These are some of the most important events that occurred in the history of AIDS over the period 1987-1992.
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
The ‘tombstone’ AIDS advert that was aired in 1987 in the UK. ©
"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", when there were numerous TV and radio programs on AIDS in the UK.6 Many other countries also had education campaigns.
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
Silence=Death, gay protest
'Silence=mort' is the French language version of 'Silence=Death'.
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" and the poster "AIDS: 1 in 61" about babies born HIV positive in New York City.16
On the other side of the world, in Australia, the Grim Reaper education campaign was launched, with television images of death mowing down a range of victims in a bowling alley. Although widely criticised at the time, the advertisements did succeed in ensuring widespread discussion of AIDS.17
The Australian AIDS commercial from 1987.
"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."18
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.19 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."20
But to many people it appears clear that HIV was isolated in Paris a year before it was isolated in the USA.21
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,
Kissing doesn't kill advert
Poster "Kissing doesn't Kill: Greed and indifference do" Gran Fury collection
"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."22
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."23
The WHO Global Programme on AIDS had 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, and it included the need for every country to have a "supportive and non-discriminatory social environment".24
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.25
Australian Grim Reaper advert
Grim Reaper (Australian AIDS campaign) circa 1987
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.26
"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."27
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.28 Subsequently in July the "Helms amendment" created by Senator Jesse Helms added HIV infection to the exclusion list.29 Few foresaw the implications of the addition and it went virtually unnoticed.30
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.31
In light of more widespread HIV testing, the CDC revised their definition of AIDS to place a greater emphasis on HIV infection status.32
Prejudice against people with HIV continued in America. The Ray family lived in Arcadia, Florida, and they had three sons, each of whom was a haemophiliac and was 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.33
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'.34
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.35 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.36
Shilts was the first to identify a French-Canadian flight attendant called Gaetan Dugas as '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.37 But there never was a Patient Zero.
1 in 61 advert
Poster "AIDS: 1 IN 61" Gran Fury collection
"There's no Patient Zero. It's lots and lots 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 Moss38
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.39 In Uganda, 16 volunteers who had been personally affected by HIV/AIDS came together to found the community organisation TASO.40
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.41
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.42 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.43
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).
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.44
1988 History
1988 World AIDS day logo
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, and there were delegates from 148 countries.
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.45 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 1988.46
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:
All people with AIDS are innocent
Poster "All people with AIDS are innocent" Gran Fury collection
"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."47
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.48 The distribution took place of 107 million copies of "Understanding AIDS", a booklet by Surgeon General C. Everett Koop.49 'Understanding AIDS' was the single most widely read publication in the United States in June 1988, with 86.9 million readers.50
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.51
"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."
AIDS activists conveying the message that every half an hour someone dies from AIDS; Washington DC, 1988
AIDS Activists, Washington DC, 1988
In the USA frustration continued to grow over the slowness of 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.52
Eight days after the ACT-UP demonstration the FDA announced new regulations to speed drug approval.53
The first official needle exchange was started in the US to prevent transmission of HIV through drug use.54 A limited experiment started in November in New York City and, at about the same time, the Prevention Point opened in San Francisco.55 56 But Congress prohibited the use of federal funds to support needle exchange programs.57
On December 1st, the first World AIDS Day took place, with the WHO asking everyone to "Join the Worldwide Effort."58
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.59 Much of the data that led to this approval was collected by CCC, the County Community Consortium of San Francisco, with further data collected by another community research organisation called CRI, the Community Research Initiative of New York.60
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.61
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.62 In June a protest against the law took place at the opening ceremony of the Fifth International Conference on AIDS in Montreal, when 250 protestors with placards stormed the stage.63
AZT bottles
Zidovudine, better known as AZT
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, and 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."
