Professional Documents
Culture Documents
AIDS up to 1986.
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). 6
Around this time a number of theories emerged about the possible cause of
these opportunistic infections and cancers. Early theories included infection
with cytomegalovirus, the use of amyl nitrite or butyl nitrate 'poppers', and
'immune overload'. 7 8 9
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. 10 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 11
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. 12 At the same time the first case of AIDS was documented in the
UK. 13
1982 History
As the disease still did not have a name, organisations 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. 14 15
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". 16 Others
called
it
GRID
(gay-related
immune
deficiency),
AID
(acquired
immunodeficiency disease), "gay cancer" or "community-acquired immune
dysfunction". 17 18
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. 19
By the beginning of July a total of 452 cases, from 23 states, had been reported
to the CDC. 20
Later that month the first reports appeared that the disease was occurring in
Haitians, as well as haemophiliacs. 21 22 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. 23
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. 24 By August this name was being used in
newspapers and scientific journals. 25 26 27 AIDS (Acquired Immune Deficiency
Syndrome) was first properly defined by the CDC in September . 28
By the beginning of July a total of 452 cases, from 23 states, had been reported
to the CDC.
An anagram of AIDS, SIDA, was created for use in French and
Spanish. 29 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. 30
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 31
By 1982 a number of AIDS specific voluntary organisations 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). 32 In November 1982
the first AIDS organisation, 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 organisations were already producing safer sex advice for gay men. 33
In December a 20-month old child who had received multiple transfusions of
blood and blood products died from infections related to AIDS. 34 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. 35
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.
risk
of
AIDS: homosexuals,
haemophiliacs,
heroin
addicts
Haitians. 44 45 Some people substituted 'hookers' for haemophiliacs. 46
and
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.
In the UK there were public concerns about the blood supply with references in
newspapers to "killer blood". 47 The media more generally started to take
notice of AIDS, with the screening of a TV Horizon programme, "The Killer in the
Village", and a number of newspaper articles on the subject of the "gay
plague". 48 49
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. 51 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. 52
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. 53
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 54
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, Commisioner of Health, New York City 55
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 56
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,
1984 History
At the CDC researchers had been continuing to investigate the cause of AIDS
through a study of the sexual contacts of homosexual men in Los Angeles and
New York. They identified a man as the link between a number of different
cases and they named him "patient 0". The research appeared to confirm that
AIDS was a transmittable disease, and the co-operation of "patient 0"
contributed to the study. 67
One of the researchers, Darrow, was to later change his original statement,
saying that he did not name the man as patient zero but rather he named him
patient O, for Out of California 68
"I called this guy Patient O... But my colleagues read it as Patient Zero."
- Darrow for Newsweek 69
Whatever Darrow did, or didnt say, in 1984 the myth of Patient Zero had
begun. 70 See the History of 1987 page for more about Patient Zero.
Margaret Heckler
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. 71
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". 72
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. 73 74 The
"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." 78
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". 79 The Zairian study found there to be a "strong indication of
heterosexual transmission". 80
In light of these findings the Zairian Department of Public Health, in
collaboration with American and European scientists, launched a national AIDS
research programme called Project SIDA. 81
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. 82 83 In the UK there
had been 108 cases and 46 deaths. 84
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. 85 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. 86
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
centred on issues of confidentiality and the meaning of a positive test
result. 87 88
"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 89
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. 90
In April more than 2000 people attended the first international Conference on
AIDS held in Atlanta. Three major topics of discussion were the new HTLV-III/LAV
test, the situation with regards to AIDS internationally, and the extent of
heterosexual transmission. 91
"Some experts are sceptical 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 92
Immediately after the conference, the World Health Organization (WHO)
organized an international meeting to consider the AIDS epidemic and to
initiate concerted worldwide action. 93
Meanwhile in many countries there was a separate "epidemic of fear" and
prejudice. 94
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. 95 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. 96 97 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. 98
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. 99 100
"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 101
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. 102
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 103
Drugs such as ribavirin, thought to be active against HTLV-III/LAV, were being
smuggled from Mexico into the USA. 104
The actor Rock Hudson died of AIDS on October 3rd 1985. He was the first
major public figure known to have died of AIDS. 105
All UK blood transfusion centres began routine testing of all blood donations for
HTLV-III/LAV in October. 106
For the Global Surveillance of AIDS, the WHO had initially used the definition of
AIDS as developed in the USA in 1982. But this definition was difficult to use in
developing countries where there was a lack of sophisticated laboratory tests.
So in order to help with the surveillance of AIDS, particularly in Africa, a new
WHO definition was adopted in October. This definition of AIDS became known
as the Bangui definition. 107
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 HTLVIII/LAV. The site and timing of the first reported cases suggested that the
disease arose in neighbouring Tanzania. Some scientists who studied slim
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." 125
As in Western countries, AIDS in Africa was found to primarily affect young and
middle-aged people, especially those who were unmarried. The sex and age
distributions were seen to reflect other sexually transmitted diseases, and the
major transmission routes had been identified:
"Available data suggest that heterosexual activity, blood transfusions, vertical
transmission from mother to infant, and probably frequent exposure to
unsterilized needles account for the spread of HIV infection and AIDS in
Africa." 126
HIV and AIDS had also been detected in India among sex workers in the
southern state of Tamil Nadu, igniting fears that the disease would soon spread
across the subcontinent. In response, the Indian government decided to
increase the number of HIV testing centres and improve the screening of blood
donations. 127
By the end of the year, 85 countries had reported 38,401 cases of AIDS to the
World Health Organisation. By region these were: Africa 2,323, Americas
31,741, Asia 84, Europe 3,858, and Oceania 395. 128
See
more
1986.htm#sthash.BjR8o4L5.dpuf
at:
http://www.avert.org/history-aids-
1987 History
At the beginning of January the UK Secretary of State for Social Services,
Norman Fowler, visited San Francisco, and in a widely publicised visit shook
hands with an AIDS patient. It was suggested that Princess Diana should follow
his example, which she did later in the year. 1 2
A leaflet about AIDS was delivered to every household in the UK, and the British
Government also launched a major advertising campaign with the slogan
"AIDS: Don't Die of Ignorance", and with the secondary advice: 3 4
"Anyone can get it, gay or straight, male or female. Already 30,000 people are
infected." 5
In February there was a general media "AIDS week", which included numerous
TV and radio programmes about AIDS in the UK. 6 By this time, the World
Health Organisation had been notified of 43,880 cases of AIDS in 91
countries. 7
The first HIV case was officially recorded in the Soviet Union, and a massive HIV
testing programme was conducted. 8
Meanwhile in San Francisco, gay rights activist Cleve Jones made the first panel
for the AIDS Memorial Quilt in memory of his friend Marvin Feldman. 9
"The Names project is a campaign to provide memorials to those lives by
creating a huge quilt made up of individual panels, each 3 by 6 feet, that have
been made by families friends and co-workers of those who died. Each of the
nearly 3000 panels, which have come from all over the country, bears the
name of a victim of acquired immune deficiency." 10
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. 11
Around the same time the organisation 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. 12
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. 13
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: 14
"a band of individuals united in anger and dedicated to exploiting the power of
art to end the AIDS crisis" 15
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" 16 and the poster "AIDS: 1 in 61" about babies born HIV
positive in New York City. 17
In Australia, the Grim Reaper education campaign was launched, with television
images of 'death' knocking down people in a bowling alley. Although widely
criticised at the time, the advertisements succeeded in ensuring widespread
discussion of AIDS. 18
"A bowling alley of death, haunted by decomposing grim reaper bowling over
men, pregnant women, babies and crying children was featured on national
television last night as the part of a $3 million AIDS education campaign, The
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
publicised by the media. 38 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 39
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. 40 In Uganda, 16 volunteers who had been personally affected by
HIV/AIDS came together to found the community organisation TASO. 41
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. 42
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. 43 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. 44
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). 45
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. 46
1988 History
As the global mobilisation against AIDS continued, a world summit of ministers
of health was held in London to discuss a common AIDS strategy. The summit
focused on programmes for AIDS prevention. Delegates from 148 countries
attended.
One outcome of the meeting was the London Declaration on AIDS Prevention,
which emphasised education, the free exchange of information and experience,
and the need to protect human rights and dignity. 47 The Director-General of
the World Health Organization chose this occasion to announce that the WHO
intended to promote an annual World AIDS Day, and the first such day would
be on 1st December 1988. 48
Eight days after the ACT-UP demonstration the FDA announced new regulations
to speed drug approval. 55
The first official needle exchange was started in the US to prevent transmission
of HIV through drug use. 56 A limited experiment started in November in New
York City and, at about the same time, the Prevention Point opened in San
Francisco. 57 58 But Congress prohibited the use of federal funds to support
needle exchange programmes. 59
On December 1st, the first World AIDS Day took place, with the WHO asking
everyone to "Join the Worldwide Effort." 60
1989 History
On February 7th, the FDA announced that it was going to approve an aerosol
form of the drug Pentamidine for the treatment of PCP (a type of pneumonia) in
people with AIDS. 61 Much of the data that led to this approval was collected
by CCC, County Community Consortium of San Francisco, with further data
collected by another community research organisation called CRI, Community
Research Initiative of New York. 62
By March 1st, 145 countries had reported 142,000 cases of AIDS to the World
Health Organisation (WHO). The WHO regarded this as under-reporting, and
estimated the actual number of people with AIDS around the world to be over
400,000. It was predicted that this figure would rise to 1.1 million by 1991. It
was also estimated that 5-10 million people were already infected with HIV. 63
On April 2nd, Hans Verhoef, a Dutch man with AIDS, was jailed in Minnesota
under the federal law banning travellers with HIV from entering the USA. 64 In
June a protest against the law took place at the opening ceremony of the Fifth
International Conference on AIDS in Montreal, when 250 protesters with
placards stormed the stage. 65
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." 66
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. 67 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". 68 69
In September, the cost of the drug was cut by 20 percent. 70
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." 71
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 programme on AIDS, noted that 'Eastern Europe is
the new frontier for the AIDS epidemic'. 72
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. 73
In New York city the needle exchange scheme was closed down. 74
Jonathan Mann resigned as the head of the WHO AIDS programme, 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. 75 During Jonathan Mann's leadership, the AIDS
programme became the
programme
in
the
organisation's
history. 76 But
more
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. 79 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. 80
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. 81 82 83
In June, a TV programme called 'The AIDS Catch' was screened in the UK, again
questioning whether HIV caused AIDS and whether AIDS was infectious. The
programme provoked a hostile response among the AIDS community and AIDSrelated organisations. 84 Some people felt that the programme was
sensationalist and contained factual inaccuracies. It was also felt the
programme caused significant distress among people with HIV and undermined
the efforts carried out in the field of HIV/AIDS prevention. 85
Protests against the ban on HIV positive people entering America continued.
