The presence of other sexually transmitted infections (STIs)– especially those
causing ulcers, which are common in most developing countries – facilitates
heterosexual transmission." [41] "The World Health Organization
estimates that heterosexual transmission has accounted for 75% of the HIV
infections in adults world-wide." Globally, 85% of HIV transmission is
through heterosexual intercourse. [40] "The major route of HIV
transmission worldwide is heterosexual sex, although risk factors vary within
and across populations. In many regions of the world, men who have sex with
men, injection drug users, and sex workers account for significant proportions
of infections." [4]
"Anyone at any age can get HIV/AIDS." [33] "AIDS Diagnoses by Age" [21] Unicef today said it was a "disgrace" that more than 95% of children with Aids around the world were not receiving any treatment. The UN charity, launching a global campaign to highlight the disease's impact on children, said 1,800 were infected with the virus every day. Unicef said that, every minute, a child dies of an Aids-related illness, a child becomes infected with HIV, and four people aged between 15 and 24 become infected. [42] According to estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS [47] and the World Health Organization (WHO), 1.4 million children were living with HIV at the end of 2000. In 2000, an estimated 600,000 children aged 14 or younger became infected with HIV. More than 1,000 children are newly infected with HIV every day, and of these more than half will die as a result of AIDS because of a lack of access to HIV treatment. At the end of 2009, there were 2.5 million children living with HIV around the world. An estimated 400,000 children became newly infected with HIV in 2009. Of the 1.8 million people who died of AIDS during 2009, one in seven were children. Every hour, around 30 children die as a result of AIDS. [31] Every minute of every day a child under the age of 15 is infected with HIV. 1,400 children die of AIDS each day and more than a half million young lives are claimed by this disease each year. According to the UNAIDS 2006 Report [4] there are 2.3 million children (under the age of 15) living with HIV/AIDS around the world.
AIDS is caused by the Human immunodeficiency virus (HIV), which originated in non-human primates in Sub-Saharan Africa and was transferred to humans during the late 19th or early 20th century. Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century. HIV descends from the related simian immunodeficiency virus (SIV), which infects apes and monkeys in Africa. Most HIV researchers agree that HIV evolved at some point from the closely related Simian immunodeficiency virus (SIV), and that SIV or HIV (post mutation) was transferred from non-human primates to humans in the recent past (as a type of zoonosis). Two types of HIV infect humans: HIV-1 and HIV-2. HIV-1 is more virulent, is more easily transmitted and is the cause of the vast majority of HIV infections globally. [22] The pandemic strain of HIV-1 is closely related to a virus found in the chimpanzees of the subspecies Pan troglodytes, which lives in the forests of the Central African nations of Cameroon, Equatorial Guinea, Gabon, Republic of Congo (or Congo-Brazzaville), and Central African Republic. Scientists generally accept that the known strains (or groups) of HIV-1 are most closely related to the simian immunodeficiency viruses (SIVs) endemic in wild ape populations of West Central African forests. Particularly, each of the known HIV-1 strains is either closely related to the SIV that infects the chimpanzee subspecies Pan troglodytes (SIVcpz), or to the SIV that infects Western lowland gorillas (Gorilla gorilla), called SIVgor. [8] The pandemic HIV-1 strain (group M or Main) and a very rare strain only found in a few Cameroonian people (group N) are clearly derived from SIVcpz strains endemic in Pan troglodytes chimpanzee populations living in Cameroon. [48]
Another very rare HIV-1 strain (group P) is clearly derived from SIVgor strains of the same country. Finally, the primate ancestor of HIV-1 group O, a strain infecting tens of thousands of people mostly from Cameroon but also from neighboring countries, is still uncertain, but there is evidence that it is either SIVcpz or SIVgor. [9] It is clear that the several HIV-1 and HIV-2 strains descend from SIVcpz, SIVgor, and SIVsmm viruses, and that bush meat practice provides the most plausible venue for cross-species transfer to humans. [9] According to the natural transfer theory (also called 'Hunter Theory' or 'Bush meat Theory'), the "simplest and most plausible explanation for the cross-species transmission" of SIV or HIV (post mutation), the virus was transmitted from an ape or monkey to a human when a hunter or bush meat vendor/handler was bitten or cut while hunting or butchering the animal. [10] The resulting exposure to blood or other bodily fluids of the animal can result in SIV infection. [10] The pandemic HIV-1 group M is most closely related to the SIVcpz collected from the southeastern rain forests of Cameroon (modern East Province) near the Sangha River. [8] Thus, this region is presumably where the virus was first transmitted from chimpanzees to humans. However, reviews of the epidemiological evidence of early HIV-1 infection in stored blood samples, and of old cases of AIDS in Central Africa have led many scientists to believe that HIV-1 group M early human epicenter was probably not in Cameroon, but rather farther south in the Democratic Republic of the Congo, more probably in its capital city, Kinshasa. [48] A study published in 2008, analyzing viral sequences recovered from a recently discovered biopsy made in Kinshasa, in 1960, along with previously known sequences, suggested a common ancestor between 1873 and 1933 (with central estimates varying between 1902 and 1921). The earliest known positive identification of the HIV-1 virus comes from the Congo in 1959 and 1960 though genetic studies indicate that it passed into the human population from chimpanzees around fifty years earlier. [44] Some molecular datation studies suggest that HIV-1 group M had its most recent common ancestor (MRCA) (that is, started to spread in the human population) in the early 20th century, probably between 1915 and 1941. [20] Using HIV-1 sequences preserved in human biological samples along with estimates of viral mutation rates, scientists calculate that the jump from chimpanzee to human probably happened during the late 19th or early 20th century, a time of rapid urbanization and colonization in equatorial Africa. There is evidence that humans who participate in bush meat activities, either as hunters or as bush meat vendors, commonly acquire SIV. However, only a few of these infections were able to cause epidemics in humans, and all did so in the late 19th—early 20th century. To explain why HIV became epidemic only by that time, there are several theories, each invoking specific driving factors that may have promoted SIV adaptation to humans, or initial spread: social changes following colonialism, rapid transmission of SIV through unsafe or unsterile injections (that is, injections in which the needle is reused without being sterilized), colonial abuses and unsafe smallpox vaccinations or injections, or prostitution and the concomitant high frequency of genital ulcer diseases (such as syphilis) in nascent colonial cities. [38]
In 1983, two separate research groups led by Robert Gallo and Luc Montagnier independently declared that a novel retrovirus may have been infecting AIDS patients, and published their findings in the same issue of the journal Science. [7] [28] In May 1983, doctors from Dr. Luc Montagnier's team at the Pasteur Institute in France reported that they had isolated a new retrovirus from lymphoid ganglions that they believed was the cause of AIDS. [7] The virus was later named lymphadenopathy-associated virus (LAV) and a sample was sent to the U.S. Centers for Disease Control, which was later passed to the National Cancer Institute (NCI). On May 4, 1984, Gallo and his collaborators published a series of four papers in the scientific journal Science demonstrating that a retrovirus they had isolated, called HTLV-III in the belief that the virus was related to the leukemia viruses of Gallo's earlier work, was the cause of AIDS. [14] [26] [27] [29] A French team at the Pasteur Institute in Paris, France, led by Luc Montagnier, had published a paper in Science in 1983, describing a retrovirus they called LAV (lymphadenopathy associated virus), isolated from a patient at risk for AIDS. [7] In May 1984 a team led by Robert Gallo of the United States confirmed the discovery of the virus, but they renamed it human T lymphotropic virus type III (HTLV-III). [26] In January 1985 a number of more detailed reports were published concerning LAV and HTLV-III, and by March it was clear that the viruses were the same, were from the same source, and were the etiological agent of AIDS. In May 1986, the International Committee on Taxonomy of Viruses ruled that both names should be dropped and a new name, HIV (Human Immunodeficiency Virus), be used. [50] In 2008, Together with his colleague Françoise Barré-Sinoussi from the Institute Pasteur, Montagnier was awarded one half of the 2008 Nobel Prize in Physiology or Medicine for their work on the "discovery of human immunodeficiency virus". Harald zur Hausen also shared the Prize for his discovery that human papilloma viruses lead to cervical cancer, but Gallo was left out.
