General Information about HIV

Whether you are some one who would like to get involved in the field or whether you, a family member or a frined have been diagnosed as HIV positive - 'knowledge is power'. Sound scientific knowledge and information can help you to make better choices.

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7 Things You May Believe About HIV/AIDS That Turn out to be Wrong 20/4/2016

1. HIV is a death sentence

WRONG

HIV/AIDS is the deadliest pandemic in recent history: it has killed twice as many people as the first World War. But the progress made in a mere 30 years against the disease has been spectacular. Today, someone who takes antiretroviral drugs every day has a very low risk of developing AIDS and can live a long and fulfilling life.

… BUT ALSO, UNFORTUNATELY, RIGHT FOR THOSE NOT ON ARV…

if you’re unlucky enough to live in a place with poor access to lifesaving ARV. Over 75% of the people living with HIV in West and Central Africa - 5 million people - are not on ARV treatment and therefore condemned to a slow, painful and unnecessary death. The situation is even worse for the 730,000 HIV-infected children in the region: 90% don’t have access to ARVs. Urgent action is needed to change this situation.

2. HIV mostly affects gay men

WRONG.

It may be the case in Western countries, but not worldwide. In fact, the face of HIV globally today is a young woman. 59% of people living with HIV in Sub-Saharan Africa are women. In South Africa, girls age 15-19 are as much as eight times more at risk of HIV infection than their male counterparts.

IT’S TRUE that men who have sex with men are disproportionally affected by the pandemic. It’s also the case for sex workers or injectable drug users. This is the reason why the United Nations’ plan to combat HIV/AIDS puts a lot of emphasis on these most-at-risk groups. But still, 45% of all children who are born with the virus come from West and Central Africa. Why? Because their mothers did not have access to treatment

3. You cannot have a healthy baby if you’re HIV positive

WRONG

A pregnant HIV+ woman on optimal ARV treatment has less than 2% risk of transmitting the virus to her baby. This is fantastic news: thanks to ARVs, the number of children born with the virus worldwide has been cut by 60% since 2000 and last year Cuba became the first country to declare that it had completely eliminated mother-to-child HIV transmission.

But again, this victory depends on the availability of ARV treatment. In West and Central Africa, only 39% of HIV positive pregnant women are on treatment. This is why the number of children born with the virus in this region is so disproportionately high: whereas West and Central Africa accounts for 17.9% of the total number of people living with HIV in the world, it records close to half of the births of HIV-infected children.

Those babies are born with a disease that could have been prevented. And it’s all the more dramatic that 90% of the HIV positive babies in this region do not have access to pediatric HIV treatment either. Without treatment, about one-third of children living with HIV will not survive past their first birthday; half of them will not celebrate their second birthday and only one in five of these children will celebrate a fifth birthday.

4. Using condoms is the only way to avoid infecting your partner or getting infected by HIV

WRONG

For sure, using condoms is very effective in preventing HIV infection. But it’s not the only way.

Studies have shown that optimal treatment on ARV reduces the risk of transmitting the virus by 96% in couples in which one is HIV-positive. New drugs even allow HIV negative people to be protected against infection.

Promoting the use of condoms is an important tool against HIV, but people need a combination of prevention tools to choose from, to fit best with their situation. Offering ARV treatment for all is a key component to put the HIV/AIDS pandemic under control, and therefore, it’s a huge problem that so few people – less than 1 in 4 – have access to treatment in West and Central Africa. Without treatment for all who need it, everywhere, the chances of bringing the global pandemic under control are very slim. This is why MSF is calling for an urgent, ambitious catch up plan for countries with low coverage of ARVs.

5. The more HIV+ people in a country, the more AIDS-related deaths

WRONG

South Africa has, by far, the largest number of people living with HIV (6.8 million), and AIDS still takes a staggering toll in the country with 14,000 deaths a year. But as staggering as it is, this number remains below Nigeria’s, which has half the number of HIV+ people. Can you guess why? Again, it’s simple: Nigerians have far less access to ARVs than South Africans (22% versus 45% coverage of ARV).

Similarly, Guinea recorded roughly the same number of AIDS-related deaths in 2014 (3,800) as Swaziland (3,500). But Swaziland has twice the number of people living with the virus (210,000 versus 120,000) and the highest proportion of adults living with HIV worldwide (27.7%).

In short, in places where antiretroviral treatment is not widely accessible, people suffer and die proportionally more from HIV/AIDS.

6. The less HIV+ people in a country, the easier it is to fight the disease

WRONG

Logic suggests that the Democratic Republic of Congo (DRC), where ‘only’ 1.2% of its population is living with HIV, would be better able to provide ARV daily treatment than Malawi. After all, both countries are relatively comparable on paper in terms of GDP per capita[1] or human development index[2]. Yet Malawi has managed to put 50% of its HIV-infected population on ARVs. The DRC, less than 25%.

Doesn’t make sense? Well there are some explanations. If, as in the DRC, HIV is less visible in society, media and political agenda’s, it gets lost among many other health priorities. This is understandable. What is less understandable is the constant neglect by international actors of countries with low HIV prevalence like those in West and Central Africa.

7. Only rich, stable countries have the capacity to offer lifelong, daily treatment

WRONG

This seems to make logical sense; after all, even health systems in rich countries are already under strain to provide treatment for growing number of people with chronic conditions: diabetes, obesity… So imagine the situation in a country like Malawi that needs to provide daily HIV treatment for 10% of its adult population, even though it has six times less health workers than the bare minimum recommended by WHO.

In fact,  the most noteworthy progress against HIV/AIDS have been achieved in resource-poor countries. In fact, the introduction of ARVs in the 2000s was the single most important factor to increase life expectancy in Southern Africa.

MSF has even built experience over the years as to how to provide HIV care in conflict settings, for example in Yemen or CAR, to avoid making people double victims of both war and their HIV+ status. Continuing care is imperative even in the most challenging, unstable areas.

Just because a country has limited resources or a context is complicated or unstable doesn’t have to mean that people living with HIV cannot be provided with ARV treatment.

It is essential that none of us, anywhere, forget the most neglected victims of HIV/AIDS. For this reason, MSF is calling calls on donors, affected governments and UN agencies to develop and implement a fast-track plan to scale-up life-saving antiretroviral treatment in countries where ART coverage reaches less than one-third of the population, particularly in West and Central Africa.

The time is now.

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Basics About Living With HIV.

Basics about living with HIV - especially when you are newly diagnosed is available on the NAM website.
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Global HIV/AIDS Timeline.

Published at Kaiser Family Foundation
13/07/2015


Introduction

On June 5, 1981, the U.S. Centers for Disease Control and Prevention (CDC) issued its first warning about a relatively rare form of pneumonia among a small group of young gay men in Los Angeles, which was later determined to be AIDS-related. While scientists believe that HIV was present years before the first case was brought to public attention, 1981 is generally referred to as the beginning of the HIV/AIDS epidemic. Since that time, tens of millions of people have been infected with HIV worldwide. The Global HIV/AIDS Timeline is designed to serve as an ongoing reference tool for the many political, scientific, cultural, and community developments that have occurred over the history of the epidemic.

Timeline by Year

View: 1981 | 82 | 83 | 84 | 85 | 86 | 87 | 88 | 89 |90|  91 | 92 | 93 | 94 | 95 | 96 | 97 | 98 | 99 |2000| 01 | 02 | 03 | 04 |05 | 06 | 07 | 08 | 09 | 10 | 11 | 12 | 13 | 14 | 15

1981

  • U.S. Centers for Disease Control and Prevention (CDC) reports first cases of rare pneumonia in young gay men in the June 5 MMWR. These cases were later determined to be AIDS. This marks the official beginning of the HIV/AIDS epidemic. CDC also issues report on highly unusual occurrence of rare skin cancer, Kaposi’s Sarcoma, among young gay men in the July 4 MMWR.
  • First mainstream news coverage of the CDC’s June 5 MMWR by the Associated Press and the LA Times on the same day it is issued. The San Francisco Chronicle reports on it the next day.
  • New York Times publishes its first news story on AIDS on July 3.

1982

  • U.S. CDC establishes term Acquired Immune Deficiency Syndrome (AIDS); refers to four “identified risk factors:” male homosexuality, intravenous drug abuse, Haitian origin, and hemophilia A.
  • Cases of AIDS now present in many states and its cause not yet known. See news report: ABC World News Tonight, October 18, 1982.
  • “GRID” or “gay-related immune deficiency” increasingly used by media and health care professionals, mistakenly suggesting inherent link between homosexuality and AIDS.
  • First U.S. Congressional hearings on AIDS held.
  • Gay Men’s Health Crisis, the first community-based AIDS service provider in the U.S., established in New York City.
  • City and County of San Francisco, working closely with San Francisco AIDS Foundation, Shanti Project and others, develops the “San Francisco Model of Care,” which emphasizes home- and community-based services for people with AIDS.
  • First AIDS case reported in Africa.