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.64 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".65 66
In September, the cost of the drug was cut by 20%.67
In October the second drug for the treatment of AIDS, dideoxyinosine (ddI), started to be 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."68
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'.69
In China, 146 people in Yunnan Province near the Burmese border were found to have HIV infection 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.70
"AIDS and drug addiction are still seen as consequences of contact with the West, AIDS being known as aizibing, the 'loving capitalism disease'."71
In New York city the needle exchange scheme was closed down.72
Jonathan Mann
Johnathan Mann
Jonathan Mann resigned as the head of the WHO AIDS programme, to protest against the failure of the UN and governments worldwide to respond adequately to the exploding pandemic, and to protest against the actions of the then WHO director-general Dr. Hiroshi Nakajima.73 During Jonathan Mann's leadership, the AIDS programme became the largest single programme in the organisation's history.74 But more importantly:
"Jonathan's persistence and passion helped wake up the world."75
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."76
Ryan White
Ryan White, 1971-1990
On April 8th Ryan White died in the United States. He was a haemophiliac infected with HIV through the use of infected blood products. He had become well known a few years earlier as a result of his fight to be allowed to attend public school.77 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 disease.78
In the UK and the US, there started to be more discussion about whether there would ever be a heterosexual epidemic because of the difficulty of female-to-male transmission of HIV.79 80 81
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 or not. The programme provoked a hostile response among the AIDS community and organisations.82 Some people felt that the programme was sensationalist and contained factual inaccuracies. It was also felt that the programme caused significant distress among people with HIV and undermined the efforts carried out in the field of HIV/AIDS prevention.83
Protests against the ban on HIV positive people entering America had 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".84 Consequently there was a widespread boycott of the conference, and many people who did speak 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."85
Many demonstrations took place during the conference week, the most significant being the "United Call to Action", in which activists, scientists, and many others marched together to emphasise the importance of unified action to end AIDS.86
ACTUP protestors at the AIDS conference
ACT-UP protests at AIDS Conference, San Francisco
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.87 As a result of the US travel policy, no major international AIDS conference was to be held in the USA after 1990.
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.88 A couple of months later the patient was named as 22-year old Kimberly Bergalis and the dentist was named as David Acer.89
"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 -90
In the UK, Prime Minister John Major announced that the Government would pay £42 million compensation to haemophiliacs infected with HIV and their dependants.91
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.92
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 given birth to around 3 million infants, of whom over 700,000 were likely to have become infected with HIV.
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.93 Such was the public concern about this 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.94 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.95 96
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 HIV-positive.97
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:98
"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.99 100
During the summer, a third antiretroviral drug dideoxycytidine (ddC) was authorised by the FDA for use by patients intolerant of AZT.101
Also during the summer, a study was published which showed that HIV was transmitted much more easily through breast milk than had previously been thought.102 But despite admitting that the news was discouraging, the 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.103
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.104
A video of Magic Johnson announcing his retirement at a press conference on 7th November 1991
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." - 105
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.106
In France, haemophiliacs who became infected through infected 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.107 108
AIDS Ribbon
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.109
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.110
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.111
In the UK, the Department of Health made it an offence to sell, advertise or supply HIV antibody testing kits to the public.112
During 1992, a major UK newspaper ran a series of articles challenging the orthodox view that HIV alone causes AIDS.113
"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 Hodgkinson114
Many other British newspapers joined the heated debate with journalists, researchers, activists and organisations expressing their opinions about the cause of AIDS.115
"'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?" - 116
Tennis star Arthur Ashe announced that he had been infected with HIV as a result of a blood transfusion in 1983.117
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.118
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.119
"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 1993.120 121
The VIII International Conference was successfully held in Amsterdam rather than in its originally planned venue in Boston due to the U.S. travel policies on HIV positive people.122
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.123 124 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.125
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% of the national health budget. Most of this money would come from a World Bank loan.126 Experts predicted that within five years there might be more people affected by AIDS in India than in any other country
These are some of the most important events that have occurred in the history 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 6 of these new cases were acquired through heterosexual intercourse.5
HIV positive Romanian children
HIV-positive Romanian children
In Romania, despite the progress made since the overthrow of the Causescu 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% 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
A video of Princess Diana speaking at an AIDS conference in 1993.
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
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
A video of Dr R.P. Brettle talking in 1993 about AIDS treatment and the results of the Concorde trial.
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 22
The World Bank reviewed it activities against AIDS in 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".23
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'.”24
At the beginning of the year the CDC had expanded the US definition of AIDS to include people with other 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. European data collection on this basis began on July 1st.25
In mid-1993 six United Nations organizations, including the WHO, began to seek agreement on forming a novel joint and cosponsored UN programme on HIV/AIDS.26
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.27
A video of Dr. Brettle talking in 1993 about combination therapy.
