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History of AIDS

History of AIDS

In the 1980s and early 1990s, the outbreak of HIV and AIDS swept across the United States and rest of the world, though the disease originated decades earlier. Today, more than 70 million people have been infected with HIV and about 35 million have died from AIDS since the start of the pandemic, according to the World Health Organization (WHO).

What is HIV?

The human immunodeficiency virus, or HIV, is a virus that attacks the immune system, specifically CD4 cells (or T cells).

The virus is transmitted through bodily fluids such as blood, semen, vaginal fluids, anal fluids, and breast milk. Historically, HIV has most often been spread through unprotected sex, the sharing of needles for drug use, and through birth.

Over time, HIV can destroy so many CD4 cells that the body can’t fight infections and diseases, eventually leading to the most severe form of an HIV infection: acquired immunodeficiency syndrome, or AIDS. A person with AIDS is very vulnerable to cancer and to life-threatening infections, such as pneumonia.

Though there is no cure for HIV or AIDS, a person with HIV who receives treatment early can live nearly as long as someone without the virus. And a study in 2019 in the medical journal, Lancet, showed that an anti-viral treatment effectively halted the spread of HIV.

Where Did AIDS Come From?

Scientists have traced the origin of HIV back to chimpanzees and simian immunodeficiency virus (SIV), an HIV-like virus that attacks the immune system of monkeys and apes.

In 1999, researchers identified a strain of chimpanzee SIV called SIVcpz, which was nearly identical to HIV. Chimps, the scientist later discovered, hunt and eat two smaller species of monkeys—red-capped mangabeys and greater spot-nosed monkeys—that carry and infect the chimps with two strains of SIV. These two strains likely combined to form SIVcpz, which can spread between chimpanzees and humans.

SIVcpz likely jumped to humans when hunters in Africa ate infected chimps, or the chimps’ infected blood got into the cuts or wounds of hunters. Researchers believe the first transmission of SIV to HIV in humans that then led to the global pandemic occurred in 1920 in Kinshasa, the capital and largest city in the Democratic Republic of Congo.

The virus spread may have spread from Kinshasa along infrastructure routes (roads, railways, and rivers) via migrants and the sex trade.

In the 1960s, HIV spread from Africa to Haiti and the Caribbean when Haitian professionals in the colonial Democratic Republic of Congo returned home. The virus then moved from the Caribbean to New York City around 1970 and then to San Francisco later in the decade.

International travel from the United States helped the virus spread across the rest of the globe.

READ MORE: Pandemics That Changed History: A Timeline

The AIDS Epidemic Arises

Though HIV arrived in the United States around 1970, it didn’t come to the public’s attention until the early 1980s.

In 1981, the Centers for Disease Control and Prevention (CDC) published a report about five previously healthy homosexual men becoming infected with Pneumocystis pneumonia, which is caused by the normally harmless fungus Pneumocystis jirovecii. This type of pneumonia, the CDC noted, almost never affects people with uncompromised immune systems.

The following year, The New York Times published an alarming article about the new immune system disorder, which, by that time, had affected 335 people, killing 136 of them. Because the disease appeared to affect mostly homosexual men, officials initially called it gay-related immune deficiency, or GRID.

Though the CDC discovered all major routes of the disease’s transmission—as well as that female partners of AIDS-positive men could be infected—in 1983, the public considered AIDS a gay disease. It was even called the “gay plague” for many years after.

In September of 1982, the CDC used the term AIDS to describe the disease for the first time. By the end of the year, AIDS cases were also reported in a number of European countries.

READ MORE: Pandemics that Changed History











The HIV Test Arrives

In 1984, researchers finally identified the cause of AIDS—the HIV virus—and the Food and Drug Administration (FDA) licensed the first commercial blood test for HIV in 1985.

Today, numerous tests can detect HIV, most of which work by detecting HIV antibodies. The tests can be done on blood, saliva, or urine, though the blood tests detect HIV sooner after exposure due to higher levels of antibodies.

In 1985, actor Rock Hudson became the first high-profile fatality from AIDS. In fear of HIV making it into blood banks, the FDA also enacted regulations that ban gay men from donating blood. The FDA would revise its rules in 2015 to allow gay men to give blood if they’ve been celibate for a year, though blood banks routinely test blood for HIV.

By the end of 1985, there were more than 20,000 reported cases of AIDS, with at least one case in every region of the world.

AZT is Developed

In 1987, the first antiretroviral medication for HIV, azidothymidine (AZT), became available.

Numerous other medications for HIV are now available, and are typically used together in what’s known as antiretroviral therapy (ART) or highly active antiretroviral treatment (HAART).

The regimes work by preventing the virus from multiplying, giving the immune system a chance to recover and fight off infections and HIV-related cancers. The therapy also helps reduce the risk of HIV transmission, including between an infected mother and her unborn child.

The World Health Organization (WHO), in 1988, declared December 1st to be World AIDS Day. By the end of the decade, there were at least 100,000 reported cases of AIDS in the United States and WHO estimated 400,000 AIDS cases worldwide.

HIV/AIDS in the 1990s and 2000s

In 1991, the red ribbon became an international symbol of AIDS awareness.

In that year, basketball player Magic Johnson announced he had HIV, helping to further bring awareness to the issue and dispel the stereotype of it being a gay disease. Soon after, Freddie Mercury—lead singer of the band Queen—announced he had AIDS and died a day later.

In 1994, the FDA approved the first oral (and non-blood) HIV test. Two years later, it approved the first home testing kit and the first urine test.

AIDS-related deaths and hospitalizations in developed countries began to decline sharply in 1995 thanks to new medications and the introduction of HAART. Still, by 1999, AIDS was the fourth biggest cause of death in the world and the leading cause of death in Africa.

HIV Treatment Progresses

WATCH: 30 Years of AIDs Research

In 2001, generic drug manufacturers began selling discounted copies of patented HIV drugs to developing countries, leading to several major pharmaceutical manufacturers slashing prices on their HIV drugs. The following year, the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that AIDS was by far the leading cause of death in sub-Saharan Africa.

In 2009, President Barack Obama lifted a 1987 U.S. ban that prevented HIV-positive people from entering the country.

The FDA approved pre-exposure prophylaxis, or PrEP, for HIV-negative people in 2012. When taken daily, PrEP can reduce the risk of HIV from sex by more than 90 percent and from intravenous drug use by 70 percent, according to the CDC. A major study completed in 2019 showed that over 750 gay men on an anti-viral treatment did not transmit the virus to their partners. "Our findings provide conclusive evidence that the risk of HIV transmission through anal sex when HIV viral load is suppressed is effectively zero," the paper, published in Lancet, stated.

At the end of 2019, some 38 million people were living with HIV/AIDS worldwide, and 940,000 people died from AIDS-related illnesses that year, according to WHO. Sub-Saharan Africa remains the most severely affected region, accounting for nearly two-thirds of the world’s current HIV cases.

Sources:

Origin of HIV and AIDS: AVERT.
HIV Originated With Monkeys, Not Chimps, Study Finds: National Geographic.
HIV pandemic originated in Kinshasa in the 1920s, say scientists: The Guardian.
America’s HIV outbreak started in this city, 10 years before anyone noticed: PBS.
HIV Testing: CDC.
About HIV/AIDS: CDC.
How HIV spread across the West: CNN.
Obama Lifts a Ban on Entry Into U.S. by H.I.V.-Positive People: The New York Times.
Global Health Observatory (GHO) data: World Health Organization.


HIV in America: The Complicated Truth

A guide to the not-so-secret history of HIV, treatment, and activism in the United States.

HIV is the most infamous virus of the late 20th century. Its history has an almost Hollywood arc: A mysterious virus struck young, otherwise healthy gay men in the early 1980s. The Reagan administration's homophobia and scientific heel-dragging helped catalyze a fiery activist movement emblazoned with pink triangles and the warning: Silence = Death. Eventually, this movement propelled the world to action: Medication trials began, U.S. state and government resources poured in for research and programs, scientists identified effective drugs, and, finally, the plague years came to an end.

But that cause-and-effect Hollywood arc lacks important context. Because many of the young men afflicted were gay, it took longer than it should have for scientists to figure out the sicknesses were caused by a virus, not a lifestyle. And sadly, it took even longer for public health officials to confirm people could get HIV from exchange of body fluids (unprotected vaginal and anal sex, breastfeeding, sharing injection equipment) whether they were gay or straight, male or female, young or old. Because of this, in the early 1980s, tens of thousands of people acquired a virus that is relatively easy to protect against.

And it should be mentioned that HIV is a real and present epidemic in America today, in spite of the effective drugs and promising new options for HIV prevention&mdashin fact, the number of people living with HIV worldwide has climbed to nearly 40 million since that early spate in the 1980s. One in two young gay men of color is likely to acquire HIV in his lifetime. New clusters of cases are emerging in places where opiate addiction soars. In a time of need, precedent for action and tools for hope can be found beyond history's headlines.

1960s&ndash1970s: The wrong "patient zero"

The myth: In his indispensable history of the early days of AIDS, Randy Shilts argued that the HIV epidemic in America got its start with Gaetan Dugas, a Canadian flight attendant who had a lot of sex in a lot of the places where HIV first emerged. The story, which labeled Dugas "patient zero" in the American epidemic, is so entrenched in AIDS history that its recent scientific debunking made major headlines.

The truth: The first documented case of HIV in America was likely in a young African-American man, Robert Rayford, who died in Missouri in 1969 of what scientists believe was HIV.

Why it matters: Origin myths like this one are a powerful force. The standard history of American HIV not only begins with white gay men, it keeps them central to the narrative over time. "As long as we keep telling the story starting with gay men, we are never going to be able to look at and change the racist and biased systems that impact health outcomes," says Ted Kerr, an AIDS activist and writer who studied Rayford's life.

1980s: ACT UP is AIDS activism

The myth: The most famous AIDS activism was the only AIDS activism. Activist group ACT UP seized the streets and defined the strategies of civil disobedience, smart graphics, and actions&mdashlike throwing the ashes of loved ones who had died of HIV on the White House lawn&mdashthat unforgettably channeled its rage.

The truth: While ACT UP may have increased the epidemic's visibility, it wasn't the only form of effective campaigning. Activism that focused on scientific research throughout the 1980s ultimately paid incalculable dividends in the form of antiretroviral medications that, when used in combination, effectively stop the virus from copying itself. But this was just one part of AIDS activism, which also included less visible, but no less important, efforts to address the social factors (such as racism, poverty, homelessness, and homophobia) putting people at risk.

Why it matters: "Activist work in the U.S. is still divided [between] treatment and research advocacy work and folks who do work along social determinants like mass incarceration and housing," Kenyon Farrow, director of U.S. Policy for the Treatment Action Group, explained at a recent discussion on the history of HIV activism. Splitting agendas sometimes means splitting scant resources, resulting in half a solution to a complex problem.

1990s&ndashearly 2000s: The AIDS crisis is over

The myth: The potent "cocktail" of antiretroviral medications introduced in 1996 brought an end to the epidemic in America.

The truth: Antiretroviral therapy has indeed saved countless lives. Over time, the costs of these drugs decreased, and they became simpler to take&mdashfewer pills, fewer side effects. People with HIV who take their medications as prescribed and have an undetectable viral load (meaning there's virtually no HIV circulating in their blood) have a negligible risk of passing the virus to their sexual partners. But pills don't save lives if people can't take them. From the moment the cocktail was introduced, gaps by race and gender emerged in terms of who got the meds to survive.