1983

  • The U.S. Public Health Service issues recommendations for preventing transmission of the infection through sexual contact and blood transfusions.
  • U.S. CDC clarifies its use of term “high risk group” and urges that it not be used to justify discrimination or unwarranted fear of casual transmission.
  • U.S. CDC adds female sexual partners of men with AIDS as fifth risk group.
  • The Orphan Drug Act is signed into U.S. law, providing incentives to drug companies to develop therapies for rare diseases.
  • In the September 9 MMWR, U.S. CDC notes that AIDS has not been spread through casual contact and declares that “AIDS is not known to be transmitted through food, water, air, or environmental surfaces.”
  • Dr. Luc Montagnier of the Pasteur Institute in France isolates lymphadenopathy-associated virus (LAV) — which he believed to be related to AIDS — and publishes findings. That same year, Dr. Robert Gallo of the National Cancer Institute in the U.S. successfully cultivates LAV (which he identified as HTLV-III) in lab and submits paper for publication proposing that a retrovirus causes AIDS.
  • The World Health Organization (WHO) holds first meeting to assess the impact of AIDS globally and begins international surveillance.
  • People living with AIDS (PWAs) take over plenary stage at a U.S. conference and issue statement on the rights of PWAs referred to as The Denver Principles.
  • National Association of People with AIDS (NAPWA) and Federation of AIDS Related Organizations form.
  • AIDS Candlelight Memorial held for the first time.

1984

  • U.S. Department of Health and Human Services (HHS) announces Dr. Robert Gallo of the National Cancer Institute finds that a retrovirus causes AIDS. Dr. Gallo and Dr. Luc Montagnier of the Pasteur Institute hold joint press conference in June announcing discovery that a retrovirus (identified as HTLV-III by Gallo and LAV by Montagnier; see 1983 entry) — later named Human Immunodeficiency Virus (HIV) — causes AIDS.
  • U.S. CDC states that abstention from intravenous drug use and reduction of needle-sharing “should also be effective in preventing transmission of the virus.”
  • San Francisco officials order bathhouses closed; major public controversy ensues and continues in Los Angeles, New York and other cities. See news report: ABC World News Tonight, November 23, 1984.
  • AIDS Action Council is formed by small group of AIDS service organizations from across the U.S.

1985

  • First International AIDS Conference held in Atlanta, hosted by U.S. HHS and WHO.
  • At least one HIV/AIDS case reported in each region of the world. First HIV case reported in China.
  • First HIV test licensed by the U.S. Food and Drug Administration (FDA); detects antibodies to HIV. Blood banks begin screening the U.S. blood supply.
  • Pentagon announces it will begin testing all new recruits for HIV and will reject those who are positive.
  • U.S. Public Health Service issues first recommendations for preventing transmission of HIV from mother to child.
  • Rock Hudson announces that he has AIDS and dies later this year. See news report:  ABC World News Tonight, October 2, 1985.
  • Ryan White, an Indiana teenager with AIDS, is barred from school; goes on to speak out publicly against AIDS stigma and discrimination.
  • First major play about the early days of the AIDS epidemic, “The Normal Heart” by playwright Larry Kramer, opens.
  • American Foundation for AIDS Research (amfAR) founded by Co-Chairs Mathilde Krim and Michael S. Gottlieb, and National Chair Elizabeth Taylor.
  • Project Inform founded to advocate for faster government approval of HIV drugs.
  • National AIDS Network (NAN) in the U.S. forms.

1986

  • President Reagan first mentions word AIDS in public.
  • National Academy of Sciences issues report critical of U.S. response to “national health crisis;” calls for $2 billion investment.
  • U.S. Surgeon General Koop issues Surgeon General’s Report on AIDS, calling for education and condom use.
  • Institute of Medicine report calls for a national education campaign and creation of National Commission on AIDS in U.S.
  • AZT, the first drug used to treat HIV/AIDS, begins clinical trials. See news report: ABC World News Tonight, September 19, 1986. 
  • First HIV cases reported in Russia and India.
  • 2nd International AIDS Conference held in Paris, France.
  • International Steering Committee for People with HIV/AIDS (ISC) created; becomes Global Network of People Living with HIV/AIDS (GNP+) in 1992.
  • Ricky Ray, a nine-year-old hemophiliac with HIV,  barred from Florida school; his family’s home burned by arsonists the following year.
  • Robert Wood Johnson Foundation creates “AIDS Health Services Program,” providing funding to hard hit U.S. cities; program is precursor to Ryan White CARE Act.
  • Informal distribution of clean syringes begins in Boston and New Haven.
  • First panel of the AIDS Memorial Quilt created.

1987

  • First antiretroviral (ARV) drug — zidovudine or AZT (a nucleoside analog) — approved by U.S. FDA.
  • U.S. Congress approves $30 million in emergency funding to states for AZT.
  • AIDS Coalition to Unleash Power (ACT UP) established in New York in response to proposed cost of AZT; the price of AZT is subsequently lowered.
  • President Reagan makes first public speech about AIDS; establishes Presidential Commission on HIV (Watkins Commission). See news report: ABC World News Tonight, April 1, 1987.
  • U.S. CDC launches first AIDS-related public service announcements, “America Responds to AIDS.”
  • U.S. CDC holds its first National Conference on HIV and communities of color.
  • U.S. FDA adds HIV prevention as a new indication for male condoms.
  • U.S. FDA creates new class of experimental drugs called Treatment Investigational New Drugs (INDs), which accelerates drug approval by two to three years.
  • U.S. FDA sanctions first human testing of candidate vaccine against HIV.
  • U.S. Congress adopts Helms Amendment banning use of federal funds for AIDS education materials that “promote or encourage, directly or indirectly, homosexual activities,” often referred to as the “no promo homo” policy.
  • U.S. adds HIV as a “dangerous contagious disease” to its immigration exclusion list; mandates testing of all applicants.
  • 3rd International AIDS Conference is held in Washington, D.C.
  • AIDS becomes first disease debated on floor of United Nations (UN) General Assembly. Assembly designates WHO to lead effort to address AIDS globally.
  • Global Programme on AIDS launched by WHO.
  • AIDS Support Organisation (TASO) forms in Uganda.
  • National Black Leadership Commission on AIDS, National Minority AIDS Council, and National Task Force on AIDS Prevention form in the U.S.
  • First issue of “AIDS Treatment News” published to provide HIV treatment information to community members.
  • “And the Band Played On: Politics, People and the AIDS Epidemic,” a history of the epidemic’s early years by Randy Shilts, published.
  • AIDS Memorial Quilt displayed on National Mall in Washington, DC, for first time.
  • Entertainer Liberace dies of AIDS.

1988

  • World AIDS Day first declared by WHO on December 1.
  • WHO reports AIDS cases increased 56% worldwide. See news report: ABC World News Tonight, January 8, 1988.
  • UNAIDS reports the number of women living with HIV/AIDS in sub-Saharan Africa exceeds that of men.
  • 4th International AIDS Conference is held in Stockholm, Sweden; International AIDS Society (IAS) forms.
  • Watkins Commission on AIDS presents report to President Reagan.
  • U.S. National Institutes of Health (NIH) establishes Office of AIDS Research (OAR) and AIDS Clinical Trials Group (ACTG).
  • U.S. FDA allows importation of unapproved drugs for persons with life-threatening illnesses, including HIV/AIDS.
  • ACT UP demonstrates at U.S. FDA headquarters in protest of slow pace of drug approval process.
  • The U.S. Health Resources and Services Administration (HRSA) awards 21 grants to plan for HIV/AIDS systems of care, laying groundwork for statewide programs later funded through Ryan White CARE Act.
  • U.S. Health Omnibus Programs Extension (HOPE) Act of 1988 authorizes use of federal funds for HIV/AIDS prevention, education, and testing.
  • U.S. Surgeon General Koop and U.S. CDC mail brochure “Understanding AIDS” to all U.S. households; first and only national mailing of its kind.
  • U.S. Justice Department says people with HIV/AIDS cannot be discriminated against. See news report: ABC World News Tonight, October 6, 1988.
  • Judge in Florida rules young girl with AIDS can only attend school if in glass enclosure. See news report: ABC World News Tonight, August 29, 1988.
  • U.S. CDC launches TV commercial campaign about AIDS awareness aimed at minorities. See news report: ABC World News Tonight, October 17, 1988.
  • Elizabeth Glaser, an HIV positive mother of two HIV positive children, and two friends form the Pediatric AIDS Foundation; later renamed the Elizabeth Glaser Pediatric AIDS Foundation.
  • First comprehensive needle exchange program (NEP) established in North America in Tacoma, Washington; New York City creates first government-funded NEP; San Francisco establishes what becomes largest NEP in the U.S.