HIV-1 strains are thought to have arrived in the United States from Haiti in the late 1960s or early 1970s. [30] A 2007 study states that a strain of HIV-1 probably moved from Africa to Haiti and then entered the United States around 1969. [30] HIV-1 is believed to have arrived in Haiti from central Africa, possibly through professional contacts with the Democratic Republic of the Congo. The current consensus is that HIV was introduced to Haiti by an unknown individual or individuals who contracted it while working in the Democratic Republic of the Congo circa 1966, or from another person who worked there during that time. A mini-epidemic followed, and, circa 1969, yet another unknown individual brought HIV from Haiti to the United States.
Ardoin Antonio, a Jamaican-American shipping clerk who was raised in Haiti, died in New York on June 28, 1959 of Pneumocystis Pneumonia, an AIDS-defining illness.
One of the earliest documented HIV-1 infections was discovered in a preserved blood sample taken in 1959 from a man from Leopoldville, Belgian Congo (now Kinshasa, Democratic Republic of the Congo). A second early documented HIV-1 infection was discovered in a preserved lymph node biopsy sample taken in 1960 from a woman from Leopoldville, Belgian Congo.
The first confirmed case of AIDS in the United States, a 15-year-old teenage boy who died in 1969. Robert Rayford has since been confirmed as the first documented victim of HIV/AIDS in North America, having died at age 16 in May 1969. In 1969, a 15-year-old African-American male known to medicine as Robert R. died at the St. Louis City Hospital from aggressive Kaposi's sarcoma. Robert Rayford (c. 1953 – May 15 or May 16,1969), sometimes identified as Robert R. due to his age, was an American teenager from Missouri who was the earliest confirmed victim of HIV/AIDS in North America. AIDS was suspected as early as 1984, and in 1987, researchers at Tulane University School of Medicine confirmed this, finding HIV-1 in his preserved blood and tissues. Robert had never traveled outside the United States and, indeed, never left the Midwest, and had told doctors that he had never received a blood transfusion. Since Rayford's infection was almost certainly through sexual contact and he had never left the country, it is obvious that he must have received the virus from somebody else already living with it in the United States, meaning that AIDS was present in North America before Robert began showing symptoms in 1966. He also never ventured into cosmopolitan cities such as New York, Los Angeles, or San Francisco, which were the sites where the HIV-AIDS epidemic was first observed in the United States. He reported having experienced symptoms since 1966.
A Norwegian sailor and truck driver, who was probably infected in Cameroon some time between 1961 and 1965, and died in 1976. In 1976, a Norwegian sailor, with the alias name Arvid Noe, his wife, and his nine-year-old daughter died of AIDS. Arvid Noe (1946 – 1976) is the alias of a Norwegian sailor who is the first person known to have contracted HIV and died from AIDS outside of the United States. He is the second person confirmed to have died from AIDS, after the teenager known as Robert R., from St. Louis, Missouri, in 1969. The sailor had first presented symptoms in 1969, eight years after he first spent time in ports along the West African coastline. Based on research conducted after his death, Noe is believed to have contracted HIV in Cameroon in 1961 or '62, where he was known to have been sexually active with many African women, including prostitutes. Tissues of Noe, his wife and daughter all tested positive for HIV in an epidemiology study in 1988. Tissue samples from the sailor and his wife were tested in 1988 and found to contain HIV-1 (Group O). Noe was infected with HIV-1 group O, which is known to have been prevalent in Cameroon in the early 1960s.
Margrethe P. Rask (1930 – December 12, 1977), better known as Grethe Rask, was a Danish physician and surgeon who practiced medicine in what was then known as Zaire (today the Democratic Republic of the Congo). She was likely directly exposed to blood from many Congolese patients, one of who infected her. She died in December 1977. Rask, who died three and a half years prior to AIDS being recognized by the Centers for Disease Control in June 1981, was one of the first non-Africans (along with Arvid Noe) known to have died of AIDS-related causes.
Gaëtan Dugas (French: [ɡaetɑ̃ dyˈɡa]; February 20, 1953 – March 30, 1984) was a Canadian who worked for the national carrier as a flight attendant. Gaëtan Dugas, so-called "Patient Zero", was a flight attendant who had over 2,500 sexual partners across North America. Dugas became notorious as the alleged patient zero for AIDS, though he is now more accurately regarded as one of many highly sexually active men who spread AIDS widely before the disease was identified. [24] A Canadian airline steward named Gaëtan Dugas was referred to as "Patient 0" in an early AIDS study by Dr. William Darrow of the Centers for Disease Control. He was called "Patient Zero" because at least 40 of the 248 people known to be infected by AIDS in 1983 had had sex with him, or with someone who had sexual intercourse with him. At least 40 of the 248 people diagnosed with AIDS by April 1982 were thought to have had sex either with him or with someone who had. Because of this, many people had considered Dugas to be responsible for bringing HIV to North America. This is inaccurate however, as HIV had spread long before Dugas began his career. [30] The vast majority of cases of AIDS outside sub-Saharan Africa can be traced back to that single patient (although numerous unrelated incidents of AIDS among Haitian immigrants to the U.S. were recorded in the early 1980s, and, as evidenced by the case of Robert R., isolated incidents of this infection may have been occurring as early as 1966.) [30] A November 2007 article in the Proceedings of the National Academy of Sciences dismisses the Patient Zero hypothesis and claims that AIDS transited from Africa to Haiti in 1966 and from Haiti to the United States in 1969. [30]
One of the first high profile victims of AIDS was the American Rock Hudson, a gay actor who had been married and divorced earlier in life, who died on 2 October 1985 having announced that he was suffering from the virus on 25 July that year. It had been diagnosed during 1984. The virus claimed perhaps its most famous victim yet on 24 November 1991, when British rock star Freddie Mercury, lead singer of the band Queen, died from an AIDS related illness having only announced that he was suffering from the illness the previous day. However he had been diagnosed as HIV positive during 1987. One of the first high profile heterosexual victims of the virus was Arthur Ashe, the American tennis player. He was diagnosed as HIV positive on 31 August 1988, having contracted the virus from blood transfusions during heart surgery earlier in the 1980s. Further tests within 24 hours of the initial diagnosis revealed that Ashe had AIDS, but he did not tell the public about his diagnosis until April 1992. He died, aged 49, as a result of the AIDS virus on 6 February 1993.
