The History of HIV

1. The History of HIV Professor David Watkins September 1st, 2015

2. 1981 History Kaposi's Sarcoma (KS) was a rare form of relatively benign cancer that tended to occur in older people. But by March 1981 at least eight cases of a more aggressive form of KS had occurred amongst young gay men in New York. At about the same time there was an increase, in both California and New York, in the number of cases of a rare lung infection Pneumocystis carinii pneumonia (PCP). In April this increase in PCP was noticed at the Centers for Disease Control (CDC) in Atlanta. A drug technician, Sandra Ford, observed a high number of requests for the drug pentamine, used in the treatment of PCP: "A doctor was treating a gay man in his 20s who had pneumonia. Two weeks later, he called to ask for a refill of a rare drug that I handled. This was unusual - nobody ever asked for a refill. Patients usually were cured in one 10-day treatment or they died" - Sandra Ford for Newsweek In June, the CDC published a report about the occurrence, without identifiable cause, of PCP in five men in Los Angeles. This report is sometimes referred to as the "beginning" of AIDS, but it might be more accurate to describe it as the beginning of the general awareness of AIDS in the USA. A few days later, following these reports of PCP and other rare life-threatening opportunistic infections, the CDC formed a Task Force on Kaposi's Sarcoma and Opportunistic Infections (KSOI).

3. 1981 History Because there was so little known about the transmission of what seemed to be a new disease, there was concern about contagion, and whether the disease could by passed on by people who had no apparent signs or symptoms. Knowledge about the disease was changing so quickly that certain assumptions made at this time were shown to be unfounded just a few months later. For example, in July 1981 Dr. Curran of the CDC was reported as follows: "Dr. Curran said there was no apparent danger to non homosexuals from contagion. 'The best evidence against contagion', he said, 'is that no cases have been reported to date outside the homosexual community or in women" - The New York Times Just five months later, in December 1981, it was clear that the disease affected other population groups, when the first cases of PCP were reported in injecting drug users. At the same time the first case of AIDS was documented in the UK.

4. 1982 History As the disease still did not have a name, organizations were referring to it in different ways. The CDC generally referred to it by reference to the diseases that were occurring, for example lymphadenopathy (swollen glands), although on some occasions they referred to it as KSOI, the name already given to the CDC task force. In contrast some still linked the disease to its initial occurrence in gay men, with a letter in The Lancet calling it "gay compromise syndrome". Others called it GRID (gay-related immune deficiency), AID (acquired immunodeficiency disease), "gay cancer" or "community-acquired immune dysfunction". In June a report of a group of cases amongst gay men in Southern California suggested that the disease might be caused by an infectious agent that was sexually transmitted. By the beginning of July a total of 452 cases, from 23 states, had been reported to the CDC. Later that month the first reports appeared that the disease was occurring in Haitians, as well as haemophiliacs. This news soon led to speculation that the epidemic might have originated in Haiti, and caused some parents to withdraw their children from haemophiliac camps. The occurrence of the disease in non-homosexuals meant that names such as GRID were redundant. The acronym AIDS was suggested at a meeting in Washington, D.C., in July. By August this name was being used in newspapers and scientific journals. AIDS (Acquired Immune Deficiency Syndrome) was first properly defined by the CDC in September

5. 1982 History An anagram of AIDS, SIDA, was created for use in French and Spanish. Doctors thought AIDS was an appropriate name because people acquired the condition rather than inherited it; because it resulted in a deficiency within the immune system; and because it was a syndrome, with a number of manifestations, rather than a single disease. Still very little was known about transmission and public anxiety continued to grow. "It is frightening because no one knows what's causing it, said a 28-year old law student who went to the St. Mark's Clinic in Greenwich Village last week complaining of swollen glands, thought to be one early symptom of the disease. Every week a new theory comes out about how you're going to spread it." - The New York Times By 1982 a number of AIDS specific voluntary organizations had been set up in the USA. They included the San Francisco AIDS Foundation (SFAF), AIDS Project Los Angeles (APLA), and Gay Men's Health Crisis (GMHC). In November 1982 the first AIDS organization, the Terry Higgins Trust (later known as the Terrence Higgins Trust), was formally established in the UK, and by this time a number of AIDS organizations were already producing safer sex advice for gay men. In December a 20-month old child who had received multiple transfusions of blood and blood products died from infections related to AIDS. This case provided clearer evidence that AIDS was caused by an infectious agent, and it also caused additional concerns about the safety of the blood supply. Also in December, the CDC reported the first cases of possible mother to child transmission of AIDS. By the end of 1982 many more people were taking notice of this new disease, as it was clearer that a much wider group of people was going to be affected. "When it began turning up in children and transfusion recipients, that was a turning point in terms of public perception. Up until then it was entirely a gay epidemic, and it was easy for the average person to say 'So what?' Now everyone could relate." - Harold Jaffe of the CDC for Newsweek It was also becoming clear that AIDS was not a disease that just occurred in the USA. Throughout 1982 there were separate reports of the disease occurring in a number of European countries. Meanwhile in Uganda, doctors were seeing the first cases of a new, fatal wasting disease. This illness soon became known locally as 'slim'.

6. 1983 History In January, reports of AIDS among women with no other risk factors suggested the disease might be passed on through heterosexual sex. At about the same time the CDC convened a meeting to consider how the transmission of AIDS could be prevented, and in particular to consider the newly emerged evidence that AIDS might be spread through blood clotting factor and through blood transfusions. As James Curran, the head of the CDC task force, said: "The sense of urgency is greatest for haemophiliacs. The risk for others [who receive blood products] now appears small, but is unknown.” The risk for haemophiliacs was so great because the blood concentrate that some haemophiliacs used exposed them to the blood of up to 5,000 individual blood donors. In March, the CDC stated that, "persons who may be considered at increased risk of AIDS include those with symptoms and signs suggestive of AIDS; sexual partners of AIDS patients; sexually active homosexual or bisexual men with multiple partners; Haitian entrants to the United States; present or past abusers of IV drugs; patients with haemophilia; and sexual partners of individuals at increased risk for AIDS." The same report also said, "each group contains many persons who probably have little risk of acquiring AIDS... Very little is known about risk factors for Haitians with AIDS.” Nevertheless, the inclusion of Haitians as a risk group caused much controversy. Haitian Americans complained of stigmatisation, officials accused the CDC of racism, and Haiti suffered a serious blow to its tourism industry. Before long people were talking colloquially of a "4-H Club" at risk of AIDS: homosexuals, haemophiliacs, heroin addicts and Haitians. Some people substituted 'hookers' for haemophiliacs.