1989

  • A foreign traveler with AIDS is not allowed into U.S. because he has AIDS. See news report: ABC World News Tonight, April 6, 1989.
  • U.S. Congress creates National Commission on AIDS.
  • U.S. CDC issues first guidelines for prevention of Pneumocystis carinii pneumonia (PCP), an AIDS-related opportunistic infection and major cause of morbidity and mortality for people with HIV.
  • Head of NIH’s National Institute of Allergy and Infectious Diseases (NIAID), Dr. Anthony Fauci, endorses parallel track policy, giving those that do not qualify for clinical trials access to experimental treatments.
  • AIDS activists stage several major protests about AIDS drugs during year, including at the Golden Gate Bridge, the New York Stock Exchange, and U.S. headquarters of Burroughs Wellcome.
  • 5th International AIDS Conference (“The Scientific and Social Challenge of AIDS”) held in Montreal, Canada.
  • First “Day Without Art” organized by Visual AIDS to underscore impact of AIDS on the arts. See news report: ABC World News Tonight, December 1, 1989.
  • Dancer and choreographer Alvin Ailey dies of AIDS.
  • Photographer Robert Mapplethorpe dies of AIDS.

1990

  • Ryan White dies at 18. See news report: ABC World News Tonight, April 8, 1990.
  • Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 enacted by U.S. Congress. Provides federal funds for community-based care and treatment services; funded at $220.5 million in first year. See news report: ABC World News Tonight, April 9, 1990.
  • Americans with Disabilities Act of 1990 (ADA) enacted by U.S. Congress; prohibits discrimination against individuals with disabilities, including people living with HIV/AIDS.
  • U.S. FDA approves use of AZT for pediatric AIDS.
  • 6th International AIDS Conference (“AIDS in the Nineties: From Science to Policy”) held in San Francisco, CA. To protest U.S. immigration policy, domestic and international non-governmental groups boycott conference. The 1992 conference, scheduled to take place in Boston, moved to Amsterdam.
  • Kimberly Bergalis, of Florida, believed to have been infected with HIV by her dentist, causing major public debate.
  • First National Conference on Women and AIDS held in Boston.
  • “Women, AIDS and Activism,” developed by ACT UP’s Women’s Caucus, published, becoming the first book of its kind.
  • Pop artist Keith Haring dies of AIDS.

1991

  • NBA legend Earvin “Magic” Johnson announces he is HIV-positive and retires from basketball.
  • U.S. CDC recommends restrictions on practice of HIV-positive health care workers; U.S. Congress enacts law requiring states to take similar action.
  • Housing Opportunities for Persons with AIDS (HOPWA) Act of 1991 enacted by U.S. Congress. Provides housing assistance to people living with AIDS through grants to U.S. states and local communities.
  • 7th International AIDS Conference (“Science Challenging AIDS”) held in Florence, Italy.
  • ICASO (International Council of AIDS Service Organizations) forms as global network of non-governmental and community-based organizations.
  • Red ribbon introduced as international symbol of AIDS awareness at Tony Awards by Broadway Cares/Equity Fights AIDS and Visual AIDS.
  • Lead singer of band Queen Freddie Mercury dies of AIDS.

1992

  • AIDS becomes number one cause of death for U.S. men ages 25 to 44.
  • U.S. FDA licenses first rapid HIV test, which provides results in as little as ten minutes.
  • 8th International AIDS Conference (“A World United Against AIDS”) held in Amsterdam, the Netherlands; would have taken place in Boston but was moved due to U.S. immigration ban.
  • International Community of Women Living with HIV/AIDS (ICW) founded.
  • Teenager Ricky Ray, whose home was torched because he and his siblings were HIV-positive, dies of AIDS. See news report: ABC World News Tonight, December 18, 1992.
  • Mary Fisher and Bob Hattoy, each HIV-positive, address the Republican and Democratic National Conventions, respectively.
  • Tennis star Arthur Ashe announces he has AIDS.

1993

  • U.S. President Clinton establishes White House Office of National AIDS Policy (ONAP).
  • U.S. CDC initiates HIV prevention community planning process for local distribution of federal prevention funding.
  • U.S. CDC expands case definition of AIDS to reflect fuller spectrum of the disease, including adding conditions specific to women and injection drug users.
  • U.S. FDA approves female condom for sale in U.S.
  • U.S. Congress enacts NIH Revitalization Act, giving the OAR primary oversight of all NIH AIDS research; requires NIH and other research agencies to expand involvement of women and minorities in all research. President Clinton signs HIV immigration exclusion policy into law as part of the same law.
  • Women’s Interagency HIV Study (WIHS) and HIV Epidemiology Study (HERS) begin; both major U.S. federally-funded research studies on women and HIV/AIDS.
  • First annual “AIDSWatch” — hundreds of community members from across U.S. converge in Washington, D.C. to lobby Congress for increased AIDS funding.
  • 9th International AIDS Conference is held in Berlin, Germany.
  • “Angels in America,” Tony Kushner’s play about AIDS, wins Tony Award and Pulitzer Prize for Drama.
  • “Philadelphia,” film starring Tom Hanks as a lawyer with AIDS, opens in theaters, becoming first major Hollywood movie on AIDS.
  • Ballet dancer Rudolf Nureyev dies of AIDS.
  • Tennis star Arthur Ashe dies of AIDS.
  • Leading advocate for women with AIDS in prison Katrina Haslip dies of AIDS.

1994

  • AIDS becomes leading cause of death for all Americans ages 25 to 44; remains so through 1995.
  • U.S. Public Health Service recommends use of AZT by pregnant women to reduce perinatal transmission of HIV; based on “076” study showing up to 70% reduction in transmission.
  • U.S. FDA approves oral HIV test, first non-blood based antibody test for HIV.
  • NIH issues guidelines requiring applicants for NIH grants to address “the appropriate inclusion of women and minorities in clinical research.”
  • 10th International AIDS Conference (“The Global Challenge of AIDS: Together for the Future”) held in Yokohama, Japan.
  • Author of “And the Band Played On” Randy Shilts dies of AIDS. See news report: ABC World News Tonight, February 22, 1994.
  • Pedro Zamora, a young gay man living with HIV, appears on the cast of MTV’s popular show, The Real World; dies later in the year at age 22.
  • Co-founder of Pediatric AIDS Foundation Elizabeth Glaser dies of AIDS.

1995

  • First protease inhibitor, saquinavir, approved in record time by the U.S. FDA, ushering in new era of highly active antiretroviral therapy (HAART).
  • U.S. CDC issues first guidelines for prevention of opportunistic infections in persons infected with HIV.
  • U.S. CDC issues report on syringe exchange programs (SEPs). The National Academy of Sciences concludes SEPs are effective component of a comprehensive HIV prevention strategy.
  • U.S. President Clinton establishes Presidential Advisory Council on HIV/AIDS (PACHA).
  • First White House Conference on HIV/AIDS held.
  • First National HIV Testing Day held on June 27; created by the National Association of People with AIDS (NAPWA).
  • Olympic Gold Medal diver Greg Louganis discloses he is living with HIV; announcement leads to public debate regarding disclosure of HIV status. See news report: ABC World News Tonight, February 23, 1995.
  • Rap artist Eric Wright (Eazy-E of NWA) dies of AIDS.

1996

  • 11th International AIDS Conference (“One World, One Hope”) held in Vancouver, Canada; highlights effectiveness of HAART, creating a period of optimism. See news report: ABC World News Tonight, July 8, 1996.
  • UNAIDS (Joint United Nations Programme on HIV/AIDS) begins operations; established to advocate for global action on epidemic and coordinate HIV/AIDS efforts across UN system.
  • IAVI (International AIDS Vaccine Initiative) forms to speed the search for effective HIV vaccine.
  • Brazil begins national ARV distribution; first developing country to do so.
  • Number of new AIDS cases diagnosed in U.S. declines for first time in history of epidemic.
  • HIV no longer leading cause of death for all Americans ages 25-44; remains leading cause of death for African-Americans in this age group.
  • ABC News poll on public attitudes towards AIDS. See news report: ABC World News Tonight, February 1, 1996.
  • Time Magazine names AIDS researcher Dr. David Ho as its “Man of the Year.” See interview with Dr. Ho: ABC World News Tonight, February 1, 1996.
  • The Levine Committee, a blue ribbon advisory panel, calls for overhaul of NIH AIDS research, including stronger role for OAR and increased support for vaccine-related and investigator-initiated research.
  • U.S. FDA approves viral load test, a new test that measures the level of HIV in the body.
  • U.S. FDA approves first HIV home testing and collection kit.
  • U.S. FDA approves first HIV urine test.
  • U.S. FDA approves first non-nucleoside reverse transcriptase inhibitor (NNRTI), nevirapine.
  • U.S. Congress reauthorizes Ryan White CARE Act.
  • AIDS awareness ad campaigns target larger public, not only those at high risk. See news report: ABC World News Tonight, July 8, 1996.
  • Former heavyweight boxing champion Tommy Morrison announces he is HIV-positive.

1997

  • AIDS-related deaths in U.S. decline by more than 40 percent compared to prior year, largely due to HAART.
  • U.S. President Clinton announces goal of finding an effective vaccine in 10 years and creation of Dale and Betty Bumpers Vaccine Research Center.
  • U.S. FDA approves Combivir, a tablet combining two ARV drugs, making it easier for people living with HIV to take medication.
  • U.S. Congress enacts FDA Modernization Act of 1997, codifying accelerated approval process and allowing dissemination of information about off-label uses of drugs.

