Table of Contents Untitled
  • Untitled AIDS Trends and Epidemiology
  • Untitled Historical Overview : Untitled [1 - 2 - 3 - 4 - 5 - 6 ]
  • Untitled AIDS News and Information
  • Untitled AIDS Information Sources ; in Untitled Spanish
  • Untitled AIDS Organizations and Support Groups

    Overview
      "Historical" Impressions. AIDS reared its ugly head in the United States in the early 1980's. It was first diagnosed, as a rare and often fatal form of cancer (Kaposi's sarcoma) affecting gay men in San Francisco and New York. This rare form of cancer was soon discovered to be one of the consequences associated with impaired immune system during the advanced stages of infection with what was later on discovered to be a virus; thus the terms, "human immunodeficiency virus (HIV)" and "acquired immunodeficiency syndrome (AIDS)".

      Within a few years, the 41 gay men who were infected with HIV were soon joined by thousands, then tens of thousands, then hundreds of thousands infected with "HIV".

      The number of people in the United States living with HIV and AIDS peaked in the early 1990's. At the height of the AIDS epidemic, estimates of as high as 1-2 million Americans were predicted. However, the estimates have been lowered regularly, and the actual cases and deaths fell steadily thereafter, as people are being diagnosed much earlier, new and more effective antiretroviral drugs became available as well as improved care to mitigate the impacts of AIDS-related illnesses and other opportunistic infections. took hold. The cases and deaths have been nearly flat since 1998, the Centers for Disease Control and Prevention said.

      During the early stages of the epidemic, to be diagnosed as "infected with HIV" was synonymous to a death warrant. In the United States, the fact that the disease affected mostly gay men and was transmittted through sexual contact further stigmatized those infected with HIV, and by extension, the gay community, in general.

      Unfortunately, the "wild fire" spread of the disease during the 1980's also coincided with the growing political power of the self-appointed Christian "moral majority". To the latter group, AIDS has become another political weapon to further ostracize, if not politically isolate, a historically victimized community.

      The inadequate response (or lack thereof) of the Reagan administration to the growing AIDS epidemic is a testament to the political clout of the self-appointed Christian "moral majority". There was no equivalent federally-funded "Star Wars" against the growing AIDS epidemic. In fact, the spectre of the growing AIDS epidemic was used to justify further discrimination of the gay community. Calls to "quarantine" were popular during the early stages of the AIDS epidemic.

      Grassroot Campaigns and the "AIDS Coalition". The government and societal apathy to the disease, if not downright hostility to those infected with HIV, soon galvanized and further politicized the gay community, the minority group who suffered most from the then growing AIDS epidemic. Very soon , both formal and informal grassroot organizations, largely from the gay community, were sprouting all over the United States and Western countries -- to educate others of the perils of HIV infection and AIDS, as well as join the political fight in the struggle to find cure for the disease. The more "civil society" has to contend with the unconventional demonstrations of members of "ACT UP", "Queer Nation", and other more radical members of the "Rainbow Coalition". Most however devoted their efforts at the community level, reaching or helping one person at a time.

      As important, the grassroots actions were motivated also to join the societal debate on the socio-political ramifications of the AIDS epidemic. This socio-political struggles continue to shape policies on privacy, discrimination, allocation of resources, etc.

      Notwidthstanding the growing power and concerted effort of the conservative political right, the gay community were soon joined by other groups, attracted for diverse reasons in the collective effort to prevent further spread, fight and find cure for HIV/AIDS. The more compassionate members of the community have been touched by the number of those dying young from AIDS-related illnesses. Members of the scientific community were enamored by the intellectual challenge of understanding the biology and vanquishing the virus that causes HIV.

      With the growth of biotechnology industry in the 1980's, the marriage of scientific discovery and commercial profit, enticed a different breed of scientists, biotechnology and pharmaceutical companies to seek profit in the fight against HIV/AIDS. It was not surprising therefore that the Montagnier-Gallo controversy became an international protracted fight concerning the discovery of HIV. It required the intervention of both the governments of the United States and France to come to a "political resolution" regarding ownership of the patent and commercialization of the discovery.

      Aftermath. The convergence of these diverse interests and goals soon forced politicians to heed the political lobbies from the informal "AIDS Coalition". Eventually, more federal funds were soon allocated to HIV/AIDS research and information campaign. This political power gained by the informal "AIDS Coalition", is a testament to the vast potential of grassroots campaigns. Today, the total federal funds devoted to AIDS research, education and prevention dwarf even the amount devoted to other diseases, e.g., cardiovascular diseases and stroke -- still the major causes of death and disability in the United States. The latter is causing further unease in some sectors of society or even some members of the scientific community who are concerned about the allocation of limited research funds.