7. 1983 History In the UK there were public concerns about the blood supply with references in newspapers to "killer blood”. The media more generally started to take notice of AIDS, with the screening of a TV Horizon program, "The Killer in the Village", and a number of newspaper articles on the subject of the "gay plague". In May 1983, doctors at the Institute Pasteur in France reported that they had isolated a new virus, which they suggested might be the cause of AIDS. 50 Little notice was taken of this announcement at the time, but a sample of the virus was sent to the CDC. A few months later the virus was named lymphadenopathy-associated virus or LAV, patents were applied for, and a sample of LAV was sent to the National Cancer Institute. But whilst progress was being made by scientists there was increasing concern about transmission, and not just in relation to the blood supply. A report of AIDS occurring in children suggested quite incorrectly the possibility of casual household transmission. AIDS transmission became a major issue in San Francisco, where the Police Department equipped patrol officers with special masks and gloves for use when dealing with what the police called "a suspected AIDS patient". "The officers were concerned that they could bring the bug home and their whole family could get AIDS." - The New York Times And in New York: "landlords have evicted individuals with AIDS" and "the Social Security Administration is interviewing patients by phone rather than face to face." - Dr. David Spencer, Commissioner of Health, New York City

8. 1983 History There was considerable fear about AIDS in many other countries as well: "In many parts of the world there is anxiety, bafflement, a sense that something has to be done - although no one knows what." - The New York Times As anxiety continued, the CDC tried to provide reassurance that children with AIDS had probably acquired it from their mothers and that casual transmission did not occur: "The cause of AIDS is unknown, but it seems most likely to be caused by an agent transmitted by intimate sexual contact, through contaminated needles, or, less commonly, by percutaneous inoculation of infectious blood or blood products. No evidence suggests transmission of AIDS by airborne spread. The failure to identify cases among friends relatives, and co-workers of AIDS patients provides further evidence that casual contact offers little or no risk [...] the occurrence in young infants suggests transmission from an affected mother to a susceptible infant before, during, or shortly after birth.” Reports from Europe suggested that two rather separate AIDS epidemics were occurring. In the UK, West Germany and Denmark, the majority of people with AIDS were homosexual, and many had a history of sex with American nationals. However in France and Belgium AIDS was occurring mainly in people from Central Africa or those with links to the area. Examples of this second epidemic included a number of previously healthy African patients who were hospitalized in Belgium with opportunistic infections (such as PCP and cryptosporidosis), Kaposi's sarcoma, or other AIDS-like illnesses. All of these Africans had immune deficiency similar to that of American AIDS patients. However they had no history of blood transfusion, homosexuality, or intravenous drug use. In light of such reports, European and American scientists set out to discover more about the occurrence of AIDS in Central Africa. By this time, doctors working in parts of Zambia and Zaire had already noticed the emergence of a very aggressive form of Kaposi's sarcoma. This cancer was endemic in Central Africa, but previously it had progressed very slowly and responded well to treatment, whereas the new cases looked very different and were often fatal.

9. 1984 History On April 22nd, Dr. Mason of the CDC was reported as saying: "I believe we have the cause of AIDS." He was referring to the French virus, LAV, and he was basing his opinion on the findings made in the preceding weeks by the researchers at the Pasteur Institute who had discovered the virus the previous year. Just one day later, on April 23rd, the United States Health and Human Services Secretary Margaret Heckler announced that Dr. Robert Gallo of the National Cancer Institute had isolated the virus which caused AIDS, that it was named HTLV-III, and that there would soon be a commercially available test able to detect the virus with "essentially 100 percent certainty". It was a dramatic and optimistic announcement that also included: "We hope to have a vaccine [against AIDS] ready for testing in about two years." And it concluded with: "yet another terrible disease is about to yield to patience, persistence and outright genius”. The same day patent applications were filed covering Gallo's work, but there was clearly a possibility that LAV and HTLV-III were the same virus. The scientific papers regarding Gallo's discovery of HTLV-III were published on 4th May. 75 By 17th May, private companies were already applying to the Department of Health & Human Services for licenses to develop a commercial test, which would detect evidence of the virus in blood, a test which it had already been said would be used to screen the entire supply of donated blood in the USA.

10. 1984 History Meanwhile there was still concern about the public health aspect of AIDS. This was particularly the case in San Francisco where all the gay bath houses and private sex clubs were closed. Some gay men regarded the closures as an attack on their civil rights. But Mervyn Silverman, Director of the San Francisco Department of Public Health stated the public health view as follows: "There are certain places where things are allowed and certain places where they are not. You can't have sex at the McDonald's. You generally cannot have sex in the pews of a church or in a synagogue. People don't feel their civil liberties are being in any way abrogated because of that.” Researchers who had visited Central Africa in late 1983 reported they had identified 26 patients with AIDS in Kigali, Rwanda, and 38 in Kinshasa, Zaire. The Rwandan study concluded that, "an association of an urban environment, a relatively high income, and heterosexual promiscuity could be a risk factor for AIDS in Africa”. The Zairian study found there to be a "strong indication of heterosexual transmission". In light of these findings the Zairian Department of Public Health, in collaboration with American and European scientists, launched a national AIDS research program called Project SIDA. By the end of 1984, there had been 7,699 AIDS cases and 3,665 AIDS deaths in the USA, and 762 cases had been reported in Europe. In the UK there had been 108 cases and 46 deaths.

11. 1985 History In January 1985 a number of more detailed reports were published concerning LAV and HTLV-III, and by March it was clear that the viruses were the same. The same month the U.S Food and Drug Administration (FDA) licensed, for commercial production, the first blood test for AIDS. The test would reveal the presence of antibodies to HTLV-III/LAV, and it was announced that anyone who had antibodies in their blood would not in future be allowed to donate blood. There were a number of social and ethical issues, as well as certain medical matters, that had to be considered before the new test could be used even to ensure the safety of the blood supply. And even more aspects needed to be considered before the test could be more widely used. Concern particularly centered on issues of confidentiality and the meaning of a positive test result. "Richard Dunne, director of the Gay Men's Health Crisis, said that the group would not object to the wider availability of the procedure provided that certain safeguards were assured: informed consent, good counselling and confidentiality, 'which means anonymity,' he said. He stressed that the city must prevent insurance companies, employers, schools and others from gaining access to test results." - The New York Times The first small-scale needle and syringe exchange project had been started in 1984 in Amsterdam, the Netherlands, but more projects were started in 1985 as a result of growing concerns about HTLV-III/LAV.