1998

  • First large-scale human trials (Phase III) for an HIV vaccine begin.
  • Despite earlier optimism, several reports indicate growing signs of treatment failure and side effects from HAART.
  • U.S. HHS issues first national guidelines for use of antiretroviral therapy in adults.
  • U.S. HHS Secretary Shalala determines needle exchange programs to be effective and do not encourage use of illegal drugs, but Clinton Administration does not lift ban on use of federal funds for such purposes.
  • U.S. Supreme Court, in Bragdon v. Abbott, rules that Americans with Disabilities Act covers those in earlier stages of HIV disease, not just AIDS.
  • Ricky Ray Hemophilia Relief Fund Act of 1998 enacted by U.S. Congress, authorizing payments to hemophiliacs infected through un-screened blood-clotting agents between 1982 and 1987.
  • Minority AIDS Initiative created in U.S., after African-American leaders declare “state of emergency” and Congressional Black Caucus (CBC) calls on U.S. HHS to do the same.
  • 12th International AIDS Conference (“Bridging the Gap”) held in Geneva, Switzerland.
  • Treatment Action Campaign (TAC) forms in South Africa; grassroots movement pushes for access to treatment.
  • Global AIDS and human rights activists Jonathan Mann and Mary Lou Clements-Mann killed in plane crash.

1999

  • First human vaccine trial in a developing country begins in Thailand.
  • U.S. President Clinton announces Leadership and Investment in Fighting an Epidemic (LIFE) Initiative to address the global epidemic; leads to increased funding.
  • U.S. Congressional Hispanic Caucus, with the Congressional Hispanic Caucus Institute, convenes Congressional hearing on impact of HIV/AIDS on Latino community.
  • Founder of National Task Force on AIDS Prevention Reggie Williams dies of AIDS.

2000

  • 13th International AIDS Conference (“Breaking the Silence”) held in Durban, South Africa; first time held in developing nation; heightens awareness of the global pandemic.
  • U.S. National Security Council and UN Security Council each declare HIV/AIDS a security threat.
  • G8 Leaders acknowledge need for additional HIV/AIDS resources during Okinawa Meeting.
  • Millennium Development Goals, announced as part of Millennium Declaration, include reversing the spread of HIV, TB, and malaria as one of 8 key goals.
  • UNAIDS, WHO, and other global health groups announce joint initiative with five major pharmaceutical manufacturers to negotiate reduced prices for AIDS drugs in developing countries.
  • U.S. Congress enacts Global AIDS and Tuberculosis Relief Act of 2000, authorizing up to $600 million for U.S. global efforts.
  • U.S. President Clinton announces Millennium Vaccine Initiative, creating incentives for development and distribution of vaccines against HIV, TB and malaria.
  • U.S. President Clinton issues Executive Order 13155 to assist developing countries in importing and producing generic forms of HIV treatments.
  • U.S. President Clinton creates first ever Presidential Envoy for AIDS Cooperation.
  • U.S. CDC forms Global AIDS Program (GAP).
  • U.S. CDC reports that among men who have sex with men in the U.S., African-American and Latino cases exceed those among whites.
  • U.S. Congress reauthorizes the Ryan White CARE Act for the second time.
  • U.S. HHS approves first state 1115 Medicaid expansion waivers for low-income people with HIV in Maine, Massachusetts and District of Columbia; in 2001, Massachusetts becomes first state to enroll new clients.

2001

  • June 5 marks 20 years since first AIDS case reported.
  • UN General Assembly convenes first ever special session (UNGASS) on HIV/AIDS.
  • UN Secretary-General Kofi Annan calls for a global fund, a “war chest”, to address AIDS, during African Summit on HIV/AIDS in Abuja, Nigeria.
  • Newly appointed U.S. Secretary of State, Colin Powell, reaffirms U.S. statement that HIV/AIDS is a national security threat.
  • World Trade Organization announces “DOHA Agreement” to allow developing countries to buy or manufacture generic medications to meet public health crises, such as HIV/AIDS.
  • Generic drug manufacturers offer to produce discounted, generic forms of HIV/AIDS drugs; several major pharmaceutical manufacturers agree to offer further reduced drugs prices in developing countries.
  • First National Black HIV/AIDS Awareness Day in U.S.
  • First National HIV Vaccine Awareness Day in U.S.
  • See news report for current state of HIV treatment and vaccine research: ABC World News Tonight, June 25, 2001.

2002

  • HIV is leading cause of death worldwide among those aged 15-59.
  • Global Fund to Fight AIDS, Tuberculosis and Malaria begins operations; approves first round of grants later this year.
  • 14th International AIDS Conference (“Knowledge and Commitment”) held in Barcelona, Spain.
  • UNAIDS reports that women comprise about half of all adults living with HIV/AIDS worldwide.
  • U.S. National Intelligence Council releases report on “next wave” of epidemic, focused on India, China, Russia, Nigeria, and Ethiopia.
  • U.S. FDA approves OraQuick Rapid HIV-1 Antibody Test; first rapid test to use finger prick. OraQuick granted Clinical Laboratory Improvement Amendments (CLIA) waiver in 2003, enabling test to be performed outside of laboratory, allowing more widespread use.
  • See news report on impact of HIV/AIDS on African Americans: ABC World News Tonight, July 7, 2002.

2003

  • President Bush announces President’s Emergency Plan for AIDS Relief (PEPFAR), a five-year, $15 billion initiative to address HIV/AIDS, TB, and malaria in hard hit countries.
  • G8 Evian Summit includes special focus on HIV/AIDS; new commitments to the Global Fund announced.
  • WHO announces “3 by 5” Initiative, intended to bring treatment to 3 million people by 2005.
  • Government of South Africa announces new antiretroviral treatment program.
  • William J. Clinton Presidential Foundation secures price reductions for HIV/AIDS drugs from generic manufacturers to benefit developing nations.
  • First National Latino AIDS Awareness Day in U.S.

2004

  • PEPFAR begins first round of funding.
  • UN Secretary-General Kofi Annan compares war on terror to war on AIDS. See news report: ABC World News Tonight, July 13, 2004.
  • UNAIDS launches Global Coalition on Women and AIDS to raise the visibility of epidemic’s impact on women and girls.
  • Group of Eight (G8) nations call for creation of “Global HIV Vaccine Enterprise,” a consortium of government and private sector groups designed to coordinate and accelerate research efforts to find an effective HIV vaccine.
  • 15th International AIDS Conference (“Access for All”) held in Bangkok, Thailand; first time held in Southeast Asia.
  • Global Fund to Fight AIDS, Tuberculosis and Malaria holds first ever “Partnership Forum” in Bangkok, Thailand; 400 delegates participate.
  • U.S. HHS announces expedited review process by U.S. FDA for fixed dose combination and co-packaged products; to be used by the U.S. in purchasing medications under PEPFAR.
  • U.S. FDA approves OraQuick Rapid HIV-1 Antibody Test for use with oral fluid; oral fluid rapid test granted CLIA waiver.
  • See news report on HIV/AIDS in China: ABC World News Tonight, July 12, 2004.

2005

  • United Kingdom hosts G8 Summit at Gleneagles; focus on development in Africa, including HIV/AIDS.
  • World Economic Forum’s Annual Meeting in Davos, Switzerland includes focus on addressing HIV/AIDS in Africa and other hard hit regions.
  • UN General Assembly convenes high-level meeting to review progress on targets set at 2001 UNGASS on HIV/AIDS.
  • WHO, UNAIDS, U.S. Government, and Global Fund to Fight AIDS, Tuberculosis and Malaria announce results of joint efforts to increase availability of antiretroviral drugs in developing countries. An estimated 700,000 people had been reached by the end of 2004.
  • U.S. FDA grants “Tentative Approval to Generic AIDS Drug Regimen for Potential Purchase Under the President’s Emergency Plan for AIDS Relief”, marking first ever approval of an HIV drug regimen manufactured by a non-U.S.-based generic pharmaceutical company, under U.S. FDA’s new expedited review process.
  • First Indian drug manufacturer (Ranbaxy) gains U.S. FDA approval to produce generic antiretroviral for PEPFAR.
  • First National Asian and Pacific Islander HIV/AIDS Awareness Day in U.S.

2006

  • June 5 marks quarter century since first AIDS case reported.
  • United Nations convenes follow-up meeting and issues progress report on the implementation of the Declaration of Commitment on HIV/AIDS.
  • Russia hosts G8 Summit for first time (in St. Petersburg); HIV/AIDS is addressed.
  • First Eastern European and Central Asian AIDS Conference (EECAAC) held in Moscow, Russia.
  • 16th International AIDS Conference (“Time to Deliver”) held in Toronto, Canada.
  • U.S. CDC releases revised HIV testing recommendations for health-care settings, recommending routine HIV screening for all adults, aged 13-64, and yearly screening for those at high risk.
  • U.S. Congress reauthorizes Ryan White CARE Act for third time.
  • First National Women and Girls HIV/AIDS Awareness Day in U.S.
  • First National Native HIV/AIDS Awareness Day in U.S.