The original name for what is know as "Human Immunodeficiency Virus" (HIV), which causes "Acquired Immunodeficiency Syndrome" (AIDS) in Humans was "Simian Immunodeficiency Virus" (SIV) [35] which causes [1] "Simian Acquired Immune Deficiency Syndrome" (SAIDS) [34] in wild Chimpanzees [8] (Pan troglodytes) [45] Based on analysis of strains found in four species of monkeys from Bioko Island, which was isolated from the mainland by rising sea levels about 11,000 years ago, it has been concluded that SIV has been present in monkeys and apes for at least 32,000 years, and probably much longer. Prior to 1982, AIDS was known as "Community-Acquired Immune Dysfunction" and to the Centers For Disease Control And Prevention (CDC) as "The 4H Disease" [48] The term AIDS (for acquired immune deficiency syndrome) was proposed at a meeting in Washington, D.C., on July 27, 1982. [37] By September 1982 the CDC started using the name AIDS, and properly defined the illness. The CDC used the term for the first time in September 1982, when it reported that an average of one to two cases of AIDS were being diagnosed in America every day. [19] [49] Michael Gottlieb was the principal author of the first report that appeared in the Morbidity and Mortality Weekly Report for June 5, 1981 under the quiet title “Pneumocystis carinii pneumonia (PCP)— Los Angeles.” The initial report described emergency rooms in New York City and Los Angeles seeing a rash a number of previously seemingly healthy young men showing up in both places who suddenly began to develop fevers, flu-like symptoms, and rare types of pneumonia, including PCP, rare opportunistic infections and cancers, including Kaposi's sarcoma, and other unusual infections and other rare illnesses which until then had been virtually unheard of among such people, and that seemed stubbornly resistant to any treatment being reported by doctors in New York and California from 1979-1981. In July of that year, the New York Times reported some bizarre new disease outbreaks of a rare form of cancer, later identified as Kaposi's Sarcoma (a kind of tumor that later became the face of HIV/AIDS), among men in New York and California. Other opportunistic infections accompanied these diagnoses. This report was followed quickly by more series, and within a few months, the basic outline of the epidemic was established. Additional opportunistic complications were soon described, including mycobacterium infections, toxoplasmosis, invasive fungal infections, Kaposi’s sarcoma, and non-Hodgkin’s lymphoma. Within months, dozens of similar cases had been reported in 23 American states and in the UK, representing the start of a massive and unprecedented epidemic. At this time, AIDS did not yet have a name, but it quickly became obvious that all the men were suffering from a common syndrome. Doctors soon discovered a distinctive feature of these cases. All patients presenting with these uncommon illnesses were strangely immunodeficient—their immune systems could not fight off even simple infections. This immune deficiency explained why they were so vulnerable to disease, and many died soon after. Each had abnormal ratios of lymphocyte subgroups and was actively shedding cytomegalovirus. The evidence that the disease was caused by cytomegalovirus, as posited in the early reports, was straightforward: groups with the new immunodeficiency had extremely high rates of infection with cytomegalovirus, a potentially immunosuppressive virus. More than anything else, the men were lacking a specific type of white blood cell, which is essential to a healthy immune system. Normally, people have between 600 and 1,500 "CD4+ cells" (also called T helper cells) in each cubic millimeter of their blood. But the men with the strange new disease typically had very much lower levels. These were conditions not usually found in people with healthy immune systems. The cases were clearly related in time and by population group (initially injecting drug users). No cause of immune deficiency could be found, but it was clearly not inherited. The working definition for AIDS, developed by the Centers for Disease Control, has required just a single revision in the past decade. The latest US AIDS definition was created in 1993. [12] However, cases started to be seen in heterosexuals, drug addicts, and people who received blood transfusions, proving the syndrome knew no boundaries. The risk groups soon included: Haitians, as a group, seemed to be susceptible to this strange malady (Even non-drug-using Haitian heterosexuals got it), suddenly hemophiliacs living outside the usual risk areas, who needed Factor VIII, which was extracted from the whole blood of thousands of donors, came down with the same symptoms (Those with hemophilia are at particular risk for transfusion-related infections, since a single dose of cryoprecipitate contains products from between 1000 and 20,000 donors), infants, female sexual contacts of infected men, prisoners, and Africans. Following the discovery of a number of Haitians with Kaposi's Sarcoma and other AIDS-related conditions, medical journals and books began to claim that AIDS had come from Haiti, and that Haitians were responsible for the AIDS epidemic in the United States. Haitians were added to homosexuals, hemophiliacs and heroin users to make the 'Four-H Club' of groups at high risk of AIDS. These claims were often founded on dubious evidence. Since intravenous drug users were frequent blood donors, for both altruistic and financial reasons, the blood supply was quickly tainted. The first alarm about the safety of the blood supply was sounded in July 1982, with the first reports of the newly described immunodeficiency syndrome among hemophiliacs and injection drug users (IDUs). In January 1983 the CDC reported the first case of heterosexual transmission. In the early years, many numerous possible theories were considered regarding the cause of AIDS, many of which now seem eccentric: the use of "poppers", A case was made for attributing causality to amyl nitrite, a prescription drug, and to isobutyl nitrite, a closely related chemical marketed as a room deodorizer (Both were used as sexual stimulants but were also known immunosuppressive agents), a sophisticated theory developed around the notion that repeated exposure to another's sperm could trigger an immune response resulting in a condition resembling chronic graft-versus-host disease and ultimately opportunistic infections, one prominent dissident has theorized that the disease occurs because of long-term use of recreational drugs and is exacerbated by nucleoside analogues given as treatment, exposure to rare tropical diseases, etc. Each, in its turn, was rejected for lack of substantiating evidence. [46] By 1982, the initial diagnosis had acquired a number of names - In the general press, the incriminating acronym GRID, which stood for Gay Related Immunodeficiency Disease, had been coined [3] ‘gay cancer’, ‘community-acquired immune dysfunction’ and ‘gay compromise syndrome’. [16] The popular press coined “a disease of the “four H club” as it seemed to single out Haitians, homosexuals, hemophiliacs, and heroin users– even though there had been cases among people who did not fall into one of these groups. In the CDC, in search of a name, and looking at the infected communities, AIDS had become "the 4H disease”– homosexuals, heroin addicts, hemophiliacs and Haitians [48] But that name changed. However, after determining that AIDS was not isolated to the gay community, [43] the term GRID became misleading and AIDS was introduced at a meeting in July 1982. [37] In this new name, scientists were supported by political figures that realized that the term "gay-related" did not accurately describe the demographic that the disease affected. The term AIDS (for acquired immune deficiency syndrome) was proposed in 1982 [37] by researchers concerned with the accuracy of the disease's name. It was not until July at a meeting in Washington, D.C., that the acronym AIDS (Acquired Immune Deficiency Syndrome) was suggested. By September 1982 the CDC started using the name AIDS, and properly defined the illness. [19] The CDC used the term for the first time in September 1982, when it reported that an average of one to two cases of AIDS were being diagnosed in America every day. [49] On April 23, 1984, the U.S. Department of Health and Human Services Secretary announced at a press conference that the probable cause of AIDS had been discovered: the retrovirus subsequently named human immunodeficiency virus or HIV in 1986. In 1982 Scientists and public health officials grouped together all of these strange new cases and began to use the term "Acquired Immune Deficiency Syndrome" – or AIDS for short, to describe the occurrences of opportunistic infections, Kaposi's sarcoma, and Pneumocystis carinii pneumonia in previously healthy men. In 1982, no-one claimed to know the cause of AIDS, so the first definition was based on the diagnosis of one of 13 rare diseases known to be linked to immune deficiency (including Kaposi's sarcoma and PCP) "occurring in a person with no known cause for diminished resistance to that disease". [19] Over the years, the US definition has been refined, as hundreds of thousands of similar cases have been documented, sometimes involving other diseases, but always associated with the same distinctive immune deficiency. Under this definition, someone has AIDS if they have one of 26 specific diseases (28 in children) but no known cause of immune deficiency other than HIV (with some diseases, a positive HIV test is required); or if they have a CD4+ cell count below 200 cells per cubic millimeter of blood, or less than 14% of all lymphocytes, plus a positive HIV test. The virus was at first named by an international scientific committee. The US government announces their scientist; Dr. Robert Gallo isolates a retrovirus HTLV-III HTLV-III/LAV (human T-cell lymphotropic virus-type III/lymphadenopathy- associated virus). International committees of scientists rename the virus HIV. [46] Nonetheless, doubt about a viral cause persisted until the actual virus was detected, confirmatory studies were performed, and the reports of transmission through blood and blood products became too numerous to ignore. The discovery of HIV, the Human Immunodeficiency Virus, was made soon after. In some quarters, doubt persists that HIV causes AIDS. Dissident arguments have received attention from the popular media, as well as from scientific journals. And with the rise of the Internet, alternative views have found a much wider audience. Some of their followers are intrigued by conspiracy theories involving sinister drug companies or government persecution of minority groups. Some believe that HIV is a 'conspiracy' or that it is 'man-made'. A recent survey carried out in the US for example, identified a significant number of African Americans who believe HIV was manufactured as part of a biological warfare programme, and designed to wipe out large numbers of black people. Many say this was done under the auspices of the US federal 'Special Cancer Virus Program' (SCVP), possibly with the help of the CIA. [39] Linked in to this theory is the belief that the virus was spread (either deliberately or inadvertently) to thousands of people all over the world through the smallpox inoculation programme. But alternative explanations can also appeal to those diagnosed with HIV or AIDS, who read that their condition might not be fatal, that they shouldn't take toxic drugs, and that unprotected sex poses no risks. Even a few AIDS service organizations have adopted non-HIV viewpoints. It seems likely that new and better evidence, including the obvious benefits of modern drug treatments, has caused many former dissidents to change their minds. The alternative definition of AIDS requires a CD4+ cell count consistently below 200 cells per cubic millimeter of blood, which cannot be explained by any factor other than HIV (such as cancer, malnutrition, radiation or chemotherapy). While none of these theories can be definitively disproved, the evidence given to back them up is usually based upon supposition and speculation, and ignores the clear link between SIV and HIV or the fact that the virus has been identified in people as far back as 1959. [23] The emotionally-charged culture of blame and prejudice that surrounded HIV and AIDS in the early years meant that it soon became politically difficult to present epidemiological findings in a neutral and objective way. The delay on the part of some in accepting a novel viral cause may appear puzzling now, but investigators may have been intimidated by the enormous implications that a new virus would carry for blood banking, the safety of health care workers, and the overall public health. There was also hesitancy, particularly among those outside the medical community, to acknowledge that the infection could be spread through heterosexual contact. Indeed, many preferred to invoke any but the obvious cause. The spread of the disease in Haiti, for example, was postulated to be a result of voodoo practices rather than heterosexual sex. Today, most human immunodeficiency virus (HIV) infections in the world derive from heterosexual transmission — a fact that is still overlooked by many. [15]
What caused the epidemic to spread so suddenly? There are a number of factors that may have contributed to the sudden spread of HIV, most of which occurred in the latter half of the twentieth century.