Why it matters: Once the U.S. had drugs that worked, HIV funds at state and federal levels were funneled into clinics and medical services and away from community-based groups run by and for the people most at risk. With the fabric of social support fraying, many people at risk for HIV or in need of treatment didn't have access to affordable, trustworthy services.

Today: It will never be like the '80s

The myth: We won't ever live in a world without HIV medications again. The pills are here, as is pre-exposure prophylaxis (PrEP), a revolutionary, once-daily antiretroviral drug that people who are HIV-negative can take to prevent HIV. But current medicine isn't a firewall against the flare-up of epidemics.

The truth: If the Trump administration makes good on its promise to gut the Affordable Care Act (ACA), many people with HIV could lose their access to affordable medication. The ACA made a huge impact&mdashin part because HIV could previously be deemed a "pre-existing condition" to deny coverage. Its impact depended on location, however. Southern states, which have the highest rates of new HIV diagnoses in the nation, refused federal money for expanding Medicaid under the ACA&mdashkeeping HIV meds out of the reach of many in need.

Why it matters: If the ACA is stripped down, new HIV diagnoses and AIDS deaths could soar without diagnosis and treatment. History tells us so.


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  • June 5: First official reporting of what will be known as AIDS.
    • A report described Pneumocystis pneumonia in previously healthy, gay men in LA. This is the first official reporting of what will be known as the AIDS epidemic. Link to the first official report of what will be known as the AIDS epidemic
    • About 30 Epidemic Intelligence Service officers and staff participated.
    • Link to the report of Kaposi's Sarcoma and Pneumocystis pneumonia in 26 homosexual men in New York and California
    • September 24: CDC uses the term "AIDS" for the first time and releases the first case definition for AIDS.
    • CDC reports a case of AIDS in an infant who received a blood transfusion. Link to CDC reports a case of AIDS in an infant who received a blood transfusion
    • MMWR reports 22 cases of unexplained immunodeficiency and opportunistic infections in infants. Link to Reports of AIDS hinting of perinatal transmission

    • CDC establishes the National AIDS Hotline to respond to public inquiries about the disease.
    • January 7: Report of AIDS in female sexual partners of males with AIDS.
      • Link to report of AIDS in female sexual partners of males with AIDS
      • MMWR suggests that AIDS may be caused by an infectious agent that is transmitted sexually or through exposure to blood or blood products and issues recommendations for preventing transmission. Link to report of most cases of AIDS have been among homosexual men, injection drug users, Haitians, and people with hemophilia
      • Link to report of CDC first recommendations to prevent occupational exposure for healthcare workers
      • Link to report of CDC identification of all major routes of transmission
      • July 13: Needle-sharing identified as transmission method.
        • CDC states that avoiding injection drug use and reducing needle-sharing "should also be effective in preventing transmissions of the virus." Link to report from CDC to avoid injection drug use and reduce needle sharing should also be effective in preventing transmission of the virus
        • CDC, along with colleagues from Zaire and Belgium, establishes Project SIDA, which would become the largest HIV/AIDS research project in Africa in the 1980s.

        • January 11: Revised AIDS case definition notes AIDS is caused by HIV. Blood screening guidelines issued.
          • Link to report of CDC revised AIDS case definition notes causes by HIV Blood screening guidelines

          • October 22: Surgeon General, C. Everett Koop, issues the Surgeon General's Report on AIDS. The report makes it clear that HIV cannot be spread casually and calls for a nationwide education campaign (including early sex education in schools), increased use of condoms, and voluntary HIV testing.
            • Link to report of Surgeon General, C. Everett Koop on AIDS/
            • August: CDC holds the first national conference on HIV and Communities of Color in New York.
            • August 14: CDC issues Perspectives in Disease Prevention and Health Promotion: Public Health Service Guidelines for Counseling and Antibody Testing to Prevent HIV Infections and AIDS.
            • CDC begins working in Côte d'Ivoire, establishing a field station in Abidjan and launching the Retrovirus Côte d'Ivoire (CDC Retro-CI).

            • The brochure "Understanding AIDS" is sent to every household in the US—107 million copies in all.
              • News article: Link to the news article of mailing to every household in US about Understanding AIDS
              • Brochure: Link to brochure called Understanding AIDS
              • June 16: CDC issues first guidelines for preventing Pneumocystis carinii pneumonia (PCP).
                • Link to CDC report on preventing Pneumocystis carinii pneumonia (PCP)

                • July 27: CDC reports possible transmission of HIV to a patient through a dental procedure performed by a dentist living with HIV.

                • July 12: CDC issues recommendations for healthcare workers with HIV.
                  • Link to CDC report on recommendations for healthcare workers with HIV
                  • Congress enacts a law requiring states to adopt the CDC restrictions or to develop and adopt their own.
                  • AIDS becomes the number one cause of death for US men aged 25-44.
                    • Link to CDC report on AIDS becomes the number one cause of death for US men aged 25-44
                    • Labor Responds to AIDS begins in 1995.
                    • CDC expands case definition for AIDS, declaring those with CD4 count below 200 to have AIDS. Link to CDC report on expanding case definition for AIDS, declaring those with CD4 count below 200 to have AIDS

                    • Community-planning process launched.
                      • CDC institutes the community-planning process to better target local prevention efforts.
                      • May 20: CDC publishes guidelines for preventing HIV transmission through tissue and organ transplants.
                        • Link to CDC report on guidelines for prevention of HIV transmission through tissue and organ transplants
                        • July 14: CDC issues first guidelines to help healthcare providers prevent OIs in people living with HIV.

                        • UNAIDS established.
                        • CDC reports the first substantial decline in AIDS deaths in the US.
                          • AIDS-related deaths in the US decline by 47% from the previous year, due largely to the use of HAART. Link to CDC report on first substantial decline in AIDS deaths in the US

                          • CDC reports that African Americans account for 49% of US AIDS-related deaths.
                            • The AIDS-related mortality for African Americans is almost 10 times that of whites. Link to CDC report on African Americans accounts for 49% of US AIDS-related deaths
                            • Link to CDC report on the first national treatment guidelines for the use of antiretroviral therapy in adults and adolescents with HIV
                            • July: Leadership and Investment in Fighting an Epidemic (LIFE) launched to combat AIDS in Africa.
                              • President Bill Clinton launches the LIFE Initiative to expand efforts to combat AIDS in Africa, and CDC provides critical technical support. Link to President Bill Clinton launch of the LIFE Initiative to expand efforts to combat AIDS in Africa

                              • July: Congress enacts Global AIDS and TB Relief Act authorizes $600 million in funding.

                              • CDC announces a new HIV Prevention Strategic Plan to cut annual HIV infections in the US by half within the five years.
                                • Link to CDC announcement on a new HIV Prevention Strategic Plan to cut annual HIV infections in the US by half within the five years
                                • $500 million mother-to-child HIV prevention initiative in Africa and Carribean.
                                  • President George W. Bush announces a $500 million initiative to prevent mother-to-child transmission of HIV and improve health care delivery in 14 African and Caribbean countries. Link to President George W. Bush announcement on $500 million initiative to prevent mother-to-child transmission of HIV

                                  • Over two-thirds of new HIV infections in US are from those who do not know they are infected.
                                    • CDC estimates that 27,000 of the estimated 40,000 new infections that occur each year in the US result from transmission by individuals who do not know they are infected. Link to CDC report that estimates 27,000 of the 40,000 new infections that occur each year in US result from transmission by individuals who do not know they are infected
                                      aims to reduce barriers to early diagnosis and increase access to, and utilization of, quality medical care, treatment, and ongoing prevention services for those living with HIV.
                                    • Congress authorizes PEPFAR (the "US Leadership Against HIV/ AIDS, Tuberculosis, and Malaria Act of 2003" or Global AIDS Act), a 5-year, $18 billion approach to fighting HIV/AIDS, making it the largest commitment by any nation for an international health initiative dedicated to a single disease.
                                    • January 30: CDC releases guidance for HIV testing during labor and delivery for women of unknown HIV status.
                                      • Link to CDC report on guidance for HIV testing during labor and delivery for women of unknown HIV status
                                      • PEPFAR's Track 1.0 Antiretroviral Therapy Program is launched in partnership with Ministries of Health in 13 countries, and CDC, along with HHS sister-agency HRSA, plays a leading role.
                                      • January 21: CDC releases recommendations to prevent HIV after non-occupational exposure to the virus.
                                        • These recommendations, called non-occupational post- exposure prophylaxis or nPEP, noted that antiretrovial drugs might be beneficial in preventing HIV infection after exposure through sex or injection drug use begun within 72 hours after exposure. Link to CDC report on recommendation to prevent HIV after non-occupational exposure to the virus
                                        • September 22: CDC releases new HIV testing recommendations.
                                          • CDC releases revised HIV testing recommendations: All adults and adolescents aged 13-64 should be screened at least once, with annual screening for those at high risk. Link to CDC report releases revised HIV testing recommendations for All adults and adolescents aged 13-64

                                          • October: CDC launches Prevention IS Care campaign for healthcare providers who deliver care to people living with HIV.
                                            • The campaign emphasizes the importance of helping patients stay on HIV treatment.
                                            • Link to CDC report over 562,000 people have died of AIDS in the US since 1981
                                            • PEPFAR, with CDC support, announces a public-private partnership with Becton Dickinson to strengthen laboratory capacity in four African countries the partnership was renewed for an additional five years in 2013.
                                            • August 6: CDC estimates there are 56,300 new HIV cases each year in the United States.
                                              • CDC releases new domestic incidence estimates that are higher than previous estimates (56,300 new infections per year vs 40,000). The new estimates do not represent an actual increase in the numbers of HIV infections, but reflect a more accurate way of measuring new infections. Link to CDC report on new domestic incidence estimates of HIV infections
                                              • Congress reauthorizes PEPFAR (the "Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008") and expands the initiative by more than tripling its funding to $48 billion. The global response emphasizes a shift to building sustainable, country-owned programs that integrate HIV/AIDS services into broader health systems.

                                              • Global Health Initiative announced.
                                                • President Barack Obama announces the Global Health Initiative, a 6-year initiative to develop a comprehensive approach to global health with PEPFAR at its core.
                                                • PEPFAR and CDC establish The Shuga Initiative in partnership with the MTV Networks Africa, MTV Staying Alive Foundation, Gates Foundation, and UNICEF to increase HIV-risk perception, increase uptake of HIV-testing and counseling services, and increase knowledge of HIV-prevention strategies among youth in Kenya, Nigeria, and Botswana.
                                                • CDC and the White House launch Act Against AIDS, a multiyear, multifaceted communication campaign designed to reduce HIV incidence in the United States.
                                                • HIV infection removed from disease list that prevents non-US citizens from entering country.
                                                  • Department of Health & Human Services and CDC remove HIV infection from the list of diseases that prevent non-US citizens from entering the country.
                                                  • CDC launched the project to shift HIV-related activities to meet goals of the 2010 National HIV/AIDS Strategy. Twelve health departments in cities with high AIDS burdens participated.