2007

  • President Bush calls on Congress to reauthorize PEPFAR at $30 billion over 5 years.
  • WHO and UNAIDS issue new guidance recommending “provider-initiated” HIV testing in health-care settings.
  • WHO and UNAIDS recommend “male circumcision should always be considered as part of a comprehensive HIV prevention package.”

2008

  • U.S. Congress reauthorizes PEPFAR for an additional 5 years at up to $48 billion; the legislation ends the statutory HIV travel and immigration ban.
  • UN General Assembly convenes UNGASS follow-up meeting and issues progress report on implementation of Declaration of Commitment on HIV/AIDS.
  • 17th International AIDS Conference (“Universal Action Now”) held in Mexico City; first time held in Latin America.
  • U.S. CDC releases new HIV incidence estimates for U.S., showing that the U.S. epidemic is worse than previously thought.
  • First National Gay Men’s HIV/AIDS Awareness Day in U.S.

2009

  • U.S. President Obama launches the Global Health Initiative (GHI), an effort to develop a comprehensive U.S. Government approach to addressing global health in low- and middle-income countries, with PEPFAR as a core component.
  • Obama Administration officially lifts HIV travel and immigration ban by removing final regulatory barriers to entry; to take effect in January 2010. Leads to announcement that International AIDS Conference will return to U.S. for first time in more than 20 years, and be held in Washington, D.C., in 2012.
  • U.S. President Obama calls for first-ever National HIV/AIDS Strategy for U.S.
  • U.S. Congress eliminates long-standing statutory ban on use of federal funding for needle exchange in U.S., with caveats.
  • First National Caribbean American HIV/AIDS Awareness Day in U.S.

2010

  • Removal of U.S. HIV travel and immigration ban officially begins.
  • Large international clinical study (iPrEx) shows daily dose of combination antiretroviral pill reduced risk of acquiring HIV among men who have sex with men and transgendered women who have sex with men.
  • South African researchers announce results of clinical trial CAPRISA 004 showing that use of microbicide gel reduced risk of HIV infection among sexually active women.
  • 18th International AIDS Conference (“Rights Here, Right Now”) held in Vienna, Austria; focus is on human rights as a critical part of HIV response.
  • UN convenes a summit to accelerate progress toward the 2015 UN Millennium Development Goals.
  • Obama Administration releases first comprehensive National HIV/AIDS Strategy for U.S.
  • U.S. President Obama signs comprehensive health reform, the Patient Protection and Affordable Care Act (ACA), into law, which provides new health insurance coverage opportunities for millions of individuals in U.S., including people with HIV. Provisions of law to be implemented in coming years.

2011

  • June 5 marks 30 years since first AIDS case reported.
  • Large multinational study of serodiscordant, mostly heterosexual, couples (HPTN 052) shows early treatment of HIV-infected person greatly reduces transmission to negative partner.
  • UN General Assembly convenes meeting to review progress on HIV/AIDS; adopts new Political Declaration on HIV/AIDS.
  • Obama Administration announces goal of AIDS-free generation, highlighted in speeches by Secretary of State Clinton and President Obama.
  • U.S. Congress reinstates decades-long ban on federal funding for needle exchanges only two years after eliminating the same ban.
  • U.S. CDC releases new HIV incidence estimates for U.S.
  • U.S. HHS launches 12 Cities Project, focusing resources on areas with the highest HIV/AIDS burden in the country.
  • AIDS activist and actress Elizabeth Taylor dies.

2012

  • XIX International AIDS Conference held in Washington, D.C., marking first time conference held in U.S. since 1990.
  • U.S. FDA approves OraQuick In-Home Test, first rapid test using oral fluid that can be bought over-the-counter; results of which are obtained at home.
  • U.S. FDA approves the use of Truvada (emtricitabine/tenofovir disoproxil fumarate) for reducing risk of HIV infection in uninfected individuals at high risk, marking the first HIV treatment to be approved for pre-exposure prophylaxis (PrEP).

2013

  • UNAIDS reports that since 2005, deaths related to AIDS have declined by almost 30%.
  • WHO releases new guidelines recommending earlier use of antiretrovirals, calling for treatment to begin when CD4 cell count falls below 500 cells/mm3, a change from the previous standard of 350 cells/mm3; also includes recommendations related to antiretroviral therapy for children under 5 with HIV, pregnant and breastfeeding women with HIV, and HIV-positive persons with uninfected sexual partners.
  • Article published in the New England Journal of Medicine details case of an infant thought to be cured of HIV by starting HAART 30 hours after birth.
  • U.S. Secretary of State John Kerry marks the 10th anniversary of PEPFAR.
  • U.S. Preventative Services Task Force gives routine HIV screening an A grade, indicating “there is high certainty that the net benefit is substantial.”
  • U.S. Congress passes HIV Organ Policy Equity (HOPE) Act, allowing HIV-infected organs to be donated to persons who are already living with HIV.

2014

  • Child thought to be HIV-free tests positive for HIV, a disappointing setback in the quest for a cure.
  • 20th International AIDS Conference (“Stepping up the Pace”) held in Melbourne, Australia.
  • Major coverage reforms under the U.S. Affordable Care Act go into affect, impacting health coverage for many people with HIV in U.S.

2015

  • Findings from Ipergay and PROUD studies show PrEP to be effective in reducing HIV incidence among gay men.
  • Findings from “Strategic Timing of AntiRetroviral Treatment” (START) study released; show starting antiretroviral treatment early improves health outcomes for people with HIV.
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Stages of HIV Infection

From AIDS.gov

 Stage 1Stage3

 

WHAT are the stages of hiv infection?

HIV infection has a well-documented progression. If you are infected with HIV and don’t get treatment, HIV will eventually overwhelm your immune system. This will lead to your being diagnosed with Acquired Immune Deficiency Syndrome (AIDS).

However, there’s good news: when used consistently, antiretroviral therapy (ART) prevents the HIV virus from multiplying and from destroying your immune system. This helps keep your body strong and healthy by helping you fight off life-threatening infections and preventing HIV from progressing to AIDS. In addition, research has shown that taking ART can help prevent the spread of HIV to others. (Read more about HIV treatment.)

Below are the stages of HIV infection. People may progress through these stages at different rates, depending on a variety of factors.

acute infection stage

Within 2-4 weeks after HIV infection, many, but not all, people develop flu-like symptoms, often described as “the worst flu ever.” Symptoms can include fever, swollen glands, sore throat, rash, muscle and joint aches and pains, fatigue, and headache. This is called “acute retroviral syndrome” (ARS) or “primary HIV infection,” and it’s the body’s natural response to the HIV infection.

During this early period of infection, large amounts of virus are being produced in your body. The virus uses CD4 cells to replicate and destroys them in the process. Because of this, your CD4 count can fall rapidly. Eventually your immune response will begin to bring the level of virus in your body back down to a level called a viral set point, which is a relatively stable level of virus in your body. At this point, your CD4 count begins to increase, but it may not return to pre-infection levels. It may be particularly beneficial to your health to begin ART during this stage.

It is important to be aware that you are at particularly high risk of transmitting HIV to your sexual or drug using partners during this stage because the levels of HIV in your blood stream are very high. For this reason, it is very important to take steps to reduce your risk of transmission.

For more information, see NIH’s Guidelines for the Use of ART in HIV-1-Infected Adults and Adolescents: Acute and Recent (Early) HIV infection.

clinical latency stage

After the acute stage of HIV infection, the disease moves into a stage called the “clinical latency” stage. “Latency” means a period where a virus is living or developing in a person without producing symptoms. During the clinical latency stage, people who are infected with HIV experience no HIV-related symptoms, or only mild ones. (This stage is sometimes called “asymptomatic HIV infection” or “chronic HIV infection.”)

During the clinical latency stage, the HIV virus continues to reproduce at very low levels, although it is still active. If you take ART, you may live with clinical latency for several decades because treatment helps keep the virus in check. (Read more about HIV treatment.) For people who are not on ART, the clinical latency stage lasts an average of 10 years, but some people may progress through this stage faster.

It is important to remember that people in this symptom-free stage are still able to transmit HIV to others, even if they are on ART, although ART greatly reduces the risk of transmission.

If you have HIV and you are not on ART, then eventually your viral load will begin to rise and your CD4 count will begin to decline. As this happens, you may begin to have constitutional symptoms of HIV as the virus levels increase in your body.

AIDS

This is the stage of HIV infection that occurs when your immune system is badly damaged and you become vulnerable to infections and infection-related cancers called opportunistic infections. When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3), you are considered to have progressed to AIDS. (In someone with a healthy immune system, CD4 counts are between 500 and 1,600 cells/mm3.) You are also considered to have progressed to AIDS if you develop one or more opportunistic illnesses, regardless of your CD4 count.