Although there had been minor changes to the law, at the time of the 6th
International Conference on AIDS in San Francisco in June it was still considered
by many to be "discriminatory and medically unsupportable". 86 Consequently
there was a widespread boycott of the conference, and many people who spoke
at the conference took the opportunity to voice their views. One such person
was June Osborn, the Chair of the National Commission on AIDS, who said:
"How sorry I am, and how embarrassed as an American, that our country
whose tradition serves as a proud beacon for emerging democracies, should
persist in such misguided and irrational current policy." 87
Many demonstrations took place during the conference week, the most
significant being "A United Call to Action", in which activists, scientists, and
many others marched together to emphasise the importance of unified action
to end AIDS. 88
The International AIDS Society (IAS) announced that no further IAS sponsored
conference would be held in a country that restricted the entry of HIV infected
travellers. 89
other risk factors or behaviours that could have put the patient at risk of HIV
infection. 90 A couple of months later the patient was named as 22-year old
Kimberly Bergalis and the dentist was named as David Acer. 91
"When she was diagnosed with AIDS we were in disbelief. All we could wonder
was whether something went wrong at the dentists. Health officials said no
way, it just can't happen. But Kimberly stuck by her guns and kept telling them
to look at the dentist. Eventually the CDC supported her conclusion." - George
Bergalis 92
In the UK, Prime Minister John Major announced that the Government would
pay 42 million compensation to haemophiliacs infected with HIV and their
dependants. 93
By the end of the year, over 307,000 AIDS cases had been officially reported to
the WHO, but the actual number was estimated to be closer to a million. It was
estimated that 8-10 million people were living with HIV worldwide, of whom
about 5 million were men and 3 million were women. 94
Area
Estimated HIV
Reported AIDS
Estimated AIDS
Africa
>5,500,000
77,043
>650,000
N America
1,000,000
156,658
200,000
S America
1,000,000
28,937
90,000
Asia
500,000
843
2,000
Europe
500,000
41,564
50,000
Oceania
30,000
2,334
2,700
Total
<9,000,000
307,379
<1,000,000
The 3 million HIV-infected women were estimated to have collectively given
birth to around 3 million infants, of whom over 700,000 were likely to have
become infected with HIV. 95
1991 History
At the beginning of 1991 the CDC published a report confirming that, in
addition to Kimberly Bergalis, two other patients had probably been infected by
the same dentist. 96 Such was the public concern that America's leading
medical and dental associations announced that HIV positive doctors and
dentists should warn their patients about their infection status or give up
surgery. 97 During the summer, in the midst of continuing public hysteria, the
CDC also recommended that infected health care workers should be barred
from certain procedures. 98 99
The largest peak in requests for HIV testing in the UK was observed in January
1991 when the character Mark Fowler, in the BBC television series EastEnders,
was diagnosed with HIV. 100
Tennis star Arthur Ashe announced he had become infected with HIV as a result
of a blood transfusion in 1983. 123
Fearful that it was discouraging tourists, a new government in Thailand
threatened to scale down the country's extensive AIDS awareness campaign,
which had begun in 1991 and won international acclaim. However, the
government lost power within weeks and the campaign was restored. 124
The FDA approved the use of ddC in combination with AZT for adult patients
with advanced HIV infection who were continuing to show signs of clinical or
immunological deterioration. This was the first successful use of combination
drug therapy for the treatment of AIDS. 125
"This new drug is not a cure, said James Mason, M.D., assistant secretary for
health and head of the Public Health service, but it constitutes an important
addition to the expanding group of antiviral drugs currently available, including
AZT and DDI, for treating people with AIDS."
The CDC, under pressure from patients and doctors, decided to revise its
definition of AIDS. The previous list of illnesses that defined AIDS had been
criticised for some time because it did not include many of the conditions most
often seen in HIV positive women and injecting drug users. The new definition
would take effect from the start of 1993. 126 127
The VIII International Conference was successfully held in Amsterdam rather
than in its originally planned venue in Boston. 128
In France four health care officials were brought to trial accused of allowing the
distribution, between 1980 and 1985, of blood products known to be
contaminated with HIV. 129 130 The former director of the transfusion service,
Michel Garretta, was sentenced to four years in prison, as was Jean-Pierre
Allain, the former head of research at the transfusion centre. The third doctor,
Jacques Roux, was given a four-year suspended sentence, whilst the fourth
doctor was acquitted. 131
In response to rising HIV prevalence, the Indian government decided to allocate
$100 million to the National AIDS Control project over the next five years,
which amounted to more than 15 percent of the national health budget. Most
of this money would come from a World Bank loan. 132 Experts predicted that
within five years there might be more people affected by AIDS in India than in
any other country. 133
See
more
at:
1992.htm#sthash.DxQLsker.dpuf
History of AIDS: 1993-1997
http://www.avert.org/history-aids-1987-
Princess Diana continued her HIV/AIDS advocacy work and spoke at the
opening address of the 2nd International Conference on HIV in Children and
Mothers in Edinburgh.
"By the year two thousand, only seven years from now - even the most
conservative estimates predict there will be more than thirty million people
worldwide with HIV - equivalent to more than half the population of the United
Kingdom." - Diana - Princess of Wales, 1993
The World Bank reviewed its HIV and AIDS activities Africa, and decided that
AIDS should not dominate its agenda on population, health and nutrition issues.
The World Bank believed that AIDS would have little demographic effect but
recognised that it was a serious threat to health and economic development.
With reference to blood screening, it was argued that this was costly and
"might not be cost-effective under all circumstances". 22
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'.23
At the beginning of the year the CDC had expanded the US definition of AIDS to
include people with certain opportunistic infections, as well as HIV infected
adults with a CD4 count of less than 200. The expert epidemiology group of the
European Centre for the Epidemiological Monitoring of AIDS together with the
WHO's Regional Office for Europe accepted the inclusion of the additional
indicator diseases but not the CD4 cell count criteria. 24
In mid-1993 six United Nations organisations, including the WHO, began to
seek agreement on forming a joint and cosponsored UN programme on
HIV/AIDS. 25
By this time it had been realised that HIV was also spreading rapidly in the Asia
and Pacific regions, home to more than half the world's population, where more
than 700,000 people were already believed to be infected. 26
The drug 3TC was authorised by the FDA in the USA and the Federal Health
Protection Branch in Canada, to be used in "compassionate" therapy in people
who had not responded to other AIDS treatment or who are not eligible for
clinical trials. 27 Those patients who had developed a resistance to AZT were
offered didanosine (ddI) and dideoxycytidine (ddC) - drugs that had been
extensively studied. A number of trials were underway comparing the
effectiveness of taking AZT on its own and in combination with ddI and ddC. 28
Despite the years of litigation and number of newspaper accounts of the
infection of haemophiliacs and transfusion recipients, no formal investigation of
what had happened in Germany was undertaken until the 'scandal' of October
1993. In October, the failure of a small German blood supply company called
UB Plasma to screen blood and plasma for HIV was made public. The
company's misconduct was discovered by the Federal Health Office by chance,
as a result of routine examination of positive HIV test results. 29 The Federal
Government also admitted that officials had covered up 373 cases of HIVcontaminated blood in the 1980s. 30
On World AIDS Day, 1st December, Benetton in collaboration with ACT UP Paris
placed a giant condom (22 metres high and 3.5 wide) on the obelisk in Place de
la Concorde in Central Paris in an effort to waken the world to the reality of the
disease. A symbolic monument to HIV prevention, it appeared on the covers of
newspapers worldwide. 31
At the end of 1993 the estimated number of AIDS cases worldwide was 2.5
million. 32
Region
Australasia
North America
Western Europe
Latin America & Caribbean
Sub-Saharan Africa
South and South-East Asia
East Asia and Pacific
Eastern
Europe
and
Central Asia
North Africa & The Middle
East
Total
1994 History
Estimated
infection
>25000
>1 million
500000
1.7 million
>9 million
2 million
>35000
>50000
Adult
HIV
75000
12000
>14 million
>2.5 million
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.'" 33
(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". 35
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." 36
Randy Shilts, author of the book 'And the band played on' also died in
February. 37
In March, the actor Tom Hanks won an Oscar for playing a gay man with AIDS in
the film Philadelphia. 38
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. 39
In France, on 7th April all the television networks, public and private, broadcast
'Tous contre le Sida' ('All against AIDS'), a special 4-hour AIDS programme. The
aim was to heighten awareness about HIV/AIDS and to raise money. 40 The
estimated audience for the program was 33 million. Some 32,000 cases of AIDS
had been recorded in France, with 15 deaths each day, and an estimated
150,000 people were thought to be infected. 41
During the summer, the AIDS Prevention Agency in Brussels, in collaboration
with the European Union, launched a campaign whose central image was 'the
flying condom'. This was intended to serve as a visual reminder to young
travellers of the risks of HIV infection. The logo was displayed in airports,
railway stations, popular holiday destinations and other places young people
visited during the summer. 42
A large European study on mother-to-child transmission showed that Caesarean
section halved the rate of HIV transmission. 43
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. 44
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. 45 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. 46
At the end of July, it was announced that the WHO's Global programme on AIDS
would be replaced. The UN Economic and Social Council approved the
establishment of a new "joint and cosponsored UN programme on HIV/AIDS".