                                                  • CDC launches the Link to High Impact HIV Prevention (HIP) framework to reduce new HIV infections in the United States.
                                                    • HIP focuses on using combinations of scientifically proven, cost-effective, and scalable interventions targeted to the right populations in the right geographic areas in order to increase the impact of HIV prevention efforts.
                                                    • Link to CDC report on interim guidance to health care providers on the use of PrEP as an HIV prevention strategy among men who have sex with men
                                                    • CDC studies TDF2s and Partner PrEP provide the first evidence that a daily oral dose of antiretroviral drugs used to treat HIV infection can also reduce HIV acquisition among uninfected individuals exposed to the virus through heterosexual sex.
                                                    • The annual number of new HIV infections in the United States was relatively stable at approximately 50,000 new infections each year between 2006 and 2009. However, HIV infections increased among young gay and bisexual men, driven by increases among young, black gay and bisexual men – the only subpopulation to experience a sustained increase during the time period. Link to CDC report on new HIV incidence estimates
                                                    • Link to CDC press release on fourth National Gay Men's HIV/AIDS Awareness Day, CDC awars $55 million to 34 community-based organizations to expand HIV prevention for young gay and bisexual men of color and transgender youth of color
                                                    • Link to CDC vital signs report of people living with HIV
                                                    • Link to CDC launching Testing Makes Us Stronger, national HIV testing campaign for young African American gay and bisexual men
                                                    • NIH's HPTN 052 study results are released demonstrating that treatment reduces transmission of HIV by nearly 96% and ushers in the concept of "treatment as prevention."
                                                    • CDC transitions PEPFAR programs to Ministries of Health and indigenous organizations in 13 countries.
                                                      • CDC transitions its Track 1.0 Antiretroviral Therapy programs in 13 countries from US-based organizations and grantees to Ministries of Health and indigenous organizations.
                                                      • Link to CDC campaign on Take Charge. Take the Test. for HIV testing and awareness among African American women
                                                      • CDC convenes East African faith leaders for a meeting in Kenya to examine the role of faith-based organizations in the response to HIV/AIDS.
                                                      • Link to CDC report on pilot project to train pharmacists and retail store clinic staff to deliver confidential rapid HIV testing
                                                      • Link to CDC launch of Let's Stop HIV together campaign
                                                      • Link to CDC report showing only a quarter of Americans with HIV their virus under control
                                                      • Link to CDC interim guidance on use of medication to prevent HIV infection among heterosexually active adults
                                                      • Link to CDC vital sign report that young people between ages 13 and 24 represent 26% of new HIV infection each year


                                                      • June: CDC launches Reasons/Razones, a national, bilingual campaign that asks Latino gay and bisexual men to consider their reasons for getting tested for HIV.
                                                        • Link to CDC new campaign called Reasons/Razones for getting tested for HIV
                                                        • The "PEPFAR Stewardship and Oversight Act of 2013" reauthorizes PEPFAR,extends a number of existing authorities, and strengthens the oversight of the program through updated reporting requirements.
                                                        • February: CDC releases report showing about one-third of blacks living with HIV have their virus under control.
                                                          • Among blacks who have been diagnosed with HIV, 75 percent were linked to care, 48 percent stayed in care, 46 percent were prescribed antiretroviral therapy, and 35 percent achieved viral suppression. Link to CDC report showing about one-third of blacks living with HIV have their virus under control
                                                          • Link to CDC report for new clinical guidelines on health care providers considering PrEP for patients with substantial risk for HIV
                                                          • Start Talking. Stop HIV. encouraging gay and bisexual men to talk openly with their sexual partners about HIV risk and prevention strategies. Link to Start Talking Campaign
                                                          • We Can Stop HIV One Conversation at a Time, a bilingual communication campaign encouraging Latinos to talk openly about HIV with their families and friends. Link to We Can Stop HIV campaign
                                                          • HIV Treatment Works, encouraging treatment and care for people living with HIV. Link to HIV Treatment works campaign
                                                          • Declines were observed in several key populations, but increases were found among certain age groups of gay and bisexual men, especially young men. Link to CDC report on annual HIV diagnosis rate declined by 30% from 2002-2011
                                                          • Only half of gay and bisexual men diagnosed with HIV are receiving treatment for their infections. Link to CDC report that finds gaps in care and treatment among gay men diagnosed with HIV
                                                          • Among Latinos who have been diagnosed with HIV, just over half (54 percent) were retained in care. Fewer than half (44 percent) of those diagnosed have been prescribed antiretroviral therapy, and just 37 percent have achieved viral suppression. Link to CDC report that finds gaps in care and treatment among Latinos diagnosed with HIV
                                                          • Link to CDC report that only 30% of Americans with HIV had virus under control in 2011 and approximately two-thirds of those whose virus was not controlled had been diagnosed but were no longer in care



                                                          • February 25: 184 cases of HIV linked to injection drug use in Indiana.
                                                            • Indiana state health officials announce an HIV outbreak linked to injection drug use in the southeastern portion of the state. By the end of the year, Indiana will confirm 184 new cases of HIV linked to the outbreak.
                                                            • http://archinte.jamanetwork.com/article.aspx?articleid=2130723
                                                            • http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6424a2.htm
                                                            • http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6439a2.htm
                                                            • http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6446a4.htm?s_cid=mm6446a4_w
                                                            • CDC announces that annual HIV diagnoses in the US fell by 19% from 2005-2014. There were steep declines among heterosexuals, people who inject drugs, and African Americans (especially black women), but trends for gay/bisexual men varied by race/ ethnicity. Diagnoses among white gay/bisexual men decreased by 18%, but they continued to rise among Latino gay/bisexual men and were up 24%. Diagnoses among black gay/bisexual men also increased (22%), but the increase has leveled off since 2010. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/hiv-data-trends-fact-sheet-508.pdf
                                                            • February: CDC announced lifetime risk of HIV at the Conference on Retroviruses and Opportunisitic Infections.
                                                              • CDC estimates that 1 in 2 gay/bisexual black men, 1 in 4 gay/ bisexual Latino men, and 1 in 6 gay/bisexual men will be diagnosed with HIV if current trends continue. The overall lifetime risk of HIV diagnosis in the United States is 1 in 99.
                                                              • Press release: http://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html
                                                              • CDC releases study showing if PrEP use increases in high-risk populations, almost 20% of the estimated 265,330 new HIV infections expected to occur through 2020 could be prevented. The number could be even higher if NHAS targets are achieved.
                                                              • 1 in 10 HIV diagnoses are among people who inject drugs.
                                                              • The use of syringe services has increased, but access to sterile needles still needs to improve for effective HIV prevention. https://www.cdc.gov/vitalsigns/hiv-drug-use/index.html

                                                              • February: CDC announces annual new HIV infections in the U.S. fell 18% between 2008 and 2014. The decline signals HIV prevention and treatment efforts are paying off, but not all communities are seeing the same progress.
                                                              • March: The first study of PrEP use by race and risk group shows that African Americans and Latinos account for the smallest percentage of prescriptions, despite comprisingm two-thirds of people who could potentially benefit from the preventive medicines.

                                                              • March: CDC publishes an article showing an association between increased PrEP coverage and decreased HIV diagnosis rates in recent years.
                                                                • Data table: https://www.cdc.gov/nchhstp/newsroom/images/2018/hiv/PrEP-table_highres.jpg

                                                                * Estimates of persons living with HIV infection (diagnosed or undiagnosed) were derived by using back-calculation on HIV data for persons aged ≥13 years at diagnosis in the 50 states and the District of Columbia

                                                                ** The methodology to derive the estimated annual number of new HIV infections (also called HIV incidence) has changed over the years. From 1980 through 2006, numbers of HIV infections were calculated using back-calculation methodology. From 2006 through 2010, HIV infections were estimated from a statistical method that applied a stratified extrapolation approach using results from a test for recent HIV infection and HIV testing history data collected by jurisdictions that conducted HIV incidence surveillance.

                                                                *** The estimate of the number of persons diagnosed with HIV are based on HIV surveillance data for persons aged≥ 13 at time of diagnosis in the 50 states and District of Columbia.


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                                                                Grmek, a Serbian physician and naturalized French citizen, gives us a broad overview of Aids and how it has shaped the world since its appearance in 1981. The book first examines the early years of the epidemic and then looks at issues created by the new virus. Most of what one has heard about the disease, from stories of Soviet propaganda to popular misconceptions, is touched upon in the book at one place or another. Considerable length is devoted to the question of when and where Aids began, a matter of interest to almost everyone who might want to read this work.

                                                                I have two problems with this book. First of all, while comprehensive, it skips too quickly from topic to topic and gives too little detail about some important matters. Secondly, it is quite out of date by now. Scientific progress, not to mention the Aids virus itself, is changing rapidly and so Grmek might be advised to put out an updated edition

                                                                I would like to repeat the praise for Dr. Mirko D. Grmek's "History of AIDS." This book is truly a "page-turner," and a worthy one. The translators also deserve applause for turning the original French into English prose that is both highly accessible and technically correct in its treatment of medical science.

                                                                I must, however, disagree with other reviewers who state that this book is "out of date." While scientific research has made many strides since the volume's publication, Grmek addresses himself not so much to the science of HIV and AIDS as to the early history of this science, and the history of the epidemic. In fact, it is remarkable--and tellingly so for reasonably objective accounts such as Grmek's--how little our understanding of this history has changed since 1990. This, despite various highly publicized propaganda campaigns that have sought to alter the public perception of AIDS: dissident activist John Lauritsen's vehement revisionist portrayals of the early epidemic and the first drug trials, or journalist John Crewdson's hit pieces painting early HIV researcher Bob Gallo as a shrewdly manipulative liar.

                                                                Grmek, an eminently qualified commentator with no apparent axe to grind, provides a fine, detailed, and thoroughly-referenced summary of HIV and AIDS in the 1980s, spiced throughout with illustrative anecdote and adorned with illuminating quotes at the start of each chapter. This book is an excellent resource AND a good read.


                                                                NATURAL HISTORY OF SIVcpz INFECTION

                                                                Initially, SIVcpz was thought to be harmless for its natural host. This was because none of the few captive apes that were naturally SIVcpz infected suffered from overt immunodeficiency, although in retrospect this conclusion was based on the immunological and virological analyses of only a single naturally infected chimpanzee (Heeney et al. 2006). In addition, SIV-infected sooty mangabeys and African green monkeys showed no sign of disease despite high viral loads in blood and lymphatic tissues (Paiardini et al. 2009), leading to the belief that all naturally occurring SIV infections are nonpathogenic. However, the sporadic prevalence of SIVcpz, along with its more recent monkey origin, suggested that its natural history might differ from that of other primate lentiviruses. To address this, a prospective study was initiated in Gombe National Park, Tanzania, the only field site where SIVcpz infected chimpanzees are habituated and so can be observed in their natural habitat.

                                                                Gombe is located in northwestern Tanzania on the shores of Lake Tanganyika. The park is home to three communities, termed Kasekela, Mitumba, and Kalande, which have been studied by Goodall and colleagues since the 1960s, 1980s, and 1990s, respectively (Pusey et al. 2007). Prospective studies of SIVcpz in Gombe began in 2000 (Santiago et al. 2002). By 2009, infections were documented in all three communities, with mean biannual prevalence rates of 13%, 12%, and 46% in Mitumba, Kasekela, and Kalande, respectively (Rudicell et al. 2010). Analysis of epidemiologically linked infections revealed that SIVcpz spreads primarily through sexual routes, with an estimated transmission probability per coital act (0.0008𠄰.0015) that is similar to that of HIV-1 among heterosexual humans (0.0011) (Gray et al. 2001 Rudicell et al. 2010). SIVcpz also appears to be transmitted from infected mothers to their infants, and in rare cases, possibly by aggression (Keele et al. 2009). Migration of infected females constitutes a major route of virus transmission between communities (Rudicell et al. 2010).