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.28 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.29
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.30 The Federal Government also admitted that officials had covered up 373 cases of HIV-contaminated blood in the 1980s.31
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.32
At the end of 1993 the estimated number of AIDS cases worldwide was 2.5 million33
Region Estimated Adult HIV infection Estimated adult AIDS cases
Australasia >25000 5000
North America >1 million 400000
Western Europe 500000 125000
Latin America & Caribbean 1.7 million 300000
Sub-Saharan Africa >9 million 1.7 million
South and South-East Asia 2 million >75000
East Asia and Pacific >35000 >1000
Eastern Europe and Central Asia >50000 4500
North Africa & The Middle East 75000 12000
Total >14 million >2.5 million
1994 History
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.'"34
Your pocket guide to sex
'Your Pocket Guide to Sex' Book
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.35 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".36
In February the film maker Derek Jarman died of AIDS. He wrote 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."37
Randy Shilts
Randy Shilts
Randy Shilts, author of the book 'And the band played on' also died in February.38
In March, the actor Tom Hanks won an Oscar for playing a gay man with AIDS in the film Philadelphia.39
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 20-35.40
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.41 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. 42
European safe sex campaign
'The Flying Condom' AIDS prevention campaign, Europe
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.43
A large European study on mother-to-child transmission showed that Caesarean section halved the rate of HIV transmission.44
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% in 1989 to 94% in 1993.45
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% in the past year from an estimated 2.5 million in July 1993 to 4 million in July 1994.46 It was estimated that worldwide there were three men infected for every two women, and that by the year 2000 the number of new infections among women would be equal to that among men.47
At the end of July, the UN Economic and Social Council approved the establishment of a new "joint and cosponsored UN programme on HIV/AIDS" to replace the WHO's Global Programme on 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 1996.48 Later 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.49
A study, ACTG 076, showed that AZT reduced by two thirds the risk of HIV transmission from infected mothers to their babies.50 Somepeople believed that ACTG076 was:
“the most stunning and important result in clinical acquired immunodeficiency syndrome research to date.”51
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 -52
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.53
Pedro Zamora
Pedro Zamora
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.54
India by this time had around 1.6 million people living with HIV, up by 60% since 1993. Local and state governments were accused of underusing and misusing HIV prevention funds.55
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.56
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 AIDS.57
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.58
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 -59
Two research reports provided important new information about how HIV replicates in the body and how it affects the immune system.60 61
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.62 63
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.64 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."65
The South African Ministry of Health announced that some 850,000 people - 2.1% of the 40 million population - were believed to be HIV positive. Among pregnant women the figure had reached 8% and was rising.66
Peter Piot
Peter Piot Director of UNAIDS
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.67
In July, the US Senate voted to extend the Ryan White Care Act.68 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".69
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."70
Also in August, researchers announced the results of a study in Tanzania, which found that treating people for sexually transmitted diseases such as gonorrhoea substantially reduced their risk of becoming infected with HIV.71
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.72
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."73
Protease Inhibitors
Protease Inhibitors
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."74
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.75
Other organisations estimated that by the end of 1995, 9.2 million people worldwide had died from AIDS.76
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 infection.77
The WHO's Global programme on AIDS closed as planned on 31st December 1995.78 They estimated that by the end of the century, 30 to 40 million people would have been affected by HIV.79
1996 History
United Nations Logo
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.80
In February the heavyweight boxer Tommy Morrison was identified as HIV positive after being tested prior to a fight.81
"'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.' - These words were spoken not in 1986 but in 1996 by Tommy Morrison."82
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."83
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."84
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 American 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.'"85
Meanwhile in China it was estimated that the actual 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 dirty needles had helped the spread of HIV.86
Nevirapine
Nevirapine (Viramune)
In June the FDA approved the drug Viramune (nevirapine), the first in a new class of drugs known as non-nucleoside reverse transcriptase inhibitors.87 Another treatment development that took place was the introduction of the viral load test, which provided information about the risk of disease progression.88
Throughout 1996 there was excitement and optimism about the treatment of HIV infected people.89 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".90
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."91
Some scientists even declared that:
"aggressive treatment with multiple drugs can convert deadly AIDS into a chronic, manageable disorder like diabetes."92
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.93
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."94
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.95
"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 Sawyer96
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.97
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.98 99
"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 Turney100
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 plan101
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 Donato102
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 Piot103
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
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.104 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 Ward105
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.106 The number of babies being born HIV positive had also declined dramatically.107
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 with many pills needing to be taken each day.108
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.109 110 Some doctors were particularly concerned about the recommendations concerning the beginning of treatment when patients did not have symptoms.111 The US approach was sometimes referred to as the "hit early, hit hard"112 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.113
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 Clinton114
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 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.115
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.116
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.117
"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 Times118
South African Kids
South African Children
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.119
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."120
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."121
These are some of the most important events that occurred in the history 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 contained 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
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 Francisco13
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 Curran15
Red ribbon in South Africa dedicated to Gugu Dlamini
Red ribbon in South Africa dedicated to Gugu Dlamini
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 Mbeki18
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
Country 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
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.24 Later 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.27 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%.28 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 1999.29
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."30
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.31