Travel
Both national and international travel undoubtedly had a major role in the initial spread of HIV. In the US, international travel by young men making the most of the gay sexual revolution of the late 70s and early 80s would certainly have played a large part in taking the virus worldwide. In Africa, the virus would probably have been spread along truck routes and between towns and cities within the continent itself. However, it is quite conceivable that some of the early outbreaks in African nations were not started by Africans infected with the 'original' virus at all, but by people visiting from overseas where the epidemic had been growing too. The process of transmission in a global pandemic is simply too complex to blame on any one group or individual.
Much was made in the early years of the epidemic of a so-called 'Patient Zero' who was the basis of a complex "transmission scenario" compiled by Dr. William Darrow and colleagues at the Centre for Disease Control in the US. This epidemiological study showed how 'Patient O' (mistakenly identified in the press as 'Patient Zero') had given HIV to multiple partners, who then in turn transmitted it to others and rapidly spread the virus to locations all over the world. A journalist, Randy Shilts, subsequently wrote a book based on Darrow's findings, which named Patient Zero as a gay Canadian flight attendant called Gaetan Dugas. For several years, Dugas was vilified as a 'mass spreader' of HIV and the original source of the HIV epidemic among gay men. However, four years after the publication of Shilts' article, Dr. Darrow repudiated his study, admitting its methods were flawed and that Shilts' had misrepresented its conclusions. While Gaetan Dugas was a real person who did eventually die of AIDS, the Patient Zero story was not much more than myth and scaremongering. HIV in the US was to a large degree initially spread by gay men, but this occurred on a huge scale over many years, probably a long time before Dugas even began to travel.
The blood industry
As blood transfusions became a routine part of medical practice; an industry to meet this increased demand for blood began to develop rapidly. In some countries such as the USA, donors were paid to give blood, a policy that often attracted those most desperate for cash; among them intravenous drug users. In the early stages of the epidemic, doctors were unaware of how easily HIV could be spread and blood donations remained unscreened. This blood was then sent worldwide, and unfortunately most people who received infected donations went on to become HIV positive themselves. In the late 1960's hemophiliacs also began to benefit from the blood clotting properties of a product called Factor VIII. However, to produce this coagulant, blood from hundreds of individual donors had to be pooled. This meant that a single donation of HIV+ blood could contaminate a huge batch of Factor VIII. This put thousands of hemophiliacs all over the world at risk of HIV, and many subsequently became infected with the virus.
Drug use
The 1970s saw an increase in the availability of heroin following the Vietnam War and other conflicts in the Middle East, which helped stimulate a growth in intravenous drug use. As a result of sharing unsterilised needles and syringes, HIV was passed on among injecting drug users (IDUs). Due to this repeated practice many IDUs continue to be infected with HIV." [2] Until a vaccine is available, two humble but effective interventions have been shown to limit the horizontal spread of HIV: sex education and the use of condoms that results from it, 72,73 and drug-abuse treatment, including the provision of clean needles. An effective vaccine is not imminent, and most governments are unlikely to initiate frank public discussions about sexual intercourse [13] and injection-drug use, despite the glaring need. To some extent, the disease has continued to spread horizontally because of an unwillingness to use effective control measures, rather than because of the lack of a vaccine or other remedy. [11] AIDS has radically altered the development of drugs. Before the AIDS epidemic, the Food and Drug Administration (FDA) was often viewed as a remote bureaucracy. With the advent of AIDS and the community that formed around it, numerous innovative approaches were developed to expedite the development of new drugs and patients' access to investigational drugs. The FDA became substantially more efficient: in 1986, the average interval between a drug application and the granting of FDA approval was 34.1 months; by 1999, it had decreased to 12.6 months. [15] Zidovudine [Retrovir] (earlier known as azidothymidine, or AZT) was among the earliest compounds tested and gained FDA approval in 1987 and became the first drug licensed for fighting HIV and for the treatment of AIDS, and began to be used in high doses to treat people infected with HIV. Multiple studies found that AZT reduced opportunistic infections and increased CD4+ cell counts and survival among people with AIDS. [17] In the 1990s, highly active antiretroviral therapy (HAART) first became available, and it fundamentally altered the epidemic in the United States. [46] The 1992 addition of the drug Hivid, the first drug the FDA approved to be used in combination with AZT, marked the beginning of HIV/AIDS combination therapies. Since the mid-1990s, other types of anti-HIV drugs have also been available, including power HIV-fighting drugs called Protease Inhibitors, which were designed specifically to target HIV proteins. Patients with chronic infection who were treated with the protease inhibitor ritonavir had a precipitous drop in HIV RNA level, reflecting an abrupt interruption of high-grade replication of HIV (billions of copies daily). They also had an increase in the CD4 cell count, which revealed the regenerative capacity of the CD4 cell population. The establishment of these two principles profoundly influenced clinicians' subsequent approach to antiviral therapy. [46] It has been found that the use of these different drugs taken together in combination with existing HIV/AIDS drugs, they prove effective in controlling HIV bring much longer-lasting benefits than AZT alone. In the United States, 15 agents have been approved in three classes of drugs: nucleoside analogue reverse-transcriptase inhibitors, nonnucleoside reverse-transcriptase inhibitors, and protease inhibitors. [18] Numerous large-scale, controlled studies have consistently shown that the right combination of drugs can dramatically reduce incidence of AIDS and death. One drug is better than none, and two is better than one, but a combination of three drugs (from two different classes) is much better still. [25] These new "triple-therapies" give patients and scientists new hope in eliminating HIV/AIDS. Most studies have shown dramatic and durable responses for at least two thirds of patients with minimal previous antiviral exposure who adhere to a regimen of triple-drug therapy. Virologists explain that this is because HIV finds it a lot harder to evolve resistance to several drugs at the same time. With the use of these potent medications, there have been sharp and sustained declines in the incidence of AIDS and in AIDS-related mortality. [46] Modern three-drug combinations reduce the risk of AIDS and death by over 80%. Antiretroviral therapy, alongside treatment for opportunistic infections, is thought to have saved at least three million years of life in the USA alone. [5] The ability of antiretroviral drugs to prevent mother-to-child HIV transmission has been demonstrated around the world. In late 1996 data from AIDS Clinical Trials Group study 076 (ACTG 076) made it clear that Retrovir (AZT) used during pregnancy and at the time of delivery drastically reduces transmission of HIV from mother to child. Those findings led to protocols that now drastically reduce transmission from mother to child from 1 in 4 to less than 3%. Following the widespread introduction of these drugs during pregnancy, the number of reported AIDS cases among American children has fallen to around 100 per year, compared to nearly 1,000 per year in the early 1990s. [32]
"Anyone at any age can get HIV/AIDS." [33] "AIDS Diagnoses by Age" [21] Unicef today said it was a "disgrace" that more than 95% of children with Aids around the world were not receiving any treatment. The UN charity, launching a global campaign to highlight the disease's impact on children, said 1,800 were infected with the virus every day. Unicef said that, every minute, a child dies of an Aids-related illness, a child becomes infected with HIV, and four people aged between 15 and 24 become infected. [42] According to estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS [47] and the World Health Organization (WHO), 1.4 million children were living with HIV at the end of 2000. In 2000, an estimated 600,000 children aged 14 or younger became infected with HIV. More than 1,000 children are newly infected with HIV every day, and of these more than half will die as a result of AIDS because of a lack of access to HIV treatment. At the end of 2009, there were 2.5 million children living with HIV around the world. An estimated 400,000 children became newly infected with HIV in 2009. Of the 1.8 million people who died of AIDS during 2009, one in seven were children. Every hour, around 30 children die as a result of AIDS. [31] Every minute of every day a child under the age of 15 is infected with HIV. 1,400 children die of AIDS each day and more than a half million young lives are claimed by this disease each year. According to the UNAIDS 2006 Report [4] there are 2.3 million children (under the age of 15) living with HIV/AIDS around the world.