                                                                Behavioral and virological studies also provided insight into the pathogenicity of SIVcpz. Age-corrected mortality analyses revealed that infected chimpanzees had a 10- to 16-fold increased risk of death compared to uninfected chimpanzees (Keele et al. 2009). SIVcpz-infected females were less likely to give birth and had a much higher infant mortality rate than uninfected females. Postmortem analyses revealed significant CD4 + T-cell depletion in three infected individuals, but not in either of two uninfected individuals. One infected female, who died within 3 years of acquiring the virus, had histopathological findings consistent with end-stage AIDS. Taken together, these findings provided compelling evidence that SIVcpz was pathogenic in its natural host. Subsequent studies of both wild and captive chimpanzees confirmed these findings. By the end of 2010, the Kasekela and Mitumba communities had experienced three additional deaths, all SIVcpz related. One case concerned an infant born to an infected mother, whereas the other two were adult females, one of whom died with severe CD4 + T cell depletion within 5 years of acquiring SIVcpz (KA Terio et al., submitted). Moreover, demographic studies revealed that the Kalande community, which showed the highest SIVcpz prevalence rates (40%�%), had suffered a catastrophic population decline, whereas the sizes of the Mitumba and Kasekela communities, which were infected at a much lower level (12%�%), remained stable (Rudicell et al. 2010). It has been suggested that only members of the P. t. schweinfurthii subspecies, or more particularly the chimpanzees of Gombe, are susceptible to SIVcpz-associated pathogenicity (Weiss and Heeney 2009 Soto et al. 2010). However, a prospective study of orphaned chimpanzees in Cameroon identified an SIVcpz infected P. t. troglodytes ape that suffered from progressive CD4 + T cell loss, severe thrombocytopenia, and clinical AIDS (Etienne et al. 2011). Thus, it seems likely that SIVcpz has a substantial negative impact on the health, reproduction, and lifespan of all chimpanzees that harbor SIVcpz in the wild.


                                                                Contents

                                                                As of 2018 [update] , about 700,000 people have died of HIV/AIDS in the U.S. since the beginning of the HIV epidemic, and nearly 13,000 people with AIDS in the United States die each year. [2]

                                                                With improved treatments and better prophylaxis against opportunistic infections, death rates have significantly declined. [3]

                                                                The overall death rate among persons diagnosed with HIV/AIDS in New York City decreased by sixty-two percent from 2001 to 2012. [4]

                                                                After the HIV/AIDS outbreak in the 1980s, various responses emerged in an effort to alleviate the issue. [5] These included new medical treatments, [6] travel restrictions, [7] and new public health policies [8] in the United States.

                                                                Medical treatment Edit

                                                                Great progress was made in the U.S. following the introduction of three-drug anti-HIV treatments ("cocktails") that included antiretroviral drugs. David Ho, a pioneer of this approach, was honored as Time Magazine Man of the Year for 1996. Deaths were rapidly reduced by more than half, with a small but welcome reduction in the yearly rate of new HIV infections. Since this time, AIDS deaths have continued to decline, but much more slowly, and not as completely in Black Americans as in other population segments. [9] [10]

                                                                Travel restrictions Edit

                                                                In 1987, the Department of Health and Human Services (HHS) included HIV in its list of “communicable diseases of public health significance,” denying immigrants and short term foreign visits from anyone who tested positive for the virus. [11] [12] In 1993, the US Congress passed the National Institutes of Health Revitalization Act of 1993, removing the HHS’ authority to dictate HIV as a “public health significance,” and explicitly including HIV as a cause for denying immigrants and foreign visitors entry into the US. [13] [14] Anyone seeking US citizenship during the HIV ban was required to undergo a medical exam during the legalization process - testing positive would permanently deny the applicant entry into the country. [15] The law extended to include medication, where foreign travelers could be arrested for having antiretroviral drugs in their carry-on luggage. A famous example was in 1989, when a Dutch traveler to Minnesota was arrested for “several days” because he was carrying AZT in his luggage. [13]

                                                                During the turn of the 21st century, people who were HIV positive and seeking temporary visas or vacationing to the US had to avoid revealing their status on application forms, and either plan for their medication to be sent to the US or stop taking their medication. [16] Eventually the US began offering temporary admission waivers for people who were HIV positive. As stated in an interoffice memorandum in 2004, foreign nationals who were HIV positive could qualify for the waiver for either humanitarian/public interest reasons, or being “attendees of certain designated international events held in the United States”. [17]

                                                                In early December 2006, President George W. Bush indicated that he would issue an executive order allowing HIV positive people to enter the United States on standard visas. It was unclear whether applicants would still have to declare their HIV status. [18] However, the ban remained in effect throughout Bush's presidency.

                                                                In August 2007, Congresswoman Barbara Lee of California introduced H.R. 3337, the HIV Nondiscrimination in Travel and Immigration Act of 2007. This bill allowed travelers and immigrants entry to the United States without having to disclose their HIV status. The bill died at the end of the 110th Congress. [19]

                                                                In July 2008, President George W. Bush signed H.R. 5501 that lifted the ban in statutory law. However, the United States Department of Health and Human Services still held the ban in administrative (written regulation) law. New impetus was added to repeal efforts when Paul Thorn, a UK tuberculosis expert who was invited to speak at the 2009 Pacific Health Summit in Seattle, was denied a visa due to his HIV positive status. A letter written by Mr. Thorn, and read in his place at the Summit, was obtained by Congressman Jim McDermott, who advocated the issue to the Obama administration's Health Secretary. [19]

                                                                On October 30, 2009 President Barack Obama reauthorized the Ryan White HIV/AIDS Bill which expanded care and treatment through federal funding to nearly half a million. [20] The Department of Health and Human Services also crafted regulation that would end the HIV Travel and Immigration Ban, effective in January 2010. [20] On January 4, 2010, the United States Department of Health and Human Services and Centers for Disease Control and Prevention removed HIV infection from the list of "communicable diseases of public health significance," due to its not being spread by casual contact, air, food or water, and removed HIV status as a factor to be considered in the granting of travel visas, disallowing HIV status from among the diseases that could prevent people who were not U.S. citizens from entering the country. [21]

                                                                Public health policies Edit

                                                                Since the beginning of the HIV epidemic, several U.S. presidents have attempted to implement a national plan to control the issue. In 1987, President Reagan created a Presidential Commission on the HIV Epidemic. This commission was recruited to investigate what steps are necessary for responding to the HIV outbreak, and the consensus was to establish more HIV testing, focus on prevention and treatment as well as expanding HIV care throughout the U.S. [22] However, these changes were not implemented during this time, and the commission recommendations were largely ignored.

                                                                Another attempt to respond to the HIV outbreak took place in 1996, when President Clinton established the National AIDS Strategy, which aimed to reduce number of infections, enhance research on HIV treatment, increase access to resources for people affected by AIDS, and also alleviate the racial disparities in HIV treatment and care. [23] Similarly to Reagan's plan, the National AIDS Strategy was not successfully enforced, providing only objectives without a specific action plan for implementation.

                                                                In 2010, President Obama created the National HIV/AIDS Strategy for the United States (NHAS), with its three main objectives being to reduce the annual number of infections, reduce health disparities, and increase access to resources and HIV care. [22] However, this new strategy differs in that it includes an Implementation Plan, with a timeline for achieving each of the three goals, as well as a document outlining the specific action plan that will be used. [24]

                                                                President Trump announced a plan in his 2019 State of the Union Address to stop new HIV infections in the United States by 2030, though critics pointed to the President's policies reducing access to health insurance, anti-immigrant and anti-transgender policies as undermining this goal. [25] The Department of Health and Human Services issued grants to 32 HIV "hotspots" in 2019, and Congress earmarked over $291 million for the president's plan in FY2020. [26]

                                                                One of the best known works on the history of HIV is the 1987 book And the Band Played On by Randy Shilts. Shilts contends that Ronald Reagan's administration dragged its feet in dealing with the crisis due to homophobia, while the gay community viewed early reports and public health measures with corresponding distrust, thus allowing the disease to infect hundreds of thousands more. This resulted in the formation of ACT-UP, the AIDS Coalition to Unleash Power by Larry Kramer. Galvanized by the federal government's inactivity, the movement by AIDS activists to gain funding for AIDS research, which on a per-patient basis out-paced funding for more prevalent diseases such as cancer and heart disease, was used as a model for future lobbying for health research funding. [27]

                                                                The Shilts work popularized the misconception that the disease was introduced by a gay flight attendant named Gaëtan Dugas, referred to as "Patient Zero," although the author did not actually make this claim in the book. However, subsequent research has revealed that there were cases of AIDS much earlier than initially known. HIV-infected blood samples have been found from as early as 1959 in Africa (see HIV main entry), and HIV has been shown to have caused the 1969 death of Robert Rayford, a 16-year-old St. Louis male, who could have contracted it as early as 7 years old due to sexual abuse, suggesting that HIV had been present, at very low prevalence, in the U.S. since before the 1970s.

                                                                An early theory asserted that a series of inoculations against hepatitis B that were performed in the gay community of San Francisco were tainted with HIV. Although there was a high correlation between recipients of that vaccination and initial cases of AIDS, this theory has long been discredited. However, the theory has never been officially proven or disproven. HIV, hepatitis B, and hepatitis C are bloodborne diseases with very similar modes of transmission, and those at risk for one are at risk for the others. [28]

                                                                Activists and critics of current AIDS policies allege that another preventable impediment to stemming the spread of the disease and/or finding a treatment was the vanity of "celebrity" scientists. Robert Gallo, an American scientist involved in the search for a new virus in the people affected by the disease, became embroiled in a legal battle with French scientist Luc Montagnier, who had first discovered such a virus in tissue cultures derived from a patient suffering from enlargement of the lymphnodes (an early sign of AIDS). Montagnier had named the new virus LAV (Lymphoadenopathy-Associated Virus).

                                                                Gallo, who appeared to question the primacy of the French scientist's discovery, refused to recognize the "French virus" as the cause of AIDS, and tried instead to claim the disease was caused by a new member of a retrovirus family, HTLV, which he had discovered. Critics claim that because some scientists were more interested in trying to win a Nobel prize than in helping patients, research progress was delayed and more people needlessly died. After a number of meetings and high-level political intervention, the French scientists and Gallo agreed to "share" the discovery of HIV, although eventually Montagnier and his group were recognized as the true discoverers, and won the 2008 Nobel Prize for it.

                                                                Publicity campaigns were started in attempts to counter the incorrect and often vitriolic perception of AIDS as a "gay plague". These included the Ryan White case, red ribbon campaigns, celebrity dinners, the 1993 film version of And the Band Played On, sex education programs in schools, and television advertisements. Announcements by various celebrities that they had contracted HIV (including actor Rock Hudson, basketball star Magic Johnson, tennis player Arthur Ashe and singer Freddie Mercury) were significant in arousing media attention and making the general public aware of the dangers of the disease to people of all sexual orientations. [29]

                                                                AIDS was met with great fear and concern by the nation, much like any other epidemic, and those who were primarily affected were populations that the majority did not think highly of: homosexuals, African-Americans, Latinos, and intravenous drug users. The general thought of the population was to create distance and establish boundaries from these people, and some doctors were not immune from such impulses. During the epidemic, doctors began to not treat AIDS patients, not only to create distance from these groups of people, but also because they were afraid to contract the disease themselves. A surgeon in Milwaukee stated, "I've got to be selfish. It's an incurable disease that's uniformly fatal, and I'm constantly at risk for getting it. I've got to think about myself. I've got to think about my family. That responsibility is greater than to the patient." [30]

                                                                Some doctors thought it was their duty to stay away from the virus because they had other patients to think of. In a survey of doctors in the mid to late 1980s, a substantial number of physicians indicated that they didn't have an ethical obligation to treat and care for those patients with HIV/AIDS. [31] A study of primary care providers showed that half would not care for patients if they were given a choice. [32] In 1990, a national survey of doctors showed that "only 24% believed that office-based practitioners should be legally required to provide care to individuals with HIV infection." [30] However, there were many doctors who chose to care for these patients with AIDS for different reasons: they shared the same sexual orientation as the infected, a commitment to providing care to the diseased, an interest in the mysteries of infectious disease, or a desire to tame the awful threat. [30] Treating patients infected with the AIDS virus changed some doctors' personal lives, as it caused them to have to deal with some of the same stigmas that their patients had. This disease also weighed on their minds, because they often had to deal with witnessing the death of patients and most often those patients were as young or even younger than they were.

