began in August was so critical that by December, UK Prime Minister Gordon
Brown was describing the crisis as an international emergency. 30The effect
of the outbreak on people living with HIV and AIDS was compounded by the
collapse of the health system, the governments block on foreign aid, and
widespread malnutrition, leading to an equally devastating AIDS crisis. 31 32
Medicines Sans Frontiers (MSF) estimated that in Bulawayo (the second largest
city in Zimbabwe) there were 2,500 patients still waiting to receive
antiretroviral drugs by the end of 2008. Even those who were able to access
drugs were put at risk by the widespread lack of food, with 2008 producing the
worst harvest Zimbabwe had experienced since the country gained
independence in 1980. 33The governments decision to ban most international
aid groups, which was imposed at the beginning of June and lasted throughout
July and August, exacerbated food and drug shortages farther. MSF called for
an urgent increase in the humanitarian response to the crisis, and stressed the
importance of HIV and AIDS being a prominent part of this response 34
The seventeenth International AIDS Conference took place in Mexico City in
August. For the first time in the history of the Conference, 2008 saw the use of
conference hubs: a network of locations around the world where conference
sessions were screened and accompanied by moderated discussion. The hubs
were considered very successful in widening the reach of the conference. 35
In the same month, UNAIDS published its 2008 report on the global AIDS
epidemic. The report warned that with 2010 only two years away, the target
of universal access by 2010 would be unattainable unless the global response
to HIV was substantially strengthened and accelerated. However it also
emphasised that signs of major progress in the HIV response were being seen
for the first time in 2008.
The 2008 Report on the global AIDS epidemic confirms that the world is, at
last, making some real progress in its response to AIDS.Peter Piot, Executive
Director of UNAIDS
Describing a "stabilization of the global epidemic", the report estimated that by
the end of 2007 there were 33 million people living with HIV worldwide (down
from the 39.5 million estimate made at the end of 2006). Although much of the
reduction was attributed to better surveillance techniques in many countries, it
also reflected the drop in HIV prevalence in certain areas, including subSaharan Africa. The report estimated that the annual number of AIDS deaths

had declined from 2.2 million in 2005 to 2 million in 2007, reflecting an

increase in the number of people receiving antiretroviral drugs. 36

Dr. Robert Gallo

In September, the resignation of president Thabo Mbeki was welcomed as a
potential turning point in the controversial history of HIV and AIDS in South
Africa. A Harvard study published shortly after asserted that more than 330,000
lives were lost between 2000 and 2005 as a direct result of the South African
governments failures in the provision of antiretroviral drugs. 37The decision of
interim president Kgalema Motlanthe to immediately appoint a new health
minister, Barbara Hogan, was celebrated by AIDS activists as a sign of a new
commitment to the AIDS response.38 39
An old controversy was revived in October with the announcement of the
winners of the Nobel Prize for medicine. The prize was split between Franoise
Barr-Sinoussi and Luc Montagnier of the Pasteur Institute in Paris for their
discovery of HIV, and a third scientist for his work on a separate disease. The
decision not to credit American researcher Robert Gallo for his contribution to
early work on AIDS resurrected a bitter dispute over who claimed rights to the
discovery. In awarding the prize, the chair of the Nobel committee, Professor
Bertil Fredholm, stated:
"I think it is really well established that the initial discovery of the virus was in
the Institute Pasteur." 40
In November, German haematologist Gero Huetter announced that he
had cured a man of HIV through a bone marrow transplant from a donor who
had a genetic resistance to the virus. Huetter spoke at a press conference in
Berlin stating that the patient, who was taken off antiretroviral drugs after the
transplant two years before, continued to show no traces of the virus, leading
doctors to declare him functionally cured. 41However, it was generally
accepted that the operation did not present a viable HIV cure. Researchers
cautioned that further testing was needed to ensure that the virus had been
completely eradicated and not just suppressed to very low levels or become
latent. 42
Also in November, Barack Obama was elected President of the United States of
America. As part of his election campaign, Obama released a plan to combat
global HIV and AIDS promising a move away from ideology and a greater focus
on best practice in Americas HIV/AIDS strategy. 43At home, Obama
committed to implementing a comprehensive national strategy on HIV
and AIDS in America in his first year, and to signing universal health care
legislation by the end of his first term. In terms of Americas response to HIV