AIDS is caused by the Human immunodeficiency virus (HIV), which originated in non-human primates in Sub-Saharan Africa and was transferred to humans during the late 19th or early 20th century. Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century. HIV descends from the related simian immunodeficiency virus (SIV), which infects apes and monkeys in Africa. Most HIV researchers agree that HIV evolved at some point from the closely related Simian immunodeficiency virus (SIV), and that SIV or HIV (post mutation) was transferred from non-human primates to humans in the recent past (as a type of zoonosis). Two types of HIV infect humans: HIV-1 and HIV-2. HIV-1 is more virulent, is more easily transmitted and is the cause of the vast majority of HIV infections globally. [22] The pandemic strain of HIV-1 is closely related to a virus found in the chimpanzees of the subspecies Pan troglodytes, which lives in the forests of the Central African nations of Cameroon, Equatorial Guinea, Gabon, Republic of Congo (or Congo-Brazzaville), and Central African Republic. Scientists generally accept that the known strains (or groups) of HIV-1 are most closely related to the simian immunodeficiency viruses (SIVs) endemic in wild ape populations of West Central African forests. Particularly, each of the known HIV-1 strains is either closely related to the SIV that infects the chimpanzee subspecies Pan troglodytes (SIVcpz), or to the SIV that infects Western lowland gorillas (Gorilla gorilla), called SIVgor. [8] The pandemic HIV-1 strain (group M or Main) and a very rare strain only found in a few Cameroonian people (group N) are clearly derived from SIVcpz strains endemic in Pan troglodytes chimpanzee populations living in Cameroon. [48]
Another very rare HIV-1 strain (group P) is clearly derived from SIVgor strains of the same country. Finally, the primate ancestor of HIV-1 group O, a strain infecting tens of thousands of people mostly from Cameroon but also from neighboring countries, is still uncertain, but there is evidence that it is either SIVcpz or SIVgor. [9] It is clear that the several HIV-1 and HIV-2 strains descend from SIVcpz, SIVgor, and SIVsmm viruses, and that bush meat practice provides the most plausible venue for cross-species transfer to humans. [9] According to the natural transfer theory (also called 'Hunter Theory' or 'Bush meat Theory'), the "simplest and most plausible explanation for the cross-species transmission" of SIV or HIV (post mutation), the virus was transmitted from an ape or monkey to a human when a hunter or bush meat vendor/handler was bitten or cut while hunting or butchering the animal. [10] The resulting exposure to blood or other bodily fluids of the animal can result in SIV infection. [10] The pandemic HIV-1 group M is most closely related to the SIVcpz collected from the southeastern rain forests of Cameroon (modern East Province) near the Sangha River. [8] Thus, this region is presumably where the virus was first transmitted from chimpanzees to humans. However, reviews of the epidemiological evidence of early HIV-1 infection in stored blood samples, and of old cases of AIDS in Central Africa have led many scientists to believe that HIV-1 group M early human epicenter was probably not in Cameroon, but rather farther south in the Democratic Republic of the Congo, more probably in its capital city, Kinshasa. [48] A study published in 2008, analyzing viral sequences recovered from a recently discovered biopsy made in Kinshasa, in 1960, along with previously known sequences, suggested a common ancestor between 1873 and 1933 (with central estimates varying between 1902 and 1921). The earliest known positive identification of the HIV-1 virus comes from the Congo in 1959 and 1960 though genetic studies indicate that it passed into the human population from chimpanzees around fifty years earlier. [44] Some molecular datation studies suggest that HIV-1 group M had its most recent common ancestor (MRCA) (that is, started to spread in the human population) in the early 20th century, probably between 1915 and 1941. [20] Using HIV-1 sequences preserved in human biological samples along with estimates of viral mutation rates, scientists calculate that the jump from chimpanzee to human probably happened during the late 19th or early 20th century, a time of rapid urbanization and colonization in equatorial Africa. There is evidence that humans who participate in bush meat activities, either as hunters or as bush meat vendors, commonly acquire SIV. However, only a few of these infections were able to cause epidemics in humans, and all did so in the late 19th—early 20th century. To explain why HIV became epidemic only by that time, there are several theories, each invoking specific driving factors that may have promoted SIV adaptation to humans, or initial spread: social changes following colonialism, rapid transmission of SIV through unsafe or unsterile injections (that is, injections in which the needle is reused without being sterilized), colonial abuses and unsafe smallpox vaccinations or injections, or prostitution and the concomitant high frequency of genital ulcer diseases (such as syphilis) in nascent colonial cities. [38]
In 1983, two separate research groups led by Robert Gallo and Luc Montagnier independently declared that a novel retrovirus may have been infecting AIDS patients, and published their findings in the same issue of the journal Science. [7] [28] In May 1983, doctors from Dr. Luc Montagnier's team at the Pasteur Institute in France reported that they had isolated a new retrovirus from lymphoid ganglions that they believed was the cause of AIDS. [7] The virus was later named lymphadenopathy-associated virus (LAV) and a sample was sent to the U.S. Centers for Disease Control, which was later passed to the National Cancer Institute (NCI). On May 4, 1984, Gallo and his collaborators published a series of four papers in the scientific journal Science demonstrating that a retrovirus they had isolated, called HTLV-III in the belief that the virus was related to the leukemia viruses of Gallo's earlier work, was the cause of AIDS. [14] [26] [27] [29] A French team at the Pasteur Institute in Paris, France, led by Luc Montagnier, had published a paper in Science in 1983, describing a retrovirus they called LAV (lymphadenopathy associated virus), isolated from a patient at risk for AIDS. [7] In May 1984 a team led by Robert Gallo of the United States confirmed the discovery of the virus, but they renamed it human T lymphotropic virus type III (HTLV-III). [26] In January 1985 a number of more detailed reports were published concerning LAV and HTLV-III, and by March it was clear that the viruses were the same, were from the same source, and were the etiological agent of AIDS. In May 1986, the International Committee on Taxonomy of Viruses ruled that both names should be dropped and a new name, HIV (Human Immunodeficiency Virus), be used. [50] In 2008, Together with his colleague Françoise Barré-Sinoussi from the Institute Pasteur, Montagnier was awarded one half of the 2008 Nobel Prize in Physiology or Medicine for their work on the "discovery of human immunodeficiency virus". Harald zur Hausen also shared the Prize for his discovery that human papilloma viruses lead to cervical cancer, but Gallo was left out.