The separate AIDS programmes of the UNDP, World Bank, UN Population Fund,
UNICEF and UNESCO would have headquarters with the WHO in Geneva,
starting in 1996. 47Later in the year it was announced that Dr. Peter Piot, the
head of the research and intervention programme within the Global Programme
on AIDS, would be the head of the new UN program. 48
An exciting study, ACTG 076, showed that AZT reduced by two thirds the risk of
HIV transmission from infected mothers to their babies. 49 Some people
believed that ACTG 076 was:
the most stunning and important result in clinical acquired immunodeficiency
syndrome research to date. 50
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 - 51
In early August 1994, the Tenth International Conference on AIDS was held in
Yokohama, Japan. It was the first of the International Conferences to be held in
Asia. No major breakthroughs emerged, and it was announced that in future
the international conference would be held every two years. 52
Meanwhile in the Russian Federation, deputies in the Russian Parliament, the
Duma, voted at the end of October to adopt a law making HIV tests compulsory
for all foreign residents, tourists, businessmen and even members of official
delegations. 53
India by this time had around 1.6 million people living with HIV, up by 60
percent since 1993. Local and state governments were accused of underusing
and misusing HIV prevention funds. 54
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. 65
health professionals. Under the new system, someone would buy a sampling kit
from a shop or by mail order, collect a sample of their blood, send it to a
laboratory for testing, and receive their results by phone.
"'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.'" 84
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. 85
Nevirapine
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). 86 Another treatment development that took place was the
introduction of the viral load test, which provided information about the risk of
disease progression. 87
Throughout 1996 there was excitement and optimism about the treatment of
HIV infected people. 88 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". 89
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." 90
Some scientists even declared that:
"aggressive treatment with multiple drugs can convert deadly AIDS into a
chronic, manageable disorder like diabetes." 91
One doctor suggested that giving combination therapy to patients in the first
few weeks of infection might mean that the virus could be completely
eliminated in two or three years. 92
However, Nkosazana Zuma, the health minister of South Africa, reminded the
conference delegates that:
"most people infected with HIV live in Africa, where therapies involving
combinations of expensive antiviral drugs are out of the question." 93
It was also reported that there were limitations on the use of the drugs, such as
severe side effects and the difficulty of taking large numbers of pills each
day. 94
"If you think the cure is here, think again. The cure is not here. We are a long
way from a cure, even for the rich who can afford the treatments." - Eric
Sawyer 95
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. 96
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. 9798
"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 99
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 100
AIDS advocates said that much would depend on how the stategy was
implemented.
"It doesn't require rocket science to figure out what to do, what it requires is
the political will to back it up." - Paul Donato 101
New outbreaks of HIV infection were erupting in Eastern Europe, the former
Soviet Union, India, Vietnam, Cambodia, China and elsewhere.
"The epidemic is starting to skyrocket in Russia and the Ukraine where
transmission is from everything - injecting drugs, poor hygiene, and
heterosexual and homosexual intercourse." - Dr Peter Piot 102
At the end of the year UNAIDS estimated that during 1996 some three million
people, mostly under the age of 25, had become newly infected with HIV,
bringing to nearly 23 million the total number of infected people. In addition an
estimated 6.4 million people - 5 million adults and 1.4 million children - had
already died.
1997 History
"It is a crisis of staggering proportion, that is going to affect not only the future
of these countries, it is going to affect the entire global network of trade,
diplomacy and development. What we are talking about here is something that
has never been seen before, which is countries with one-sixth to one-quarter of
all children without one or both parents." 120
History of AIDS: 1998-2002
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". 6
In the UK the London Lighthouse charity closed its residential unit. 7
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." 8
"A series of reports about new problems with anti-HIV drugs and setbacks in
vaccine trials left many participants thinking that their best hope against the
epidemic was the strategy they had since it began: prevention." 11
A French court ordered the former French prime minister Laurent Fabius to
stand trial on charges of involuntary homicide for allowing HIV-tainted blood to
be used in transfusions. 12
The first case of a patient being infected with a strain of HIV resistant to the
most powerful new antiretroviral drugs was reported in San Francisco in July.
The mutated strain of HIV, seemingly impervious to protease inhibitors and
older drugs, was found in a newly infected patient at San Francisco General
Hospital.
"We may be seeing an emerging and dangerous edge to the epidemic." - Dr.
Frederick Hecht of the University of California at San Francisco 13
The United Nations issued new recommendations advising that HIV positive
women in developing countries should be counselled to make their own
decisions about how to feed their babies. This was interpreted as a major policy
shift towards endorsing the use of infant formula. At the same time the United
Nations decided to conduct pilot projects in eleven developing countries to
expand access to services to prevent mother-to-child transmission of HIV. 14
Jonathan Mann, the first director of the Global Program on AIDS, died in the
crash of Swissair flight 111, along with his wife the AIDS researcher Mary-Lou
Clements-Mann.
"It was always safe for scientists and institutions to think of AIDS as a virus, a
transmissible infection but Dr. Mann structured it as a human rights issue,
and a global rights issue. He really was a spiritual leader as well as scientific
leader." - Dr. James Curran 15
The FDA gave approval for various new drugs including Sustiva (efavirenz),
another drug in the NNRTI group. 16
In South Africa, Gugu Dlamini, an AIDS activist, was beaten to death by her
neighbours after revealing her HIV positive status on Zulu television. This
happened just a month after Deputy President Thabo Mbeki had called for
people to "break the silence about AIDS" in order to defeat the epidemic. 17
"It is a terrible story. We have to treat people who have HIV with care and
support, and not as if they have an illness that is evil." - Thabo Mbeki 18
The 1998 World AIDS Campaign 'Young People: Force for Change' was
prompted in part by the epidemic's threat to those under 25 years old, for as
HIV rates rose in the general population, new infections were increasingly
concentrated in the younger age groups. The campaign also had a special
representative, Brazilian footballer Ronaldo. 19
UNAIDS estimated that during the year a further 5.8 million people became
infected with HIV, half of them being under 25. 20
REGION
Estimated new HIV infections 1998
North America
44,000
Caribbean
45,000
Latin America
160,000
Western Europe
30,000
North Africa/Middle East
19,000
Sub-Saharan Africa
4 million
Eastern Europe/Central Asia
80,000
East Asia/Pacific
200,000
South Asia/South-East Asia
1.2 million
Australia & New Zealand
600
Global total
5.8 million
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. 21
1999 History
In the United States a doctor who injected his former lover with HIV infected
blood was sentenced to 50 years in prison. 22
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. 23
disease in 1999, more than in any other year since the epidemic began. 48 It
was also reported that for the first time more women than men were infected
with HIV in Africa. 49
"In 1992, a team headed by the late Dr. Jonathan Mann at the Harvard School
of Public Health, published estimates of HIV infections in sub-Saharan Africa
ranging from 20.8 million to 33.6 million by 2000. The World Health
Organisation criticized Dr. Mann's estimates as excessive. Now academic
scientists are criticizing the figures of Dr. Piot's Team. 'When we look at the
figures today, they are worse than the scenarios Jonathan had published,' Dr.
Piot" 50
The World Bank warned that the effect of AIDS in Asia could be to erase the
region's economic gains over the last two decades unless governments
maintained funding for social programs. The United Nations estimated that 7
million people in Asia were living with HIV/AIDS. 51
2000 History
In January, the Centers for Disease Control and Prevention (CDC) reported that,
for the first time, the rate of AIDS diagnoses among black and Hispanic gay
men had overtaken that among white gay men in the U.S. Statistics showed
that African Americans comprised 57% of all new HIV infections, even though
they made up just 13% of the U.S. population. 52 In order to publicise the
importance of HIV testing for African Americans, reverend Jesse Jackson
publicly took an oral HIV test. 53
A more definitive study was published about the risk of transmitting HIV
through oral sex. Although earlier studies had identified oral sex as a means of
transmitting HIV, the new study was designed to find out the extent of HIV
transmission through oral sex among men who have sex with men. The
research suggested that oral sex accounted for about 7% of cases. 58
"I think it reinforces what we've said already - which is that condoms should be
used for whatever type of sex you have." - Dr. Robert Janssen, Director of the
Division of HIV/AIDS prevention at the CDC 59
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. 60 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. 61
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 6263
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." 64 65
In Botswana, as many as one in four adults and four of every ten pregnant
women were estimated to be infected with HIV. 66 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. 67
The Clinton Administration formally declared HIV/AIDS to be a threat to U.S
national security. The United States government believed that the global
spread of AIDS was reaching catastrophic dimensions that could topple foreign
governments, spark ethnic wars and undo decades of work building free-
market democracies abroad. It was the first time the National Security Council
was involved in fighting an infectious disease. 68 69
"We shouldn't pretend that we can give injections and work our way out of this.
We have to change behaviour, attitudes, and it has to be done in an organized,
disciplined, systematic way." - Bill Clinton 70
Later in the year, the U.S. Institute of Medicine released a report that sharply
criticised the Clinton Administration for failure to develop a comprehensive and
effective plan to combat the disease in the United States. 71
In May, at the opening of the first meeting of the presidential advisory panel on
AIDS in South Africa, President Mbeki offered his first detailed explanation of
why he had consulted the two American 'dissident' AIDS researchers. He also
explained why the 33-member presidential AIDS advisory panel contained
people who believed that HIV caused AIDS and others who did not.
