II. History of HIV /AIDS

A.  Possible Origins and Transfer to Humans

The origin of AIDS has involved a great deal of research in hope of finding out further ways of prevention and development of medication to help curb the disease once a person is infected. 

The Center for Disease Control reports:

“The earliest known case of HIV-1 in a human was from a blood sample collected in 1959 from a man in Kinshasa, Democratic Republic of Congo. (How he became infected is not known.) Genetic analysis of this blood sample suggested that HIV-1 may have stemmed from a single virus in the late 1940s or early 1950s.

We know that the virus has existed in the United States since at least the mid- to late 1970s. From 1979-1981 rare types of pneumonia, cancer, and other illnesses were being reported by doctors in Los Angeles and New York among a number of male patients who had sex with other men. These were conditions not usually found in people with healthy immune systems.

In 1982 public health officials began to use the term "acquired immunodeficiency syndrome," or AIDS, to describe the occurrences of opportunistic infections, Kaposi's sarcoma (a kind of cancer), and Pneumocystis carinii pneumonia in previously healthy people. Formal tracking (surveillance) of AIDS cases began that year in the United States.

In 1983, scientists discovered the virus that causes AIDS. The virus was at first named HTLV-III/LAV (human T-cell lymphotropic virus-type III/lymphadenopathy- associated virus) by an international scientific committee. This name was later changed to HIV (human immunodeficiency virus).

For many years scientists theorized as to the origins of HIV and how it appeared in the human population, most believing that HIV originated in other primates. Then in 1999, an international team of researchers reported that they had discovered the origins of HIV-1, the predominant strain of HIV in the developed world. A subspecies of chimpanzees native to west equatorial Africa had been identified as the original source of the virus. The researchers believe that HIV-1 was introduced into the human population when hunters became exposed to infected blood.” (The Center for Disease Control, (April 30, 2005).

B.  Spreading of the Virus

Gaetan Dugas, a Canadian flight attendant who traveled extensively  became known as “patient zero.”  Several early cases of AIDS showed that the infected individuals had direct or indirect sexual contact with Dugas.  These cases were located in several American cities, showing how one person’s behavior contributed to the rapid spread of the epidemic. 

In addition to Dugas transmitting the disease, the collecting and transfusion of blood contributed to the spread of AIDS. Prior to having knowledge of the disease, blood donors were paid to donate blood and the blood was not screened for HIV.  Now, as anybody knows who donates blood, the Red Cross and other blood banks carefully scrutinize donations to insure that the infection is not transmitted in this manner.

Illicit drug use has also played a large part in the spread of the HIV infection.  In the 1970’s after the Vietnam war and other conflicts in the Middle East, there was an increase in the availability of heroine.  This led to the sharing of syringes and the inadvertent sharing of HIV infected blood between drug users.   (Kanabus, A. and Fredriksson-Bass, J., April 30, 2005).In all of these ways HIV/AIDS spread through the United States to become the epidemic it is today. 

C.  The History of HIV/AIDS in the United States

The following timeline from the United States Food and Drug Administration (2005) bring us up from 1981 when the virus was first diagnosed in the United States and shows the general progress of HIV/AIDS medical  treatment in the United States to the present:

FDA HIV/AIDS Time Line ~
A Chronology of Significant Events

1981-1990

This decade saw the first report of AIDS and its identification as a retrovirus, approval of the first immunoassay test, and approval of AZT,  the first drug to treat AIDS, and the first drugs for treatment and prevention of certain opportunistic infections, and a mechanism for expanded access to promising therapies prior to approval...

1991-1994

These years saw the creation of the National Task Force on AIDS Drug Development, large scale expanded access to pre-approved HIV therapies, and approval of a number of new drugs. Accelerated approval permitted earlier approval of therapies based on surrogate marker activity. The first non blood-based collection system was approved to test for HIV, and the female condom was approved, providing women with a barrier product that didn't rely on a woman's partner to use...

1995-1999

The final years of the century saw approval of the first protease inhibitor, a new class of drugs for treating HIV, the first home-use AIDS test kit, the first antigen test kit to screen blood donors for HIV-1, and the first viral load test ...

2000-present

In the first years of the century, new formulations and combinations of medications were approved to reduce pill burden. HIV genotyping was approved to help improve treatment outcome. The first nucleic acid test for plasma screening, the first rapid HIV test for use in outreach settings, the first fusion inhibitor for treatment of HIV/AIDS, and the first generic version of an HIV therapeutic agent were also approved.

D.  2004 HIV/AIDS Statistics

The United Nations AIDS organization collects yearly statistics and presents them in their world report on AIDS.   The following are statistics that show the extent to which HIV/AIDS has grown and affected millions of individuals.  No doubt the great majority of these individuals have friends and family who have mourned, with and for, those who have been infected.

UNAIDS global summary of the HIV/AIDS epidemic December 2004:

From: http://www.unaids.org/wad2004/report.html

Updated Statistics from UNAIDS (2005)

 HIV and AIDS statistics and features, in 2003 and 2005

The number of people living with HIV in North America, Western and Central Europe rose to 1.9 million [1.3–2.6 million] in 2005, with approximately 65 000 people having acquired HIV in the past year. Wide availability of antiretroviral therapy has helped keep AIDS deaths comparatively low, at about 30 000.