and AIDS overseas, Obama pledged that he would substantially increase

funding to both PEPFAR and the Global Fund. 44However, commentators
questioned the likelihood of this pledge being followed through in the context
of an unfolding international financial crisis.
Obama also openly supported lifting the ban on states using federal funding
for needle exchange programmes 45and pledged to overturn the controversial
policy banning funding to international organisations that perform or promote
abortion (known as the global gag rule). As the year drew to a close, HIV/AIDS
advocacy groups and commentators expressed high expectations for the future
of America's response to the AIDS epidemic under Obama. However there was
emphasis on the need to maintain pressure to ensure that campaign promises
are followed through. 46
2009 History
In January the long standing UNAIDS Executive Director, Peter Piot, stood down
from his post to be replaced by Michel Sidib. Sidib began with the promise...
I will do everything in my power to bring around an AIDS reversal where less
people become infected than are put on treatment. 47
The beginning of the year also saw the HIV/AIDS crisis worsen in Zimbabwe
with 400 people dying a day from AIDS, 48the closure of two of the largest
hospitals in Harare, 49and a black market for ARVs springing up. 50Later in the
year Zimbabwe was granted $37.9 million by the Global Fund for its fight
against HIV/AIDS, TB and Malaria, to be administered by the UN. 51
In January, newly elected President Obama took the opportunity to announce
the reversion of the global gag rule, legislation first brought under Ronald
Reagan that had impeded funds from going to organisations which provide
services linked with abortion. 52This accompanied a promise to lift the U.S
travel ban, which had, for 22 years, prevented people with HIV/AIDS from
entering the U.S. The lifting of the ban was finally announced in October when
Obama formally declared it would take effect after a routine 60-day waiting
period. 53
February brought the news that a microbicide trial had not proved as effective
as hoped, with the results from the PRO 2000 trial shown to be not statistically
significant. 54 55

In March a report from the Washington DC Health Department revealed that

Washington DC had a higher rate of HIV than West Africa with 3 percent
prevalence - enough to describe it as a severe and generalised epidemic. 56

Also in March the Pope warned against condom use, stating that condoms
actually increase the problem of AIDS. He called the HIV/AIDS epidemic...
"A tragedy that cannot be overcome by money alone, that cannot be overcome
through the distribution of condoms, which even aggravates the problems". 57
The Popes comments elicited criticism from several EU states and the World
Health Organization who responded that such a message was not only incorrect
but dangerous. The Dutch Development Minister said it was "extremely
harmful and very serious" that the Pope was "forbidding people from protecting
themselves". 58
Anti-discrimination legislation received a boost in India in July as the high court
overturned section 377 of India's Penal Code which had banned
homosexuality. 59This 150-year-old law had stigmatised a marginalised group
in Indian society, making it difficult for men who have sex with men to access
HIV prevention, treatment and care.
In August researchers in North Carolina announced that they had mapped the
entire genome of HIV-1. One of the researchers stated, We are beginning to
understand tricks the genome uses to help the virus escape detection by
human host. 60
September saw renewed, but short-lived hope that an AIDS vaccine may not
be far off. The United States military, in partnership with researchers in
Thailand released results from a trial which tested a combination of two
vaccines dubbed RV144. The trial, with 16,000 participants, was the largest
ever conducted. 61The preliminary analysis of the results claimed to provide a
33% chance of protection against HIV. However, closer investigation of the data
revealed that the supposed effectiveness was actually lower (26%) and could
have been due to chance. 62The leaders of the study were criticised for not
revealing both sets of data at the same time and therefore misleading the
general public and scientific community.
Also in September, a report from UNAIDS and the WHO showed an increase in
those receiving HIV treatment, with a 36% increase in access to ARVs for those
living with HIV in just one year. The most progress was seen in sub-Saharan
Africa. In addition, the report showed that in 2009 approximately 45% of HIV
positive pregnant women are receiving ARVS when only 35% had access in
2007. 63However the report also contained a note of caution. In particular, it
highlighted the possibility that an increased funding gap as a result of the
recession in 2009 could jeopardise access to life-prolonging drugs.
In November, UNAIDS published its annual Epidemic Update stating that the
decade had seen a significant decline in new HIV infections. The number of new
infections had dropped by 17% since 2001, and thanks to the increased