"We were looking for answers because all the information that has been
communicated points to the reality that we are faced with a catastrophe, and
you can't respond to a catastrophe merely by saying I will do what is
routine." 72
Five pharmaceutical companies offered to negotiate steep reductions in the
prices of AIDS drugs for Africa and other poor regions. 73 A couple of months
later the United States offered sub-Saharan African nations loans to finance the
purchase of AIDS drugs and medical services. 74 The offer was not seen as
very helpful and was rejected by many African nations. 75
"Making drugs affordable is the solution rather than offering loans that have
interest." 76
According to the latest UNAIDS report, there were 34.3 million people infected
with HIV worldwide, of whom 1.3 million were children under the age of
15. 77 It was predicted that AIDS would cause early death in as many as half of
the teenagers living in the hardest hit countries of southern Africa, causing
population imbalances. In particular, it was predicted that two thirds of 15 yearold children in Botswana would die of AIDS before they reached 50. 78
Almost four million people were estimated to be living with HIV in India. This
meant that the country had the second largest HIV population in the world:
only South Africa had more people living with HIV.79
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. 80 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. 81 82
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. 83
"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." 84
"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 - 93
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." 94
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. 95
There has been a lot of confusion about what Mbeki said and did not say during
the year. 96 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." 97
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. 98
2001 History
After years of denial, China finally admitted that HIV/AIDS threatened its public
health and economic security. China's most senior AIDS researcher stated that
China could soon have one of the world's largest populations of people living
with HIV. Infections were predicted to grow from about 600,000 to 6 million by
2005. 99 It was believed that nearly 75% of people living with HIV in China had
acquired the virus through injecting drug use or transfusion with contaminated
blood. 100
The Indian drug company Cipla offered to make AIDS drugs available at
reduced prices to the international aid organisation Medecins Sans Frontieres
(MSF). Cipla's offer to produce drugs at a price less than $1 per day put further
pressure on multinational drug companies. 101
The U.S. Government threatened Brazil with legal action over its production of
generic HIV drugs. 102The complaint was dropped later in the year and Brazil
promised to give the USA advance warning before changing its patent law for
drugs. 103
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 TshabalalaMsimang, who said that the government already offered adequate treatment to
AIDS patients and that proposals to buy antiretroviral drugs were still being
considered. 104 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. 105
According to a CDC study of six large U.S. cities, 30% of young gay black men
were infected with HIV. 106
"When people think 'gay', they think 'white'. But the people still at the greatest
risk are sexually active gay men, and that cuts across all races." - Helene Gayle
of the CDC 107
The CDC also reported that the rate of new HIV infections was increasing twice
as fast among people aged over 50 as among younger age groups.
"Officials have speculated that a more open society, people entering the dating
scene after the monogamy of marriage and the absence of a fear of pregnancy
is causing the alarming rise in sexually transmitted infections." 108
Zimbabwe's government announced that it would dissolve the board of the
National AIDS Council, after allegations of inappropriate political support and
mismanagement of funds. Zimbabwe had one of the highest HIV infection rates
in Africa. It was estimated in 2001 that AIDS had orphaned 1 million children
and 25% of Zimbabwe's 12 million population were HIV positive. 109
In April 2001, it was reported that the year 2000 saw by the far the largest
number of new HIV cases yet recorded in the UK. The Public Health Laboratory
Service (PHLS) recorded 3,435 new diagnoses in 2000. 110
"Many of those being diagnosed are people infected some years ago, but who
are now coming forward for testing. This is good news because once people
are diagnosed they can seek treatment." - Barry Evans 111
There was a sudden explosion in HIV cases among injecting drug users in
Dublin, Ireland. It was reported that diagnoses jumped fivefold between January
1999 and June 2000. Diagnoses fell to a low of 12 in 1998, but in the next 18
months 96 people tested positive. Doctors blamed this on a sudden tightening
of regulations around the supply of the heroin substitute methadone, which
caused more people to start injecting street heroin. 123
Stephen Kelly was found guilty at Glasgow High Court of 'culpable and reckless
conduct' for having unprotected sex despite knowing that he had HIV. He
infected his girlfriend in 1994. Kelly was the first person to be tried under
Scottish law for this type of offence. It was feared that the threat of legal action
would make people more reluctant to be tested for HIV. 124
President George Bush appointed an openly gay man, Scott Evertz, as Director
of the Office of National AIDS Policy, but did not find any extra money in his
2002 budget for AIDS prevention or treatment. 125
The US Food and Drug Administration (FDA) issued a warning letter to
manufacturers of HIV/AIDS drugs, cautioning them to tone down the optimistic
tone of their antiretroviral drug advertisements. 126
"Examples of such images range from robust individuals engaged in strenuous
physical activity to healthy-looking individuals giving testimonials of a specific
drug's benefit. However, not all individuals have a response to ARV therapy; in
fact, some patients will still have disease progression despite ARV
therapy." 127
A former Japanese Health Ministry official was found guilty of negligence for
failing to stop the sale of untreated blood products. Over 1,800 haemophiliacs
had contracted HIV in Japan since the early 1980s from untreated blood and
more than 500 had died. 128
AIDS and other diseases without having to get permission from patent holders.
It was hoped that the new rules would help improve access to
antiretrovirals. 131
It was reported that some Asian countries had reduced the transmission of HIV
through widespread condom use. In Thailand, the rate of new infections had
plummeted from 143,000 in 1991 to 20,000 in 2000. 132 Meanwhile HIV was
spreading fastest in Eastern Europe and Russia. 133
A senior Iranian health official warned that the number of AIDS cases in the
country had risen dramatically. In the past, Iranian officials estimated the
number of HIV-positive people to be around 2,000, but the Deputy Health
Minister said that the real figure was more than 15,000. 134
2002 History
Ukraine became the first nation in Europe to have 1% of its adult population
infected with HIV. 135
Botswana became the first African country to begin providing antiretroviral
treatment through the public sector. It was estimated the programme would
cost $24.5 million in its first year and would reach 19,000 people. 136
The US Secretary of State Colin Powell strongly advocated condom use to
prevent the spread of AIDS and other sexually transmitted diseases, setting
himself apart from President Bush's views on sex education in an MTV
broadcast:
"In my own judgement, condoms are a way to prevent infection Therefore, I
not only support their use, I encourage their use among people who are
sexually active and need to protect themselves." 137
A new line of condoms carrying the logos of most important Brazilian football
teams went on sale. The campaign was helped by a TV advertisement in which
supporters wore caps with their team colours in the shape of a condom.
"The level of success was more than we had expected We are selling the
condoms in places not normally associated with this sort of product, such as
news stands and bakeries." 138
Later in the year, for the first time ever in Brazil, an HIV prevention campaign
was being aimed at male homosexuals. 139
A study showed that approximately 50% of Americans still believed they could
acquire HIV through everyday contact, and most supported the mandatory
testing of groups at highest risk of HIV infection.140
A report warned that Papua New Guinea was on the brink of an HIV/AIDS
epidemic and the country could face losing 13-38% of its working population by
2020. It was estimated that Papua New Guinea had between 10,000 to 15,000
people infected with HIV. In comparison, Australia with a population almost 5
times that of Papua New Guinea had less than 12,000 HIV positive people. It
was feared that HIV/AIDS could spread rapidly since 90% of infections were
transmitted through heterosexual sex. 149
A major Spanish study found that over 19,000 instances of unprotected oral
sex did not lead to a single case of HIV transmission among 135 HIV-negative
heterosexuals in a sexual relationship with a person with HIV. 150
The WHO warned that HIV could spread rapidly throughout Afghanistan due to
high levels of injecting drug use and unsafe blood transfusions. It also said that
refugees were especially vulnerable to HIV infection because of sexual abuse,
violence and lack of information and education. To learn more about this
problem, the WHO was funding the first survey of HIV/AIDS in Afghanistan. 151
The UN Secretary General, Kofi Annan, used World AIDS Day as a platform to
speak out against HIV-related stigma and discrimination. He said that, 'the
impact of stigma can be as detrimental as the virus itself,' and he urged people
to replace 'fear with hope, silence with solidarity'. He went on to say that, 'the
fear of stigma leads to silence and when it comes to fighting AIDS, silence is
death'. The use of phrase 'silence is death' was interesting, as it had been used
around the world for many years by AIDS activists, initially by the group ACT
UP. 164
History of AIDS: 2003-2006
Just two days later, US Health Secretary Tommy Thompson was elected as the
new chairman of the Global Fund for HIV, TB and Malaria. It was hoped this
move would prevent a conflict between the Bush administration and the
international health community. 6
In February, a rare case of female-to-female sexual transmission of HIV was
reported. Doctors suggested the woman may have been infected through
sharing sex toys after drug resistance tests found striking similarities between
the HIV strains in her and her female partner. 7
There had still been no dramatic increase in HIV transmission in Cuba since the
beginning of the epidemic. The rate of infection was 0.03% and thought to be
one of the lowest in the world. There had been virtually no transmission of HIV
through injecting drug use, blood transfusion or from mother to child. The
government had ensured that all HIV-positive mothers were treated with
prophylactic AZT therapy and that their babies were delivered by caesarean
section. The country had produced enough antiretrovirals to supply the
country's patients. 8
Globally the epidemic continued to expand, reducing world population
estimates by 0.4 billion to 8.9 billion for 2050.
"The long-term impact of the epidemic remains dire HIV/AIDS is a disease of
mass destruction and we do not see a vaccine coming soon."Joseph Chamie,
director of the UNPD - 9
An expert group reaffirmed that unsafe sexual practices were responsible for
the majority of HIV infections in sub-Saharan Africa. This announcement was a
response to claims made in 2002 that unsafe medical practices were to blame
for an important portion of HIV transmission in Africa. 10
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 sceptical of the
ethnic group part of the study. 11 12 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 - 13
Researchers warned that the number of women being diagnosed with HIV in
Europe was rapidly catching up with men. The researchers also noted that
initiatives supplying drug users with clean needles had been effective in
Europe. HIV transmission through injecting drug use was said to have been
almost eliminated in France, Germany and the UK, and significantly reduced in
Spain and Italy. 14
In March the Treatment Action Campaign (TAC) filed manslaughter charges
against the health minister and the trade and industry minister in South Africa.