      In retrospect, most of the basic science in HIV/AIDS research, in the United States and other Western countries, were largely funded by government research grants. Even AZT was developed mainly through federal grants, as a potential anticancer agent before the AIDS epidemic. Its initial development as a potential drug against HIV was also funded by federal grants. In fact, many of the current antiretroviral drugs came from prior anticancer research, also funded mostly by the federal government.

      Because of the urgency posed by the growing epidemic, Food and Drug Administration policies and practices were radically modified and streamlined to accelerate clinical testing and approval of promising drugs and therapies against HIV and AIDS. This development proved to be quite useful also to clinical testing and approval of drugs and therapies against other diseases. Moreover, discoveries about the basic biology of HIV proved useful in other areas of biomedical research and clinical therapy.

      Twenty years since the epidemic started, there is still no known cure against AIDS. While there is some renewed optimism, there is still no vaccine against HIV. The virus, HIV, responsible for AIDS, has been the most intensively studied virus by the most number of researchers around the world, and yet the biology of HIV still raises many puzzling questions.

      On the bright side, to be diagnosed as "infected with HIV" has ceased to become an automatic death sentence. With the advances in antiretroviral and combination drug therapies against AIDS-related illnesses and opportunistic infections, people living with HIV or AIDS can expect to live longer. AIDS-related illnesses have ceased to become one of the top ten leading causes of death in the United States*.

      As a result of these successes, the estimates of those living with HIV and AIDS, in the United States, have been revised down regularly. Today, an estimated 800-900 thousand Americans are living with HIV/AIDS. While still unacceptably high, the population pales in comparison with the percentage rate of those living with HIV/AIDS in regions like Sub-Saharan Africa and the Caribbean.

      Future Horizons. The aforementioned welcome developments in the two-decade long AIDS epidemic in the United States hide some forebodding clouds in the horizon. The recent successes of the combination drug therapies work only for a significant number, but not all, of those living with HIV/AIDS. Current antiretroviral drugs also were developed mainly against the HIV strains predominant in the United States and other Western countries. In fact, the predominant HIV strains are different in other parts of the world. Moreover, the ability of the HIV to mutate rapidly has created new HIV strains resistant to the combination therapies.

      It remains to be shown whether new and more potent drug therapies can cope with the rapid mutation of HIV, or to deal with patients refractory to current combination drug therapies. What is known however is that the rate of decline of deaths from AIDS-related illnesses has begun to level off.

      More troubling, those who were not around during the height of the AIDS epidemic in the 1980's have been found to engage in substance abuse and sexual practices that could lead to HIV infection. Coupled with this, many are not aware that they may have already been infected with HIV and thus could pass on the virus to their partners. These developments are behind the resurgence of HIV infection and AIDS among younger people in the United States.

      Equally disconcerting, the disease is no longer just a "white gay male disease". It is significantly invading the heterosexual population, especially minorities, including African-Americans and Hispanics. The latter development is following the past trend of the AIDS epidemic in other parts of the world. So far, the visible political leaders in these communities in the United States have only given tepid acknowledgement and response to the encroaching impact of the AIDS epidemic in their respective communities. This seeming apathy parallels the previous behaviors of some political leaders in the less developed countries who then considered AIDS to be mainly a "Western" disease.

      With increasing globalization and mobility, other HIV strains, that were once localized, are being introduced in other parts of the world. It is grim to imagine a new round of AIDS epidemic in the future, here in the United States, where even more resistant or new strains of HIVs may come into play.

      Because of the gestation period and the progression of the disease, it is unclear whether these new developments could lead to future resurgence of the AIDS epidemic here in the United States.

      In the age of internet and mass-media saturation, it brings pause as to whether these target populations are indeed reached by the HIV/AIDS education campaign. If the education programs succeeded in informing these groups about the modes of transmission of HIV, what is behind the complacency of the younger population, certain minority groups and political leaders? Understanding this apathy may lead to more effective educational outreach education programs in the continuing fight against the spread of HIV/AIDS.

      _______
      N.B.: *As discussed in the "Introduction" of AIDS Primer, the situation is more grim in other parts of the world. By the end of year 2000, an estimated 36 million are living with HIV/AIDS, almost 70% of them live in Sub-Saharan Africa. The tepid response of the entire world to the more devastating global AIDS epidemic is very discouraging.