HIV-1 strains are thought to have arrived in the United States from Haiti in the late 1960s or early 1970s. [30] A 2007 study states that a strain of HIV-1 probably moved from Africa to Haiti and then entered the United States around 1969. [30] HIV-1 is believed to have arrived in Haiti from central Africa, possibly through professional contacts with the Democratic Republic of the Congo. The current consensus is that HIV was introduced to Haiti by an unknown individual or individuals who contracted it while working in the Democratic Republic of the Congo circa 1966, or from another person who worked there during that time. A mini-epidemic followed, and, circa 1969, yet another unknown individual brought HIV from Haiti to the United States.
Ardoin Antonio, a Jamaican-American shipping clerk who was raised in Haiti, died in New York on June 28, 1959 of Pneumocystis Pneumonia, an AIDS-defining illness.
One of the earliest documented HIV-1 infections was discovered in a preserved blood sample taken in 1959 from a man from Leopoldville, Belgian Congo (now Kinshasa, Democratic Republic of the Congo). A second early documented HIV-1 infection was discovered in a preserved lymph node biopsy sample taken in 1960 from a woman from Leopoldville, Belgian Congo.
The first confirmed case of AIDS in the United States, a 15-year-old teenage boy who died in 1969. Robert Rayford has since been confirmed as the first documented victim of HIV/AIDS in North America, having died at age 16 in May 1969. In 1969, a 15-year-old African-American male known to medicine as Robert R. died at the St. Louis City Hospital from aggressive Kaposi's sarcoma. Robert Rayford (c. 1953 – May 15 or May 16,1969), sometimes identified as Robert R. due to his age, was an American teenager from Missouri who was the earliest confirmed victim of HIV/AIDS in North America. AIDS was suspected as early as 1984, and in 1987, researchers at Tulane University School of Medicine confirmed this, finding HIV-1 in his preserved blood and tissues. Robert had never traveled outside the United States and, indeed, never left the Midwest, and had told doctors that he had never received a blood transfusion. Since Rayford's infection was almost certainly through sexual contact and he had never left the country, it is obvious that he must have received the virus from somebody else already living with it in the United States, meaning that AIDS was present in North America before Robert began showing symptoms in 1966. He also never ventured into cosmopolitan cities such as New York, Los Angeles, or San Francisco, which were the sites where the HIV-AIDS epidemic was first observed in the United States. He reported having experienced symptoms since 1966.
A Norwegian sailor and truck driver, who was probably infected in Cameroon some time between 1961 and 1965, and died in 1976. In 1976, a Norwegian sailor, with the alias name Arvid Noe, his wife, and his nine-year-old daughter died of AIDS. Arvid Noe (1946 – 1976) is the alias of a Norwegian sailor who is the first person known to have contracted HIV and died from AIDS outside of the United States. He is the second person confirmed to have died from AIDS, after the teenager known as Robert R., from St. Louis, Missouri, in 1969. The sailor had first presented symptoms in 1969, eight years after he first spent time in ports along the West African coastline. Based on research conducted after his death, Noe is believed to have contracted HIV in Cameroon in 1961 or '62, where he was known to have been sexually active with many African women, including prostitutes. Tissues of Noe, his wife and daughter all tested positive for HIV in an epidemiology study in 1988. Tissue samples from the sailor and his wife were tested in 1988 and found to contain HIV-1 (Group O). Noe was infected with HIV-1 group O, which is known to have been prevalent in Cameroon in the early 1960s.
Margrethe P. Rask (1930 – December 12, 1977), better known as Grethe Rask, was a Danish physician and surgeon who practiced medicine in what was then known as Zaire (today the Democratic Republic of the Congo). She was likely directly exposed to blood from many Congolese patients, one of who infected her. She died in December 1977. Rask, who died three and a half years prior to AIDS being recognized by the Centers for Disease Control in June 1981, was one of the first non-Africans (along with Arvid Noe) known to have died of AIDS-related causes.
Gaëtan Dugas (French: [ɡaetɑ̃ dyˈɡa]; February 20, 1953 – March 30, 1984) was a Canadian who worked for the national carrier as a flight attendant. Gaëtan Dugas, so-called "Patient Zero", was a flight attendant who had over 2,500 sexual partners across North America. Dugas became notorious as the alleged patient zero for AIDS, though he is now more accurately regarded as one of many highly sexually active men who spread AIDS widely before the disease was identified. [24] A Canadian airline steward named Gaëtan Dugas was referred to as "Patient 0" in an early AIDS study by Dr. William Darrow of the Centers for Disease Control. He was called "Patient Zero" because at least 40 of the 248 people known to be infected by AIDS in 1983 had had sex with him, or with someone who had sexual intercourse with him. At least 40 of the 248 people diagnosed with AIDS by April 1982 were thought to have had sex either with him or with someone who had. Because of this, many people had considered Dugas to be responsible for bringing HIV to North America. This is inaccurate however, as HIV had spread long before Dugas began his career. [30] The vast majority of cases of AIDS outside sub-Saharan Africa can be traced back to that single patient (although numerous unrelated incidents of AIDS among Haitian immigrants to the U.S. were recorded in the early 1980s, and, as evidenced by the case of Robert R., isolated incidents of this infection may have been occurring as early as 1966.) [30] A November 2007 article in the Proceedings of the National Academy of Sciences dismisses the Patient Zero hypothesis and claims that AIDS transited from Africa to Haiti in 1966 and from Haiti to the United States in 1969. [30]
One of the first high profile victims of AIDS was the American Rock Hudson, a gay actor who had been married and divorced earlier in life, who died on 2 October 1985 having announced that he was suffering from the virus on 25 July that year. It had been diagnosed during 1984. The virus claimed perhaps its most famous victim yet on 24 November 1991, when British rock star Freddie Mercury, lead singer of the band Queen, died from an AIDS related illness having only announced that he was suffering from the illness the previous day. However he had been diagnosed as HIV positive during 1987. One of the first high profile heterosexual victims of the virus was Arthur Ashe, the American tennis player. He was diagnosed as HIV positive on 31 August 1988, having contracted the virus from blood transfusions during heart surgery earlier in the 1980s. Further tests within 24 hours of the initial diagnosis revealed that Ashe had AIDS, but he did not tell the public about his diagnosis until April 1992. He died, aged 49, as a result of the AIDS virus on 6 February 1993.