The TAC held the ministers responsible for the deaths of 600 people a day
whose lives could have been saved if they had had access to antiretroviral
drugs. 15
Russia received an approval for a long delayed loan from the World Bank to
tackle HIV/AIDS and TB. For its part, the Russian Government promised to
match the loan with $134 million in new money over 5 years for HIV/AIDS and
TB. This contribution from the government signalled growing recognition that
both HIV/AIDS and TB epidemics represented a threatening crisis for Russia's
development. 16
South Korean Lee Jong-wook took office as the new Director-General of the
World Health Organisation (WHO) and named HIV/AIDS as his top priority in his
first speech. 21
Meanwhile concerns were mounting over the Global Fund's sustainability as it
faced a serious funding shortfall. 22
New HIV/AIDS figures were released in India in July, and it was estimated that
between 3.82 and 4.58 million Indians were HIV positive. 23
In September the WHO declared that the failure to deliver treatment to nearly
six million people with HIV/AIDS in developing countries was a global public
health emergency. Only about 300,000 people in developing countries received
the drugs at all, and in sub-Saharan Africa, where 4.1 million people were
infected, just over 1% or about 50,000 people had access to antiretroviral
treatment. 24
Vatican cardinal Alfonso Lopez Trujillo stated that condoms were not safe and
did not protect against the transmission of HIV.
"I simply wished to remind the public, seconding the opinion of a good number
of experts, that when the condom is employed as a contraceptive, it is not
totally dependable, and that the cases of pregnancy are not rare. In the case of
the AIDS virus, which is around 450 times smaller than the sperm cell, the
condom's latex material obviously gives much less security."Cardinal Trujillo
- 25
In response the WHO said that it was "totally wrong" to claim that condoms did
not protect against HIV and:
"It is quite dangerous to claim the contrary when you realize that today we are
facing an epidemic which has already killed 20 million people and 42 million
people are infected today." 26
There was a sharp rise in trafficking of heroin through central Asia. This caused
an increase in drug addiction and cases of HIV in many impoverished states
including Tajikistan. Since the fall of the Taliban, who had banned the growing
of opium poppies (the raw material for making heroin), production had
skyrocketed in Afghanistan. 27
In the US, estimates suggested there had been fewer than 100 AIDS
diagnosses among children during 2002, compared to nearly 1,000 in 1992.
The dramatic reduction was due to widespread use of antiretroviral drugs and
avoidance of breastfeeding. 28
South Africa approved the long-awaited provision of free antiretroviral drugs in
public hospitals
In November the UN World Food Programme said it would shift its humanitarian
aid effort in southern Africa from traditional emergency food supply to a greater
response to HIV/AIDS including providing nutritional support, awareness
campaigns, food baskets and other services to HIV-positive people. 29
Many drug manufacturers lowered their prices of antiretroviral drugs in
resource-poor countries during 2003. Although these price reductions were
welcomed by many countries and organisations, it was understood that 'lower
price medicines alone will not deliver treatment'. What was also needed was
the ability of countries to deliver these drugs, building of stronger health
systems and training of more health care workers in resource-poor
countries. 30
South Africa approved the long-awaited provision of free antiretroviral drugs in
public hospitals in November. The cabinet instructed the Department of Health
to proceed with implementation of the plan, which envisaged that within a year
there would be at least one service point in every health district across the
country, and within five years, one service point in every local municipality. 31
UNAIDS warned that the efforts to stem the world's AIDS epidemic were
'entirely inadequate'. It was estimated that around 14,000 people became
infected with HIV each day in 2003. It was estimated that 40 million around the
world including 2.5 million children were living with HIV/AIDS. 32 33
Meanwhile India's health minister said that there would never be a widespread
AIDS epidemic in the country.
"I will prove all experts wrong. We are taking on the disease from all fronts. We
are tackling it very bravely."Sushma Swaraj - 34
On World AIDS Day the WHO announced a new plan called '3 by 5', which
aimed to provide 3 million people in resource-poor countries with antiretroviral
treatment by 2005. This target was seen as a step towards achieving the
ultimate goal of universal access. 35
"Nothing close to this has ever been tried. It's not like finding babies with
diarrohea and treating them for a week, or adults with tuberculosis and
treating them for six months - both of which have been major efforts by the
WHO in recent decades... HIV infection is a chronic disease. The 3 million - and
the millions who will come after them - will have to take their medicine for
years, until they die." 36
Also on World AIDS Day, Wen Jiabao became the first Chinese premier to shake
the hand of an AIDS patient. Mr Wen's handshake broadcast in close-up was the
most dramatic of a series of government moves that demonstrate a new
determination to fight AIDS.
"This was like breaking the ice It's something that a lot of people working in
the AIDS field inside China and outside have been hoping for and waiting
for."Joel Rehnstrom, the co-ordinator in China for UNAIDS - 37
The Chinese government announced a policy of 'Four Frees and One Care',
which promised free antiretrovirals to poor city dwellers and to everyone in the
countryside; free voluntary counselling and testing; free drugs to prevent
mother-to-child transmission; free schooling for AIDS orphans; and care and
economic assistance to the households of people living with HIV/AIDS. 38
According to new estimates, the number of people infected with HIV in the UK
increased by almost 20 percent between 2001 and 2002, from 41,700 to
49,500, of whom 31 percent were undiagnosed.
"World AIDS Day reminds us that the problems we face with HIV are not going
away, despite it being a disease that is largely preventable."Kevin Fenton, a
public health consultant - 39
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. 40 Also, 10 million free
condoms were given out to people in Brazil during the carnival season as part
of an AIDS-prevention campaign. 41
In parts of Russia and Eastern Europe, HIV was spreading faster than anywhere
else in the world.
In February, President Bakili Muluzi of Malawi announced that his brother had
died from AIDS. This was intended to highlight issues of stigma and
discrimination related to HIV/AIDS. President Muluzi made the announcement
as he launched the first AIDS policy in a country where an estimated 15 percent
of the 15 million population were HIV-positive. 42
The Global Fund to Fight AIDS, Tuberculosis and Malaria suspended payments
to three HIV/AIDS programmes in Ukraine, citing concerns over slow progress
and management problems. It was the first time in its history that the Global
Fund had stopped funding to a scheme that it had supported. 43
In parts of Russia and Eastern Europe, HIV was spreading faster than anywhere
else in the world. A survey by the United Nations Development Programme
estimated that almost one in 100 Russians were HIV-positive and that AIDS
could claim up to 20.7 million lives by 2045. 44 The head of the UN
Development Programme, Mark Malloch Brown, criticised Russia's efforts to
combat the virus:
"President Putin mentioned it last May, but one speech is not enough and one
reference in a speech is not enough." 45
Stephen Lewis, the UN special envoy for HIV/AIDS in Africa warned that the
WHO's attempt to get three million people onto treatment by the end of 2005
was compromised by lack of financial support from the world's richest
countries.
"There has never been a more determined plan of action If 3 by 5 fails, as it
surely will without the dollars, then there are no excuses left, no
rationalizations to hide behind, no murky slanders to justify indifference. There
will only be the mass graves of the betrayed."Stephen Lewis, UN Special Envoy
for HIV/AIDS in Africa - 46
In March, the US Food and Drug Administration approved the first oral fluid
rapid HIV test. 47
South Africa began a programme to give out free HIV/AIDS drugs after years of
confusion and delays. The program started in South Africa's richest province,
Gauteng, where five major hospitals, including Chris Hani Baragwanath, the
largest in Africa, were selected to administer the drugs. 48
"To me, it means a lot," said the frail man, whose girlfriend and 2-year-old
daughter have also tested positive for HIV. "I have a child to raise... I want to
take her to her first day of school, and I can only do that if I am healthy."27year-old HIV-positive South African man 49
despite these being the peak years for AIDS deaths. The stories increased
slightly in 1991, when Magic Johnson spoke publicly about his HIV status. The
number of stories revived again in 1996-7 with the introduction of combination
therapy. 51
In May, five Bulgarian nurses and a Palestinian doctor accused of deliberately
infecting children with HIV were sentenced to death by a Libyan court. The
medical staff had been detained in 1998 and the trial had started in 2000. 52
The US porn industry was hit by fears of HIV outbreak among its stars. By May,
five porn actors had been found to be HIV-positive. 53 54
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. 55
A new UNAIDS report estimated that 37.8 million people were living with HIV at
the end of 2003, including 17 million women and 2.1 million children under 15
years old. It was estimated that there were nearly 8,000 AIDS deaths per day
during 2003. These were slightly lower than previous estimates because
improvements had been made to the estimation process, but without doubt the
epidemic was still expanding. The number of AIDS orphans had risen to 15
million, of whom 12.1 million lived in sub-Saharan Africa. 56
The WHO announced that, by the end of June, 440,000 people in developing
and transitional countries were receiving antiretroviral treatment, an
improvement of 40,000 since the end of 2003. 57
The Bill and Melinda Gates Foundation announced that it would donate $50
million to the Global Fund, bringing its total Fund contributions so far to $150
million. 58
The South African Treatment Action Campaign and its leader, Zackie Achmat,
were jointly nominated for the 2004 Nobel Peace Prize, but were not chosen to
win. 59
In November the Global Fund said that it would delay launching its fifth round
of grants for five months because of a funding shortfall. Some commentators
said the US was not providing enough support for the Global Fund because it
preferred its own PEPFAR initiative. 60
Botswana's antiretroviral treatment programme, which had made dramatic
progress during 2004, was providing medication to around 36,000 and 39,000
people by the end of the year - around half of the number who needed the
drugs. 61
Women, Girls, HIV and AIDS was chosen as the theme of World AIDS Day 2004.