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.32
"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 2002.33
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 1984.34 A survey published in August found that growing numbers of gay men in San Francisco were having unprotected sex.35 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.36
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.37
Injecting drug use in Russia
Drug use in Russia
"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."38
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.39 Shortly after the advertisement was seen by hundreds of millions of people, it was banned by the State Administration of Industry and Commerce.40
'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.41
T-20, a member of a new class of AIDS drugs called fusion inhibitors, went into clinical trials.42
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 Moi43
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.44
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 25.45
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.46 It was also reported that for the first time more women than men were infected with HIV in Africa.47
"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"48
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.49
2000 History
Jesse Jackson publicly taking an oral HIV test
Jesse Jackson publicly taking an oral HIV test
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.50 In order to publicise the importance of HIV testing for African Americans, reverend Jesse Jackson publicly took an oral HIV test.51
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.52
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.53 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.54
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.55
"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 CDC56
Thabo Mbeki
Thabo Mbeki
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.57 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.58
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 Force59
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."60
In Botswana, as many as one in four adults and four of every ten pregnant women were estimated to be infected with HIV.61 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.62
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.63
"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 Clinton64
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.65
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."66
Five pharmaceutical companies offered to negotiate steep reductions in the prices of AIDS drugs for Africa and other poor regions.67 A couple of months later the United States offered sub-Saharan African nations loans to finance the purchase of AIDS drugs and medical services.68 The offer was not seen as very helpful and was rejected by many African nations.69
"Making drugs affordable is the solution rather than offering loans that have interest."70
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. 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 year-old children in Botswana would die of AIDS before they reached 50.71
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.72
HIV positive woman marching during the AIDS conference
HIV positive woman marching during the Durban AIDS conference
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.73 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.74
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.75
"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."76
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.77
Nelson Mandela, South Africa's former president, closed the AIDS conference with a call for action to combine efforts and save people.78
"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.79
"If you use nonoxynol-9, you are either wasting your money or possibly wasting your life."Dr. Joseph Perriens80
For some people these were not surprising findings, since the toxic effects of nonoxynol-9 had been reported since 1989.81
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.82 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.83
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 -84
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."85
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.86
There has been a lot of confusion about what Mbeki said and did not say during the year.87 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."88
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.89
2001 History
Chinese campaign poster for World AIDS day
Chinese campaign poster for World AIDS day, 2001
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 2005.90 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.91
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.92
The U.S. Government threatened Brazil with legal action over its production of generic HIV drugs.93 The complaint was dropped later in the year and Brazil promised to give the USA advance warning before changing its patent law for drugs.94
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 Tshabalala-Msimang, who said that the government already offered adequate treatment to AIDS patients and that proposals to buy antiretroviral drugs were still being considered.95 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 2000.96
According to a CDC study of six large U.S. cities, 30% of young gay black men were infected with HIV.97
"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 CDC98
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."99
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.100
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 2000.101
"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 Evans102
Kofi Annan
Kofi Annan
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.103 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.104 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.105
"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 Genoa106
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.107 The amount of money donated to the Fund was a disappointingly low $1.6 billion108much 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 AIDS109
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."110
Kofi Annan appointed the Canadian Stephen Lewis as his 'Special Envoy for AIDS in Africa'.111
Stephen Lewis
Stephen Lewis
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.112
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 2010.113
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.114
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.115
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.116
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.117
"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."118
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.119
Publicty for the UN special sessions on HIV/AIDS 2001
Publicty for the UN special session on HIV/AIDS 2001
In August, AIDS activists took legal action against the South African health ministry over its continuing refusal to supply antiretrovirals to prevent mother-to-child transmission (MTCT) of HIV.120 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 2002.121
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.122
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 2000.123 Meanwhile HIV was spreading fastest in Eastern Europe and Russia.124
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 15,000.125
2002 History
Ukraine became the first nation in Europe to have 1% of its adult population infected with HIV.126
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.127
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."128
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."129
Later in the year, for the first time ever in Brazil, an HIV prevention campaign was being aimed at male homosexuals.130
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.131
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.132
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.133
The board of directors of the Global Fund to Fight AIDS, Tuberculosis and Malaria selected Richard Feachem to be its first leader.134 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.135
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."136
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.137
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.138
"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. Wolfensohn139
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.140
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.141
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.142
Treatment activist protesting during the 2002 conference
Treatment activist protesting during the 2002 AIDS conference
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 ceremony143
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'.144
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.145
"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.146
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.147
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'.148
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.149
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.150
HIV+ woman South Africa
For the first time, it was reported that women accounted for about half of all HIV-infected adults.