12. 1985 History "Some experts are skeptical that AIDS will spread as rapidly among heterosexuals as it has among homosexuals. Yet other experts, taking their cues from data emerging from preliminary studies from Africa showing equal sex distribution among males and females, are less sure." - The New York Times Immediately after the conference, the World Health Organization (WHO) organized an international meeting to consider the AIDS epidemic and to initiate concerted worldwide action. Meanwhile in many countries there was a separate "epidemic of fear" and prejudice. In the UK tabloid press, AIDS was the subject of many headlines and caused alarm among the public. In some newspapers, the prejudice was obvious. The haemophiliacs were seen as the "innocent victims" of AIDS whereas gay men and drug-users were seen as having brought the disease upon themselves. The fear of AIDS caused firemen to ban the kiss of life, and caused holidaymakers to cut their holiday short for fear of contracting AIDS from an HTLV-III positive passenger on the Queen Elizabeth 2. A 9-year old HTLV-III positive haemophiliac was allowed to attend the local school, but some of the pupils where kept home by anxious parents In the US, it was feared that drinking communion wine from a common cup could transmit AIDS, and Ryan White, a 13-year old haemophiliac with AIDS, was banned from school. "In 1985, at 13, Ryan White became a symbol of the intolerance that is inflicted on AIDS victims. Once it became known that White, a haemophiliac, had contracted the disease from a tainted blood transfusion, school officials banned him from classes." - Time Magazine

13. 1985 History The CDC removed Haitians from their list of AIDS risk groups, in light of information that suggested both heterosexual contact and exposure to contaminated needles played a role in transmission. On September 17th, President Reagan publicly mentioned AIDS for the first time, when he was asked about AIDS funding at a press conference. At the same press conference he was also asked a question whether he would send his children if they were younger to school with a child who has AIDS. "It is true that some medical sources had said that this cannot be communicated in any way other than the ones we already know and which would not involve a child being in the school. And yet medicine has not come forth unequivocally and said, 'This we know for a fact, that it is safe.' And until they do, I think we just have to do the best we can with this problem. I can understand both sides of it." - Ronald W. Reagan Drugs such as ribavirin, thought to be active against HTLV-III/LAV, were being smuggled from Mexico into the USA. The actor Rock Hudson died of AIDS on October 3rd 1985. He was the first major public figure known to have died of AIDS. All UK blood transfusion centres began routine testing of all blood donations for HTLV-III/LAV in October.

14. 1985 History Towards the end of the year, Western scientists became much more aware of the "slim disease" that had become increasingly common in South West Uganda since 1982. Studies found that most cases were among promiscuous heterosexuals, the majority of whom tested positive for antibodies to HTLV-III/LAV. The site and timing of the first reported cases suggested that the disease arose in neighbouring Tanzania. Some scientists who studied slim concluded: "Although slim disease resembles AIDS in many ways, it seems to be a new entity.” However, others thought differently: "[Evidence] suggests that slim disease cannot be distinguished from AIDS and ARC [AIDS related complex] by extreme weight loss and diarrhea. Thus slim disease may not be a new syndrome but simply identical with AIDS as seen in Africa.” In December 1985, the Pasteur Institute filed a lawsuit against the National Cancer Institute to claim a share of the royalties from the NCI's patented AIDS test. During the year, knowledge of transmission routes was to change again, when it was reported that the virus had been transmitted from mother to child through breast feeding. The first case of AIDS was also reported in China, and as a result, AIDS had been reported in every region in the world. By the end of 1985, 20,303 cases of AIDS had been reported to the World Health Organisation. In the USA 15,948 cases of AIDS had been reported, 114 and in the UK 275 cases.

15. 1986 History In the UK the first needle exchange scheme started in Dundee and the AIDS charity AVERT was started. In March in the UK, the government launched the first public information campaign on AIDS, with the slogan "Don't Aid AIDS". There were a series of advertisements in national newspapers. At this time there was still disagreement about the name of the virus. "The name of the virus had itself become a political football as the French insisted on LAV (lymphadenopathy-associated virus), while Gallo's group used HTLV-3 (human T-cell lymphotropic virus, type 3)." - Time Magazine In May 1986, the International Committee on the Taxonomy of Viruses ruled that both names should be dropped. The dispute was solved with a new name, HIV (Human Immunodeficiency Virus). In September there was dramatic progress in the provision of medical treatment for AIDS, when early results of clinical tests showed that a drug called azidothymidine (AZT) slowed down the attack of HIV. AZT was first synthesized in 1964 as a possible anticancer drug but had proved ineffective. The AZT clinical trial divided patients into two groups: one received AZT and the other received a placebo. At the end of six months, only one patient in the AZT group had died, whilst there were 19 deaths among the placebo group. The clinical trial was stopped early, because it was thought to be unethical to deny the patients of the placebo groups a better chance of survival. "The announcement set off a flurry of excitement and controversy. AIDS hotlines and doctors' offices were flooded with calls, community leaders warned about undue optimism, and doctors debated the ethical and medical issues raised by the early cancellation of the AZT study." - Time Magazine - See more at: http://

16. 1986 History In the United States, the Surgeon General's Report on AIDS was published. The report was the Government's first major statement on what the nation should do to prevent the spread of AIDS. The "unusually explicit" report urged parents and schools to start "frank, open discussions" about AIDS. By this time, scientists had accumulated enough evidence to form an overview of AIDS in Africa. Studies of medical records showed there had been marked increases in a number of AIDS-related conditions during the late 1970s and early 1980s. In particular: Slim disease in Kinshasa, Zaire (late 1970s) Slim disease in Uganda and Tanzania (early 1980s) Esophagel candidiasis in Rwanda (from 1983) Aggressive Kaposi's sarcoma in Kinshasa, Zaire (early 1980s) Aggressive Kaposi's sarcoma in Zambia and Uganda (from 1982 and 1983) Crypotococcal meningitis in Kinshasa, Zaire (late 1970s to early 1980s). In conclusion: "These studies suggested that while isolated cases of AIDS may have occurred in Africa earlier, it was probably rare until the late 1970's and early 1980's, a pattern similar to that in the United States and Haiti.”

17. 1987 History In March the U.S. Food and Drug Administration (FDA) approved AZT as the first antiretroviral drug to be used as a treatment for AIDS. Around the same time the organization ACT UP (the AIDS Coalition to Unleash Power) was founded. ACT UP was committed to direct action to end the AIDS crisis, and their demands included better access to drugs as well as cheaper prices, public education about AIDS and the prohibition of AIDS-related discrimination. On 24th March they held their first mass demonstration on Wall Street. Many of the placards used in ACT-UP's demonstrations carried the graphic emblem "SILENCE=DEATH". Created in 1987 by a group of gay men calling themselves the Silence=Death project, the emblem was leant to ACT-UP and for many Americans it became the symbol of AIDS activism. One ACT-UP committee used the emblem in a window display called "Let the Record Show" at the New Museum of Contemporary Art in New York; afterwards they regrouped as Gran Fury: "a band of individuals united in anger and dedicated to exploiting the power of art to end the AIDS crisis” Over the next few years Gran Fury produced many high profile public projects including the art banner announcing "Kissing doesn't kill: Greed and indifference do” and the poster "AIDS: 1 in 61" about babies born HIV positive in New York City. In Australia, the Grim Reaper education campaign was launched, with television images of 'death' knocking down people in a bowling alley. Although widely criticized at the time, the advertisements succeeded in ensuring widespread discussion of AIDS.

