29 November 2003

What do we know about the history of AIDS in 2003 ?

What do we know about the history of AIDS in 2003 ?


The official scientific history regarding AIDS began in the summer of 1981.  Scientific journals noted cases of a rare type of pneumonia (PCP) and Kaposi’s Sarcoma (KS) amongst several groups of gay men living in large cities.  These diseases are normally non-existent since a healthy immune system is able to protect people from them, yet their appearance in these gay men, who seemed to be in perfect health, suggested that something about this specific group contributed to a reduction in their immune system.  This syndrome was subsequently named GRID (gay-related immune disorder).

Shortly afterwards, the disease appeared in conventional magazines and newspapers with titles mentioning “The Gay Plague” or “The Gay Cancer”…in effect, they knew nothing about it beyond the fact that it afflicted and killed gay men.  In 1982, more cases emerged, but this time the disease affected other communities as well such as IDU (Injection Drug Users), hemophiliacs, Haitians, and receipients of blood transfusions. The term AIDS (Acquired Immune Deficiency Syndrome) began to be widely used, but it was still unknown as to what the cause of the disease was, although several assumptions were considered. Some, for example, went far enough to believe that anal relations themselves were the cause, that it was a punishment of God on homosexual sinners, or that it was a plot by the CIA against homosexuals. But the discovery of cases as a result of blood transfusions reinforced the assumption of a transmissible agent. In Quebec, the Haitian community was affected during the early years of the epidemic, but since 1984, gay men or MSM (men who have sex with men) is the group most devastated by the disease.

VIH, © Russell Kightley Media The virus responsible for AIDS was isolated in 1983, but was not named officially “HIV” (human immunodeficiency virus) until 1986, after a battle of words between various research laboratories. The world learned more about the virus in the years that followed: its biology, the way in which the disease develops, the existence of several different strains in constant evolution (grouped under the terms HIV-1 and HIV-2), the fact that one can be carrying the virus for several years before developing the disease, modes of transmission (blood and sperm, among others), etc. Moreover, the spectrum of diseases associated with AIDS widens considering that their infection coupled with HIV is extremely complex. As the virus tackles the immune system and slowly weakens our defenses, we become susceptible to other infections. Hence, one really does not die from AIDS itself, but from the diseases that one can become susceptible to if he/she already has AIDS.  It was thus difficult at the time, considering there was no test to track the existence of HIV, to confirm that a patient had died or suffered from AIDS.

In 1985 a new test called the ELISA test became available.  The test scans the blood for antibodies produced by the body in reaction to the harmful presence of HIV. Hence, laboratories around the world finally had a way to test for the presence of HIV and whether or not people were infected with the virus. Consequently, one could take the test and learn about his/her sero-status, but considering that there were yet no drugs available to combat the virus or treat the disease, the future prospects remained bleak.   

Gay communities were decimated, entire groups of friends died, and the headlines were filling up with the names of famous people that died from the virus, such as the Hollywood screen legend Rock Hudson, the extravagant Liberace, the French historian-philosopher Michel Foucault, and others… bringing the question of AIDS to the attention of the mass media.   It was understood that the virus was transmitted sexually, hence community groups, especially in the gay and lesbian community, began to promote activities labeled as safe sex or “safe(r)-sex”.   In 1987, the first antiretroviral treatment, AZT, which attempts to prevent the reproduction of the virus, was discovered.  The discovery stirred hope as well as anger. Indeed, there was finally a drug, which some thought would improve to a significant degree the chances of survival for those infected with the virus, but the costs of the treatment amounted to approximately 10 000$ per year per person and the early results, with respect to how effective the drug was not, were still inconclusive. In the same year, the organization ACT UP was created in New York City – an organization with a slightly utopian purpose: to put an end to the AIDS crisis, or in other words, to make political powers that be (who up to that point had been rather apathetic to the crisis) to raise the social conscience of the population towards the stakes surrounding AIDS, to force pressure on pharmaceutical companies, and to begin prevention campaigns.