Events to mark the occasion took place around the world, including in China,
where Premier Wen Jiabao called for "unremitting efforts" against the epidemic,
and the Executive of the Global Fund warned of catastrophic consequences
should such efforts fail. 62 63 64
"Today the face of AIDS is increasingly young and female... We will not be able
to stop this epidemic unless we put women at the heart of the response to
AIDS."Peter Piot, head of UNAIDS, on World AIDS Day 65
2005 History
A London Stop AIDS campaign bus for World AIDS Day, 2005
At the start of the year, UNAIDS published a report predicting the future of the
global AIDS epidemic. Three very different scenarios highlighted how much
would depend on the responses of governments, donors and civil society. 66
Also in January, both the WHO and PEPFAR published figures detailing numbers
of people receiving AIDS drugs. PEPFAR said it had helped to provide treatment
to nearly 155,000 people in its fifteen focus countries by end of
September. 67 The WHO said that the total number receiving treatment in all
developing and transitional countries had risen to 700,000 by the end of 2004,
meaning that the 3 by 5 initiative had achieved its latest target. 68
The US Food and Drug Administration (FDA) for the first time approved a
generic AIDS drug made by a foreign company. PEPFAR had decided not to trust
any drug that had not been approved by the FDA, which meant that all PEPFARfunded programmes had had to stick to the more expensive brand-named
products. However in January the FDA gave its approval to two drugs made by
the South African company Aspen Pharmacare. This came just weeks after a
product of the US company Barr Laboratories had become the first ever FDAapproved generic, and was predicted to mark a turning point in providing
cheaper treatment in Africa. 69
Nelson Mandela announced that his eldest son Makgatho had died of AIDS,
aged 54.
"Let us give publicity to HIV/AIDS and not hide it, because [that is] the only way
to make it appear like a normal illness."Nelson Mandela 70
Publication of death certificate data from South Africa revealed that the total
number of reported deaths had increased by 57 percent between 1997 and
2002. Among those aged 25-49 years, the rise was 116 percent in the same six
year period. 71 Based on an analysis of a sample of death certificates, the
South African Medical Research Council estimated that nearly two-thirds of
deaths related to AIDS had been misclassified (wrongly attributed to other
causes) during 2000-2001. 72
In April, the US Institute of Medicine published the results of an extensive
review of data relating to the use of the drug nevirapine. It found that the drug
was a safe and effective way to prevent mother-to-child transmission of HIV,
and that news stories suggesting otherwise had distorted the facts.
"It is conceivable that thousands of babies will become infected with HIV and
die if single-dose nevirapine for mother-to-infant HIV prevention is withheld
because of misinformation."National Institute of Allergy and Infectious Diseases
- 73
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
programme 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". 74
A new set of international treatment figures were published by the WHO in
June. They revealed that the 3 by 5 initiative was a long way off track, because
only 970,000 people (15% of those in need) were receiving treatment,
compared to a target of 1.6 million. The WHO admitted that it would be unlikely
to achieve its goal of 3 million by the end of the year. 75
PEPFAR said it had exceeded one of its own targets by helping to provide
treatment to 235,000 people in its focus countries by the end of March. 76 The
figure given for Botswana was disputed by the country's health officials. They
said the US was claiming credit for helping thousands of people whose
treatment had in fact been funded overwhelmingly by the Botswanan
government. 77
Speaking at the 2005 National HIV Conference, the acting director of the CDC
announced a new estimate of HIV prevalence in the USA. The CDC had
calculated that between 1.039 million and 1.185 million Americans were living
with HIV at the end of 2003, of whom 47 percent were black. One in four HIVpositive people did not know they were infected. Other studies presented at the
conference showed that new infections among African Americans were rising,
and the total number of new cases was remaining stable at around 40,000 per
year. 78
In the UK at least, 2005 had been hailed as the Year of Africa - the year in
which real progress would be made towards relieving poverty and disease in
that continent. The UK held the presidency of the European Union for the
second half of the year, and in July the UK hosted the G8 (Group of Eight)
summit of world leaders in Gleneagles, Scotland. Prime Minister Tony Blair
promised that the main themes of the summit would be Africa and climate
change. The meeting was preceded by massive "Live8" pop concerts around
the world, and other events associated with the Make Poverty History
campaign.
At the summit the leaders promised to double aid to Africa by 2010, and to
cancel the debts of 18 poor countries, but no progress was made in improving
trade justice, which many groups considered to be the most important issue.
However, the leaders were praised for pledging to ensure as near as possible to
universal access to antiretroviral treatment worldwide by 2010. 79
South Africa's latest antenatal clinic survey showed that 29.5 percent of
pregnant women were HIV positive at the end of 2004. According to the report,
the total number of people living with the virus had risen to an estimated 6.29
million - far more than in any other country. 80
The Global Fund to Fight AIDS, TB and Malaria in August suspended all grants to
Uganda following concerns about possible corruption within the country's
health ministry. Uganda's suspension was lifted in November, after an
agreement was reached with the ministry over better financial management.
Meanwhile the Fund announced its global AIDS programmes had exceeded
targets for 2005. 81 82 83
By August, nine generic antiretroviral drugs had been approved by the
American Food and Drug Administration (FDA). However several African
countries refused to allow the drugs to be imported until they had also been
approved by the WHO. 84 PEPFAR would not begin distributing generic drugs
until near the end of the year. 85
PEPFAR's approach to HIV prevention (described as "ABC") came under
increasingly heavy fire from commentators who said it was motivated by
ideology, and was focusing too much on abstinence until marriage while
downplaying the role of condoms. Among the fiercest critics were Professor
Duff Gillespie, a public health expert and former senior USAID official, who
called PEPFAR's policies "outrageous and stupid", and Stephen Lewis, the UN
Special Envoy for HIV/AIDS in Africa, who said the approach to HIV prevention
would "cause a significant number of infections which should never have
occurred". Two prominent US medical associations, the IDSA and the HIVMA,
were also critical. However PEPFAR officials maintained that their approach to
HIV prevention was balanced and based on evidence of effectiveness. 86 87 88
featured were President Thabo Mbeki and Health Minister Manto TshabalalaMsimang.
"South Africa has become a safe haven for AIDS denialists and is the AIDS
denialist capital of the world... Were it not for the influence of dissidents, South
Africa would long ago have been able to take the steps that countries like
Brazil and Thailand have taken to stop new AIDS infections, provide
appropriate education and offer meaningful treatment to those already
infected."Democratic Alliance health spokeswoman, Dianne Kohler-Barnard - 96
By late 2005, it was clear that the World Health Organisation's 3 by 5 plan
would fail to achieve its goal of 3 million people on treatment in resource-poor
countries by end of the year. With refreshing honesty, the head of the WHO's
HIV/AIDS programme admitted as much and apologised.
"All we can do is apologise. I think we just have to admit weve not done
enough and we started way too late."Dr Jim Yong Kim
However, Dr Kim said the initiative should certainly not be deemed a failure:
"Before Three by Five, there was not an emphasis on saving lives... Many
leaders in the world were saying we just have to forget about this generation of
people who are infected, we're really thinking about the next generation... So
something has happened that's extraordinary." 97
The WHO estimated that expanded access to treatment had saved between
250,000 and 350,000 lives during 2005. However, their estimates also revealed
there were more new HIV infections and more AIDS deaths in 2005 than in any
previous year.
"2005 is likely to be remembered more for the 3 million deaths and almost 5
million new infections it heralded than for the 300 000 lives saved through
treatment for HIV"Front cover of The Lancet Volume 366 Number 9500 98
2006 History
The final results of the 3 by 5 initiative were revealed in March. By the end of
2005, only around 1.3 million people in low- and middle-income countries had
been receiving antiretroviral treatment less than half of the 3 million target.
Though this result was highly disappointing, the WHO stressed that it still
represented a more than three-fold increase within two years. Of the 152
countries involved in the initiative, only 18 met the target of 50 percent
treatment coverage. Among the worst performers were Russia and India, and
among the best was Botswana, where coverage had reached around 85
percent.
"Two years ago, political support and resources for the rapid scale-up of HIV
treatment were very limited. Today 3 by 5 has helped to mobilize political and
financial commitment to achieving much broader access to treatment. This
fundamental change in expectations is transforming our hopes of tackling not
just HIV/AIDS, but other diseases as well."WHO Director-General, Dr Lee Jongwook 100
PEPFAR announced that it was helping to provide treatment to 401,000 people
in its fifteen focus countries, 101 but this news was soon overshadowed by yet
more criticism of the plans HIV prevention policies. A report by the
Government Accountability Office revealed that, by allocating one third of its
prevention budget to programmes promoting abstinence and fidelity, PEPFAR
was forcing countries to cut funding for efforts to help high-risk groups and to
prevent mother-to-child transmission. 102
A new study suggested that the rate of new HIV infections in Southern India
might have declined between 2000 and 2004, perhaps because of changes in
sexual behaviour. One of the authors, Professor Prabhat Jha, said their results
contradicted previous assumptions:
There have been many predictions, mostly based on guesswork, that India's
AIDS problem will explode as it did in southern Africa but we now have
direct evidence of something positive. 103
Reports that an HIV-positive orphan, Isaiah Gakuyo, had been violently
murdered by his uncle sparked protest marches in Kenya. Before his death, the
teenager had been mistreated and isolated by his relatives because of his
infection.
The boy was facing violence on a daily basis. We don't want this to happen
again.March organiser, Inviolata Mwali M'Mbwari - 104
Dr Lee Jong-wook, Director General of the WHO, died after undergoing
emergency surgery in May. Dr Lee had led the 3 by 5 initiative, and was
especially passionate about achieving universal access to HIV/AIDS prevention,
treatment and care. 105
At the end of May, twenty-five years after doctors first became aware of AIDS,
UNAIDS published an especially comprehensive report on the global epidemic.
