HIV/AIDS

HIV/AIDS
• Unknown prior to 1980 (Period of silence)
• By 1980 spread to five continents:
– Africa, North America, South America, Europe
and Australia
– 100,000 to 300,000 persons infected
• Johnathan Mann
1981
 • "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

• California and New York: the number of cases of

a rare lung infection Pneumocystis carinii
pneumonia (PCP) increasing
• Kaposi's Sarcoma (KS) (rare form of relatively
benign cancer mostly in older people).
• By March at least eight cases of a more
aggressive form of KS had occurred amongst
young gay men in New York
• A Task Force on Kaposi's Sarcoma and
Opportunistic Infections (KSOI) formed

• A number of theories were developed; including:

– infection with cytomegalovirus,
– the use of amyl nitrite or butyl nitrate "poppers", and
– "immune overload".

• 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
• Five months later, in December 1981, the
first cases of PCP were reported in
injecting drug users

• At the same time the first case of AIDS was

documented in the UK
1982
• Different groups had different names:
– lymphadenopathy
– KSOI
– 'gay compromise syndrome’
– 'community-acquired immune dysfunction'
• In August, given the name AIDS, Acquired Immune
Deficiency Syndrome
• The doctors thought 'AIDS' suitable 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.
• "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

• A number of AIDS
organisations were already
producing safer sex advice
for gay men
• December
– a 20-month old child who had received multiple
transfusions of blood and blood products died
from infections related to AIDS.
– CDC reported the first cases of possible mother
to child transmission of AIDS

• "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
1983
• In May 1983, doctors at the Institute
Pasteur in France reported that they had
isolated a new virus, which they believed to
be the cause of AIDS.
• They named it LAV (lymphadenopathy-
associated virus)
• Little notice was taken
• The number of people who could become infected
was to widen again at the beginning of 1983,
when it was reported that the disease could be
passed on heterosexually from men to women

• "The sense of urgency is greatest for haemophiliacs. The risk for others [who
receive blood products] now appears small, but is unknown.“
• James Curan, Head of CDC Task Force
• A report of AIDS occurring in children
suggested quite incorrectly the
possibility of casual household
transmission
• In San Francisco, 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

• 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
• 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

• In November there began a global surveillance of AIDS by the WHO

1984
• 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
• On April 23th, the US 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 for the virus
• Continued concern about the public health aspects
of AIDS.
• Especially 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.

• "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".
• Mervyn Silverman,
Director of the San Francisco Department of Public Health
1985
• In January:
– it became clear that LAV and HTLV-III were the same.
– FDA licensed, for commercial production, the first blood
test for AIDS
– The test would reveal the presence of antibodies to
LAV/HTLV-III
– It was announced that anyone who had antibodies in
their blood would not in future be allowed to donate
blood
• A number of social and ethical issues, as well as
certain medical matters, had to be considered
before the new test could be used even to ensure
the safety of the blood supply
• Concern particularly centred on issues of
confidentiality and the meaning of a positive test
result
• "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
• Meanwhile in many countries there was a separate
"epidemic of fear" and prejudice
• In the UK
– Tabloid press, AIDS gained 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 gays and drug-users were seen as
having brought the disease upon themselves.
– The fear of AIDS caused firemen to ban the kiss of life
– Caused holidaymakers to cut their holiday short for
fear of contracting AIDS from an HIV-positive
passenger on the Queen Elisabeth 2.
– 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
• In the US, it was feared that drinking communion wine
from a common cup could transmit AIDS

• "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
Time For A Change
• On September 17th, President
Reagan publicly mentioned AIDS
for the first time
• 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
• The actor Rock Hudson died of
AIDS on October 3rd 1985. He
was the first major public figure
known to have died of AIDS

• All UK blood transfusion centres

began routine HIV testing of all
blood donations in October
1986
• The first UK needle exchange
scheme started in Dundee in
February
• In the UK, the government
launched, in March, the first
public information campaign
on AIDS, with the slogan
"Don't Aid AIDS".
• There were a series of
advertisements in national
newspapers
• There was still at this time disagreement about
the name of the virus
• In May, the International Committee on the
Taxonomy of Viruses ruled that both names
should be dropped and the dispute solved by a
new name, HIV, (Human Immunodeficiency
Virus)
• At the opening speech of the
International Conference in
Paris, Dr H Mahler, the
Director of WHO,
announced that as many as
10 million people world
wide could already be
infected with HIV
• 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
• 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
• In September there was dramatic progress in the
provision of medical treatment for AIDS.
• Early results of clinical tests showed that a drug
called azidothymidine (AZT) slowed down the attack
of the AIDS virus.
• AZT was first synthesised in 1964 as a possible
anticancer drug but it proved ineffective
Over
the
years
Today
• It is now generally accepted that HIV is a
descendant of a Simian Immunodeficiency Virus
because certain strains of SIVs bear a very close
resemblance to HIV-1 and HIV-2
• Theories for zoonosis:
– The ‘Hunter’ Theory
– The Oral Polio Theory
– The Contaminated Needle Theory
– The Colonialism Theory
– The Conspiracy Theory
• Three of the earliest known instances of HIV infection are as
follows:
1. A plasma sample taken in 1959 from an adult male living in
what is now the Democratic Republic of Congo.
2. HIV found in tissue samples from an American teenager who
died in St. Louis in 1969.
3. HIV found in tissue samples from a Norwegian sailor who
died around 1976.
• A 1998 analysis of the plasma sample from 1959 has
suggested7 that HIV-1 was introduced into humans around the
1940s or the early 1950s; much earlier than previously
thought. Other scientists have dated the sample to an even
earlier period - perhaps as far back as the end of the 19th
century
• So did it definitely come from Africa?
• Given the evidence, it is likely that Africa was indeed the
continent where the transfer of HIV to humans first
occurred (monkeys from Asia and South America have
never been found to have SIVs that could cause HIV in
humans).
• However, who exactly spread the virus from Africa , to
America and beyond remains a mystery.
• It is quite possible that separate 'pockets' of the virus could
have been developing in a number of different countries
years before the first cases were ever officially identified,
making it virtually impossible to trace one single source
• What did cause the epidemic to spread so
suddenly then?
• There are a number of factors that may have
contributed to the sudden spread of HIV, most of
which occurred in the latter half of the twentieth
century
– Travel
– The Blood Industry
– Drug use