18. 1987 History On 31st March, at a ceremony at the White House attended by President Reagan, it was announced that an agreement had been reached regarding ownership of the HIV antibody test patent. The Pasteur Institute agreed that it would end its legal challenge, and would share the profits from the test with the U.S. Department of Health and Human Services. Although the agreement officially resolved the question of who had invented the HIV antibody test, it did not address the question of who had discovered HIV and identified it as the cause of AIDS. It was generally agreed that: "historians can decide who found the AIDS virus first." – Newsweek But to many people it appears clear that HIV was isolated in Paris a year before it was isolated in the USA. In the autumn, a book by Randy Shilts called 'And the Band Played On' was published, which chronicled the early years of the AIDS epidemic. Shilts' book made an important contribution to documenting the history of AIDS, but his view of "the facts about AIDS", as well as his opinions, differ greatly from others on a number of occasions. Shilts was the first to identify a French-Canadian flight attendant called Gaetan Dugas as 'Patient Zero'. (See the History of AIDS up to 1986 for an introduction to 'Patient Zero'). Shilts claimed that Gaetan Dugas played a key role in the early spread of AIDS in America, and the story of 'Patient Zero' was widely publicized by the media. But the claim has since been widely disputed: "There's no Patient Zero. It's lots and lots of people moving around from New York to San Francisco, and the rest of the world. If there ever was an original Patient Zero, it would have been back in the mid-Seventies. But there isn't an original Patient Zero." - Andrew Moss

19. 1987 History In Africa, President Kaunda of Zambia announced that his son had died of AIDS, and appealed to the international community to treat AIDS as a worldwide problem. In Uganda, 16 volunteers who had been personally affected by HIV/AIDS came together to found the community organization TASO. In October, AIDS became the first disease ever debated on the floor of the United Nations (UN) General Assembly. The General Assembly resolved to mobilize the entire UN system in the worldwide struggle against AIDS, under the leadership of the WHO. The American scientist Dr. Peter Duesberg published a scientific paper in a cancer journal that questioned the then dominant theory that viruses were involved in cancer causation, and also queried the link between HIV and AIDS. In November, Channel 4 broadcast the documentary 'AIDS: the Unheard Voices' to its British audience. In the documentary Duesberg and others argued that HIV could not be the cause of AIDS. By December, 71,751 cases of AIDS had been reported to the World Health Organisation, with the greatest number reported by the USA (47,022). Countries reporting over 2,000 cases included France (2,523), Uganda (2,369) and Brazil (2,102). Five other countries reported more than 1,000 cases: Tanzania (1,608), Germany (1,486), Canada (1,334), UK (1,170) and Italy (1,104). The WHO also reported that an estimated 5 to 10 million people were infected with HIV worldwide, with 150,000 cases of AIDS expected to develop in the following 12 months and up to 3 million within the next 5 years.

20. 1988 History In the USA frustration continued to grow over the slow progress in improving access to drugs. When the Presidential Commission on the HIV Epidemic issued its final report in June 1988, it declared that the FDA arrangements were "not meeting the needs of people with AIDS". On October 11th more than 1,000 ACT-UP demonstrators virtually shut down operations at the FDA headquarters. Eight days after the ACT-UP demonstration the FDA announced new regulations to speed drug approval. The first official needle exchange was started in the US to prevent transmission of HIV through drug use. A limited experiment started in November in New York City and, at about the same time, the Prevention Point opened in San Francisco. But Congress prohibited the use of federal funds to support needle exchange programmes. On December 1st, the first World AIDS Day took place, with the WHO asking everyone to "Join the Worldwide Effort."

21. 1989 History In August, there were more developments with respect to treatment, when the results were announced of a major drug trial known as ACTG019. ACTG019 was a trial of the drug AZT, and it showed that AZT could slow progression to AIDS in HIV positive individuals with no symptoms at all. The findings were considered extremely exciting. On August 17th a press conference was held, at which the Health Secretary, Louis Sullivan said: "Today we are witnessing a turning point in the battle to change AIDS from a fatal disease to a treatable one.” The result had enormous financial implications for the makers of the drug, Burroughs Wellcome. The day after the press conference, the value of the company's stock rose by 32 per cent. The high price of AZT angered many people; with a year's supply for one person costing about $7,000, Burroughs Welcome were accused of "price gouging and profiteering”. In September, the cost of the drug was cut by 20 percent. In October the second drug for the treatment of AIDS, dideoxyinosine (ddI), was made available to people with AIDS, even though only preliminary tests had been completed. "It become clear that ddl was not just another drug in terms of need: it was a life-and-death matter, said Richard L. Gelb, chairman of Bristol Myers.”

22. 1990 History At the beginning of the year, it was reported that a large number of children in Romanian hospitals and orphanages had become infected with HIV as a result of multiple blood transfusions and the reuse of needles. Jonathan Mann, the head of the WHO's Global program on AIDS, noted that 'Eastern Europe is the new frontier for the AIDS epidemic’. In China, 146 people in Yunnan Province near the Burmese border were found to be infected with HIV due to sharing needles. This shocked public health officials in China. It was not known whether this was the first sign of an epidemic or an isolated outbreak. In New York city the needle exchange scheme was closed down. Jonathan Mann resigned as the head of the WHO AIDS program, in protest of the failure of the UN and governments worldwide to respond adequately to the exploding pandemic, and against the actions of the then WHO director-general Dr. Hiroshi Nakajima. During Jonathan Mann's leadership, the AIDS program became the largest single program in the organization's history. But more importantly: "Jonathan's persistence and passion helped wake up the world.”and, "Had it not been for Jonathan's unique contributions, the world's approach to AIDS might very well have gone towards mandatory testing and quarantine.” On April 8th Ryan White died in the United States. He was a haemophiliac infected with HIV through blood products. He had become well known a few years earlier as a result of his fight to be allowed to attend public school. Just a few months later the Ryan White CARE Act was passed by Congress. The aim of the act was to provide grants to improve the quality and availability of care for individuals and families with HIV. In the UK and the US, discussion grew about whether there would ever be a heterosexual epidemic because of the difficulty of female-to-male transmission of HIV.