                                                                African Americans continue to experience the most severe burden of HIV, compared with other races and ethnicities. Black people represent approximately 13% of the U.S. population, but accounted for an estimated 43% of new HIV infections in 2017. [33] Furthermore, they make up nearly 52% of AIDS-related deaths in America. While the overall rates of HIV incidences and prevalence have decreased, they have increased in one particular demographic: African American gay and bisexual men (a 4% increase). In America, Black households were reported to have the lowest median income, leading to lower rates of individuals with health insurance. This creates cost barriers to antiretroviral treatments. The racial disparities between women afflicted with HIV/AIDS have been made clear in a 2010 study as well, which showed that 64% of women infected with HIV that year were Black women. [34] The trend is longstanding: CDC data from 2006 revealed that about half of the 1 million Americans living with HIV were Black. [35] This unequal distribution has led researchers to studying the long-term effects of racial and gender discrimination along with HIV-related stigma, and how this plays a role in people's lives.

                                                                Hispanics/Latinos are also disproportionately affected by HIV. Hispanics/Latinos represented 16% of the population but accounted for 21% of new HIV infections in 2010. This disparity is even more apparent among Latina women, which represent 13% of the population but account for 20% of reported HIV cases among women in the United States. [36] Hispanics/Latinos accounted for 20% of people living with HIV infection in 2011. Disparities persist in the estimated rate of new HIV infections in Hispanics/Latinos. In 2010, the rate of new HIV infections for Latino males was 2.9 times that for white males, and the rate of new infections for Latinas was 4.2 times that for white females. Since the epidemic began, more than 100,888 Hispanics/Latinos with an AIDS diagnosis have died, including 2,863 in 2016. [37]

                                                                American Indian/Alaskan Native communities in the United States see a higher rate of HIV/AIDS in comparison to whites, Asians, and Native Hawaiians/other Native Pacific Islanders. Although AI/AN with HIV/AIDS only represent roughly 1% of positive cases in the U.S., [38] the number of diagnoses among AI/AN gay and bisexual men rose by 54% between 2011 and 2015. Additionally, the survival rate of diagnosed AI/AN was the lowest of all races in the United States between 1998 and 2005. [39] In recent years, the Centres for Disease Control and Prevention (CDC) have put in place a "high impact prevention approach" [40] in partnership with the Indian Health Service and the CDC Tribal Advisory Committee to tackle the growing rates in a culturally appropriate way. The higher rate of HIV/AIDS cases among AI/AN people have been attributed to a number of factors including socioeconomic disadvantages faced by AI/AN communities, which may result in difficulty accessing healthcare and high-quality housing. It may be more difficult for gay and bisexual AI/AN men to access healthcare due to living in rural communities, or due to stigma attached to their sexualities. AI/AN people have been reported to have higher rates of other STIs, including chlamydia and gonorrhea, which also increases likeliness of contracting or transmitting HIV. [41] Furthermore, as there are over 560 federally recognized AI/AN tribes, there is some difficulty in creating outreach programs which effectively appeal to all tribes whilst remaining culturally appropriate. As well as fear of stigma from within AI/AN communities, there may also be a fear among LGBTQ+ AI/AN of a lack of understanding from health professionals in the United States, particularly among Two Spirit people. A 2013 NASTAD report calls for the inclusion of LGBT and Two Spirit AI/AN in HIV/AID program planning and asserts that "health departments should utilize local experts to better understand regional definitions of "Two Spirit" and incorporate modules on Native gay men and Two Spirit people into cultural sensitivity courses for public health service providers". [42]

                                                                "Down-low" culture among Black MSM Edit

                                                                Down-low is an African American slang term [43] that typically refers to a subculture of Black men who usually identify as heterosexual, but who have sex with men some avoid sharing this information even if they have female sexual partner(s) married or single. [44] [45] [46] [47]

                                                                According to a study published in the Journal of Bisexuality, "[t]he Down Low is a lifestyle predominately practiced by young, urban Black men who have sex with other men and women, yet do not identify as gay or bisexual". [48]

                                                                In this context, "being on the Down Low" is more than just men having sex with men in secret, or a variant of closeted homosexuality or bisexuality—it is a sexual identity that is, at least partly, defined by its "cult of masculinity" and its rejection of what is perceived as white culture (including white LGBT culture) and terms. [45] [49] [50] [51] A 2003 New York Times Magazine cover story on the Down Low phenomenon explains that the Black community sees "homosexuality as a White man's perversion." [49]

                                                                The CDC cited three findings that relate to African-American men who operate on the down-low (engage in MSM activity but don't disclose to others):

                                                                • African American men who have sex with men (MSM), but who do not disclose their sexual orientation (nondisclosers), have a high prevalence of HIV infection (14%) nearly three times higher than nondisclosing MSMs of other races/ethnicities (5%).
                                                                • Confirming previous research, the study of 5,589 MSM, aged 15–29 years, in six U.S. cities found that African American MSM were more likely not to disclose their sexual orientation compared with white MSM (18% vs. 8%).
                                                                • HIV-infected nondisclosers were less likely to know their HIV status (98% were unaware of their infection compared with 75% of HIV-positive disclosers), and more likely to have had recent female sex partners. [52]

                                                                Risk factors contributing to the Black HIV rate Edit

                                                                Access to healthcare is very important in preventing and treating HIV/AIDS. It can be affected by health insurance which is available to people through private insurers, Medicare and Medicaid which leaves some people still vulnerable. Historically, African-Americans have faced discrimination when it comes to receiving healthcare. [53]

                                                                Homosexuality is viewed negatively in the African-American Community. "In a qualitative study of 745 racially and ethnic diverse undergraduates attending a large Midwestern university, Calzo and Ward (2009) determined that parents of African-American participants discussed homosexuality more frequently than the parents of other respondents. In analyses of the values communicated, Calzo and Ward (2009) reported that Black parents offered greater indication that homosexuality is perverse and unnatural". [54]

                                                                Homosexuality is seen as a threat to the African-American empowerment. [55] Masculinity is seen as important for the African-American community because it shows that the community is in control of their own destiny. Since the stigma circling homosexuality is that it is "effeminate", then homosexuality is seen as a threat to masculinity. "Black manhood, then, depends on men's ability to be provider, progenitor, and protector. But, as the Black male performance of parts of this script is thwarted by economic and cultural factors, the performance of Black masculinity becomes predicated on a particular performance of Black sexuality and avoidance of weakness and femininity. If sexuality remains one of the few ways that Black men can recapture a masculinity withheld from them in the marketplace, endorsing Black homosexuality subverts the cultural project of reinscribing masculinity within the Black community." This critical view is influenced by Internalized homophobia. "Internalized homophobia is defined as the lesbian, gay, or bisexual individual's inward direction of society's homophobic attitudes (Meyer 1995)." [54]

                                                                A homophobic culture is sustained in the African-American community through the church because religion is a vital part of the African-American community: "As reported by Peterson and Jones (2009), AA MSM tended to be more involved with religious communities than NHW MSM." Because the church reiterates this stigma of homosexuality, the African-American community has higher rates of internalized homophobia. This internalized homophobia causes a lower chance of HIV/AIDS education on prevention and care within the African-American community. [54]

                                                                Sex education varies throughout the United States and in some areas could use more informative measures. African-Americans and Hispanic/Latinos experience higher rates of lower socioeconomic statuses and fewer opportunities than white people. This causes limited access to (higher) education in lower socioeconomic areas. Sex education on HIV prevention has decreased from 64% (2000) to 41% (2014). Out of the 50 states, 26 put a larger emphasis on abstinence sex education. Abstinence-only sex education is correlated to increasing rates of HIV especially in teenagers and young adults. [56]

                                                                With mass incarceration of the African-American community, HIV has been spreading rapidly throughout jails and prisons. "Among jail populations, African American men are 5 times as likely as white men, and twice as likely as Hispanic/Latino men, to be diagnosed with HIV." Since most people contract HIV before being incarcerated, it is hard to know who has the disease and to keep it from spreading. Typical prison culture often makes transmission of HIV nearly an endemic problem to deal with. Many prisoners will either force themselves upon or be forced into sexual encounters, which coupled with a lack of condoms, often results in many prisoners contracting and spreading the disease further. Many inmates do not disclose their high-risk behaviors, such as injection drug use, because they fear being stigmatized and ostracized by other inmates. There is also a lack of educational programs on disease prevention for inmates. Because "nine out of ten jail inmates are released in under 72 hours which makes it hard to test them for HIV and help them find treatment," the problem persists outside of prison. [57]

                                                                Starting in the early 1980s, AIDS activist groups and organizations began to emerge and advocate for people infected with HIV in the United States. Though it was an important aspect of the movement, activism went beyond the pursuit of funding for AIDS research. Groups acted to educate and raise awareness of the disease and its effects on different populations, even those thought to be at low-risk of contracting HIV. This was done through publications and "alternative media" created by those living with or close to the disease. [58]

                                                                In contrast to this "alternative media" created by activist groups, mass media reports on AIDS were not as prevalent, most likely due to the stigma surrounding the topic. The general public was therefore not exposed to information regarding the disease. In addition, the federal government and laws in place essentially prevented individuals afflicted with AIDS from getting sufficient information about the disease. Risk reduction education was not easily accessible, so activist groups took action in releasing information to the public through these publications. [59]

                                                                Activist groups worked to prevent spread of HIV by distributing information about safe sex. They also existed to support people living with HIV/AIDS, offering therapy, support groups, and hospice care. [60] Organizations like Gay Men's Health Crisis, Proyecto ContraSIDA por Vida, the Lesbian AIDS Project, and SisterLove were created to address the needs of certain populations living with HIV/AIDS. Other groups, like the NAMES Project, emerged as a way of memorializing those who had passed, refusing to let them be forgotten by the historical narrative. One group, the Association for Drug Abuse Prevention and Treatment (ADAPT), headed by Yolanda Serrano, coordinated with their local prison, Riker's Island Correctional Facility, to advocate for those imprisoned and AIDS positive to be released early, so that they could pass away in the comfort of their own homes. [61]

                                                                Both men and women, heterosexual and queer populations were active in establishing and maintaining these parts of the movement. Because AIDS was initially thought only to impact gay men, most narratives of activism focus on their contributions to the movement. However, women also played a significant role in raising awareness, rallying for change, and caring for those impacted by the disease. Lesbians helped organize and spread information about transmission between women, as well as supporting gay men in their work. Narratives of activism also tend to focus on organizing done in coastal cities, but AIDS activism was present and widespread across both urban and more rural areas of the United States. Organizers sought to address needs specific to their communities, whether that was working to establish needle exchange programs, fighting against housing or employment discrimination, or issues faced primarily by people identified as members of specific groups (such as sex workers, mothers and children, or incarcerated people).