Without treatment, people who progress to AIDS typically survive about 3 years. Once you have a dangerous opportunistic illness, life-expectancy without treatment falls to about 1 year. However, if you are taking ART and maintain a low viral load, then you may enjoy a near normal life span. You will most likely never progress to AIDS.

Factors Affecting Disease Progression

People living with HIV may progress through these stages at different rates, depending on a variety of factors, including their genetic makeup, how healthy they were before they were infected, how soon after infection they are diagnosed and linked to care and treatment, whether they see their healthcare provider regularly and take their HIV medications as directed, and different health-related choices they make, such as decisions to eat a healthful diet, exercise, and not smoke.

Time between HIV infection and AIDS

Factors that may shorten the time between HIV and AIDS:

  • Older age
  • HIV subtype
  • Co-infection with other viruses
  • Poor nutrition
  • Severe stress
  • Your genetic background

Factors that may delay the time between HIV and AIDS:

  • Taking antiretroviral therapy
  • Staying in HIV care
  • Closely adhering to your doctor’s recommendations
  • Eating healthful foods
  • Taking care of yourself
  • Your genetic background

By making healthy choices, you have some control over the progression of HIV infection.

To learn more, see CDC’s Living with HIV.



As noted above, when used consistently, ART prevents the HIV virus from multiplying and from destroying your immune system. And there are other treatments that can prevent or cure some of the illnesses associated with AIDS, though the treatments do not cure HIV itself. The earlier you detect your HIV infection and start treatment, the better.

But not everyone is diagnosed early. Some people are diagnosed with HIV and AIDS concurrently, meaning that they have been living with HIV for a long time and the virus has already done damage to their body by the time they find out they are infected. These individuals need to seek a healthcare provider immediately and be linked to care so that they can stay as healthy as possible, as long as possible. Use the HIV Testing and Services Locator to find an HIV provider near you.

 

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The Body

 The website of The Body is an excellent source of information about all aspects of the virus and Aids.

 

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Facts for Life. What You and the People You Care About Need to Know About HIV/AIDS.

 American Foundation for AIDS Research

2006.

This FAQ from the American Foundation for AIDS Research reviews some of the most common questions people have about how HIV is transmitted, who is most at risk, and what HIV testing is all about. It's a particularly helpful resource for HIV-negative people in need of a quick education on what steps they do - and don't - need to take to protect themselves from HIV.

Download PDF, 16p, 748.40 KB

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Glossaries (What Does this Word Mean?)

Many organisations provide lists of what all the difficult terms mean.
  • The AEGIS online glossary is available here
  • If you want something you can download, or order by email, try the AIDSInfo glossary here.
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Treatment and Emergency Assistance

HIV Treatment Primer. (ACRIA) The world of HIV treatment can be intimidating: dozens of meds, lab tests, medical terms and differing opinions.Whether you’ve just been diagnosed with HIV, have known for a while, or are helping a friend with HIV, the good news is that you can learn enough to make informed decisions without becoming an infectious disease specialist. Download (972KB)

TAC's Treatment Literacy Materials as well as useful materials from other organisations.

More detailed information and resources about treatment are available here.

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Treatmant Facilities in South Africa

TAC provides a list of post-exposure prophylaxis facilities obtained from the South African Police Services.

TAC's list of Health facilities where antiretroviral treatment is available.

TAC's list of Some doctors who treat people with HIV.

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What is AIDS? A Manual for Healthworkers

World Council of Churches

Revised 2003

A basic manual for health care workers to learn about AIDS.

Any parts of this book, including the illustrations may be copied, reproduced, or adapted to meet local needs, without permission from the author or publisher, provided the parts reproduced are distributed free or at cost – not for profit.

Download PDF, 33p., 326.80 KB.

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Basic Info on HIV.

Whether you are some one who would like to get involved in the field or whether you, a family member or a frined have been diagnosed as HIV positive - 'knowledge is power'. Sound scientific knowledge and information can help you to make better choices.

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FAQs and Myths About HIV and AIDS.

THIS DOCUMENT IS PART OF THE CABSA/WORLD VISION TRAINING MANUAL

“CHURCHES, CHANNELS OF HOPE”.
 
PLEASE CONTACT THE CHRISTIAN AIDS BUREAU
FOR MORE INFORMATION ON THIS TRAINING PROGRAMME
– CABSA, PO BOX 16, WELLINGTON. 6543, TEL: 021 873 0028021 873 0028 -
The following questions and myths will be addressed in this section:
  • Is AIDS a myth?
    • MYTH ONE: HIV does not cause AIDS. AIDS is just a new name for old diseases
    • MYTH TWO: AIDS can occur without HIV
    • MYTH THREE: Seropositivity to HIV can be widespread without AIDS.
    • MYTH FOUR: The validity of AIDS epidemiological research is questionable because HIV testing is unreliable.
  • Does HIV cause AIDS? Where did this debate originate that was picked up by South Africa’s President Mbeki? How should we think about it? How do we answer people who do not believe that HIV causes AIDS?
  • What effect will AIDS have on fertility?
  • What is the possibility of developing an AIDS vaccine?
  • How are potential vaccines tested on humans?
  • How effective is the condom at preventing STD’s and sperm penetration?
  • There have been rumours of naturally occurring holes in latex that are big enough for HIV to pass through. Is this true?
  • I want to use a condom, but my partner does not. How do I negotiate for safer sex?
  • What is the female condom?
  • How effective is the female condom?
  • Is there a difference in the rate of HIV transmission between circumcised and uncircumcised men?
  • What is the risk of HIV transmission from oral sex?
 