availability of HIV drugs, deaths had declined by 10% over the past five years.
Some of the most encouraging signs came from sub-Saharan Africa where
400,000 fewer people were infected in 2008 than at the start of the decade.
East Asia also saw a dramatic 25% decrease in annual infections between 2001
and 2008. 64
The UNAIDS report coincided with a publication by Mdecins Sans Frontires,
which praised the scale up of treatment and prevention worldwide and the
achievements of the recent past, but cautioned that the crisis is not
over. 65 The report pointed to worrying sings of waning international support.
In particular, it highlighted the Global Funds struggle to keep up funding, with
Executive Director Michel Kazatchkine saying for the first time, the demand for
funds in 2009 has exceeded the funds we have available. 66
In December, the Ugandan Parliament were debating a much-publicised bill
that aimed to criminalise homosexuality with the possibility of the death
sentence for some offences committed by homosexuals, including having sex
with a person below the age of 18, with a disabled or HIV positive person. 67
2010 History
The New Year coincided with a significant event in the United States of
Americas HIV and AIDS history. From January 4th, HIV positive individuals
travelling to the country would no longer be denied entry based on their status
legislation that had been in place since 1987. 68Following the commitment to
remove the ban, it was decided that the 2012 International AIDS Conference
would be held in Washington, D.C. 69The year 2010 would be a progressive one
for the removal of travel bans, as South Korea, China and Namibia all lifted
their restrictions. 70 71 72
Speaking at two conferences in February, Professor Brian Williams from the
South African Centre for Epidemiological Modelling and Analysis suggested that
using antiretroviral treatment to stop HIV transmission could eliminate HIV
transmission in five to ten years and HIV infection in 40 years. 73 His
presentations were reported across the world and the idea of using HIV
treatment as prevention gained momentum as the year progressed.
In July the World Health Organization (WHO) released its revised editions of the
antiretroviral treatment guidelines for adults and adolescents and the
treatment
guidelines
for preventing
mother-to-child
transmission
of
HIV. 74 75 A key change in the guidelines for adults and adolescents was the
earlier initiation of antiretroviral therapy for people living with HIV. The previous
version of the guidelines (2006) recommended treatment initiation at a CD4
count of 200 cells/mm3, whereas the updated guidelines recommended
treatment initiation at 350 cells/mm3 (or those with WHO clinical stage 3 or 4
if CD4 testing was unavailable). The recommendation was based on evidence

that showed starting treatment earlier slowed disease progression and reduced
the risk of HIV transmission. The new guidelines would significantly increase
the global number of people in need of antiretroviral treatment.
The biannual International AIDS Conference was held in Vienna in July. The
theme of the conference, Rights Here, Rights Now, highlighted the need for
the protection of human rights for an effective response to the global AIDS
epidemic.
Results from CAPRISA 004, a microbicide trial, were hailed as the highlight of
the conference. The Phase IIb trial assessed the safety and effectiveness of an
antiretroviral-based gel in 900 HIV-negative, sexually active women in South
Africa. The results were statistically significant, with the gel reducing the risk of
HIV acquisition by almost 40 percent overall. 76
This is an astonishing scientific achievement and a great boost to the
microbicide field. At the same time, the results are complicated, and we will
need to work hard to make sure that women and their partners understand
what these results do and do not mean for the immediate future and in the
long-term Mitchell Warren, AVAC Executive Director 77
In September WHO, UNAIDS and UNICEF published the annual Universal Access
report for low- and middle-income countries, which showed an estimated 5.25
million people were receiving antiretroviral therapy in 2009. 78 An estimated
1.2 million people started treatment in 2009, the largest increase in one
year. 79 80However, due to WHOs revised treatment threshold of 350
cells/mm3, the number of people needing treatment increased from 10 million
to an estimated 15 million. 81
UNAIDS reported a continued decline in new HIV infections and AIDS-related
deaths in their biannual report on the global AIDS epidemic, published in
November. 82According to the report, since the spread of HIV had finally been
halted and reversed, the challenge was to see how quickly the global response
could end the epidemic.
This new fourth decade of the epidemic should be one of moving towards
efficient, focused and scaled-up programmes to accelerate progress for
Results. Results. Results. Michel Sidib, UNAIDS Executive Director 83
In November Pope Benedict spoke about condom use, more than a year after
his previous controversial comments about HIV and condoms. In a book based
on a series of interviews, the Pope said condoms could be used in certain
circumstances where there is a real risk to the lives of others. The Pope's
comments were the subject of considerable interpretation. The Vatican was
quick to clarify the Popes remarks, stating, the Holy Father was talking
neither about conjugal morality nor about the moral norm concerning

contraception, but those involved in prostitution who are HIV positive and
who seek to diminish the risk of contagion by the use of a condom. 84The
statement also reiterated the Catholic Churchs stance on prostitution: The
practice of prostitution should be shunned, and it is the duty of the agencies of
the Church, of civil society and of the State to do all they can to liberate those
involved from this practice.
The year ended with another success story in HIV prevention. Researchers from
a large-scale Phase III pre-exposure prophylaxis (PrEP) trial revealed there had
been a 44 percent reduction in HIV infection risk among HIV-negative
participants taking a daily dose of antiretroviral drugs compared to those
taking a placebo. 85The iPrEX trial, which recruited men who have sex with
men in six countries, was the first to prove the concept of PrEP for HIV infection
could work.
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Arson Cause Of Fire At Rays -- Boys Start School Today

September 23, 1987|By Mike Thomas, Sentinel Tampa Bureau
ARCADIA Arson caused the fire that destroyed the home of three AIDSinfected brothers, investigators said Tuesday, but they admitted they do not
have enough evidence to arrest a suspect.
Meanwhile, Clifford and Louise Ray, who fled Arcadia after the fire destroyed
their house Aug. 28, planned to let their sons -- Ricky, 10, Robert, 9, and Randy,
8 -- start school today in Sarasota.