The original name for what is know as "Human Immunodeficiency Virus" (HIV), which causes "Acquired Immunodeficiency Syndrome" (AIDS) in Humans was "Simian Immunodeficiency Virus" (SIV) [35] which causes [1] "Simian Acquired Immune Deficiency Syndrome" (SAIDS) [34] in wild Chimpanzees [8] (Pan troglodytes) [45] Based on analysis of strains found in four species of monkeys from Bioko Island, which was isolated from the mainland by rising sea levels about 11,000 years ago, it has been concluded that SIV has been present in monkeys and apes for at least 32,000 years, and probably much longer. Prior to 1982, AIDS was known as "Community-Acquired Immune Dysfunction" and to the Centers For Disease Control And Prevention (CDC) as "The 4H Disease" [48] The term AIDS (for acquired immune deficiency syndrome) was proposed at a meeting in Washington, D.C., on July 27, 1982. [37] By September 1982 the CDC started using the name AIDS, and properly defined the illness. The CDC used the term for the first time in September 1982, when it reported that an average of one to two cases of AIDS were being diagnosed in America every day. [19] [49] Michael Gottlieb was the principal author of the first report that appeared in the Morbidity and Mortality Weekly Report for June 5, 1981 under the quiet title “Pneumocystis carinii pneumonia (PCP)— Los Angeles.” The initial report described emergency rooms in New York City and Los Angeles seeing a rash a number of previously seemingly healthy young men showing up in both places who suddenly began to develop fevers, flu-like symptoms, and rare types of pneumonia, including PCP, rare opportunistic infections and cancers, including Kaposi's sarcoma, and other unusual infections and other rare illnesses which until then had been virtually unheard of among such people, and that seemed stubbornly resistant to any treatment being reported by doctors in New York and California from 1979-1981. In July of that year, the New York Times reported some bizarre new disease outbreaks of a rare form of cancer, later identified as Kaposi's Sarcoma (a kind of tumor that later became the face of HIV/AIDS), among men in New York and California. Other opportunistic infections accompanied these diagnoses. This report was followed quickly by more series, and within a few months, the basic outline of the epidemic was established. Additional opportunistic complications were soon described, including mycobacterium infections, toxoplasmosis, invasive fungal infections, Kaposi’s sarcoma, and non-Hodgkin’s lymphoma. Within months, dozens of similar cases had been reported in 23 American states and in the UK, representing the start of a massive and unprecedented epidemic. At this time, AIDS did not yet have a name, but it quickly became obvious that all the men were suffering from a common syndrome. Doctors soon discovered a distinctive feature of these cases. All patients presenting with these uncommon illnesses were strangely immunodeficient—their immune systems could not fight off even simple infections. This immune deficiency explained why they were so vulnerable to disease, and many died soon after. Each had abnormal ratios of lymphocyte subgroups and was actively shedding cytomegalovirus. The evidence that the disease was caused by cytomegalovirus, as posited in the early reports, was straightforward: groups with the new immunodeficiency had extremely high rates of infection with cytomegalovirus, a potentially immunosuppressive virus. More than anything else, the men were lacking a specific type of white blood cell, which is essential to a healthy immune system. Normally, people have between 600 and 1,500 "CD4+ cells" (also called T helper cells) in each cubic millimeter of their blood. But the men with the strange new disease typically had very much lower levels. These were conditions not usually found in people with healthy immune systems. The cases were clearly related in time and by population group (initially injecting drug users). No cause of immune deficiency could be found, but it was clearly not inherited. The working definition for AIDS, developed by the Centers for Disease Control, has required just a single revision in the past decade. The latest US AIDS definition was created in 1993. [12] However, cases started to be seen in heterosexuals, drug addicts, and people who received blood transfusions, proving the syndrome knew no boundaries. The risk groups soon included: Haitians, as a group, seemed to be susceptible to this strange malady (Even non-drug-using Haitian heterosexuals got it), suddenly hemophiliacs living outside the usual risk areas, who needed Factor VIII, which was extracted from the whole blood of thousands of donors, came down with the same symptoms (Those with hemophilia are at particular risk for transfusion-related infections, since a single dose of cryoprecipitate contains products from between 1000 and 20,000 donors), infants, female sexual contacts of infected men, prisoners, and Africans. Following the discovery of a number of Haitians with Kaposi's Sarcoma and other AIDS-related conditions, medical journals and books began to claim that AIDS had come from Haiti, and that Haitians were responsible for the AIDS epidemic in the United States. Haitians were added to homosexuals, hemophiliacs and heroin users to make the 'Four-H Club' of groups at high risk of AIDS. These claims were often founded on dubious evidence. Since intravenous drug users were frequent blood donors, for both altruistic and financial reasons, the blood supply was quickly tainted. The first alarm about the safety of the blood supply was sounded in July 1982, with the first reports of the newly described immunodeficiency syndrome among hemophiliacs and injection drug users (IDUs). In January 1983 the CDC reported the first case of heterosexual transmission. In the early years, many numerous possible theories were considered regarding the cause of AIDS, many of which now seem eccentric: the use of "poppers", A case was made for attributing causality to amyl nitrite, a prescription drug, and to isobutyl nitrite, a closely related chemical marketed as a room deodorizer (Both were used as sexual stimulants but were also known immunosuppressive agents), a sophisticated theory developed around the notion that repeated exposure to another's sperm could trigger an immune response resulting in a condition resembling chronic graft-versus-host disease and ultimately opportunistic infections, one prominent dissident has theorized that the disease occurs because of long-term use of recreational drugs and is exacerbated by nucleoside analogues given as treatment, exposure to rare tropical diseases, etc. Each, in its turn, was rejected for lack of substantiating evidence. [46] By 1982, the initial diagnosis had acquired a number of names - In the general press, the incriminating acronym GRID, which stood for Gay Related Immunodeficiency Disease, had been coined [3] ‘gay cancer’, ‘community-acquired immune dysfunction’ and ‘gay compromise syndrome’. [16] The popular press coined “a disease of the “four H club” as it seemed to single out Haitians, homosexuals, hemophiliacs, and heroin users– even though there had been cases among people who did not fall into one of these groups. In the CDC, in search of a name, and looking at the infected communities, AIDS had become "the 4H disease”– homosexuals, heroin addicts, hemophiliacs and Haitians [48] But that name changed. However, after determining that AIDS was not isolated to the gay community, [43] the term GRID became misleading and AIDS was introduced at a meeting in July 1982. [37] In this new name, scientists were supported by political figures that realized that the term "gay-related" did not accurately describe the demographic that the disease affected. The term AIDS (for acquired immune deficiency syndrome) was proposed in 1982 [37] by researchers concerned with the accuracy of the disease's name. It was not until July at a meeting in Washington, D.C., that the acronym AIDS (Acquired Immune Deficiency Syndrome) was suggested. By September 1982 the CDC started using the name AIDS, and properly defined the illness. [19] The CDC used the term for the first time in September 1982, when it reported that an average of one to two cases of AIDS were being diagnosed in America every day. [49] On April 23, 1984, the U.S. Department of Health and Human Services Secretary announced at a press conference that the probable cause of AIDS had been discovered: the retrovirus subsequently named human immunodeficiency virus or HIV in 1986. In 1982 Scientists and public health officials grouped together all of these strange new cases and began to use the term "Acquired Immune Deficiency Syndrome" – or AIDS for short, to describe the occurrences of opportunistic infections, Kaposi's sarcoma, and Pneumocystis carinii pneumonia in previously healthy men. In 1982, no-one claimed to know the cause of AIDS, so the first definition was based on the diagnosis of one of 13 rare diseases known to be linked to immune deficiency (including Kaposi's sarcoma and PCP) "occurring in a person with no known cause for diminished resistance to that disease". [19] Over the years, the US definition has been refined, as hundreds of thousands of similar cases have been documented, sometimes involving other diseases, but always associated with the same distinctive immune deficiency. Under this definition, someone has AIDS if they have one of 26 specific diseases (28 in children) but no known cause of immune deficiency other than HIV (with some diseases, a positive HIV test is required); or if they have a CD4+ cell count below 200 cells per cubic millimeter of blood, or less than 14% of all lymphocytes, plus a positive HIV test. The virus was at first named by an international scientific committee. The US government announces their scientist; Dr. Robert Gallo isolates a retrovirus HTLV-III HTLV-III/LAV (human T-cell lymphotropic virus-type III/lymphadenopathy- associated virus). International committees of scientists rename the virus HIV. [46] Nonetheless, doubt about a viral cause persisted until the actual virus was detected, confirmatory studies were performed, and the reports of transmission through blood and blood products became too numerous to ignore. The discovery of HIV, the Human Immunodeficiency Virus, was made soon after. In some quarters, doubt persists that HIV causes AIDS. Dissident arguments have received attention from the popular media, as well as from scientific journals. And with the rise of the Internet, alternative views have found a much wider audience. Some of their followers are intrigued by conspiracy theories involving sinister drug companies or government persecution of minority groups. Some believe that HIV is a 'conspiracy' or that it is 'man-made'. A recent survey carried out in the US for example, identified a significant number of African Americans who believe HIV was manufactured as part of a biological warfare programme, and designed to wipe out large numbers of black people. Many say this was done under the auspices of the US federal 'Special Cancer Virus Program' (SCVP), possibly with the help of the CIA. [39] Linked in to this theory is the belief that the virus was spread (either deliberately or inadvertently) to thousands of people all over the world through the smallpox inoculation programme. But alternative explanations can also appeal to those diagnosed with HIV or AIDS, who read that their condition might not be fatal, that they shouldn't take toxic drugs, and that unprotected sex poses no risks. Even a few AIDS service organizations have adopted non-HIV viewpoints. It seems likely that new and better evidence, including the obvious benefits of modern drug treatments, has caused many former dissidents to change their minds. The alternative definition of AIDS requires a CD4+ cell count consistently below 200 cells per cubic millimeter of blood, which cannot be explained by any factor other than HIV (such as cancer, malnutrition, radiation or chemotherapy). While none of these theories can be definitively disproved, the evidence given to back them up is usually based upon supposition and speculation, and ignores the clear link between SIV and HIV or the fact that the virus has been identified in people as far back as 1959. [23] The emotionally-charged culture of blame and prejudice that surrounded HIV and AIDS in the early years meant that it soon became politically difficult to present epidemiological findings in a neutral and objective way. The delay on the part of some in accepting a novel viral cause may appear puzzling now, but investigators may have been intimidated by the enormous implications that a new virus would carry for blood banking, the safety of health care workers, and the overall public health. There was also hesitancy, particularly among those outside the medical community, to acknowledge that the infection could be spread through heterosexual contact. Indeed, many preferred to invoke any but the obvious cause. The spread of the disease in Haiti, for example, was postulated to be a result of voodoo practices rather than heterosexual sex. Today, most human immunodeficiency virus (HIV) infections in the world derive from heterosexual transmission — a fact that is still overlooked by many. [15]
What caused the epidemic to spread so suddenly? There are a number of factors that may have contributed to the sudden spread of HIV, most of which occurred in the latter half of the twentieth century.