23. 1991 History During the summer, a third antiretroviral drug dideoxycytidine (ddC) was authorised by the FDA for use by patients intolerant of AZT. Also during the summer, a study was published showing that HIV was transmitted much more easily through breast milk than had previously been thought. But despite admitting that the news was discouraging, WHO also said that women in developing countries should continue to breastfeed, as the threat to infant health from contaminated water was even greater than the threat from AIDS. The decision was taken to hold the 1992 international AIDS conference in Amsterdam, rather than its planned location in Boston, following the American administration's decision not to lift entry restrictions on HIV-infected travellers. In the USA Earvin (Magic) Johnson announced that he had tested HIV positive and was therefore retiring from professional basketball, on the advice of his doctors. He said that he planned to use his celebrity status to help educate young people about the disease. He also said: "I think sometimes we think, well, only gay people can get it - it is not going to happen to me. And here I am saying that it happen to anyone, even me Magic Johnson.” A couple of weeks later in the UK, Freddie Mercury, lead singer of the rock group Queen, confirmed that he had AIDS. Just one day later it was announced that he had died.

24. 1991 History

25. 1992 History During 1992, a major UK newspaper ran a series of articles challenging the orthodox view that HIV alone causes AIDS. "But suppose the researchers are looking in the wrong place. Suppose HIV doesn't equal AIDS. Then we will have witnessed the biggest medical and scientific blunder this century." - The Sunday Times journalist Neville Hodgkinson Many other British newspapers joined the heated debate with journalists, researchers, activists and organisations expressing their opinions about the cause of AIDS. "'But what if HIV does cause AIDS? What effect will such articles have on attempts to inform the public on safe sex, or on the people who are suffering from AIDS and taking anti-HIV drugs?” Mary Fisher, an HIV-positive woman and member of the Republican party in the USA, rebuked her party’s negligence in the face of the growing HIV and AIDS epidemic through a speech that was broadcast nationally: “We have killed each other with our ignorance, our prejudice, and our silence. We may take refuge in our stereotypes, but we cannot hide there long, because HIV asks only one thing of those it attacks. Are you human? ”- Mary Fisher Her address has since been considered one of the most significant American speeches of the twentieth century. Tennis star Arthur Ashe announced he had become infected with HIV as a result of a blood transfusion in 1983.

26. 1993 History In January it was reported that some people with AIDS already had resistance to the drug Zidovudine (AZT) even though they themselves had never taken the drug. "Some of the patients may have gotten the virus from other patients who have been taking AZT and who are now transmitting the resistant virus." Researchers said there was an urgent need to develop new drugs to combat the epidemic. On January 6th the Russian ballet star Rudolf Nureyev died. His doctor said that "he died from a cardiac complication following a cruel illness", but it was widely reported that he had died from AIDS. He was buried in his evening clothes with his medals and his favourite beret. During January, 116 new cases of AIDS were reported in the UK, bringing the cumulative total to 7,045. One in six of these new cases were acquired through heterosexual intercourse. In Romania, despite the progress made since the overthrow of the Ceausescu regime, the number of children infected with HIV had increased. There were an estimated 98,000 infected orphans. China had reported one thousand cases of HIV infection, mostly in injecting drug users, but it was believed that this greatly understated the scale of the country's HIV epidemic. The Ministry of Health in China announced that soon only approved government blood donation centres would be able to collect and sell blood.

27. 1993 History In February the tennis player Arthur Ashe died, less than a year after announcing that he had been infected with HIV. Meanwhile scientists had found that HIV 'hides out' in lymph nodes and similar tissue early in the course of infection. “The virus lies concealed for a decade or so, quietly seeding the destruction of the immune system, the researchers found. The finding resoundingly solves a mystery of AIDS: where does the virus secrete itself during the decade or so after an initial infection when patients feel well and little virus can be detected in their blood?” ____________________________________________________________________________________ The ninth International AIDS meeting was held in Berlin, Germany. The general feeling of the meeting was one of disappointment. The message conveyed by the people who attended was once again to put more money and effort into effective prevention of HIV and AIDS. “Dr. James W. Curran, who heads the AIDS Programme at the Centers for Disease Control and Prevention in Atlanta, said he left the meeting 'dispirited by the relentless assault of the virus'.”

28. 1993 History At the end of 1993 the estimated number of AIDS cases worldwide was 2.5 million. WHO (1995) 'Global Programme on AIDS, progress report 1992-1993', p.2

29. 1994 History In the US the CDC launched a series of 13 bold and frank AIDS advertisements breaking away from their previous low-key approach. The advertisements focused on the use of condoms, which were rarely seen or even mentioned on American television. "One of the television ads, entitled Automatic, features a condom making its way from the top drawer of a dresser across the room and into bed with a couple about to make love. The voice-over says, 'it would be nice if latex condoms were automatics. But since they're not - using them should be. Simply because a latex condom, used consistently and correctly, will prevent the spread of HIV.'” In the UK, the Department of Health vetoed an AIDS campaign promoting safer sex and condoms, developed at a cost of £2 million, on the grounds that it was too explicit. The campaign was developed by the Health Education Authority (a government funded body), who later in the year were banned by the Department of Health from distributing the book, "Your Pocket Guide to Sex”. In February the film maker Derek Jarman died of AIDS. He had written in the preface of his autobiography: "On 22nd of December 1986, finding I was body positive, I set myself a target: I would disclose my secret and survive Margaret Thatcher. I did. Now I have my sights on the millennium and a world where we are equal before the law.” Randy Shilts, author of the book 'And the band played on' also died in February. In March, the actor Tom Hanks won an Oscar for playing a gay man with AIDS in the film Philadelphia. Official statistics for Brazil, with a population of about 154 million, indicated that some 46,000 cases of AIDS had been recorded, but estimates put the actual number at anywhere between 450,000 and 3 million cases. Two thirds of the known cases were in Sao Paulo state where AIDS was the leading cause of death of women aged 20-35.

30. 1994 History Research indicated that Thailand had reduced its rate of HIV transmission. This was largely due to action by the government, which had distributed condoms to brothels and insisted that they were used consistently; establishments that failed to comply were threatened with closure. Condom use in commercial sex had risen from 14 percent in 1989 to 94 percent in 1993. By July 1994 the number of AIDS cases reported to the WHO was 985,119. The WHO estimated that the total number of AIDS cases globally had risen by 60 percent in the past year from an estimated 2.5 million in July 1993 to 4 million in July 1994. It was estimated that worldwide there were three men infected for every two women, but that by the year 2000 the number of new infections among women would be equal to that among men. __________________________________________________________________________________ An exciting study, ACTG 076, showed that AZT reduced by two thirds the risk of HIV transmission from infected mothers to their babies. Some people believed that ACTG 076 was: “the most stunning and important result in clinical acquired immunodeficiency syndrome research to date.” And according to Dr. Harold Jaffe of the CDC: “It is the first indication that mother-to-child transmission of HIV can be at least decreased, if not prevented. And it will provide a real impetus for identifying more HIV-infected women during pregnancies so that they could consider the benefit of AZT treatment for themselves and their children.”- The New York Times

