The Crisis After The Crisis
HAART stands for Highly Active Antiretroviral Therapy. This is a therapy whereby people with AIDS are given a combination of antiretroviral drugs at the same time to suppress their HIV/AIDS and stop its further progression. When HAART first came out, there was widespread disbelief. Any number of drugs and holistic remedies had been claimed as the cure for AIDS, and by 1995 people with AIDS were extremely skeptical whenever a new cure was released, especially after the study that showed that AZT, the first anti-AIDS drug, was essentially ineffective after a few weeks. But HAART proved to be the real deal. Doctors and people with AIDS describe the Lazarus effect that the combination therapy had on the afflicted. People on their deathbeds regained life and energy anecdotes of people with AIDS making their same rounds but without the use of a cane or wheelchair were not uncommon. A real solution seemed to be at hand.
Without question, HAART is an incredible innovation of modern medicine, and it has prolonged and improved the lives of a truly countless number of people with AIDS. While there were initial problems with the therapy , modern HAART therapy requires only a few pills daily. Initially, some people with AIDS quit HAART because of the side effects, but today these are far less severe. The problem lies less with HAART than the context in which it has been introduced.
Case Definition For Epidemiological Surveillance
According to a study published in the Proceedings of the National Academy of Sciences in 2008, a team led by Robert Shafer at Stanford University School of Medicine discovered that the gray mouse lemur has an endogenouslentivirus in its genetic makeup. This suggests that lentiviruses have existed for at least 14 million years, much longer than the currently known existence of HIV. In addition, the time frame falls in the period when Madagascar was still connected to what is now the African continent the said lemurs later developed immunity to the virus strain and survived an era when the lentivirus was widespread among other mammals. The study was hailed as crucial, as it fills the blanks in the origin of the virus, as well as in its evolution, and could be important in the development of new antiviral drugs.
In 2010, researchers reported that SIV had infected monkeys in Bioko for at least 32,000 years. Previous to this time, it was thought that SIV infection in monkeys had happened over the past few hundred years. Scientists estimated that it would take a similar amount of time before humans adapted naturally to HIV infection in the way monkeys in Africa have adapted to SIV and not suffer any harm from the infection.
The History Of Hiv/aids In The Us
Patient Advocate Approvedjackson monster night time power majikal cave universe via Flickr
The history of HIV/AIDS is a long and complicated one. There are many conflicting details in its story, and each life touched by the virus has a complicated and beautiful story of their own. In this synopsis, we have tried our best to highlight the most crucial parts of the story of HIV in America, understanding that this is a near-impossible task. HIV stands out from many diseases, because today we are still without a curebut also, perhaps more importantly, because the AIDS pandemic is now embedded into the histories and cultures of queer people, people of color, creative communities, and dozens of fringe and subculture groups AIDS has become part of our own personal histories.
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The Cultural Response To Hiv
Public response was negative in the early years of the epidemic.
In 1983, Dr. Joseph Sonnabend in New York was threatened with eviction for treating people with HIV, leading to the first AIDS discrimination lawsuit.
Bathhouses across the country closed due to sexual activity and the associated risk. Some schools also barred children with HIV from attending.
U.S. blood banks started screening for HIV in 1985, and men who had sex with men were banned from donating blood . first lifted some of its restrictions in December 2015. The FDA loosened its restrictions again in 2020, motivated by the blood shortage caused by COVID-19.)
In 1987, the United States placed a travel ban on visitors and immigrants with HIV.
The United States government resisted funding needle exchange programs due to the War on Drugs. NEPs were shown to be effective at reducing HIV transmission.
In 1997, researchers calculated that this resistance accounted for .
The number of avoidable transmissions may be even higher.
A 2005 study looked at people in New York City who used injectable drugs and had been admitted to a drug detoxification program. The researchers concluded that the legalization of syringe exchange programs helped reduce HIV prevalence among this group from 50 percent in 1990 to 17 percent in 2002.
Strategies Harriet Tubman And Others Used To Escape Along The Underground Railroad
The FDA approves AZT, the first medication for treat AIDS. The treatment does not cure HIV-AIDS, but can be used to slow its progress and prevent transmission in some instances, such as during birth. The FDA also adjusts regulations to expand access to experimental medications.
President Reagan and Prime Minister Jacques Chirac of France agree their countries will .
May 15 The Public Health Service adds HIV to its immigration exclusion list. For the next 23 years, visa applicants are required to take a blood test and may be denied entry to the U.S. if they test positive.
May 31 Reagan gives his first speech about AIDS. On June 24, he creates the first Presidential Commission on AIDS.
A federal judge rules that a Florida school board cannot ban three HIV-positive brothers, Ricky, Robert, and Randy Ray, from attending school. The community of Arcadia, Florida responds with death threats, bomb threats and a school boycott.
The FDA green-lights the first human test of a candidate vaccine against HIV.