Travel
Both national and international travel undoubtedly had a major role in the initial spread of HIV. In the US, international travel by young men making the most of the gay sexual revolution of the late 70s and early 80s would certainly have played a large part in taking the virus worldwide. In Africa, the virus would probably have been spread along truck routes and between towns and cities within the continent itself. However, it is quite conceivable that some of the early outbreaks in African nations were not started by Africans infected with the 'original' virus at all, but by people visiting from overseas where the epidemic had been growing too. The process of transmission in a global pandemic is simply too complex to blame on any one group or individual.
Much was made in the early years of the epidemic of a so-called 'Patient Zero' who was the basis of a complex "transmission scenario" compiled by Dr. William Darrow and colleagues at the Centre for Disease Control in the US. This epidemiological study showed how 'Patient O' (mistakenly identified in the press as 'Patient Zero') had given HIV to multiple partners, who then in turn transmitted it to others and rapidly spread the virus to locations all over the world. A journalist, Randy Shilts, subsequently wrote a book based on Darrow's findings, which named Patient Zero as a gay Canadian flight attendant called Gaetan Dugas. For several years, Dugas was vilified as a 'mass spreader' of HIV and the original source of the HIV epidemic among gay men. However, four years after the publication of Shilts' article, Dr. Darrow repudiated his study, admitting its methods were flawed and that Shilts' had misrepresented its conclusions. While Gaetan Dugas was a real person who did eventually die of AIDS, the Patient Zero story was not much more than myth and scaremongering. HIV in the US was to a large degree initially spread by gay men, but this occurred on a huge scale over many years, probably a long time before Dugas even began to travel.
The blood industry
As blood transfusions became a routine part of medical practice; an industry to meet this increased demand for blood began to develop rapidly. In some countries such as the USA, donors were paid to give blood, a policy that often attracted those most desperate for cash; among them intravenous drug users. In the early stages of the epidemic, doctors were unaware of how easily HIV could be spread and blood donations remained unscreened. This blood was then sent worldwide, and unfortunately most people who received infected donations went on to become HIV positive themselves. In the late 1960's hemophiliacs also began to benefit from the blood clotting properties of a product called Factor VIII. However, to produce this coagulant, blood from hundreds of individual donors had to be pooled. This meant that a single donation of HIV+ blood could contaminate a huge batch of Factor VIII. This put thousands of hemophiliacs all over the world at risk of HIV, and many subsequently became infected with the virus.
Drug use
The 1970s saw an increase in the availability of heroin following the Vietnam War and other conflicts in the Middle East, which helped stimulate a growth in intravenous drug use. As a result of sharing unsterilised needles and syringes, HIV was passed on among injecting drug users (IDUs). Due to this repeated practice many IDUs continue to be infected with HIV." [2] Until a vaccine is available, two humble but effective interventions have been shown to limit the horizontal spread of HIV: sex education and the use of condoms that results from it, 72,73 and drug-abuse treatment, including the provision of clean needles. An effective vaccine is not imminent, and most governments are unlikely to initiate frank public discussions about sexual intercourse [13] and injection-drug use, despite the glaring need. To some extent, the disease has continued to spread horizontally because of an unwillingness to use effective control measures, rather than because of the lack of a vaccine or other remedy. [11] AIDS has radically altered the development of drugs. Before the AIDS epidemic, the Food and Drug Administration (FDA) was often viewed as a remote bureaucracy. With the advent of AIDS and the community that formed around it, numerous innovative approaches were developed to expedite the development of new drugs and patients' access to investigational drugs. The FDA became substantially more efficient: in 1986, the average interval between a drug application and the granting of FDA approval was 34.1 months; by 1999, it had decreased to 12.6 months. [15] Zidovudine [Retrovir] (earlier known as azidothymidine, or AZT) was among the earliest compounds tested and gained FDA approval in 1987 and became the first drug licensed for fighting HIV and for the treatment of AIDS, and began to be used in high doses to treat people infected with HIV. Multiple studies found that AZT reduced opportunistic infections and increased CD4+ cell counts and survival among people with AIDS. [17] In the 1990s, highly active antiretroviral therapy (HAART) first became available, and it fundamentally altered the epidemic in the United States. [46] The 1992 addition of the drug Hivid, the first drug the FDA approved to be used in combination with AZT, marked the beginning of HIV/AIDS combination therapies. Since the mid-1990s, other types of anti-HIV drugs have also been available, including power HIV-fighting drugs called Protease Inhibitors, which were designed specifically to target HIV proteins. Patients with chronic infection who were treated with the protease inhibitor ritonavir had a precipitous drop in HIV RNA level, reflecting an abrupt interruption of high-grade replication of HIV (billions of copies daily). They also had an increase in the CD4 cell count, which revealed the regenerative capacity of the CD4 cell population. The establishment of these two principles profoundly influenced clinicians' subsequent approach to antiviral therapy. [46] It has been found that the use of these different drugs taken together in combination with existing HIV/AIDS drugs, they prove effective in controlling HIV bring much longer-lasting benefits than AZT alone. In the United States, 15 agents have been approved in three classes of drugs: nucleoside analogue reverse-transcriptase inhibitors, nonnucleoside reverse-transcriptase inhibitors, and protease inhibitors. [18] Numerous large-scale, controlled studies have consistently shown that the right combination of drugs can dramatically reduce incidence of AIDS and death. One drug is better than none, and two is better than one, but a combination of three drugs (from two different classes) is much better still. [25] These new "triple-therapies" give patients and scientists new hope in eliminating HIV/AIDS. Most studies have shown dramatic and durable responses for at least two thirds of patients with minimal previous antiviral exposure who adhere to a regimen of triple-drug therapy. Virologists explain that this is because HIV finds it a lot harder to evolve resistance to several drugs at the same time. With the use of these potent medications, there have been sharp and sustained declines in the incidence of AIDS and in AIDS-related mortality. [46] Modern three-drug combinations reduce the risk of AIDS and death by over 80%. Antiretroviral therapy, alongside treatment for opportunistic infections, is thought to have saved at least three million years of life in the USA alone. [5] The ability of antiretroviral drugs to prevent mother-to-child HIV transmission has been demonstrated around the world. In late 1996 data from AIDS Clinical Trials Group study 076 (ACTG 076) made it clear that Retrovir (AZT) used during pregnancy and at the time of delivery drastically reduces transmission of HIV from mother to child. Those findings led to protocols that now drastically reduce transmission from mother to child from 1 in 4 to less than 3%. Following the widespread introduction of these drugs during pregnancy, the number of reported AIDS cases among American children has fallen to around 100 per year, compared to nearly 1,000 per year in the early 1990s. [32]
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