Although the number of people living with HIV was still rising, there was new
evidence of HIV prevalence declines in Kenya, as well as urban areas of Burkina
Faso and Haiti. 106
The UNAIDS report also revealed that funding for the response to AIDS in lowand middle-income countries had risen from $300 million in 1996 to $8.3 billion
in 2005, yet was still a long way short of what was required for meaningful
action. Of the $18.1 billion that would be needed in 2007, only $10 billion was
likely to be available. 107
June also contained the fifth anniversary of the UNGASS declaration, in which
UN member states had set ambitious targets for combating HIV and AIDS
worldwide. Another High-level Meeting was therefore convened to agree a new
Declaration of Commitment on HIV/AIDS, which would guide the global
response over coming years. The final document was criticised by some
campaigners for being vaguely worded, and for omitting any definite spending
commitments.
I wish we could have been a bit more frank in our declaration about telling the
truth that some groups like sex workers, drug users and men who have sex
with men are more at risk This is not a time for embarrassment, this is
about telling it straight because it is about saving people's lives. Openness,
honesty, frankness, giving people enough information, not being squeamish
and telling the truth is really, really, important.Hilary Benn, UK International
Development Secretary 108
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. 109
The Gates Foundation the worlds largest private source of funding for HIV
and AIDS received a substantial boost to its finances in June, when the
billionaire Warren Buffet promised to donate $31 billion over ten years. Bill
Gates announced that he would step down as head of Microsoft to concentrate
on the work of the Foundation. 110
The first one-a-day pill for effectively treating HIV infection was approved for
sale in the USA. A result of unprecedented cooperation between two major
pharmaceutical companies, the pill, called Atripla, combined three types of
drug widely used in first-line treatment. The advent of once-daily treatment
represented great progress since the mid-1990s, when people with HIV usually
had to take several pills every few hours. 111
President Bill Clinton and Bill Gates at the International AIDS Conference in
Toronto, 2006
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
governments response to AIDS. Activists protested at the countrys 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 Africas leaders would not talk openly about
AIDS. 112 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. 113
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. 114 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. 115
To coincide with the Toronto conference, medical journal The Lancet produced a
special issue with a red cover to help promote the Product RED brand. The 130page journal was entirely devoted to AIDS-related articles, and included
prominent adverts for Product RED merchandise. 116 The Independent, a
British newspaper, had been the first publication to produce a RED edition in
May; it would repeat the stunt in September and December. 117
Protest in South Africa against the sacking of the Deputy Health Minister
Optimism regarding South Africas response to the AIDS crisis was short lived
after it was announced in August that the Deputy Health Minister Nozizwe
Madlala-Routledge had been fired. After years of denial and inaction in the
country it was felt that Madlala-Routledge was a government member who
finally recognised the seriousness of the epidemic and was determined to take
effective action. The official reason for Madlala-Routledges dismissal was cited
as her inappropriate labelling of infant deaths at Frere Hospital as a national
emergency and accusations of her attendance at an AIDS conference in Spain
without the Presidents permission. But it was felt that the underlying motive
for her dismissal was her ongoing conflict with Tshabalala-Msimang, the Health
Minister, and in particular their contrasting opinions on how to confront
AIDS. 16
It was revealed that the African nation of Botswana had managed to
dramatically reduce rates of mother to child HIV transmission. Botswana, with
one of the highest HIV prevalence rates in the world, set up a comprehensive
treatment and care programme, to ensure that all women were being tested for
HIV in pregnancy and offered appropriate drugs to prevent HIV being passed to
their babies. Without intervention, around one in three babies born to HIV
positive mothers will become infected with HIV themselves; but by
implementing this programme, Botswana successfully cut the mother-to-child
transmission rate to under 4%. 17
In August, the U.S. Food and Drug Administration (FDA) granted accelerated
approval to the new HIV drugs maraviroc (Selzentry) and raltegravir (Isentress).
These two new drugs offered hope to patients infected with virus strains
resistant to almost all other classes of drugs designed to fight AIDS.
In October, it was revealed that hundreds of South Africans who had been
involved in an AIDS vaccine trial might have an increased risk of HIV infection
as a result. The trial, which was being conducted by the Merck pharmaceutical
company, had been halted in the previous month after initial results showed
the vaccine to be ineffective, an outcome that was described by leading
vaccine researcher Dr. Gary Nabel as a big blow to the field. 18It was
revealed that the infection rate was higher among people who received the
vaccine than among those given a placebo. Experts said the vaccine itself
could not have caused HIV infection, but it may have increased the risk of
transmission by affecting immune responses. 19
The biographer of Thabo Mbeki revealed in November that the South African
President remained unconvinced that HIV caused AIDS. Mbeki had previously
stepped back from the AIDS debate in South Africa in 2000 after causing much
controversy. 20
2008 History
At the beginning of 2008 the Swiss Federal Commission for HIV/AIDS published
the findings of four studies, showing that people living with HIV who take
effective antiretroviral therapy cannot pass on the virus through unprotected
sex, as long as they adhere to the drugs, have an undetectable viral load for at
least six months, and have no other sexually transmitted infections. It was not
possible to prove conclusively that transmission is impossible, however the
commission reported that scientific evidence showed the risk to be negligibly
small. 21
The Swiss statement was met by immediate controversy, with questions over
the reliability of its conclusions coming from HIV/AIDS advocacy groups as well
as scientists. Concerns focused on the fact that the research was based solely
on heterosexual couples and therefore neglected to include anal sex 22.
UNAIDS and the WHO quickly issued a statement stressing that consistent use
of condoms was still the safest protection against HIV. 23
requirement for recipients who spend less than 50 percent of prevention funds
on abstinence-only programmes. It was argued that this perpetuated bias in
PEPFAR spending.
The political and economic climate in Zimbabwe worsened dramatically in
2008, exacerbating an already severe AIDS epidemic. A cholera outbreak that
began in August was so critical that by December, UK Prime Minister Gordon
Brown was describing the crisis as an international emergency. 30The effect
of the outbreak on people living with HIV and AIDS was compounded by the
collapse of the health system, the governments block on foreign aid, and
widespread malnutrition, leading to an equally devastating AIDS crisis. 31 32
Medicines Sans Frontiers (MSF) estimated that in Bulawayo (the second largest
city in Zimbabwe) there were 2,500 patients still waiting to receive
antiretroviral drugs by the end of 2008. Even those who were able to access
drugs were put at risk by the widespread lack of food, with 2008 producing the
worst harvest Zimbabwe had experienced since the country gained
independence in 1980. 33The governments decision to ban most international
aid groups, which was imposed at the beginning of June and lasted throughout
July and August, exacerbated food and drug shortages farther. MSF called for
an urgent increase in the humanitarian response to the crisis, and stressed the
importance of HIV and AIDS being a prominent part of this response 34
The seventeenth International AIDS Conference took place in Mexico City in
August. For the first time in the history of the Conference, 2008 saw the use of
conference hubs: a network of locations around the world where conference
sessions were screened and accompanied by moderated discussion. The hubs
were considered very successful in widening the reach of the conference. 35
In the same month, UNAIDS published its 2008 report on the global AIDS
epidemic. The report warned that with 2010 only two years away, the target
of universal access by 2010 would be unattainable unless the global response
to HIV was substantially strengthened and accelerated. However it also
emphasised that signs of major progress in the HIV response were being seen
for the first time in 2008.
The 2008 Report on the global AIDS epidemic confirms that the world is, at
last, making some real progress in its response to AIDS.Peter Piot, Executive
Director of UNAIDS
Describing a "stabilization of the global epidemic", the report estimated that by
the end of 2007 there were 33 million people living with HIV worldwide (down
from the 39.5 million estimate made at the end of 2006). Although much of the
reduction was attributed to better surveillance techniques in many countries, it
also reflected the drop in HIV prevalence in certain areas, including subSaharan Africa. The report estimated that the annual number of AIDS deaths
Also in March the Pope warned against condom use, stating that condoms
actually increase the problem of AIDS. He called the HIV/AIDS epidemic...
"A tragedy that cannot be overcome by money alone, that cannot be overcome
through the distribution of condoms, which even aggravates the problems". 57
The Popes comments elicited criticism from several EU states and the World
Health Organization who responded that such a message was not only incorrect
but dangerous. The Dutch Development Minister said it was "extremely
harmful and very serious" that the Pope was "forbidding people from protecting
themselves". 58
Anti-discrimination legislation received a boost in India in July as the high court
overturned section 377 of India's Penal Code which had banned
homosexuality. 59This 150-year-old law had stigmatised a marginalised group
in Indian society, making it difficult for men who have sex with men to access
HIV prevention, treatment and care.
In August researchers in North Carolina announced that they had mapped the
entire genome of HIV-1. One of the researchers stated, We are beginning to
understand tricks the genome uses to help the virus escape detection by
human host. 60
September saw renewed, but short-lived hope that an AIDS vaccine may not
be far off. The United States military, in partnership with researchers in
Thailand released results from a trial which tested a combination of two
vaccines dubbed RV144. The trial, with 16,000 participants, was the largest
ever conducted. 61The preliminary analysis of the results claimed to provide a
33% chance of protection against HIV. However, closer investigation of the data
revealed that the supposed effectiveness was actually lower (26%) and could
have been due to chance. 62The leaders of the study were criticised for not
revealing both sets of data at the same time and therefore misleading the
general public and scientific community.
Also in September, a report from UNAIDS and the WHO showed an increase in
those receiving HIV treatment, with a 36% increase in access to ARVs for those
living with HIV in just one year. The most progress was seen in sub-Saharan
Africa. In addition, the report showed that in 2009 approximately 45% of HIV
positive pregnant women are receiving ARVS when only 35% had access in
2007. 63However the report also contained a note of caution. In particular, it
highlighted the possibility that an increased funding gap as a result of the
recession in 2009 could jeopardise access to life-prolonging drugs.