After weeks of threats following a ruling that they could not be banned from school for being HIV-positive, the home of brothers Ricky, Robert, and Randy Ray is burned to the ground while the family is staying elsewhere. The Rays later announce that they will leave Arcadia.
The first national AIDS Awareness Month begins, with the CDC launching a massive public education campaign that warns everyone is at risk.
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The Aids Activist Is Born And New Organizations Policies And Programs Are Created
Out of the fear, hate, stigma, shame, and death, came the seeds of legendary and prolific AIDS activism. Some of the earliest activism led to the creation of Gay Mens Health Crisis in 1982. Founded by writer Larry Kramer and a small group of his friends and other volunteers, GMHC began to organize and raise money for research, and started the first AIDS hotline. The group received over 100 calls in the first night alone. Other community agencies began to pop up in Los Angeles, New York, and across the country.
In the absence of major federal attention or support, it was local queer communities that began the fierce activity that mainstream America eventually took notice of, but there was some help coming. It was actor and philanthropist Elizabeth Taylor who lent her international celebrity, time, and money to force AIDS into the mainstream. After her good friend, Rock Hudson, died of AIDS, Elizabeth Taylor co-founded amfAR and regularly lobbied President Reagan and Congress to address the crisis. She would go on to establish the Elizabeth Taylor AIDS Foundation in 1991 to provide direct care to those living with AIDS.
Aids And The Architecture Of Global Health
HIV/AIDS played a major role in shaping current global health architecture. The threat posed by HIV led WHO to establish a dedicated program in 1986. In 1996, the Joint United Nations Programme on HIV/AIDS was established to coordinate the multisectoral response. In 2001, the United Nations General Assembly Special Session on HIV/AIDS, the first high-level summit ever devoted to a disease, committed the world to specific targets. In 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria was created, and a year later, US President G.W. Bush announced the Presidents Emergency Plan for AIDS Relief, the largest bilateral health program ever undertaken. The scale-up of HIV/AIDS services has highlighted the need to focus on strengthening health systems and on other health-related Millennium Development Goals relating to maternal and child health.
A problem with the early response in the United States as well as globally was an overemphasis on universal vulnerability, the concept that everyone is at risk. Predictions of widespread, generalized HIV/AIDS epidemics among heterosexual persons outside Africa, especially in Asia, were not borne out. The concept of know your epidemic, highlighting the need to focus interventions where HIV transmission is most intense, came surprisingly late, along with acknowledgment of the fundamentally different nature of the epidemic in sub-Saharan Africa compared with elsewhere.
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Early Aids Surveillance And Epidemiology
To investigate this apparent outbreak, CDC investigators developed a simple surveillance case definition for what was first called KS/OI. The definition focused on certain OIs or KS in otherwise healthy persons and was used to establish a national reporting system. In light of new knowledge concerning AIDS and its underlying cause, the case definition was modified over time, but early surveillance indicated that an epidemic was under way and, in retrospect, had begun several years before the first reports. Retrospective testing of stored serum specimens from hepatitis patients in Los Angeles documented human immunodeficiency virus infection as early as 1979.
The initial risk groups identified were men who have sex with men and injection drug users . Field investigations and surveillance activities demonstrated sexually linked cases in MSM and in persons with hemophilia and transfusion recipients, implicating transmission by male-to-male sexual contact as well as through blood and blood products. Cases in heterosexual persons and infants indicated that transmission could also occur through heterosexual contact and from mother to child.
Aids And The Globalization Of Science Research And Practice
A positive development in the response to AIDS has been its effect on science and the globalization of research and practice. Retrovirology and immunology became well-supported disciplines whose practitioners interacted productively with workers in other subjects such as epidemiology. Cohorts of physicians and scientists built their careers in basic as well as applied and clinical research. The frequency with which tuberculosis occurs in HIV-infected persons has led to a resurgence of interest in the diagnosis and treatment of this ancient disease, especially in Africa. Advances in the treatment of HIV-associated OIs have benefited other immunosuppressed persons. In addition, sexual and reproductive health gained renewed prominence.
Scientific advances resulted in the development of lifesaving, albeit not curative, treatment for HIV. Beginning with the approval of AZT in 1987, the development of antiretroviral drugs and the design of simple and standardized approaches for therapy in the developing world constituted a public health triumph. By the end of 2009, > 5 million persons in low- and middle-income countries were accessing ART, unimaginable just a few years before and made possible through the use of generic drugs, price reductions for brand-name drugs, and efforts of international donors through initiatives such as the Presidents Emergency Plan for AIDS Relief and the Global Fund.
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Why Black Aids History Matters
Jessie Jackson speaking at AIDS rally, New York City, New York
As we enter the third year of the Covid-19 pandemic, it might be easy to forget that in early 2020 we were already living through another pandemicthe one caused by the human immunodeficiency virus and its advanced stage of infection, called acquired immunodeficiency syndrome , which was publicly recognized by doctors in the United States over forty years ago, in 1981. And while Covid-19 has disproportionately impacted Black communities, racial disparities in the US HIV/AIDS epidemic are even more stark. African Americans account for around 12 percent of the US population, but they make up 40 percent of the 1.2 million people who are living with HIV in America today.