"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."151
A study controversially suggested that more people in Africa may have been infected with HIV through medical injections and treatments than was previously thought.152
"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."153
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.154
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.155
These are some of the most important events that occurred in the history of AIDS from 2003 to 2006.
2003 History
Reports in January suggested that the rate of HIV in Swaziland was the world's highest with almost four out of ten adults infected. Prime Minister Sibusiso Dlamini said that prevalence had risen to 38.6% from 34.2% in January 2002. Although this figure was just under Botswana's rate of 38.8%, health officials said that Swaziland's figures were 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 Bush5
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 practises were to blame for an important portion of HIV transmission in Africa.10
AIDS vaccine development
AIDS vaccine development
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 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 -12
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.13
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.14
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.15
The antiretroviral Fuzeon (T-20)
The antiretroviral Fuzeon (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.16
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 recently-licensed rapid HIV test would play a key role in the new initiative.17
The US Senate approved President Bush's international AIDS bill in May, setting a timetable for spending $15 billion over five years.18
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.19
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.20
Meanwhile concerns were mounting over the Global Fund's sustainability as it faced a serious funding shortfall.21
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.22
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.23
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 -24
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."25
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.26
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.27
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.28
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.29
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.30
UNAIDS warned that the efforts to stem the world's AIDS epidemic were 'entirely inadequate'. It was estimated that every day in 2003, around 14,000 people became infected with HIV. It was estimated that 40 million around the world including 2.5 million children were living with HIV/AIDS.31
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 -32
On World AIDS Day the WHO announced a new plan called '3 by 5' to provide HIV/AIDS treatment for many resource-poor countries. The plan had many different elements, but the WHO were not planning to provide the drugs themselves. The WHO was hoping to have 3 million people in resource poor countries on AIDS drugs by the end of 2005.33
"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."34
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 -35
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.36
According to new estimates, the number of people infected with HIV in the UK increased by almost 20% between 2001 and 2002, from 41,700 to 49,500, of whom 31% 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 -37
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 $1,200.38 Also, 10 million free condoms were given out to people in Brazil during the carnival season as part of an AIDS-prevention campaign.39
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% of the 15 million population were HIV-positive.40
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.41
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 2045.42 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." 43
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 -44
In March, the US Food and Drug Administration approved the first oral fluid rapid HIV test.45
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.46
"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." - 27-year-old HIV-positive South African man -47
A study found that the HIV prevalence rate in Uganda had been reduced by 70% 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.48
"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.49
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 2000.50
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.51 52
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 2005.53
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.54
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 2003.55
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.56
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.57
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.58
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.59
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.60 61 62
"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 Day63
2005 History
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.64
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.65 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.66
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 PEPFAR-funded 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 FDA-approved generic, and was predicted to mark a turning point in providing cheaper treatment in Africa.67
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 Mandela68
Publication of death certificate data from South Africa revealed that the total number of reported deaths had increased by 57% between 1997 and 2002. Among those aged 25-49 years, the rise was 116% in the same six year period.69 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 HIV had been misclassified (wrongly attributed to other causes) during 2000-2001.70
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 -71
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".72
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.73
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.74 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.75
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% were black. One in four HIV-positive 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.76
Make Poverty History rally
Over 225,000 people gather to form a human
white band around Edinburgh city centre,
as part of the Make Poverty History campaign.
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 2010.77
South Africa's latest antenatal clinic survey showed that 29.5% 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.78
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 2005.79 80 81
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.82 PEPFAR would not begin distributing generic drugs until near the end of the year.83
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.84 85 86
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"87
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".88 89
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.90
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" 91
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.92 93
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 Tshabalala-Msimang.
"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 -94
London bus appeals for universal access to AIDS treatment
A London bus covered with hundreds of hand-written messages from campaigners appealing for universal access to AIDS treatment, on World AIDS Day 2005.