The first part of this section takes a look at myths relating to HIV as the cause of AIDS:
Q Is AIDS a myth?
A There are many reasons why people may subscribe to myths or conspiracy theories about disease. AIDS, in particular, is a disease that lends itself to the perpetuation of myths and to different forms of denial. For example, myths that deny the existence of AIDS can respond to people's emotional needs or to a desire to reassure themselves that they can avoid changing their behaviour. HIV is often transmitted through behaviours that are essentially private. Also, visible symptoms of the disease only appear after many years, making it easier for people not to accept that HIV will eventually cause AIDS. Then again, the idea of re-examining the evidence regarding the causes of AIDS may provide hope that if a cause other than HIV is identified, a cure might more readily be found. Below is a list of deceptions.
Seven Deadly Deceptions
Here is our list of the major denialist arguments. As noted above, the problem is not unorthodox ideas, but their immediate translation into personal medical advice, usually to tell patients to reject all medical care for HIV or AIDS, as well as suggesting that safer sex and other infection-control precautions can be ignored. So for each of the seven points, we include the corresponding action item. We are continually amazed at how casually sheer speculation gets translated into life-and-death decisions.
1. HIV is harmless (or does not exist), and AIDS is not contagious - so sexual and other precautions are unnecessary.
2. The HIV test is unreliable - so don't get tested.
3. AIDS drugs are poisons, pushed by doctors corrupted by the pharmaceutical industry - so don't take any of them, no matter what your doctor says - or don't go to a doctor at all, especially if you feel well.
4. Viral load and CD4 tests are useless - so don't use them.
5. AIDS deaths would have gone down anyway, even without new treatments - so you don't need medical care.
6. AIDS is over, or never existed, or only affected small risk groups - so there is no important need for medical research on AIDS or HIV, or for AIDS services.
7. The free speech of dissenters has been suppressed - so you can't believe anything you hear.
MYTH ONE: HIV does not cause AIDS.
AIDS is just a new name for old diseases
HIV infects cells of the immune system, mainly CD4 cells and macrophages - key elements of the cellular immune system, and destroys or impairs their function in the process. Progressive HIV infection results in the progressive depletion of the immune system, leading to immune deficiency. The immune system is said to be deficient when it can no longer play its role: fighting off infections, and keeping cancers from developing. People with cellular immune deficiency are much more vulnerable to infections such as Pneumocystis carinii pneumonia, toxoplasmosis, systemic and oesophageal candidiasis, generalised herpes zoster, cryptococcal meningitis, and to cancers such as Kaposi's sarcoma. These diseases are very rare amongst people without immune deficiency. Some of these diseases, namely those that are strongly associated with severe immunodeficiency, are called “opportunistic”' diseases, because they use the opportunity of a weakened immune system to develop.
Immune deficiency can also be present as a consequence of rare inherited diseases, and be acquired through cancer chemotherapy or immunosuppressive therapy in transplant recipients. However, HIV infection is the most common cause of acquired immune deficiency. The symptom complex associated with acquired deficiency of the cellular immune system was called “AIDS” when people realised they were looking at an epidemic of acquired immunodeficiency for which an explanation was lacking. It was soon apparent that the syndrome was frequent in groups with certain behavioural characteristics, such as homosexuals or injecting drug users, and certain geographical groups. The missing link that explained why some people in these groups developed AIDS, and others with the same behavioural or ethnic backgrounds did not, was found in 1983-84, when HIV was discovered. In cohort studies of such groups, the presence of HIV infection predicted overwhelmingly who would develop AIDS.
HIV infection typically follows the following course:
a) primary acute infection with a characteristic clinical picture;
b) prolonged period without obvious, visible symptoms - although laboratory studies can demonstrate continuous disease progression; and
c) a severe immunodeficiency resulting in the development of secondary opportunistic infections and tumours that, in turn, represent the major causes of death in AIDS patients.
The spectrum of opportunistic infections may differ in different geographical locations, depending on the prevalence of certain pathogens (parasites, fungi, bacteria and viruses) to which immunocompromised individuals may be exposed.
The evidence that HIV causes AIDS is overwhelming. Numerous laboratory, clinical research and epidemiological studies have shown, for example, that:
· There is significant correlation between the level of viral production and viral load and disease prognosis. The onset of AIDS is greatly delayed in individuals who have low levels of viral replication, while patients with high amounts of the virus in the blood and lymph nodes have a much worse prognosis.
· When HIV infection is treated successfully with highly active antiretroviral therapy, the immune system recovers partially and the disease manifestations of HIV infection often disappear, even if the patient has already progressed to AIDS. What symptoms remain depend on how much irreversible damage was done to the immune system before therapy began. The clinical response to therapy can be monitored and predicted by measurement of the amount of HIV in blood and lymph nodes.
· The main risk factors for HIV transmission (unprotected heterosexual or homosexual intercourse; blood transfusions; and needle-sharing during injection-drug use) are not new, but never resulted in a massive increase of morbidity and mortality prior to the appearance of HIV.
· AIDS and HIV infection are invariably linked in time, place and population groups.
Additional evidence that HIV causes AIDS comes from unfortunate accidental infections such as the one in which three laboratory workers who had no other risk factors developed AIDS after accidental exposure to a pure, molecularly cloned strain of HIV. In all three cases, HIV was isolated from the infected individual, sequenced and shown to be the infecting strain of the virus.
MYTH TWO: AIDS can occur without HIV
The existence of immunodeficiency was documented long before the onset of the AIDS epidemic but was extremely rare in the absence of cancer chemotherapy. These immuno-deficiencies have a very specific pathogenesis and specific clinical manifestations. Some very rare types of immunodeficiency occasionally present with the clinical symptoms of AIDS. However, surveys conducted in many countries have shown the number of these cases to be insignificant compared to the numbers of HIV-induced immune deficiency cases.
MYTH THREE: Seropositivity to HIV can be widespread without AIDS.
Speculation that HIV does not cause AIDS has in part been fuelled by arguments that point to the existence of groups of individuals who have been HIV-positive for many years without progressing to AIDS.
The course of HIV infection and the development of AIDS vary significantly between different individuals, indicating the presence of multiple factors that may influence the outcome of infection. In the most reliable cohort studies conducted in different regions of the world on HIV-infected individuals who do not receive antiretroviral therapy, AIDS symptoms develop on average approximately 8 to 10 years after initial HIV infection. About 5-10% of HIV-positive individuals develop AIDS symptoms very rapidly during the first years of infection and about the same proportion may be infected with HIV for 15 or more years without progressing to AIDS. It follows that the overwhelming majority of people with HIV infection will develop AIDS unless treated with antiretroviral therapy in a timely manner.
MYTH FOUR: The validity of AIDS epidemiological research is questionable because HIV testing is unreliable.
Testing for the presence of infections often uses the detection of antibodies that the human body produces in response to the presence of a pathogen. These antibodies are specific to a given pathogen, similar to a security lock and its key. Diagnosis of infection using antibody testing is one of the best-established concepts in medicine. Examples include the diagnosis of viral hepatitis, rubella, and many other infectious diseases. Antibody testing for these diseases has never been questioned. HIV antibody tests exceed the performance of most other infectious disease tests in both sensitivity and specificity. Recent HIV antibody tests have sensitivity and specificity in excess of 98% and are therefore extremely reliable.
Progress in testing methodology has also enabled detection of viral genetic material, antigens and the virus itself in body fluids and cells. While not widely used for routine testing due to high cost and requirements in laboratory equipment, these direct testing techniques have confirmed the validity of the antibody tests.
Due to under-diagnosis, under-reporting, and reporting delays, surveillance based on cases with clinical manifestations of the acquired immune deficiency syndrome is unreliable in most countries - especially those with weak health care systems. Thus, epidemiological data on the spread of HIV are most commonly based on the measurement of HIV levels in various populations. Such studies use the antibody tests described above and are performed according to internationally accepted procedures, including measures to ensure quality control.
Over the past decade many countries have built up surveillance systems that include well-selected populations, such as women attending antenatal-care, which allow for extrapolation to larger populations in the countries. More recently, population based studies in a series of countries have proven the reliability of such systems. WHO and UNAIDS assist countries in their efforts to compile reliable estimates on prevalence and trends of HIV. Estimates resulting from these efforts are based on the best available data in all countries. Studies that are based on small or questionable samples are excluded.
Some commonly asked questions:
Q Does HIV cause AIDS? How should we think about it? How do we answer people who do not believe that HIV causes AIDS?
A The human immunodeficiency virus (HIV) has been decisively established as the cause of AIDS. A small but vocal group, ignoring the evidence, has continued to question the link between HIV and AIDS. Periodically, this results in media attention and generates some renewed public interest in their views. Most recently, there has been controversy in the South African and international media over the South African government's announcement that it would convene an international panel to re-examine the scientific evidence surrounding AIDS, including evidence regarding the cause and diagnosis of the disease. The debate has also recently resurfaced in other countries.

History of the controversy: The argument that HIV does not cause AIDS first attracted broad public attention in an article, published in Cancer Research in 1987, written by Professor Peter Duesberg of the University of California in Berkeley. Duesberg's contentions were rejected by scientists, but attracted attention in the mainstream press and also with specific groups outside the scientific community. For example, his attacks on the “AIDS establishment”, whom he accused of perpetuating the myth of AIDS for their own ends, were appealing to a public who already had a growing sense of disenchantment with the broad medical community. Similarly, his attribution of AIDS to specific lifestyle choices found favour with parts of society, especially those critical of the gay movement.

At the time that the controversy started, there were still some questions unanswered on the precise mechanisms of HIV disease. Ten years later there is a more complete understanding of how HIV causes AIDS.

Q What affect will AIDS have on fertility?
A According to Whiteside and Sunter the effect on fertility will be threefold. Firstly, the number of births may be reduced if women die before reaching the end of their child-bearing years. The second effect is that HIV infection and AIDS reduce fertility through physiological means. Finally, AIDS awareness, the use of condoms and increased empowerment of women will reduce fertility.

As the total fertility rate is already declining in South Africa on account of urbanisation and rising affluence, the epidemic and the programmes to fight it could cause the rate of decline to be steeper still.

Q What is the possibility of developing an AIDS vaccine?
A An AIDS vaccine is urgently needed in a world where over 5 million people are newly infected with HIV every year, but it will take time and a concerted international effort before we have one.

Given the complexity in implementing a vaccine development programme, it is essential that all countries affected actively participate in this process. Scientists around the world are working to understand the kind of immunity a vaccine would have to induce in order to protect someone against HIV infection. They are also looking into the genetic variability of the virus, which might affect the protection a vaccine could offer. The information that scientists generate is in turn being used by the pharmaceutical and biotechnology industry to develop "candidate vaccines" to be tested in HIV-negative human volunteers.

Most likely, the initial HIV vaccines will not be 100% effective (but then, few vaccines are) and they will have to be delivered as part of a comprehensive prevention package. What is important now is to ensure that countries where there is an urgent need for HIV vaccines participate in the global effort to ensure that a vaccine appropriate for their use is developed. Likewise, it is not too early to start planning now to ensure that a future vaccine is made available in the areas of the world where it is most needed.

In the long term, a safe, effective and affordable preventive vaccine against HIV is our best hope of bringing the global epidemic under control. However, it would be a mistake to think that the development of such a vaccine will be quick or easy or to expect that once a vaccine is available it will replace other preventive measures.

Q How are potential vaccines tested on humans?
A The first human trial of an HIV-preventive vaccine was conducted in 1987 in the United States. Since then, more than 30 small-scale trials have been conducted, including 12 in developing countries (Brazil, China, Cuba, Thailand and Uganda). These trials, carried out with the participation of more than 5000 healthy volunteers have shown that the candidate vaccines are safe and that they induce immune responses that could potentially protect people against HIV infection.

The first large-scale HIV vaccine trials, designed to show whether the candidate vaccines actually protect against HIV infection or disease, were launched in 1998 in the United States and in 1999 in Thailand. The trials involve 8000 healthy volunteers who are given one of two different versions of gp120, a protein located on the outside of the virus, depending on the virus strains prevalent in the two countries. The initial results from these trials may be available within the next two years. Parallel to this, other candidate HIV vaccines are being developed through different experimental approaches. Some are based on the HIV strains prevalent in developing countries. Most of these newer candidate vaccines will be tested in small-scale trials in human volunteers, and the best will proceed to large-scale evaluation for efficacy.