In November, UNAIDS published its annual Epidemic Update stating that the
decade had seen a significant decline in new HIV infections. The number of new
infections had dropped by 17% since 2001, and thanks to the increased
availability of HIV drugs, deaths had declined by 10% over the past five years.
Some of the most encouraging signs came from sub-Saharan Africa where
400,000 fewer people were infected in 2008 than at the start of the decade.
East Asia also saw a dramatic 25% decrease in annual infections between 2001
and 2008. 64
The UNAIDS report coincided with a publication by Mdecins Sans Frontires,
which praised the scale up of treatment and prevention worldwide and the
achievements of the recent past, but cautioned that the crisis is not
over. 65 The report pointed to worrying sings of waning international support.
In particular, it highlighted the Global Funds struggle to keep up funding, with
Executive Director Michel Kazatchkine saying for the first time, the demand for
funds in 2009 has exceeded the funds we have available. 66
In December, the Ugandan Parliament were debating a much-publicised bill
that aimed to criminalise homosexuality with the possibility of the death
sentence for some offences committed by homosexuals, including having sex
with a person below the age of 18, with a disabled or HIV positive person. 67
2010 History
The New Year coincided with a significant event in the United States of
Americas HIV and AIDS history. From January 4th, HIV positive individuals
travelling to the country would no longer be denied entry based on their status
legislation that had been in place since 1987. 68Following the commitment to
remove the ban, it was decided that the 2012 International AIDS Conference
would be held in Washington, D.C. 69The year 2010 would be a progressive one
for the removal of travel bans, as South Korea, China and Namibia all lifted
their restrictions. 70 71 72
Speaking at two conferences in February, Professor Brian Williams from the
South African Centre for Epidemiological Modelling and Analysis suggested that
using antiretroviral treatment to stop HIV transmission could eliminate HIV
transmission in five to ten years and HIV infection in 40 years. 73 His
presentations were reported across the world and the idea of using HIV
treatment as prevention gained momentum as the year progressed.
In July the World Health Organization (WHO) released its revised editions of the
antiretroviral treatment guidelines for adults and adolescents and the
treatment
guidelines
for preventing
mother-to-child
transmission
of
HIV. 74 75 A key change in the guidelines for adults and adolescents was the
earlier initiation of antiretroviral therapy for people living with HIV. The previous
version of the guidelines (2006) recommended treatment initiation at a CD4
count of 200 cells/mm3, whereas the updated guidelines recommended
treatment initiation at 350 cells/mm3 (or those with WHO clinical stage 3 or 4
if CD4 testing was unavailable). The recommendation was based on evidence
that showed starting treatment earlier slowed disease progression and reduced
the risk of HIV transmission. The new guidelines would significantly increase
the global number of people in need of antiretroviral treatment.
The biannual International AIDS Conference was held in Vienna in July. The
theme of the conference, Rights Here, Rights Now, highlighted the need for
the protection of human rights for an effective response to the global AIDS
epidemic.
Results from CAPRISA 004, a microbicide trial, were hailed as the highlight of
the conference. The Phase IIb trial assessed the safety and effectiveness of an
antiretroviral-based gel in 900 HIV-negative, sexually active women in South
Africa. The results were statistically significant, with the gel reducing the risk of
HIV acquisition by almost 40 percent overall. 76
This is an astonishing scientific achievement and a great boost to the
microbicide field. At the same time, the results are complicated, and we will
need to work hard to make sure that women and their partners understand
what these results do and do not mean for the immediate future and in the
long-term Mitchell Warren, AVAC Executive Director 77
In September WHO, UNAIDS and UNICEF published the annual Universal Access
report for low- and middle-income countries, which showed an estimated 5.25
million people were receiving antiretroviral therapy in 2009. 78 An estimated
1.2 million people started treatment in 2009, the largest increase in one
year. 79 80However, due to WHOs revised treatment threshold of 350
cells/mm3, the number of people needing treatment increased from 10 million
to an estimated 15 million. 81
UNAIDS reported a continued decline in new HIV infections and AIDS-related
deaths in their biannual report on the global AIDS epidemic, published in
November. 82According to the report, since the spread of HIV had finally been
halted and reversed, the challenge was to see how quickly the global response
could end the epidemic.
This new fourth decade of the epidemic should be one of moving towards
efficient, focused and scaled-up programmes to accelerate progress for
Results. Results. Results. Michel Sidib, UNAIDS Executive Director 83
In November Pope Benedict spoke about condom use, more than a year after
his previous controversial comments about HIV and condoms. In a book based
on a series of interviews, the Pope said condoms could be used in certain
circumstances where there is a real risk to the lives of others. The Pope's
comments were the subject of considerable interpretation. The Vatican was
quick to clarify the Popes remarks, stating, the Holy Father was talking
neither about conjugal morality nor about the moral norm concerning
contraception, but those involved in prostitution who are HIV positive and
who seek to diminish the risk of contagion by the use of a condom. 84The
statement also reiterated the Catholic Churchs stance on prostitution: The
practice of prostitution should be shunned, and it is the duty of the agencies of
the Church, of civil society and of the State to do all they can to liberate those
involved from this practice.
The year ended with another success story in HIV prevention. Researchers from
a large-scale Phase III pre-exposure prophylaxis (PrEP) trial revealed there had
been a 44 percent reduction in HIV infection risk among HIV-negative
participants taking a daily dose of antiretroviral drugs compared to those
taking a placebo. 85The iPrEX trial, which recruited men who have sex with
men in six countries, was the first to prove the concept of PrEP for HIV infection
could work.
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But Citizens Against AIDS, an Arcadia group that opposed the Ray children
attending school in their community, has followed them to Sarasota and plans
to hold a seminar there tonight.
DeSoto County Sheriff Joe Varnadore said his department is continuing its
investigation into the fire and hopes to make an arrest.
The blaze was started in several places, including the utility room, hallway and
living room, Varnadore said. The arsonist used an ''accelerant'' to create a ''hot
and fast fire.'' He would not identify what type of flammable liquid was used.
''He the arsonist went in and sprinkled a few rooms and set a match to it,'' said
Armon Summerall, the county's public safety director. He said several
suspicious fires had occurred in the same area during the past five years but
would not speculate if they were related.
Varnadore said the front door of the Rays' house had been left open the night
of the fire, a common practice of the family. The only person home was Clifford
Ray's brother, Andy, who had fallen asleep watching television. He was
awakened by the flames and escaped.
While Varnadore said there is a ''very good possibility'' there won't be an arrest
because arson cases are difficult to prove, he later added, ''I think I'm going to
make an arrest.''
The fire destroyed the house five days after the Ray boys started elementary
school in Arcadia against the strong objections of hundreds of parents. The
county school board had tried to keep the children out, but a federal judge
ruled early in August that the boys did not pose a health risk to others and
should be allowed in school.
Varnadore dispelled rumors circulating in Arcadia that someone in the Ray
family was responsible for the fire.
''We have ruled out the Rays at this point,'' he said.
Varnadore also ruled out anyone associated with Citizens Against AIDS. But he
was evasive when questioned about Jimmy Smithers, a friend of the Ray family
who was at the house the night of the fire. Smithers, who lived down the street
from the Rays, told the St. Petersburg Times earlier this month that he was
considered a suspect.
Varnadore also ruled out anyone associated with Citizens Against AIDS.
But he was evasive when questioned about Jimmy Smithers, a friend of the Ray
family who was at the house the night of the fire. Smithers, who lived down the
street from the Rays, told the St. Petersburg Times earlier this month that he
was considered a suspect.
Smithers, 28, said he came by the house that night to get Andy Ray for a game
of pool. He said he saw Ray fighting the fire with a garden hose, and followed
him inside to recover belongings before they were destroyed. Smithers said
Ray started to pass out in the house and he had to help him out.
Varnadore said Smithers was given a lie detector test, the only one
administered during the investigation. Later, when questioned by reporters
about the investigation, Varnadore mentioned that the suspect was given a lie
detector test.
When asked if that meant Smithers was the suspect, Varnadore said, ''I threw
you a curve, so that's what you're going to have to live with.''
The Rays are living in Sarasota, trying to stay away from media attention and
get their lives back to normal, said their attorney, Judy Kavanaugh of Sarasota.
The three brothers will start classes at Gocio Elementary School today. While
none of the boys has AIDS, each has been exposed to the virus. It is believed
they acquired the virus from blood products used to treat their hemophilia.
County-run seminars were held Monday and Tuesday nights to educate parents
about AIDS. Monday's conference, attended by about 500 parents, was marred
by shouting from some people opposed to the county's new policy of accepting
students with AIDS. In the audience were members of Citizens Against Aids,
who drove about 45 miles to attend the meeting.
Kavanaugh said that despite some problems at the conference, parents in
Sarasota appear more enlightened and that the Ray brothers should be
accepted without much turmoil.
''Everyone has been so nice here, they decided to stay,'' Kavanaugh said.
''People are going out of their way to help.''
However, Citizens Against Aids is planning an ''informational seminar'' in
Sarasota at 7 p.m. today to answer questions about AIDS, said group president
Danny Tew. He said it is a coincidence the meeting is on the same day the Ray
children are going to school.
''We have a right to go wherever we want as long as we stay within the bounds
of the law,'' Tew said. ''This concern is for the larger issue of AIDS, not the Ray
children. There is more than the Ray children involved.''
The group wants the Legislature to require all schoolchildren be tested for AIDS
and local school boards given the option of keeping them isolated from other
children.
''Hopefully we will go to every county . . . until we get enough support to go to
the Legislature and get the bill passed,'' he said.
Sarasota school officials said they do not plan to back down from their policy
regarding AIDS in the classroom, which has been endorsed by leading health
authorities such as U.S. Surgeon General C. Everett Koop.
''The parent meetings have been interesting,'' said Roberta Palmer, a
spokeswoman for the Sarasota County School Board. ''There has been a lot of
misinformation. There is fear. There is gladness. And there is apathy.''