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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

40 Years of AIDS/HIV: ‘A Massive Failure’

By Gary Evans, Medical Writer

“The occurrence of pneumocystosis in these 5 previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual,” the Centers for Disease Control and Prevention (CDC) reported on June 5, 1981.

Indeed, it was.

What would become the ongoing AIDS/HIV pandemic began 40 years ago as of June 5, 2021. Much has been gained in research and treatment, but there is no glass half-full to be raised at this commemoration. There are 33 million dead worldwide since that first report of five hospitalized men in Los Angeles.

For more than a decade, HIV was almost certainly a terminal diagnosis, but the first effective antiretroviral therapies were developed in 1996. Still, in some sense, HIV remains much as it began, a story of the haves and the have nots. Some infected people are living fairly normal lives with almost complete viral suppression; others wither for the lack of that same treatment.

Monica Gandhi, MD, an HIV specialist at UC San Francisco, is passionate about this point.

“There are 38 million people living with HIV worldwide and only 26 million of them have access to antiviral therapy,” she tells Hospital Infection Control & Prevention. “I know that is called a success — I call that a total failure. Knowing that in the world we have 12 million people who don’t have HIV therapy — that we have had since 1996 — I call that a massive failure.”

There are great disparities in populations with infectious diseases, much as we are seeing now with COVID-19, Gandhi says. Even in the United States where treatment is available, “the people who are doing poorly despite having access are those in overlapping pandemics of homelessness, mental illness, and now COVID,” she says. “Those are a lot of the people I treat.”

The CDC has come a long way since that 1981 report, when it described the five men as “active homosexuals” — in the first sentence. Thus began the long-standing stigma against those with “gay cancer” — although the first cases in women were reported the same year, and the already tepid federal response was greatly undermined. It bears repeating the well-documented observation that then President Ronald Reagan did not say the word AIDS publicly until four years into the pandemic.

Some attribute the sudden global rise of HIV to a sexual revolution that included little fear of sexually transmitted diseases (STDs) and a lack of efforts to prevent them. It is now known that unprotected anal intercourse greatly increases the risk of HIV transmission in both heterosexuals and men who have sex with men.

The frequent reuse of needles also contributed to the spread of HIV. This is the reason the CDC recommends baby boomers get tested for the hepatitis C virus — a strong indicator of past needle reuse that is rarely sexually transmitted. It goes without saying that it is good for anyone to know their HIV status because the treatments are so effective.

With all the discussion and controversy about the origins of SARS-CoV-2, we should note that HIV has long been questioned as a man-made virus.

“Throughout the history of AIDS that has been brought up multiple times in the context of oppression and racism,” Gandhi says. “I have been studying AIDS a long time. No one has been able to create a virus.”

These pandemic viruses arise out of nature, she says. This pattern is likely to continue as humans encroach on animal habitats or unsafely farm them in a time of rapid global air travel.

HIV arose in Africa in the last century and its natural reservoir is Pan t. troglodyte chimpanzees in Cameroon and the Congo, researchers report.

Slaughtered for bushmeat, the viruses in these chimps’ blood found their way into humans. Looking back, it may have been spreading primarily as a heterosexual disease in the 1950s and 1960s in Africa, virus hunter Nathan Wolfe, PhD, has said. History will not be kind in assessing the U.S. response, and the demonization of the designated lepers that seem to be targeted in every pandemic. (See HIC, July 2013.)

Gary Evans, BA, MA, has written numerous articles on infectious disease threats to both patients and healthcare workers. These include stories on HIV, SARS, SARS-CoV-2, pandemic influenza, MERS, and Ebola. He has been honored for excellence in analytical reporting in newsletter journalism five times by the National Press Club in Washington, DC.