The 2005 UNAIDS epidemic update can be found here:  http://www.unaids.org/epi/2005/doc/report_pdf.asp

E.  How is HIV transmitted?

Further elaboration on the ways that HIV is transmitted is provided by the UNAIDS organization (2005):

To understand how AIDS can be transmitted it is important to know where in the body the virus can be found.  When a person has HIV it is in their body fluids such as blood, semen, vaginal fluids, saliva, tears and breast milk.  It is through the transference of some of these fluids through which the virus is transferred. 

The way these fluids are transferred that causes infection include penetrative and oral sex, blood transfusions, sharing needles, and from mother to child during pregnancy, childbirth and breastfeeding. (UNAIDS, 2005)

Sexual transmission

“HIV can be transmitted through unprotected penetrative sex. It is difficult to calculate the odds of becoming infected through sexual intercourse, however it is known that the risk of infection through vaginal sex is high. Transmission through anal sex has been reported to be 10 times higher than by vaginal sex. A person with an untreated sexually transmitted infection (STI), particularly involving ulcers or discharge, is, on average, 6-10 times more likely to pass on or acquire HIV during sex. 

Oral sex is regarded as a low-risk sexual activity in terms of HIV transmission. Risk can increase if there are cuts or sores around or in the mouth and if ejaculation occurs in the mouth.

Transmission through sharing of needles and syringes

Re-using or sharing needles or syringes represents a highly efficient way of transmitting HIV. The risk of transmission can be lowered substantially among injecting drug users by using new needles and syringes that are disposable or by properly sterilizing reusable needles/syringes before reuse. Transmission in a health-care setting can be lowered by health-care workers adhering to Universal Precautions.

Mother-to-child transmission (MTCT)

HIV can be transmitted to an infant during pregnancy, labor, delivery and breastfeeding. Generally, there is a 15–30% risk of transmission from mother to child before and during delivery. A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk). Transmission from mother to child after birth can also occur through breastfeeding.

Transmission through blood transfusion

There is a high risk (greater than 90%) of acquiring HIV through transfusion of infected blood and blood products. However, the implementation of blood safety standards ensures the provision of safe, adequate and good-quality blood and blood products for all patients requiring transfusion. Blood safety includes screening of all donated blood for HIV and other blood-borne pathogens, as well as appropriate donor selection.” (UNAIDS, 2005)

F.  AIDS and Minorities

 For many years the "the reality of rising HIV infection rates within communities of color is relegated to secondary mention." (Talvi)  In 1992 the deadly disease continued to spread throughout the Black community. One out of every four persons who had AIDS in the nation was Black, and six of every 10 children with AIDS were Black, according to federal health estimates.

"The statistics are alarming enough, but perhaps even more striking is the human drama of those individuals who must cope with the fear and ignorance surrounding this misunderstood disease."(Lyons, 1992)

In 1995 the Congressional Office of Technology Assessment released the following findings:

That year, the reported AIDS incidence rate per 100,000 people among African Americans was six times higher than that among Euro-Americans and nearly two times higher than that of Latinos. Rates were lowest among Native Americans/Alaska Natives and Asians/Pacific Islanders, although many providers in Asian American and Native American communities believe that infection rates are much higher than reported, owing partially to the shame which they say prevents HIV-infected persons from seeking medical attention and diagnosis.

Representing what many providers refer to as the second and third "waves" of infection, AIDS cases among women have been climbing steadily, and people under the age of twenty-five now represent an estimated one-half of ail new cases of HIV infection. Directly corresponding to the high number of women of color with HIV and AIDS, 84 percent of children reported with AIDS in 1995 were African American or Latino.

The OTA report also disclosed that, despite such alarming rates of infection, research focusing on HIV prevention among people of color lagged far behind research on other groups--namely, Euro-Americans. Before 1988, only one report on a "minority population" had been published. In 1995, only 41 such reports on African Americans and Latinos had been released, and not a single prevention study had been published solely about Native American or Asian American/Pacific Islander populations.

The more current statistics from the CDC  who an even greater disparity in HIV diagnosis:

In 2003, an estimated 1.2 million persons in the United States were living with human immunodeficiency virus (HIV) infection, 47% of whom were non-Hispanic blacks. This report describes racial/ethnic disparities in diagnoses of HIV/acquired immunodeficiency syndrome (AIDS) during 2001--2004 and reported to CDC through June 2005 by 33 states that used confidential, name-based reporting of HIV and AIDS cases for at least 4 years. Of the estimated 157,252 diagnoses of HIV infection, the number of cases and diagnosis rates among blacks were higher than those for all other racial/ethnic populations combined. Among males, blacks had the largest or second-largest percentage of cases in every transmission category; among females, blacks had the largest percentage of cases in all transmission categories. Moreover, among both males and females, blacks represented the largest percentage of HIV/AIDS diagnoses in every age group. New and improved prevention strategies, including expanded HIV testing, targeted communications, and tailored prevention services, are needed to help address disparities in HIV transmission among blacks.

Although blacks accounted for approximately 13% of the population of the 33 states during 2001--2004, they accounted for the majority [51%]) of HIV/AIDS diagnoses. Blacks accounted for the greatest percentage of cases diagnosed among males (44%) and the majority of cases among females (68%) (CDC, 2006).