A History of HIV/AIDS

Milestones of a Global Health Crisis

The HIV/AIDS pandemic arguably has been the greatest global health crisis in modern history. While others have been widespread and deadly (among them, tuberculosis pandemics and malaria epidemics), the number of deaths caused by AIDS has been unprecedented.

Over the span of a few short years, AIDS-related deaths increased from a few hundred gay men in the U.S. to hundreds of thousands of people across the planet. The fact that experts had never seen a disease like this and couldn't quickly identify a way to stop it created a sense of panic among the public and policymakers alike.

Thanks to growing scientific understanding of AIDS and its cause, the human immunodeficiency virus (HIV), a diagnosis of either has evolved from a death sentence to a manageable chronic condition.

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

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

1981

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

By December, 270 similar cases were reported in what researchers were calling gay-related immune deficiency (GRID). Of those, 112 had died of the disease within the course of the year.

1982

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

1983

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

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

Milestone: Confirmation of HIV Transmission

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

1984

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

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

1985

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

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

The AIDS Memorial Quilt was conceived by activist Cleve Jones to commemorate the lives lost to HIV. Each 3-foot by 5-foot panel paid tribute to one or more people who had died of the disease.

1986

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

1987

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

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

Milestone: Development of an HIV Drug

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

1988

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

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

1989

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

1990

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

MILESTONE: Congressional Support

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

1992

AIDS became the number one leading cause of death for American men ages 24 to 45.

1993

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

1994

AIDS became the leading cause of death among all Americans 24 to 45.

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

1995

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

Milestone: Emergence of a Treatment Protocol

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

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

1996

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

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

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

1997

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

Milestone: Africa Becomes a Hotbed for HIV

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

1998

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

1999

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

2000

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

2002

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

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

2003

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

Milestone: The First Vaccine Trials Fall Short

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

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

2006

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

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

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

2007

The CDC reported that, at that point, 565,000 Americans had died of HIV. It was also reported that the incidence of new infections among men who have sex with men was on the rise, with rates nearly doubling among young gay men between the ages of 13 and 18.

No less dismaying was the fact that of the 1.2 million Americans estimated to be living with HIV, as many as 20% to 25% did not know they were infected.

2008

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

2010

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

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

Milestone: First Steps Toward Prevention

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

2011

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

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

2012

Despite a reversal in the number of HIV-related deaths, health officials in South Africa reported that the number of new infections had increased over the previous year by more 100,000, mainly among teens and younger adults.

The FDA officially approved the use of Truvada for PrEP. It came at a time when the U.S. reported just over 50,000 new diagnoses, a figure that had remained largely unchanged since 2002.

2013

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

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

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

2014

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

Milestone: Discovery of the Origin of HIV

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

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

2015

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

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

On World AIDS Day, the CDC reported that annual HIV diagnoses in the U.S. had dropped by 9%, with the steepest declines among heterosexuals and African American women. By contrast, younger gay men remained at high risk of infection; African American gay men were reported to have a 50/50 chance of acquiring HIV in a lifetime.

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

2016

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

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

2017

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

2018

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

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

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

Milestone: HIV/AID Prevention Goes High-Tech

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

A Word From Verywell

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

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

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Article Sources

  1. A Timeline of HIV and AIDS. HIV Basics. Overview: History

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