31. 1995 History By 1st January 1995, a cumulative total of a million cases of AIDS had been reported to the World Health Organisation Global Programme on AIDS. Eighteen million adults and 1.5 million children were estimated to have been infected with HIV since the beginning of the epidemic. Later in the month the CDC announced that in the US, AIDS had become the leading cause of death amongst all Americans aged 25 to 44. “The dramatic rise is due to the accumulating toll from AIDS and is almost certain to continue because of AIDS deaths reflect infections from HIV, the AIDS virus that were acquired several years earlier.”- Dr. Harold W. Jaffe of the CDC Meanwhile in the USA, two reports by government scientists recommended that the Clinton administration lift the ban on federal funding for needle exchange programs, because the programs had been shown to be effective in reducing the spread of disease. In March the VII International Conference for People Living with HIV and AIDS was held in Cape Town, South Africa - the first time that the annual conference was held in Africa. The conference was opened by the deputy President, Thabo Mbeki, who spoke about how: "the impact has begun to cut deep. Those affected are from the young and able-bodied work-force as well as young intellectuals.” The South African Ministry of Health announced that some 850,000 people - 2.1 percent of the 40 million population - were believed to be HIV positive. Among pregnant women the figure had reached 8 percent and was rising. The conference was also addressed by Dr. Piot, the Director of the new Joint United Nations Program on AIDS (UNAIDS). Dr Piot confirmed his commitment to involve people living with HIV/AIDS in the planning, shaping and guiding of the global response to the epidemic. In July, the US Senate voted to extend the Ryan White Care Act, which provided care and support services to those affected by HIV and AIDS.

32. 1996 History "'Too many Americans do not know their HIV status. Knowledge is power, and power leads to prevention', said HHS Secretary Donna E. Shalala. 'The availability of a home test should empower more people to learn their HIV status and protect themselves and their loved ones.” Meanwhile in China it was estimated that the number of AIDS cases could be as high as 100,000. Two thirds of the reported AIDS cases had occurred in the southern province of Yunnan, where the use of heroin and the sharing of needles had helped the spread of HIV. In June the FDA approved the drug Viramune (nevirapine), the first in a new class of drugs known as non-nucleoside reverse transcriptase inhibitors ( NNRTIs). Another treatment development that took place was the introduction of the viral load test, which provided information about the risk of disease progression. Throughout 1996 there was excitement and optimism about the treatment of HIV infected people. The health of many improved enormously when they started taking combination therapy. For some people, particularly those had been ill in hospital and were then able to go home, the improvement in health was so dramatic that it was referred to as the "Lazarus Syndrome”. At the start of the 11th International Conference on AIDS in Vancouver in July: "the air was electric with excitement and anticipation about the findings on combination therapies to be reported during the meeting.”

33. 1996 History The government of Brazil pledged to begin providing free combination antiretroviral treatment by the end of the year. It said it would spend up to $45 million on protease inhibitors over the following twelve months. In October, in Washington D.C., the AIDS Memorial Quilt was displayed in its entirety for the last time, but it was also the first time that a display of the quilt had been visited by an American president. "What it has done always in the past, and will continue to do, is to put a face on this epidemic. It makes this epidemic human." - Anthony Turney In December, the White House announced its first ever AIDS strategy. This called, amongst other things, for sustained research to find a cure and a vaccine; a reduction in new infections; guaranteed access to high quality care for AIDS patients; and fighting AIDS-related discrimination. "None of us can afford to sit by and watch this epidemic continue to take our neighbors, friends and loved ones from us" - President Clinton in a letter accompanying the AIDS plan

34. 1997 History Early in 1997 it was reported that, for the first time since the AIDS epidemic became visible in 1981, the number of deaths from AIDS had dropped substantially across the USA. This was excellent news but: "The decline in deaths leaves more people living with AIDS and HIV infection. We do not want to be a wet blanket here, but we still need programs that assure good access to treatment and care for infected people." - Dr. John Ward In New York City the decline was even more dramatic, with the number of people dying from AIDS falling by about 50 per cent compared to the previous year. The number of babies being born HIV positive had also declined dramatically. By the spring it was clear that although excellent for many people, the antiretroviral drugs did have unpleasant and in some cases serious side effects. Resistance could also occur, even when three drugs were being taken, and adherence was an important issue as many pills needed to be taken each day. A number of treatment guidelines were published, and some doctors, particularly in the UK, disagreed with the more aggressive approach taken by the US guidelines. Some doctors were particularly concerned about the recommendations concerning the beginning of treatment when patients did not have symptoms. The US approach was sometimes referred to as the "hit early, hit hard” approach to treatment.

35. 1997 History In May 1997 President Clinton set a target for the USA to find an AIDS vaccine within ten years, so it could be the "first great triumph" of the 21st century. To help attain this goal Clinton announced that a dedicated HIV vaccine research and development centre would be established at the National Institutes of Health. "With the strides of recent years, it is no longer a question of whether we can develop an AIDS vaccine - it is simply a question of when. And it cannot come a day too soon." - President Clinton In July the CDC reported that it was likely that there had been a case of transmission of HIV as a result of "deep kissing", although other routes of transmission in this case could not definitely be excluded. The HIV positive man had sores in his mouth and gums that regularly bled, and his female partner also had gum disease with inflamed and sore areas in her mouth.

36. 1998 History In Canada there was an outbreak of HIV infection amongst injecting drug users in Vancouver. Glaxo Wellcome cut the price of AZT by 75% after a trial in Thailand showed it was safe and effective at preventing mother-to-child transmission of HIV in developing countries. However, even with this price cut it was expected that the drug would still be far too expensive for use in many developing countries. In some countries HIV positive people were returning to work, having recovered their health as a result of combination antiretroviral drug treatment. However, some people began to be affected by quite severe side effects of the drugs. The emergence of negative reactions - which included a kind of fat redistribution called lipodystrophy - cast doubt on the long term safety of combination therapy. The reasons why lipodystrophy appeared in some people taking anti-HIV drugs were unknown. Some reports linked the syndrome to drug regimens that contained protease inhibitors. "While fat disappears from some areas, for unknown reasons it redistributes to build up in others. The back of the neck resembles a buffalo hump. Breasts enlarge. A woman may have to buy a bra that is two sizes larger that the last one. The abdomen swells producing a sometimes painful pot belly that is dubbed 'a protease paunch'. A woman may look pregnant when she is not. Exercise may not work it off.” In April, the Clinton Administration refused to lift a ten-year ban on using federal funds for needle exchange programmes, despite concluding for the first time that such exchanges prevent the spread of HIV and do not encourage drug use. Leaders in the fight against AIDS condemned the unexpected decision, which was announced by Health and Human Services Secretary Donna Shalala. During her speech Shalala quoted NIH director Varmus as saying: "An exhaustive review of the science indicates that needle exchange programmes can be an effective component of the global effort to end the AIDS epidemic. Recent findings have strengthened the scientific evidence that needle exchange programmes do not encourage the use of illegal drugs." But, without explanation, Shalala said the administration had "decided that the best course at this time is to have local communities use their own dollars to fund needle exchange programmes”.