HIV is more than one simple virus. It raises many social economic, and cultural questions.  In the early years of the epidemic, in North America and Western Europe, the groups at most risk were considered to be a minority and/or marginal. A fair share of people became infected through blood transfusions and were viewed as victims, while those who were infected and were gay were often held responsible for their condition. The prevailing governments of the time thus did not plan to use public funds to research or fund prevention considering the minimal potential for profit from these marginal groups. Some found it intolerable that people began to speak openly about sexuality and sexual acts, although it was necessary for the prevention of HIV. They feared that the “publication” of homosexual relations and talking about the use of drugs by injection would encourage more people, and especially more young people, to practice them. Thus, one can see the connection regarding generalized homophobia within the population, the fear of sexuality, delinquency, and the slow official reaction with respect to the HIV/AIDS epidemic. In a similar way, one can see the importance of community groups and their role in the fight against HIV/AIDS and getting the topic on the agendas of governments around the world.   

Since the early 1990s, several new drugs have been discovered which patients must take in combination with other drugs, often in groups of three, to increase their effectiveness; drug therapies referred to as tri-therapies and multi-therapies. But these drugs do not make it possible to cure AIDS – they do nothing but lengthen the period between the infection with HIV and the moment of death, while generating painful and daily side effects.  Moreover, a vaccine to counter the infection and protect people does not exist.

HIV and AIDS has not only touched North America, Western Europe, and Australia, but it strikes everywhere, with the situation in developing countries being quite different from that of its Western counterparts. The first cases of AIDS surfaced around the same time in sub-Saharan Africa and Latin America as it did in the rich industrialized countries. The response to the epidemic in the developing countries was less effective than that in the industrialized countries considering the lack of money, lack of an organized social response, and the refusal of several governments to address the question. In addition to the differing economic and political situation, the groups of people touched by the disease were also different. The disease was primarily spread through tainted blood transfusions (which were not tested for a long time, in particular parts of China) and through unprotected heterosexual intercourse.  Therefore, unlike the West, where women represent a smaller proportion of the people infected by the disease (yet the proportion of women infected is increasing), women today account for approximately 58% of the cases in sub-Saharan Africa and 50% on a worldwide scale. 

According to the UNAIDS, more than 21 million people around the world have died since the beginning of the epidemic, including 3,1 million deaths in 2002 alone.  The organization estimates that at least 42 million men, women, and children around the world live with the HIV virus. The bleak fact of the matter is that new infections worldwide are not decreasing; in 2002 there were 14 000 new infections per day (95% of them in developing countries) of which half of those infected were people between 15 and 24 years of age.  Approximately, a third of all adults in some African countries are infected with HIV (39% in Botswana and 34% in Zimbabwe, in the south of Africa).  Hence, it is safe to say that close to a third of the population in those countries will disappear in decade if the drugs to treat the disease are not made accessible at more affordable prices.  It is disturbing to think about the ramifications and the effects on the society (millions of orphans of AIDS living in the streets) and economy (all these people becoming too sick to work and thus feed their family) of these countries, yet it’s important in order to understand that “the worst of the epidemic is obviously not behind us”. 

In Quebec and Canada the situation is less bleak, but the future prospects are not rosy either. The number of new infections began to increase in the year 2000, especially amongst young MSM and young women. 52 640 people in Canada have tested positive for the virus since 1985;  87% of HIV+ people live in Quebec, Ontario and British Columbia, as well as Metropolitan centers such as Montreal, Toronto, and Vancouver.

This means in short, the fight against HIV and AIDS is far from over.   It is necessary to continue to demand more funding for research to find vaccines and more effective drugs; to improve sex education programs in schools; to promote the use of condoms, safe sexual practices, and safe injection centers;  to increase the number of services people living with AIDS have access to, especially outside of urban centers; to increase the accessibility of drugs in developing countries through the lowering of prices.