Vaccine development is complicated not only by the range of virus subtypes circulating but by the wide variety of human populations who need protection and who differ, for example, in their genetic make-up and their routes of exposure to HIV. Inevitably, different types of candidate vaccines will have to be tested against various viral subtypes in multiple vaccine trials, conducted in both high-income and developing countries. It is vital for developing countries to build up their technical and human capability to conduct such trials with the highest ethical and scientific standards and with the full participation of the community.

Q How effective is the condom at preventing STD’s and sperm penetration?
A Due to sperm’s relatively large size, blocking it is the least demanding of the two. Evidence shows that a natural rubber condom, free from defects, provides a complete barrier to sperm. There are many effective means of preventing or reducing the incidence of pregnancy arising from intercourse, but there are far fewer reliable options for avoiding transmission of STD’s. Studies have shown that condoms protect against a wide range of STD’s, including syphilis, gonorrhoea, chlamydia, herpes, and hepatitis B. (source: http://www.durex.com/; scientific articles)
Q There have been rumours of naturally occurring holes in latex that are big enough for HIV to pass through. Is this true?
A The reports of holes in latex appear to have originated from an article in Science Magazine about latex gloves, not condoms. Holes as large as 5 microns in diameter were evidently identified in latex used in gloves. However, gloves are only dipped in latex once when they are made, condoms are dipped twice in latex. Gloves are allowed to fail the water leak test at a rate of 40 per thousand, while condoms are only allowed 4 failures of the water leak test per thousand condoms before the entire batch is rejected. While holes large enough for HIV to pass through have been found in natural membrane condoms, latex condoms do not allow the HIV to pass through the condom unless the condom has been damaged or torn. Used properly, latex condoms are effective in reducing the risk of HIV infection. (Source: CDC)
Q I want to use a condom, but my partner does not. How do I negotiate for safer sex?
A Many women may have contemplated using condoms but may be uncomfortable suggesting condom use to their partners. Developing condom negotiation skills may help women in this situation.

Here are some sample responses women can practice and then use when a partner objects to condoms:

· Sensation objection: "I won't feel as much if I have a condom on."
Response: "You won't feel anything if you don't have a condom on."
· Sensation objection: "It doesn't feel good."
Responses: "I think it's really sexy when a guy uses a condom. It shows he cares. What if I put it on for you?" OR "I'd feel better."
· Availability objection: "I don't have one."
Response: "I do, and it's ribbed inside for your pleasure."
· Disease prevention objection: "If you trusted me, you wouldn't ask me to use one."
Response: "I trust that you're telling me the truth, the best you can. But with some STD’s, you can't tell if you have them just by looking. Let's be safe and use condoms."
· Disease prevention objection: "You won't catch anything from me."
Response: "If you love me, respect my health."
· Spontaneity objection: "It will interrupt sex."
Responses: "Let me put it on you. You'll love it." OR "I'll wait."
· Spontaneity objection: "It spoils the mood."
Responses: "It puts me in the mood." OR "Not if I help." OR "We could always just go to a movie."
· Traditional objection: "I don’t shower with a rain coat on” OR “I don’t eat sweets with the papers on."
Response: "You will not be eating any sweets without your raincoat on.”
(Adapted from www.thriveonline.com)
Q What is the female condom?
A The female condom is a strong, soft sheath that is inserted into the vagina before sexual intercourse. It has two plastic rings:
· one at the closed end, which helps insert the condom and keep it in place, and
· the other at the open end, which remains outside the vagina.
 
It is made of polyurethane plastic, which requires no special storage and can be inserted quite a while before having sex. It does not require immediate withdrawal after ejaculation and it can be used with both oil-based and water-based lubricants. Because it is usually visible during sex, a woman cannot easily use a female condom without her partner knowing about it, but women do have more control over use of this method than they do over use of a male condom. The female condom is not meant to replace the male condom. Rather, it is meant to increase the options available to fight HIV and other sexually transmitted infections.
 
Q How effective is the female condom?
A According to a Thai study among sex workers in brothels, when a female condom was provided as an extra option to the male condom, the women experienced a 34% decrease in the number of new sexually transmitted infections. The same study also found that sex workers who had access to both the female and the male condom were less likely to have unprotected sex than women who had access only to male condoms.

Use of the product is not expected to reach the high levels recorded in many countries for the male condom. Research in Zambia and Zimbabwe reveals that after a year of mass marketing, awareness of the female condom is high but use remains extremely low. Some studies show, however, that once women try the female condom, they like it. For example, among female drug users in Brazil, 75% who used the female condom reported being comfortable with it. Follow-up interviews three months later showed that 43% reported continued use, although women living in poor areas (favelas) were less likely to continue using the condom. The biggest problem is that female condoms are several times more expensive than male condoms and therefore not readily available to all. Efforts to expand access, increase global volume and further reduce the price continue. (UNAIDS global report – June 2000)

Q Is there a difference in the rate of HIV transmission between circumcised and uncircumcised men?
A For several years, researchers have been debating the relationship between male circumcision and HIV. Several studies have indicated that circumcised men are less likely to become infected with HIV than uncircumcised men. However, because circumcision is usually linked to culture or religion, it has been argued that the apparent protective effect of the procedure is likely to be related not to removal of the foreskin but to the behaviours prevalent in the ethnic or religious groups in which male circumcision is practised. In addition, some researchers have assumed that any association between circumcision and HIV may be complicated by the presence of other sexually transmitted infections, which have been found to be more common among uncircumcised men.

Clearly, the correlations are not straightforward. In the higher-income countries, the rates of HIV infection among men who have sex with men do not vary greatly even though the circumcision rates do: few men in Europe and Japan but four-fifths of men in the United States are circumcised. In Africa, however, circumcision seems to confer some protection. A study in Nyanza Province, Kenya, among men from the same ethnic group (the Luo), found that one-quarter of uncircumcised men were infected with HIV, compared with just under one-tenth of circumcised men. The protective effect remained even after other factors, such as sexual behaviour and sexually transmitted infections, had been taken into account. A study of over 6800 men in rural Uganda has suggested that the timing of circumcision is important: HIV infection was found in 16% of men who were circumcised after the age of 21 and in only 7% of those circumcised before puberty. A recent review of 27 published studies on the association between HIV and male circumcision in Africa found that, on average, circumcised men were half as likely to be infected with HIV as uncircumcised men.

When African men with similar socio-demographic, behavioural and other factors were compared, circumcised men were nearly 60% less likely than uncircumcised men to be infected with HIV.

Even though the weight of evidence increasingly suggests that circumcising men before they become sexually active does provide some protection against HIV, the practical implications for AIDS prevention are not obvious. Circumcision, where it is practised, usually has links to religious or ethnic identities and life-cycle ceremonies, and may customarily be done after puberty. If the same scalpel were used without sterilisation on a number of boys, this could actually contribute to the transmission of HIV. Finally, if circumcision were promoted as a way of preventing HIV infection, people might abandon other safe sexual practices, such as condom use. This risk is far from negligible – already, rumours abound in some communities that circumcision acts as a "natural condom". A sex worker interviewed in the city of Kisumu in Kenya summed up this misconception, saying: "I can sleep with circumcised men without a condom because they don’t carry a lot of dirt on their penis". While circumcision may reduce the likelihood of HIV infection, it does not eliminate it. In one study in South Africa, for example, two out of five circumcised men were infected with HIV, compared with three out of five uncircumcised men. Relying on circumcision for protection is, in these circumstances, a bit like playing Russian roulette with two bullets in the gun rather than three (UNAIDS report June 2000).

Q What is the risk of HIV transmission from oral sex?
A The likelihood of transmission of HIV from an infected person to an uninfected person varies significantly, depending on the type of exposure or contact involved. The risk of becoming infected with HIV through unprotected (without a condom) oral sex is lower than that of unprotected anal or vaginal sex. However, a lower-risk activity will increase in risk when it is repeated enough.

The Options Project found that 7.8% (8 out of 102) of recently infected men who had sex with men in San Francisco were probably infected through oral sex. Most of these men believed that the risk was minimal or non-existent. Nearly half (3 out of 8) of these cases reported oral problems, including occasional bleeding gums. Almost all (7 out of 8) of these men reported having had oral contact with pre-semen or semen.

The study results emphasise that any type of sexual activity with an infected person poses a risk of HIV transmission. (7th National Conference on Retroviruses and Opportunistic Infections, January 2000) Oral sex with someone who is infected with HIV is certainly not risk-free.

This is why scientists divide the risk of contracting HIV into four categories:

 
No risk
Social contact
Low risk
French Kissing (kissing with an open mouth), sharing toothbrushes and razors, etc.
Medium risk
Oral sex
High risk
Any form of unprotected sex, of which receptive anal sex has the highest risk incidence
Without question, the greater risk of contracting HIV rests with the performer of oral sex. Having ejaculating take place outside the mouth, not swallowing ejaculate, and/or reducing the frequency of these sex acts, lowers the risk. If one receives oral sex from a partner with a cold sore or herpes, the chances of contracting this sexually transmitted disease are higher, as compared to HIV infection.
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