But Citizens Against AIDS, an Arcadia group that opposed the Ray children
attending school in their community, has followed them to Sarasota and plans
to hold a seminar there tonight.
DeSoto County Sheriff Joe Varnadore said his department is continuing its
investigation into the fire and hopes to make an arrest.

The blaze was started in several places, including the utility room, hallway and
living room, Varnadore said. The arsonist used an ''accelerant'' to create a ''hot
and fast fire.'' He would not identify what type of flammable liquid was used.
''He the arsonist went in and sprinkled a few rooms and set a match to it,'' said
Armon Summerall, the county's public safety director. He said several
suspicious fires had occurred in the same area during the past five years but
would not speculate if they were related.
Varnadore said the front door of the Rays' house had been left open the night
of the fire, a common practice of the family. The only person home was Clifford
Ray's brother, Andy, who had fallen asleep watching television. He was
awakened by the flames and escaped.
While Varnadore said there is a ''very good possibility'' there won't be an arrest
because arson cases are difficult to prove, he later added, ''I think I'm going to
make an arrest.''
The fire destroyed the house five days after the Ray boys started elementary
school in Arcadia against the strong objections of hundreds of parents. The
county school board had tried to keep the children out, but a federal judge
ruled early in August that the boys did not pose a health risk to others and
should be allowed in school.
Varnadore dispelled rumors circulating in Arcadia that someone in the Ray
family was responsible for the fire.
''We have ruled out the Rays at this point,'' he said.
Varnadore also ruled out anyone associated with Citizens Against AIDS. But he
was evasive when questioned about Jimmy Smithers, a friend of the Ray family
who was at the house the night of the fire. Smithers, who lived down the street
from the Rays, told the St. Petersburg Times earlier this month that he was
considered a suspect.
Varnadore also ruled out anyone associated with Citizens Against AIDS.
But he was evasive when questioned about Jimmy Smithers, a friend of the Ray
family who was at the house the night of the fire. Smithers, who lived down the
street from the Rays, told the St. Petersburg Times earlier this month that he
was considered a suspect.
Smithers, 28, said he came by the house that night to get Andy Ray for a game
of pool. He said he saw Ray fighting the fire with a garden hose, and followed
him inside to recover belongings before they were destroyed. Smithers said
Ray started to pass out in the house and he had to help him out.

Varnadore said Smithers was given a lie detector test, the only one
administered during the investigation. Later, when questioned by reporters
about the investigation, Varnadore mentioned that the suspect was given a lie
detector test.
When asked if that meant Smithers was the suspect, Varnadore said, ''I threw
you a curve, so that's what you're going to have to live with.''
The Rays are living in Sarasota, trying to stay away from media attention and
get their lives back to normal, said their attorney, Judy Kavanaugh of Sarasota.
The three brothers will start classes at Gocio Elementary School today. While
none of the boys has AIDS, each has been exposed to the virus. It is believed
they acquired the virus from blood products used to treat their hemophilia.
County-run seminars were held Monday and Tuesday nights to educate parents
about AIDS. Monday's conference, attended by about 500 parents, was marred
by shouting from some people opposed to the county's new policy of accepting
students with AIDS. In the audience were members of Citizens Against Aids,
who drove about 45 miles to attend the meeting.
Kavanaugh said that despite some problems at the conference, parents in
Sarasota appear more enlightened and that the Ray brothers should be
accepted without much turmoil.
''Everyone has been so nice here, they decided to stay,'' Kavanaugh said.
''People are going out of their way to help.''
However, Citizens Against Aids is planning an ''informational seminar'' in
Sarasota at 7 p.m. today to answer questions about AIDS, said group president
Danny Tew. He said it is a coincidence the meeting is on the same day the Ray
children are going to school.
''We have a right to go wherever we want as long as we stay within the bounds
of the law,'' Tew said. ''This concern is for the larger issue of AIDS, not the Ray
children. There is more than the Ray children involved.''
The group wants the Legislature to require all schoolchildren be tested for AIDS
and local school boards given the option of keeping them isolated from other
children.
''Hopefully we will go to every county . . . until we get enough support to go to
the Legislature and get the bill passed,'' he said.

Sarasota school officials said they do not plan to back down from their policy
regarding AIDS in the classroom, which has been endorsed by leading health
authorities such as U.S. Surgeon General C. Everett Koop.
''The parent meetings have been interesting,'' said Roberta Palmer, a
spokeswoman for the Sarasota County School Board. ''There has been a lot of
misinformation. There is fear. There is gladness. And there is apathy.''