This is nothing new. From the beginning of the HIV/AIDS pandemic, African Americans have been overrepresented among people testing positive. Thats why today, National Black HIV/AIDS Awareness Day, is important. But even as we recognize that AIDS has devastated, and continues to devastate Black America, our stories about the disease remain overwhelmingly white.
These stories deserve to be told, but as long as they dominate our shared understanding of AIDS and AIDS activist history, we are left with a blinkered view of the past. What would it mean to, instead, put Black America at the center of the story? How would that change how we think about the past, present, and future of the epidemic?
Impact On Young People
- Teens and young adults continue to be at risk, with those under 35 accounting for 57% of new HIV diagnoses in 2019 .50 Most young people are infected sexually.51
- Among young people, gay and bisexual men and minorities have been particularly affected.52
- Perinatal HIV transmission, from an HIV-infected mother to her baby, has declined significantly in the U.S., largely due to increased testing efforts among pregnant women and ART which can prevent mother-to-child transmission.53,54,55
- A recent survey of young adults found that HIV remains a concern for young people, especially for young people of color.56
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Impact Across The Country
- Although HIV has been reported in all 50 states, the District of Columbia, and U.S. dependencies, the impact of the epidemic is not uniformly distributed.
- Ten states accounted for about two-thirds of HIV diagnoses among adults and adolescents in 2019 .30 Regionally, the South accounted for more than half of HIV diagnoses in 2019.31
- Rates of HIV diagnoses per 100,000 provide a different measure of the epidemicâs impact, since they reflect the concentration of diagnoses after accounting for differences in population size across states. The District of Columbia has the highest rate in the nation, compared to states, nearly 3 times the national rate and Georgia was the state with highest rate , twice that of the national rate.32,33 Nine of the top 10 states by rate are in the South.34
- New HIV diagnoses are concentrated primarily in large U.S. metropolitan areas , with Miami, Orlando, and Atlanta topping the list of the areas most heavily burdened.35
|Table 1: Top Ten States/Areas by Number and Rate of New HIV Diagnoses , 2019|
|CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2019 vol. 32. May 2021.|
Why Is Haiti Significant
In the 1960s, the ‘B’ subtype of HIV-1 made its way to Haiti. This is thought to have happened because many Haitians had been working in the Democratic Republic of Congo and had then returned to Haiti. Initially, Haitians were blamed for starting the HIV epidemic, and suffered severe racism, stigma and discrimination as a result.
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The Early Years Of Aids
AIDS first appeared as a distinct illness in the summer of 1981, when the New York Times ran an article entitled Rare Cancer Seen in 41 Homosexuals. This article highlighted an outbreak of Kaposis Sarcoma in young, gay men in San Francisco and New York. Typically, Kaposis Sarcoma affected less than 6 people per million cancer diagnoses in America, but in equatorial Africa this rate increased to 9 percent of all cancer diagnoses. Kaposis Sarcoma outbreaks were the first sign of the international flow of AIDS. The average age of the gay men being diagnosed was also more than a decade younger than typical diagnoses in the United States. At the same time, Californias gay community began to see its first outbreak of Pneumocystis carinii pneumonia , a pneumonia so rare that the only known prophylaxis, which halved mortality rates, was no longer produced, and the limited supply was locked away by the CDC. Doctors who needed the prophylaxis had to specially request an overnight shipment. Despite this, the New York Times and the mainstream media, even most of the alternative media, ignored the burgeoning epidemic until, and even after, it became unavoidable.
By 1983, he had left the organization. Upon leaving, he authored a now famous essay in the New York Native entitled 1,112 and Counting. Kramers essay began:
The History Of Hiv/aids In The United States That Everyone Should Know
For people who grew up in an America where it felt like HIV/AIDS had always existed, it can be hard to imagine just how quickly the at-first-unknown virus arrived and spread in the United States shifting from a mystery to an epidemic to an effectively manageable, albeit still serious, disease.
While new diagnoses of HIV fell by 19% between 2005 and 2014, according to the Centers for Disease Control and Prevention, HIV diagnoses rose among some populations, proving that’s it’s still as important as ever to understand not only basic facts about HIV, but also the virus’ complicated history in the United States. Here are some of the most important dates:
1981: In June, the CDC published a report noting several cases of Pneumocystis carinii pneumonia, a “rare lung infection,” in five young gay men in Los Angeles, according to a timeline published by AIDS.gov. The timeline reported the “first official reporting of what will become known as the AIDS epidemic.”
Over the course of the year, there are more cases of gay men with immune deficiency, often occurring in clusters. By the end of 1981, 121 gay men have died after reported cases of “severe immune deficiency.”
1984: The national organization AIDS Action is formed with the goal of influencing AIDS policy and educating the federal government. San Francisco shuts down bathhouses.
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