37. 1998 History In the UK the London Lighthouse charity closed its residential unit. In June, the company AIDSvax started the first human trial of an AIDS vaccine using 5,000 volunteers from across the USA. "It opened a new era in AIDS research, and led us toward the human trials. It was like being in a room that was partially lit and getting darker and darker, and suddenly the lights went on and you could see the pathway out.” San Francisco started a pioneering Post Exposure Prophylaxis (PEP) program giving HIV drugs to people that might have been exposed to HIV through sexual contact or needle sharing during injecting drug use. The HIV drugs were given to people at the earliest possible time after the risk exposure. "The treatment really is to try, in case they've been exposed to HIV, to stop the replication before it infects the cells and like a brush fire gets out of control.” A study found that the combination of caesarean delivery and AZT reduced the risk of HIV transmission from a mother to her baby to less than 1%. The study also found that women who took AZT but delivered their babies by natural childbirth had a higher risk (6.6%) of transmitting HIV to their babies.

38. 1998 History UNAIDS estimated that during the year a further 5.8 million people became infected with HIV, half of them being under 25. Altman L.K. (1998, 24th November) ' Dismaying experts HIV infections soar', the New York Times Sub-Saharan Africa was home to 70% of people who became infected with HIV during the year. South Africa, which trailed behind some of its neighbouring countries in HIV infection levels at the start of the 1990s was catching up fast. It was estimated that one in seven new HIV infections in Africa were believed to be occurring in South Africa. In Botswana, Namibia, Swaziland and Zimbabwe, the estimates showed that between 20% and 26% of people were living with HIV or AIDS. UNAIDS (1998, December) ' AIDS epidemic update'

39. 1999 History A group of researchers at the University of Alabama claimed to have discovered that a particular type of chimpanzee, once common in West Central Africa, was the source of HIV. The researchers suggested that HIV-1 was introduced into the human population when hunters became exposed to infected blood. Reports started to emerge from South Africa of rape cases involving young girls. It was suggested that a popular myth that sex with a virgin could cure AIDS was the root cause of this increase in child rapes. Later on in the year, the South African President Thabo Mbeki claimed that the anti-HIV drug AZT was toxic and could be a danger to health. __________________________________________________________________________________________ 'The River', a book by Edward Hooper, was published. There was a lot of debate about the role of polio vaccines in the origin of the AIDS epidemic. The Kenyan President Daniel arap Moi declared AIDS a national disaster and ordered a National AIDS Control Council to be set up immediately. "AIDS is not just a serious threat to our social and economic development, it is a real threat to our very existence, and every effort must be made to bring the problem under control." - President Moi However the president also said that his government and Kenya's churches would not advocate the use of condoms as a method of prevention because this would encourage young people to have sex. A research study published in November argued that male circumcision could help to reduce HIV infection rates in Africa and Asia.

40. 2000 History Early in the year the South African government made a decision to invite a panel of experts to pursue debate on questions relating to HIV/AIDS. In March it was reported that South African President Thabo Mbeki had consulted two American 'dissident' researchers to discuss their claim that HIV was not the cause of AIDS. Israel lost one of its most successful singers, Ofra Haza, from what was believed to be an AIDS-related complication. Following her death there was a considerable increase in demand for helplines and anonymous HIV testing. "Nevertheless, her death has brought the whole issue of AIDS out into the open in Israel. This can only be a good thing for a country which has seven openly HIV positive people - including myself - out of an estimated 10,000." - Aviram Germanovitch, Director of the Israeli AIDS Task Force In April, President Mbeki sent a letter to world leaders explaining his views on HIV/AIDS. In this letter Mbeki argued, amongst other things, that since HIV is spread mostly through heterosexual contact in Africa, the continent's problems are unique. "Accordingly, as Africans, we have to deal with this uniquely African catastrophe... It is obvious that whatever lessons we have to and may draw from the West about the grave issue of HIV-AIDS, a simple superimposition of Western experience on African reality would be absurd and illogical.” In Botswana, as many as one in four adults and four of every ten pregnant women were estimated to be infected with HIV. The president of Botswana, Festus Mogae, announced that new contributions from donors including $50 million donated by the Bill and Melinda Gates Foundation would allow his country to provide antiretroviral therapy to all HIV-infected pregnant women and children born with the virus.

41. 2000 History In July, the 13th International AIDS Conference was held in Durban, South Africa. This was the first time that such a conference was held in a developing country or in Africa. Nkosi Johnson, an eleven year old HIV-positive boy, gave a speech in the opening ceremony of the conference and called for the government to give AZT to pregnant HIV-positive women. Mbeki used his opening address at the conference to stress the role of poverty in explaining the problems faced by Africa and compared the campaign against AIDS with the struggle against apartheid. "As I listened and heard the whole story told about our own country, it seemed to me you could not blame everything on a single virus.” An HIV-positive woman marching at the Durban AIDS Conference, South Africa To counter the comments made by president Mbeki, over 5,000 scientists around the world signed the 'Durban Declaration' affirming that HIV is the cause of AIDS. Nelson Mandela, South Africa's former president, closed the AIDS conference with a call for action to combine efforts and save people. "History will judge us harshly if we fail to do so now, and right now.”

42. 2000 History In September, the first phase of a new vaccine trial was launched in Oxford. The trials were sponsored by the International AIDS Vaccine Initiative. The research into an AIDS vaccine was criticised by the World Bank for focusing on a vaccine that could be marketed in western countries, despite the fact that more than 90% of HIV infections were in the developing world. It was reported that the number of people living with HIV in Brazil was less than half that once predicted by health experts, and the number of AIDS deaths had plummeted by as much as fifty per cent since the introduction of combination antiretroviral therapy in 1996. The country's HIV prevention and treatment programmes were seen as a model for other resource-poor countries to emulate. "It makes a lot of sense to look at what Brazil is doing... Something they're doing is working." - Mbulelo Rakwena, South Africa's ambassador to Brazil Treatment provision remained non-existent in South Africa, and President Mbeki stated in an interview with the Time Magazine that he did not think that HIV alone caused AIDS. "Clearly there is such a thing as acquired immune deficiency. The question you have to ask is what produces this deficiency. A whole variety of things can cause the immune system to collapse… But the notion that immune deficiency is only acquired from a single virus cannot be sustained. Once you say immune deficiency is acquired from that virus your response will be antiviral drugs. But if you accept that there can be a variety of reasons, including poverty and the many diseases that afflict Africans, then you can have a more comprehensive treatment response.” In October, President Mbeki announced his withdrawal from the scientific and public debate on the causes of AIDS after admitting that he had created confusion in South Africa.