                                                                Initially when the AIDS epidemic surfaced in the United States, a large proportion of patients were LGBT community members, leading to stigmatization of the disease. Because of this, the AIDS activist groups took initiative in testing and experimenting with new possible medications for treating HIV, after researchers outside of the community refused. This research originally done by early activist groups contributed to treatments still being used today. [62]

                                                                Among the landmark legal cases in gay rights on the topic of AIDS is Braschi vs. Stahl. Litigant Miguel Braschi sued his landlord for the right to continue living in their rent controlled apartment after his gay partner Leslie Blanchard died of AIDS. [63] The NY Court of Appeals became the first American appellate court to conclude that same-sex relationships are entitled to legal recognition. [64] The case was litigated at the height of the AIDS crisis and sadly, the plaintiff himself died only a year after his groundbreaking court victory. The case focused on emotional and economic interdependency rather than on the existence of legal formalities the verdict more difficult for government officials to reject the notion that same-sex couples could constitute families and that they were entitled to at least some of the protections afforded by law. [65]

                                                                Catholic Church Edit

                                                                The United States Conference of Catholic Bishops was the first church body to address the pandemic in 1987 with a document entitled "On "The Many Faces of AIDS: A Gospel Response." [66] In the document they said the church must provide pastoral care to those infected with HIV as well as medical care. [67] [68] It called discrimination against people with AIDS "unjust and immoral.", [68] but rejected extra-marital sex and the use of condoms to halt the spread of the disease. [68] They reiterated the Church's teaching that human sexuality was a gift and was to be used in monogamous marriages. [68]

                                                                The Catholic Church, with over 117,000 health centers, is the largest private provider of HIV/AIDS care. [69] Individual dioceses around the United States began hiring staff in the 1980s to coordinate AIDS ministry. [70] By 2008, Catholic Charities USA had 1,600 agencies providing services to AIDS sufferers, including housing and mental health services. [71] The Archdiocese of New York opened a shelter for AIDS patients in 1985. [72] In the same year, they opened a hotline for people to call for resources and information. [72] The Missionaries of Charity, led by Mother Teresa, opened hospices in the Greenwich Village neighborhood of New York, Washington D.C., and San Francisco in the 1980s. [73] [72] Individual parishes began opening hospices for AIDS patients, with the first being in New Orleans in 1985. [72] [74]

                                                                The bishops of the United States issued a pastoral letter in the 1980s titled, "A Call to Compassion," saying those with AIDS "deserve to remain within our communal consciousness and to be embraced with unconditional love." [75] In Always Our Children, their 1997 pastoral letter on homosexuality, the American bishops noted "an importance and urgency" to minister to those with AIDS, especially considering the impact it had on the gay community. [76] They encouraged church ministers to include prayers at Mass for those with AIDS and those who care for them, those who have died from AIDS, and all of their friends, families, and companions. [76] They recommended special masses be said for healing with anointing of the sick or other events to take place around the time of World AIDS Day. [76] They asked every Catholic to stand in solidarity with those who were affected by the disease. [77]

                                                                In 1987, the bishops of California issued a document saying that just as Jesus loved and healed lepers, the blind, the lame, and others, so too should Catholics care for those with AIDS. [72] The year before, they publicly denounced Proposition 64, a measure pushed by Lyndon H. LaRouche to forcibly quarantine those with AIDS, and encouraged Catholics to vote against it. [73] Joseph L. Bernardin, the Archbishop of Chicago, issued a 12-page policy paper in 1986 that outlined "sweeping pastoral initiatives" his archdiocese would be undertaking. [73]

                                                                Present day activism Edit

                                                                An effective response to HIV/AIDS requires that groups of vulnerable populations have access to HIV prevention programs with information and services that are specific to them. [78] In the present day, some activist groups and AIDS organizations that were established during the height of the epidemic are still present and working to assist people living with AIDS. [60] They may offer any combination of the following: health education, counseling and support, or advocacy for law and policy. AIDS organizations also continue to call for public awareness and support through participation in events like pride parades, World AIDS Day, or AIDS walks. Newer activism has appeared in advocacy for Pre-Exposure Prophylaxis (PrEP), which has shown to significantly limit transmission of HIV.

                                                                The CDC estimates at the end of 2017, there were 1,018,346 adults and adolescents with diagnosed HIV in the US and dependent areas. [1] Since 2010, the number of people living with HIV has increased, while the annual number of new HIV infections has declined to 37,832 diagnosed in 2018. [1] Within the overall estimates, however, some groups are affected more than others. 70% of 2018 diagnoses were among men who have sex with men, 7% were among injection drug users, and new infections disproportionately occurred among heterosexual women and African Americans. [1]

                                                                The most recent CDC HIV Surveillance Report estimates that 38,281 new cases of HIV were diagnosed in the United States in 2017, a rate of 11.8 per 100,000 population. [79] This rate is a decrease from the previous year's estimates, which indicated 39,589 new infections and a rate of 12.2 per 100,000 population. [79] Individuals in the age range 25–29 years-old had the highest rates of new infection, with a rate of 32.9 per 100,000. [79] With regard to race and ethnicity, the highest rates of new infections in 2017 occurred in the black/African-American population, with a new infection rate of 41.1 per 100,000. This more than doubled the next highest rate for a racial or ethnic group, which was Hispanic/Latino with a rate of 16.6 per 100,000. [79] The lowest rates of new infection in 2017 occurred in the white population and Asian population, which each had a new infection rate of 5.1 per 100,000. [79]

                                                                According to CDC estimates, the most common transmission category of new infections remained male-to-male sexual contact, which accounted for roughly 66.6% of all new infections in the United States in 2017. [79] With regard to region of residence, the highest rates of new infections in 2017 occurred in the United States South, with 19,968 total new infections and 16.1 infections per 100,000. [79] The region identified as 'South' includes Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. [79]

                                                                In the United States, men who have sex with men (MSM), described as gay and bisexual, [80] make up about 55% of the total HIV-positive population, and 83% of the estimated new HIV diagnoses among all males aged 13 and older, and approximately 92% of new HIV diagnoses among all men in their age group. 1 in 6 gay and bisexual men are therefore expected to be diagnosed with HIV in their lifetime if current rates continue. Among the proportion of new HIV positive gay and bisexual men in 2017, 39% are African American, 32% are white, and 24% are Hispanic/Latino. [80] The CDC estimates that more than 600,000 gay and bisexual men are currently living with HIV in the United States. [80] A review of four studies in which trans women in the United States were tested for HIV found that 27.7% tested positive. [81]

                                                                In a 2008 study, the Center for Disease Control found that, of the study participants who were men who had sex with men ("MSM"), almost one in five (19%) had HIV and "among those who were infected, nearly half (44 percent) were unaware of their HIV status." The research found that white MSM "represent a greater number of new HIV infections than any other population, followed closely by black MSM—who are one of the most disproportionately affected subgroups in the U.S." and that most new infections among white MSM occurred among those aged 30–39 followed closely by those aged 40–49, while most new infections among black MSM have occurred among young black MSM (aged 13–29). [82] [83]

                                                                In 2015, a major HIV outbreak, Indiana's largest-ever, occurred in two largely rural, economically depressed and poor counties in the southern portion of the state, due to the injection of a relatively new opioid-type drug called Opana (oxymorphone), which is designed be taken in pill form but is ground up and injected intravenously using needles. Because of the lack of HIV cases in that area beforehand and the youth of many but not all of those affected, the relative unavailability in the local area of treatment centers capable of dealing with long-term health needs, HIV care, and drug addiction during the initial phases of the outbreak, and political opposition to needle exchange programs, the outbreak expanded for months, resulting up to 127 preventable cases. Under pressure, officials eventually declared a state of emergency, but much of the damage had already been done. [84]


                                                                Groups and subtypes of HIV

                                                                Genetic studies have led to a general classification system for HIV that is primarily based on the degree of similarity in viral gene sequence. The two major classes of HIV are HIV-1 and HIV-2. HIV-1 is divided into three groups, known as group M (main group), group O (outlier group), and group N (new group). Worldwide, HIV-1 group M causes the majority of HIV infections, and it is further subdivided into subtypes A through K, which differ in expression of viral genes, virulence, and mechanisms of transmission. In addition, some subtypes combine with one another to create recombinant subtypes. HIV-1 group M subtype B is the virus that spread from Africa to Haiti and eventually to the United States. Pandemic forms of subtype B are found in North and South America, Europe, Japan, and Australia. Subtypes A, C, and D are found in sub-Saharan Africa, although subtypes A and C are also found in Asia and some other parts of the world. Most other subtypes of group M are generally located in specific regions of Africa, South America, or Central America.

                                                                In 2009 a new strain of HIV-1 was discovered in a woman from Cameroon. The virus was closely related to a strain of SIV found in wild gorillas. Researchers placed the new virus into its own group, HIV-1 group P, because it was unique from all other types of HIV-1. It was unclear whether the newly identified virus causes disease in humans.

                                                                HIV-2 is divided into groups A through E, with subtypes A and B being the most relevant to human infection. HIV-2, which is found primarily in western Africa, can cause AIDS, but it does so more slowly than HIV-1. There is some evidence that HIV-2 may have arisen from a form of SIV that infects African green monkeys.


                                                                A History of HIV/AIDS, Year-by-Year

                                                                What has been discovered about HIV/AIDS in this relatively short span of time is remarkable—and has saved lives.

                                                                In May, the U.S. Centers for Disease Control and Prevention (CDC) reported that five gay men in Los Angeles had developed a rare lung infection called pneumocystis carinii pneumonia (PCP) as well as an array of other diseases consistent with a collapsing immune system. By the time of the publication of the report, two of the men had died and the other three died soon thereafter.

                                                                By December, 270 similar cases were reported in what researchers were calling gay-related immune deficiency (GRID). Of those, 121 had died of the disease within the course of the year.

                                                                The disease began to appear among people other than gay men. At the same time, the CDC introduced the term acquired immune deficiency syndrome (AIDS) to the public health lexicon, defining it as a disease "occurring in a person with no known cause for diminished resistance to that disease."

                                                                Researchers at the Pasteur Institute in France, including Françoise Barré Sinoussi and Luc Montagnier, identified a novel retrovirus they suggested could be the cause of AIDS, naming it lymphadenopathy-associated virus (LAV).

                                                                In the U.S., the disease continued to spread beyond the gay community.

                                                                Milestone: Confirmation of HIV Transmission

                                                                The CDC affirmed that sexual contact and exposure to infected blood were the two major routes of transmission for the still-unnamed virus.

                                                                American researcher Robert Gallo announced the discovery of a retrovirus called human T-lymphotropic (HTLV-III), which he believed was the cause of AIDS. The announcement sparked a controversy as to whether LAV and HTLV-III were the same virus and which country owned the patent rights to it.  

                                                                By the end of the year, officials in San Francisco ordered the closure of gay bathhouses, deeming them a public health hazard in the face of the growing wave of illnesses and death among local gay men.

                                                                In January, the CDC reported that AIDS was caused by a newly identified virus—the human immunodeficiency virus (HIV). This was followed shortly by news that the U.S. Food and Drug Administration (FDA) had approved the first HIV antibody test able to detect the virus in blood samples.

                                                                Meanwhile, reports emerged that Ryan White, an Indiana teenager, was denied entrance to his high school after having developed HIV/AIDS from a blood transfusion. Two months later, actor Rock Hudson became the first high profile celebrity to die of AIDS-related illnesses.

                                                                The AIDS Memorial Quilt was conceived by activist Cleve Jones to commemorate the lives lost to HIV. Each 3-foot by 6-foot panel paid tribute to one or more people who had died of the disease.  