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 said sorry.
"All we can do is apologise. I think we just have to admit we’ve 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."95
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 950096
2006 History
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.97
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% treatment coverage. Among the worst performers were Russia and India, and among the best was Botswana, where coverage had reached around 85%.
"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 Jong-wook98
PEPFAR announced that it was helping to provide treatment to 401,000 people in its fifteen focus countries,99 but this news was soon overshadowed by yet more criticism of the plan’s 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.100
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.”101
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 -102
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.103
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.104
The UNAIDS report also revealed that funding for the response to AIDS in low- and 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.105
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 Secretary106
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.107
Bill Gates with President Bill Clinton at the International AIDS Conference in Toronto
Bill Gates with President Bill Clinton at the International AIDS Conference in Toronto
The Gates Foundation – the world’s 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.108
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.109
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 WHOand 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 government’s response to AIDS. Activists protested at the country’s 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 Africa’s leaders would not talk openly about AIDS.110 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.”111
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.112 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.113
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 130-page journal was entirely devoted to AIDS-related articles, and included prominent adverts for Product RED merchandise.114 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.115
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 XDR-TB (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 co-infected with HIV. Experts were concerned that they might be seeing the beginning of a devastating new epidemic.
The Lancet's RED edition
The Lancet's RED edition, August 2006
“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 WHO116
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.117
Product RED was launched in the USA in October, by which time Apple and Motorola were also supporting the brand.118
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% - a level not usually seen outside Africa. The country's health minister said that some isolated pockets could have rates as high as 30%.
“Papua New Guinea probably is somewhat in a class of its own in this region.” - Dr. Kevin De Cock119
In December, South Africa’s 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 country’s 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 country’s response to HIV and AIDS.120 121
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%. 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.122
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.123
These are some of the most important events that occurred in the history of AIDS from 2007 onwards.
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.1 UNAIDS 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
President Yahya Jammeh sitting & dressed in white
President Jammeh of The Gambia claimed he could cure AIDS
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 day’s treatment. Within three days the person should be tested again and I can tell you that he/she will be negative...”3
Jammeh’s claim was soon revealed to be unfounded. A scientist who conducted the tests rebutted the study’s findings, saying that none of the trial patients “could be described as cured.”4 Despite 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 president’s claims “shocking and irresponsible”5, not only for providing false hope, but also for risking people’s 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 Mlambo-Ngcuka, 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.6 The 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 HIV-positive 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”.9 The 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.10 Although 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
People wearing purple protesting
Protest at South African Deputy Health Minister's sacking
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.14 The 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
Optimism regarding South Africa’s 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-Routledge’s 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 President’s 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.18
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.”19 It 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.20
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.21
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”. 22
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 23. UNAIDS and the WHO quickly issued a statement stressing that consistent use of condoms was still the safest protection against HIV. 24
Michel Sidibe, Executive Director of UNAIDS giving a speach.
Michel Sidibé, 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". 25 Later in the year it was announced that Michel Sidibé would be Piot’s successor. 26 27
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. 28
The American PEPFAR funding program was renewed on 30th July, committing $48 billion to HIV/AIDS, malaria and tuberculosis for fiscal years 2009-2013.29 This 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. 30
The Reauthorization Act 31 also 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. 32
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”. 33 The effect of the outbreak on people living with HIV and AIDS was compounded by the collapse of the health system, the government’s block on foreign aid, and widespread malnutrition, leading to an equally devastating AIDS crisis. 34 35
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. 36 The government’s 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 37
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. 38
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 sub-Saharan 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. 39
Dr. Robert Gallo
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 government’s failures in the provision of antiretroviral drugs. 40 The 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. 41 42
An old controversy was revived in October with the announcement of the winners of the Nobel Prize for medicine. The prize was split between Françoise Barré-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." 43
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”. 44 However, it was generally accepted that the operation did not present a viable cure for AIDS. 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. 45
100 days to fight AIDS March in washington D.C.
"100 days to fight AIDS" march in Washington D.C.
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 America’s HIV/AIDS strategy. 46 At 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 America’s response to HIV and AIDS overseas, Obama pledged that he would substantially increase funding to both PEPFAR and the Global Fund. 47 However, commentators have questioned the likelihood of this pledge being followed through in the context of the unfolding international financial crisis.
Obama also openly supported lifting the ban on states using federal funding for needle exchange programmes 48 and 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. 49
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