43. 2000 History There has been a lot of confusion about what Mbeki said and did not say during the year. It is clear that over a period of some months, particularly in April and in September, Mbeki led many people to think that either 1) he does not believe that HIV causes AIDS or 2) he does not believe that HIV causes AIDS on its own. It would seem that Mbeki may have believed that immune deficiency is caused by a collection of factors such as poverty, nutrition and contaminated water as well as HIV, rather than just HIV on its own: "You cannot attribute immune deficiency solely and exclusively to a virus.” It is true that poverty related factors such as malnutrition will hasten the onset of AIDS in people who are HIV-positive. Therefore, it is also true that provision of food will slow down the progression of HIV. However improved nutrition is not enough in itself to permanently keep people healthy. History provides evidence of this.

44. 2001 History The U.S. Government threatened Brazil with legal action over its production of generic HIV drugs. The complaint was dropped later in the year and Brazil promised to give the USA advance warning before changing its patent law for drugs. Thirty-nine pharmaceutical companies withdrew their case against the South African government's efforts to lower drug prices. This victory was, however, overshadowed by a statement by the health minister Manto Tshabalala-Msimang, who said that the government already offered adequate treatment to AIDS patients and that proposals to buy antiretroviral drugs were still being considered. The South African government released its annual HIV/AIDS figures estimating that 4.7 million people were infected with HIV/AIDS and that 24.5% of pregnant women were HIV-positive in 2000.

45. 2003 History At the time, Botswana officially had the highest global HIV prevalence of 38.8 percent. However, in early January, Swaziland's Prime Minister Sibusiso Dlamini said that HIV prevalence had risen to 38.6 percent from 34.2 percent in January 2002. Although prevalence in Swaziland remained slightly lower than Botswana, reports in January suggested that HIV prevalence in Swaziland was unofficially the world's highest, as the figures released were considered to be already out of date. Botswana was struggling to expand its antiretroviral treatment program, largely because of a shortage of health workers. The government had hoped to provide drugs to 19,000 people by the end of 2002, but had enrolled only 3,200 by the end of January 2003. Jerry Thacker, a controversial Christian extremist chosen by the White House to sit on a presidential AIDS advisory panel and who once described the virus as the 'gay plague', was forced to withdraw his name after protests from gay rights groups. ____________________________________________________________________________________ Vaxgen announced that their AIDS vaccine had failed to reduce overall HIV infection rates among those who were vaccinated. The vaccine showed a reduction in certain ethnic groups, indicating that black and Asian volunteers may have produced higher levels of antibodies against HIV than white and Hispanic volunteers. However, many outside observers were skeptical of the ethnic group part of the study. In November, the AIDS vaccine also failed in a clinical trial in Thailand. "The outcome of this trial is one more reminder of how difficult it is to combat HIV and how important it is for the international public health community to redouble the effort to develop an effective vaccine.”- Donald P. Francis, Vaxgen President

46. 2004 History In January Brazil's government reached a deal with pharmaceutical companies to reduce the price of HIV/AIDS drugs by around a third. It was believed that the deal saved the government about $100 million in 2004 and cut the average treatment cost per patient to a new low of $1,200. Also, 10 million free condoms were given out to people in Brazil during the carnival season as part of an AIDS-prevention campaign. In parts of Russia and Eastern Europe, HIV was spreading faster than anywhere else in the world. ____________________________________________________________________________________ President Bush's $15 billion initiative to combat the global AIDS pandemic, by now known as PEPFAR (President's Emergency Plan For AIDS Relief), began full implementation in June, having received its first funding in January. PEPFAR was to concentrate on fifteen focus countries, all of them in Africa except Guyana, Haiti and Vietnam (which was a late addition to the list). The initiative set a goal of providing AIDS treatment to 200,000 people living in the focus countries by June 2005.

47. 2005 History Brazil turned down $40 million offered by PEPFAR because it refused to agree to a declaration condemning prostitution. The director of Brazil's HIV/AIDS program said the government had taken the decision "in order to preserve its autonomy on issues related to national policies on HIV/AIDS as well as ethical and human rights principles".

48. 2006 History The Vatican sparked excitement among AIDS campaigners when it suggested it was planning a review of its stance on condom use as a method of HIV prevention. However, it soon became clear that a major change in policy was unlikely, and that the Catholic Church would probably continue to oppose condom use in all circumstances. ________________________________________________________________________________________________ In August, attention turned to the XVI International AIDS Conference in Toronto. One major talking point was how to accelerate the expansion of antiretroviral therapy worldwide, and in particular how to alleviate dire shortages of healthcare workers in the most needy countries. Delegates also discussed the pros and cons of routine HIV testing, whereby everyone attending medical settings is offered an HIV test, regardless of symptoms. The WHO and others suggested that wider use of this approach would increase take-up of treatment and help to counter stigma. The conference provided a platform for critics of the South African government’s response to AIDS. Activists protested at the country’s exhibition stand, which was dominated by unproven nutritional remedies, with almost no reference to effective medication. Conference co-chair Mark Wainberg said it was “unconscionable” that South Africa’s leaders would not talk openly about AIDS. Stephen Lewis (UN Special Envoy for HIV/AIDS in Africa) went further in his closing speech: “South Africa is the unkindest cut of all. It is the only country in Africa … whose government is still obtuse, dilatory and negligent about rolling out treatment. It is the only country in Africa whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state... The government has a lot to atone for. I'm of the opinion that they can never achieve redemption.” Shortly after the conference, more than 80 prominent international scientists wrote an open letter to South African President Thabo Mbeki calling on him to sack health minister Manto Tshabalala-Msimang, whom they blamed for “disastrous, pseudo-scientific policies” on HIV/AIDS. Instead, the South African government set up a new inter-ministerial committee to take charge of the national AIDS response, to be headed by the deputy president, thus seeming to sideline the controversial health minister.

49. 2011 History A more positive development was announced in May. Hailed as a ground-breaking development for the field of HIV prevention, results from the HPTN 052 trial found that antiretroviral treatment could reduce the risk of transmission among discordant couples by 96 percent. Known as ' Treatment as Prevention', this prevention method involves the HIV-positive partner adhering to a regime of ARVs after diagnosis rather than waiting for their CD4 count to become low.

50. 2012 History The US’ Food and Drug Administration (FDA) announced their approval of using an antiretroviral drug combination for pre-exposure prophylaxis (PrEP), to reduce the chances of the sexual transmission of HIV. Whilst mirroring the UNAIDS guidelines released in April, FDA advice went further by also recommending that HIV-negative people, with an increased risk of becoming infected with HIV – such as, people in serodiscordant relationships, or people classed as high risk for HIV infection, e.g. MSM - should begin taking HIV treatment for prevention.