                                                                In May, the International Committee on the Taxonomy of Viruses issued a statement in which it was agreed that the virus that causes AIDS would officially be named HIV.

                                                                American playwright Larry Kramer founded AIDS Coalition to Unleash Power (ACT UP) in New York City to protest on-going inaction of the government to address the growing AIDS crisis in the United States.

                                                                Meanwhile, the U.S. and France agreed that LAV and HTLV-III were, in fact, the same virus and agreed to share patent rights, channeling the majority of the royalties to global AIDS research.

                                                                Milestone: Development of an HIV Drug

                                                                In March of 1987, the FDA approved AZT (zidovudine)—the first antiretroviral drug able to treat HIV. Soon after, they also agreed to accelerate the drug approvals process, reducing the procedural lag time by two to three years.

                                                                Elizabeth Glaser, wife of Starsky & Hutch star Paul Michael Glaser, founded the Pediatric AIDS Foundation (later renamed the Elizabeth Glaser Pediatric AIDS Foundation) after acquiring HIV from a blood transfusion. The charity soon became the world's largest funder of global AIDS research and care.

                                                                World AIDS Day was observed for the first time on December 1st.

                                                                By August, the CDC reported that the number of AIDS cases in the U.S. had reached 100,000.

                                                                The death of Indiana teenager Ryan White in April sparked a wave of protests as government officials were accused of continued inaction.

                                                                MILESTONE: Congressional Support

                                                                The U.S. Congress responded by approving the Ryan White Comprehensive AIDS Resource Emergency (CARE) Act of 1990, designed to provide federal funding to community-based HIV care and services providers.

                                                                AIDS became the number one leading cause of death for American men ages 25 to 44.  

                                                                The CDC expanded the definition of AIDS to include people with CD4 counts under 200. By June, President Bill Clinton signed into law a bill allowing for the ban of all immigrants with HIV.

                                                                AIDS became the leading cause of death among all Americans 25 to 44.

                                                                Meanwhile, results of the landmark ACTG 076 trial were released, which demonstrated that AZT given just before delivery could dramatically reduce the risk of HIV transmission from mother to child during pregnancy.   The results were quickly followed by the issuance of the first guidelines from the U.S. Public Health Service (USPHS) calling for the use of AZT in pregnant women with HIV.

                                                                The FDA approved Invirase (saquinavir mesylate), the first protease inhibitor-class drug introduced into the antiretroviral arsenal.

                                                                Milestone: Emergence of a Treatment Protocol

                                                                The use of protease inhibitors ushered in an era of high-active antiretroviral therapy (HAART), in which a combination of three or more drugs was used to treat HIV.

                                                                By the end of the year, 500,000 Americans were reported to have been infected with HIV.

                                                                The FDA approved the first viral load test able to measure the level of HIV in a person’s blood, as well the first HIV home-testing kit and the first non-nucleoside-class drug called Viramune (nevirapine).

                                                                In the same year, the USPHS issued its first recommendations on the use of antiretroviral drugs to reduce the risk of infection in people accidentally exposed to HIV in healthcare settings.   The USPHS recommendation for post-exposure prophylaxis (PEP) formed the basis for preventive treatment in cases of sexual exposure, rape, or accidental blood exposure.

                                                                The AIDS Memorial Quilt, consisting of over 40,000 panels, was laid out on the National Mall in Washington, D.C. and covered the entire span of the national public park.

                                                                The CDC reported the widespread use of HAART had dramatically reduced the risk of HIV-related illnesses and deaths, with mortality rates dropping by an astonishing 47% compared to the previous year.

                                                                Milestone: Africa Becomes a Hotbed for HIV

                                                                Meanwhile, the United Nations Programme on HIV/AIDS (UNAIDS) reported that nearly 30 million people had been infected with HIV worldwide, with southern Africa accounting for nearly half of all new infections.

                                                                The CDC issued the first national HIV treatment guidelines in April, while the U.S. Supreme Court ruled that the Americans with Disabilities Act (ADA) covered all people living with HIV.

                                                                The World Health Organization (WHO) reported that HIV was the leading cause of death in Africa as well as the fourth leading cause of death worldwide. WHO further estimated that, all told, 33 million people had been infected and that 14 million had died as a result of HIV-associated diseases.

                                                                The XIII International AIDS Conference in Durban, South Africa, was shrouded in controversy when then-President Thabo Mbeki, in the opening session, expressed doubt that HIV causes AIDS. At the time of the conference, South Africa had (and continues to have) the largest population of people living with HIV in the world.

                                                                The Global Fund to Fight AIDS, Tuberculosis, and Malaria was founded in Geneva, Switzerland, to channel funding to HIV programs in developing countries. At the time of its founding, 3.5 million new infections were reported in sub-Saharan Africa alone.

                                                                Meanwhile, in an effort to step up HIV testing in the U.S., the FDA approved the first rapid HIV blood test able to deliver results in as little as 20 minutes with 99.6% accuracy.​

                                                                President George H.W. Bush announced the formation of the President’s Emergency Plan for AIDS Relief (PEPFAR), which became the largest HIV funding mechanism by a single donor country.   Unlike the Global Fund, which provided countries a measure of sovereignty over how money could be used, PEPFAR took a more hands-on approach with greater degrees of program oversight and measures.

                                                                Milestone: The First Vaccine Trials Fall Short

                                                                The first HIV vaccine trial, using the AIDVAX vaccine, failed to reduce infection rates among study participants. It was the first of many vaccine trials that ultimately failed to achieve reasonable levels of protection for either people with HIV or those hoping to avoid the disease.

                                                                Meanwhile, the next generation nucleotide-class drug, Viread (tenofovir), was approved by the FDA. The drug, which was shown to be effective even in people with deep resistance to other HIV medications, was quickly moved to the top of the U.S. preferred treatment list.

                                                                According to WHO, over one million people in sub-Saharan Africa were receiving antiretroviral therapy, a 10-fold increase in the region since the launch of the Global Fund and PEPFAR efforts.

                                                                In the same year, researchers with the National Institutes of Health (NIH) reported that clinical trials in Kenya and Uganda were stopped after it was shown that male circumcision could reduce a man’s risk of getting HIV by as much as 53%.

                                                                Similarly, the CDC issued calls for HIV testing for all people ages 13 to 64, including a one-time yearly testing for individuals considered to be at high risk.

                                                                The CDC reported that, at that point, 565,000 Americans had died of HIV. They also reported that four transplant recipients contracted HIV from an organ donation, the first known cases from transplants in more than a decade. These cases highlighted the need for improved testing, since the donor may have contracted HIV too recently to test positive.

                                                                Timothy Brown, popularly known as the Berlin Patient, was reported to have been cured of HIV after receiving an experimental stem cell transplant. While the procedure was deemed to be too dangerous and costly to be viable in a public health setting, it gave rise to other studies hoping to repeat the results.

                                                                It was also reported that the incidence of new infections among men who have sex with men was on the rise, with rates nearly doubling among young gay men between the ages of 13 and 19.

                                                                President Barack Obama's administration officially ended the U.S.'s HIV immigration and travel ban.

                                                                In November, researchers with the IPrEx Study reported that the daily use of the combination drug Truvada (tenofovir and emtricitabine) reduced the risk of infection in HIV-negative gay men by 44%.

                                                                Milestone: First Steps Toward Prevention

                                                                The IPrEx Study is the first to endorse the use of pre-exposure prophylaxis (PrEP) to reduce the risk of HIV in non-infected individuals.

                                                                After demonstrating that people on antiretroviral therapy were 96% less likely to transmit HIV to a non-infected partner able to sustain an undetectable viral load, Science magazine named the HPTN 052 Study the Breakthrough of the Year.

                                                                The study confirmed the use of Treatment as Prevention (TasP) as a means to prevent the spread of HIV in serodiscordant couples (one partner is HIV-positive and the other is HIV-negative).

                                                                Despite a reversal in the number of HIV-related deaths, South Africa reportedly had the largest number of new HIV infections with about 1,000 new cases each day in those ranging in age from 15 to 49 years.  

                                                                The FDA officially approved the use of Truvada for PrEP.   It came at a time when the U.S. reported just over 40,000 new diagnoses, a figure that had fluctuated between this number and upwards of 55,000 since 2002.

                                                                President Obama signed the HIV Organ Policy Equity (HOPE) Act into law, which allows for the transplantation of organs from an HIV-positive donor to an HIV-positive recipient.

                                                                UNAIDS announced that the new infection rate in low- to middle-income countries had dropped by 50% as result of expanded HIV treatment programs. They also reported that an estimated 35.3 million people were infected with HIV.

                                                                The FDA approved the integrase inhibitor-class drug Tivicay (dolutegravir), which was shown to have fewer side effects and greater durability in people with deep drug resistance. The drug was quickly moved to the top of the U.S. preferred HIV drugs list.

                                                                The Affordable Care Act (ACA) expanded health insurance to individuals previously denied coverage. Before the law went into effect, fewer than one in five Americans with HIV had private health insurance.

                                                                Milestone: Discovery of the Origin of HIV

                                                                Meanwhile, scientists at Oxford University investigating historical records and genetic evidence concluded that HIV likely originated in or around Kinshasa in the Democratic Republic of Congo.

                                                                It is believed that a hybrid form of the simian immunodeficiency virus (SIV) jumped from the Pan troglodytes chimpanzee to man as a result of either blood exposure or ingesting bushmeat.

                                                                The Strategic Timing of Antiretroviral Treatment (START) Study was released to delegates at the International AIDS Society Conference in Vancouver, Canada. The study, which showed that HIV therapy provided at the time of diagnosis could reduce the risk of serious illness by 53%, elicited calls for immediate changes in public policy.

                                                                Four months later, WHO issued updated guidelines recommending HIV treatment at the time of diagnosis irrespective of CD4 count, location, income, or stage of disease. They further recommended the use of PrEP in those at substantial risk of acquiring HIV.

                                                                On World AIDS Day, the CDC reported that annual HIV diagnoses in the U.S. had dropped by 19%, with the steepest declines among heterosexuals and African American women. By contrast, younger gay men remained at high risk of infection African American gay men were reported to have a 50/50 chance of acquiring HIV in a lifetime.

                                                                On December 21, the FDA lifted its 30-year-old ban on blood donations from gay and bisexual men with a notable caveat: only those men who had not had sex for a year could donate. The decision incited anger from AIDS activists, who insisted that it was discriminatory and no less than a de facto ban.

                                                                According to WHO, 38.8 million people were infected with HIV and, all together, nearly 22 million people had died of HIV-associated causes.

                                                                With evidence that universal treatment of HIV could reverse infection rates, the United Nations launched its 90-90-90 strategy aimed at identifying 90% of people living with HIV, placing 90% of positively identified individuals on treatment, and ensuring that 90% of those on therapy were able to achieve undetectable viral loads.

                                                                In May, a CDC report revealed that the rate of death from HIV/AIDS among Black and African American people had decreased significantly: Among 18-to-34-year-olds, HIV-related deaths dropped 80%. Among those 35 and older, deaths dropped by 79%.

                                                                The year began with the death of a prominent AIDS researcher, Mathilde Krim, on January 15. Krim founded the Foundation for AIDS Research (amfAR) in 1985. Since then, the organization has invested more than $517 million in its programs.

                                                                A week later, the NIH launched a global study to look at the antiretroviral treatment regimens for pregnant women with HIV and their babies.   The goal is to make sure that such women and their children get the safest and most effective treatment.

                                                                December 1 was the 30th anniversary of World AIDS Day.

                                                                Milestone: HIV/AID Prevention Goes High-Tech

                                                                Researchers at Los Alamos National Laboratory found that computer simulation can be used to predict how HIV spreads, making it possible for state health departments to track the spread of the virus and have a powerful new tool to help prevent new HIV infections.

                                                                A Word From Verywell

                                                                For all the fear and anger caused by the HIV/AIDS pandemic, it has transformed the landscape of science and politics in innumerable ways, particularly as it relates to the advocacy for the rights and protections of patients. It also has forced the fast-tracking of the drug approvals process while spurring researchers to develop many of the genetic and biomedical tools we take for granted today.

                                                                The simple fact that HIV has gone from being an almost uniformly fatal diagnosis to one that people can now live healthy, normal lives in spite of is nothing short of astonishing. Still, we have a long way to go and many lessons to learn before we can consider the crisis over. It is only by looking back that we can better understand the challenges yet to be faced as we move toward making HIV/AIDS a thing of the past.


                                                                When and where did HIV start in humans?

                                                                Studies of some of the earliest known samples of HIV provide clues about when it first appeared in humans and how it evolved. The first verified case of HIV is from a blood sample taken in 1959 from a man living in what is now Kinshasa in the Democratic Republic of Congo. The sample was retrospectively analysed and HIV detected. There are numerous earlier cases where patterns of deaths from common opportunistic infections, now known to be AIDS-defining, suggest that HIV was the cause, but this is the earliest incident where a blood sample can verify infection.9

                                                                Did HIV start in Africa?

                                                                Using the earliest known sample of HIV, scientists have been able to create a 'family-tree' ancestry of HIV transmission, allowing them to discover where HIV started.

                                                                Their studies concluded that the first transmission of SIV to HIV in humans took place around 1920 in Kinshasa in the Democratic Republic of Congo (DR Congo).10

                                                                The same area is known for having the most genetic diversity in HIV strains in the world, reflecting the number of different times SIV was passed to humans. Many of the first cases of AIDS were recorded there too.

                                                                How did HIV spread from Kinshasa?

                                                                The area around Kinshasa is full of transport links, such as roads, railways and rivers. The area also had a growing sex trade around the time that HIV began to spread. The high population of migrants and sex trade might explain how HIV spread along these infrastructure routes. By 1937, it had reached Brazzaville, about 120km west of Kinshasa.

                                                                The lack of transport routes into the North and East of the country accounts for the significantly fewer reports of infections there at the time.11

                                                                By 1980, half of all infections in DR Congo were in locations outside of the Kinshasa area, reflecting the growing epidemic.12

                                                                Why is Haiti significant?

                                                                In the 1960s, the 'B' subtype of HIV-1 (a subtype of strain M) had made its way to Haiti. At this time, many Haitian professionals who were working in the colonial Democratic Republic of Congo during the 1960s returned to Haiti.13 Initially, they were blamed for being responsible for the HIV epidemic, and suffered severe racism, stigma and discrimination as a result.

                                                                HIV-1 subtype M is now the most geographically spread subtype of HIV internationally. By 2014, this subtype had caused 75 million infections.14


                                                                The history of the quilt

                                                                The Quilt was conceived in November of 1985 by long-time San Francisco gay rights activist Cleve Jones. Since the 1978 assassinations of gay San Francisco Supervisor Harvey Milk and Mayor George Moscone, Jones had helped organize the annual candlelight march honoring these men. While planning the 1985 march, he learned that over 1,000 San Franciscans had been lost to AIDS. He asked each of his fellow marchers to write on placards the names of friends and loved ones who had died of AIDS. At the end of the march, Jones and others stood on ladders taping these placards to the walls of the San Francisco Federal Building. The wall of names looked like a patchwork quilt.

                                                                Inspired by this sight, Jones and friends made plans for a larger memorial. A little over a year later, a small group of strangers gathered in a San Francisco storefront to document the lives they feared history would neglect. Their goal was to create a memorial for those who had died of AIDS, and to thereby help people understand the devastating impact of the disease. This meeting of devoted friends and lovers served as the foundation of the NAMES Project AIDS Memorial Quilt.

                                                                Cleve created the first panel for the AIDS Memorial Quilt in memory of his friend Marvin Feldman. In June of 1987, Jones teamed up with Mike Smith, Gert McMullin and several others to formally organize the NAMES Project Foundation.

                                                                Public response to the Quilt was immediate. People in the U.S. cities most affected by AIDS — Atlanta, New York, Los Angeles and San Francisco — sent panels to the San Francisco workshop. Generous donors rapidly supplied sewing machines, equipment and other materials, and many volunteered tirelessly.

                                                                The Inaugural Display

                                                                On October 11, 1987, the Quilt was displayed for the first time on the National Mall in Washington, D.C., during the National March on Washington for Lesbian and Gay Rights. It covered a space larger than a football field and included 1,920 panels. Six teams of eight volunteers ceremonially unfolded the Quilt sections at sunrise as celebrities, politicians, families, lovers and friends read aloud the 1,920 names of the people represented in Quilt. The reading of names is now a tradition followed at nearly every Quilt display. Half a million people visited the Quilt that weekend.

                                                                The overwhelming response to the Quilt’s inaugural display led to a four-month, 20-city, national tour for the Quilt in the spring and summer of 1988. The tour raised nearly $500,000 for hundreds of AIDS service organizations. More than 9,000 volunteers across the country helped the seven-person traveling crew move and display the Quilt. Local panels were added in each city, tripling the Quilt’s size to more than 6,000 panels by the end of the tour.

                                                                The Quilt Grows

                                                                The Quilt returned to Washington, D.C. in October of 1988, when 8,288 panels were displayed on the Ellipse in front of the White House.

                                                                With a small seed grant from the World Health Organization, Quilt organizers travelled to eight countries to mark the first World AIDS Day on December 1, 1988 with simultaneous displays broadcast from six continents. Throughout 1989, more than 20 countries launched similar commemorative projects based on the Quilt. Cleve Jones, Mike Smith and the NAMES Project Foundation were nominated for the 1989 Nobel Peace Prize in recognition of the global impact of the Quilt.

                                                                In 1989 a second tour of North America brought the Quilt to 19 additional cities in the United States and Canada. That tour and other 1989 displays raised nearly a quarter of a million dollars for AIDS service organizations. In October of that year, the Quilt (now more than 12,000 panels in size) was again displayed on the Ellipse in Washington, D.C. HBO released their documentary film on the Quilt, Common Threads: Stories from the Quilt, which brought the Quilt’s message to millions of movie-goers. The film won the Academy Award for Best Documentary of 1989.

                                                                By 1992, the AIDS Memorial Quilt included panels from every state and 28 countries. In October 1992, the entire Quilt returned to the National Mall in Washington, D.C. In January 1993, the NAMES Project was invited to march in President Clinton’s inaugural parade where over 200 volunteers carried Quilt panels down Pennsylvania Avenue.

                                                                The last display of the entire AIDS Memorial Quilt was in October of 1996 when the Quilt covered the entire National Mall in Washington, D.C. with an estimated 1.2 million people coming to view it. The Clintons and Gores attended the display, marking the first visit by a sitting president of the United States.

                                                                In 2000, the Board of Directors of The NAMES Project elected to move the Foundation’s national headquarters from San Francisco to Atlanta. The cross-country move was made to shore up the Foundation’s finances and to be in a better position to address the changing face of HIV/AIDS.

                                                                In 2004, more than 8,000 of the newest panels that had been received at or since October 1996 display were shown on The Eclipse in Washington, D.C. in observance of National HIV Testing Day.

                                                                In 2012, as part of the 25th anniversary of the NAMES Project Foundation, the Quilt returned to Washington, DC as part of a collaboration with the Smithsonian Museum’s American Folklife Festival, where the entire Quilt was displayed on the National Mall over the course of a two-week period with 1,500 blocks of panels being displayed each day. Given the size of the Quilt, it is now too large to be displayed all at once on the Mall. The International AIDS Conference was held in Washington DC immediately following the display, in which the Quilt was a major feature, with displays in more than 60 locations throughout the D.C. metro area.

                                                                In 2013, as part of ongoing awareness and educational efforts, a special Quilt program, Call My Name, was created to draw attention to HIV/AIDS in the Black community and the public health crisis that still exists today. The program aims to create a greater number of Quilt panels that reflect the impact of HIV/AIDS within the Black community and the effect stigma and prejudice have on increased infection rates. A national tour followed that included hosting panel-making workshops organized by Black churches and community groups to make panels and raiser greater awareness of on the HIV/AIDS crisis in the African American community.

                                                                Ensuring the Quilt’s Legacy

                                                                In November 2019, the National AIDS Memorial became the permanent caretaker and steward of the Quilt, returning it to San Francisco, where its story began during the height of the AIDS epidemic. At that time, the Quilt’s archival collection of 200,000 objects, documents, cards and letters that chronicle the lives remembered in it were transferred to the prestigious American Folklife Center at the Library of Congress, making this collection available through the world’s largest public library. This announcement, made at the Library of Congress in Washington, DC, featured special guests House Speaker Nancy Pelosi, Representatives John Lewis and Barbara Lee, who recognized the Quilt as a national treasure that must be preserved for its ability to teach for generations to come. See the news release announcement.

                                                                Gilead Sciences provided a $2.4 million grant the the National AIDS Memorial to relocate the Quilt from Atlanta back to the San Francisco Bay Area where is was created. The first Quilt panels arrived in January 2020.

                                                                Each year, the National AIDS Memorial works with hundreds of partners across the country to orchestrate more than 1,000 displays in schools, universities, places of worship, corporations and community centers. On World AIDS Day, December 1st, more than 1/2 of the Quilt goes on display around the nation.

                                                                Through a 20-year partnership with AIDS Quilt Touch, the Quilt can be displayed in its entirety interactively so millions of people around the world can experience it’s stories. The Quilt has also been the subject of countless books, films, scholarly papers, articles, and theatrical, artistic and musical performances.

                                                                Forty years into the pandemic more than 700,000 lives in the U.S. have been lost to AIDS and more than 1.1 million people live with HIV and an estimated 1 in 7 people do not know they have HIV. In the last figures reported in 2018, Black/African American gay and bisexual men account for the largest number of new HIV diagnoses.

                                                                Panel making remains an important element of the Quilt, as new panels continue to be made. Today, the AIDS Memorial Quilt is an epic 54-ton tapestry that includes nearly 50,000 panels dedicated to more than 105,000 individuals. It is the premiere symbol of the AIDS pandemic, a living memorial to a generation lost to AIDS and an important HIV prevention education tool. With hundreds of thousands of people contributing their talents to making the memorial panels, and tens of thousands of volunteers to help display it, the Quilt is considered the largest community arts project in history.

                                                                “It was gentle rain, no speeches or music, just thousands of people reading these names on this patchwork of placards up on that wall. And I thought to myself, It looks like some kind of quilt,’ and when I said the word "quilt" I thought of my great-grandma. . And it was such a warm and comforting and middle-American traditional-family-values sort of symbol, and I thought, ‘This is the symbol we should take.’”

                                                                — Cleve Jones, NPR interview 2016

                                                                Support the AIDS Memorial Quilt - DONATE NOW

                                                                The Qult and many of its panels are nearly 35 years old. Please help ensure that every panel is protected and preserved and that each story can forever be told to future generations.


                                                                Watch the video: Μίκης Θεοδωράκης - Του Μικρού Βοριά. Mikis Theodorakis - Tou Mikrou Voria - Official Audio Release (December 2021).