History Of Public Health At Harvard
On June 5, 1981, the Centers for Disease Control and Prevention reported on cases of Pneumocystis pneumonia that afflicted 5 young men, all active homosexuals, in Los Angeles.This report marked the beginning of public knowledge about the AIDS epidemic. What the report didnt include was two other cases of the mysterious pneumonia the first afflicting a gay African-American man, the other, a heterosexual Haitian man. This early omission of race was reflected throughout reporting during the HIV/AIDS crisis historically the narrative focus has been on how the HIV/AIDS epidemic affected gay white men, while the experiences of American black and brown people with HIV/AIDS have been under documented, ignored, or written out of history.
In fact, the first case of HIV/AIDS discovered in the United States was Robert Rayford, a 16 year old black teenager from St. Louis, Missouri who died in 1969. The story of his sickness and death, reported on in 1987, was eclipsed by the now disproven Patient Zero narrative that French-Canadian flight attendant, Gaëtan Dugas was the first person to bring HIV into the United States.
Quinn, Robert John, Robert John Quinns Memorial Books, Volume A, Documented | Digital Collections of The History Project
Today we remember Wilfred Colon Augusto, a member of the Harvard Medical School community, and a person whose story and experience should not be lost to history.
The Aids Epidemic Arises
Though HIV arrived in the United States around 1970, it didnt come to the publics attention until the early 1980s.
In 1981, the Centers for Disease Control and Prevention published a report about five previously healthy homosexual men becoming infected with Pneumocystis pneumonia, which is caused by the normally harmless fungus Pneumocystis jirovecii. This type of pneumonia, the CDC noted, almost never affects people with uncompromised immune systems.
The following year, The New York Times published an alarming article about the new immune system disorder, which, by that time, had affected 335 people, killing 136 of them. Because the disease appeared to affect mostly homosexual men, officials initially called it gay-related immune deficiency, or GRID.
Though the CDC discovered all major routes of the diseases transmissionas well as that female partners of AIDS-positive men could be infectedin 1983, the public considered AIDS a gay disease. It was even called the gay plague for many years after.
In September of 1982, the CDC used the term AIDS to describe the disease for the first time. By the end of the year, AIDS cases were also reported in a number of European countries.
What Needs To Happen
The theme of this World AIDS Day Know Your Status is important. One in four people with HIV dont know that they have HIV. To bridge some critical gaps in the availability of HIV tests, WHO recommends the use of self-tests for HIV. WHO first recommended HIV self-testing in 2016, and now more than 50 countries have developed policies on self-testing. WHO, working with international organizations such as Unitaid and others, supported the largest HIV self-testing programmes in six countries in southern Africa. This programme is reaching people who have not tested themselves before, and is linking them to either treatment or prevention services. This World AIDS Day, WHO and the International Labour Organization will also announce new guidance to support companies and organizations to offer HIV self-tests in workplace. People with HIV often have other infections known as co-morbidities such as TB or hepatitis. One in three deaths in people with HIV is from TB. Around 5 million people are living with both HIV and viral hepatitis. One in three people with HIV has heart disease. This has meant that HIV care has long needed joined-up care, although this doesnt always happen in practice. WHO is now promoting person-centred health services to all people living with HIV, to meet their holistic health needs, not just their HIV infection linking HIV services with those for TB, sexual and reproductive health, non-communicable diseases and mental health, says Dr Hirnschall.
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Where Does Hiv Come From
HIV is thought to have occurred after people ate chimps that were carrying theSimian Immunodeficiency Virus .
HIV is a type of lentivirus, which means it attacks the immune system. SIV attacks the immune systems of monkeys and apes in a very similar way. This suggests HIV and SIV are closely related, and that SIV in monkeys and apes crossed over to humans to become HIV.
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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Origin And Distribution Of Sivgor
Tetherin function and virus specific antagonism in different primate hosts. Mechanism of restricted virion release by tetherin two alternative models are shown Viral antagonists of tetherin and their sites of interaction . Vpu associates with the trans-membrane domain of tetherin, Nef targets the cytoplasmic domain, and Env interacts either with the extracellular or the cytoplasmic domain . Antitetherin function in HIV-1 and HIV-2 and their immediate simian precursors. SIVcpz acquired vpu and nef genes from different sources, the SIVgsn/mus/mon and SIVrcm lineages, respectively. During adaptation in chimpanzees, Nef evolved to become an effective tetherin antagonist. SIVgor and SIVsmm also use Nef to counteract tetherin. After transmission to humans, SIVcpz, SIVgor, and SIVsmm Nef were unable to antagonize human tetherin because of a deletion in its cytoplasmic domain. HIV-1 group M adapted by regaining Vpu-mediated antitetherin activity. The Nef and Vpu proteins of HIV-1 groups O and P remained poor tetherin antagonists. The Vpu of HIV-1 group N gained modest antitetherin activity, but lost the ability to degrade CD4. HIV-2 group A adapted by gaining Env-mediated antitetherin activity whether HIV-2 groups BH gained antitetherin function has not been tested. Proteins that are active against tetherin are highlighted in red, and those that are inactive are shown in gray .
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.
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The Amplification Of Hiv
By the mid-1900s, a blood transfusion program exploded in almost a third of African colonies and countries. According to the American Public Health Association, by 1970 one million blood transfusions were occurring per year in sub-Saharan Africa, and by the 1980s that number had risen to almost 2 million per year.
Since HIV is most effectively transmitted through infected blood and the ability to screen for HIV in blood wasn’t invented until 1985, the increased frequency of blood transfusions likely played a large role in spreading HIV.
The practice of transfusing blood was a Western invention that dramatically increased as a result of World War II, and by 1953, the United States was collecting almost 4 million blood donations every year. Eager to show off the technological prowess of Western medicine, colonial powers introduced blood transfusions into several sub-Saharan African colonies before World War II and expanded the practice after the war.
According to the ALBION Centre, the second earliest case of HIV also comes from Kinshasa in 1960 and estimates claim that by the 1960s, upwards of 2,000 people in Africa were infected with HIV.
Definitions Of Hiv And Aids
The human immunodeficiency virus has infected tens of millions of people around the globe in the past three decades, with devastating results. In its advanced stageacquired immunodeficiency syndrome the infected individual has no protection from diseases that may not even threaten people who have healthy immune systems. While medical treatment can delay the onset of AIDS, no cure is available for HIV or AIDS.
The human immunodeficiency virus kills or impairs the cells of the immune system and progressively destroys the bodys ability to protect itself. Over time, a person with a deficient immune system may become vulnerable to common and even simple infections by disease-causing organisms such as bacteria or viruses. These infections can become life-threatening.
The term AIDS comes from acquired immunodeficiency syndrome. AIDS refers to the most advanced stage of HIV infection. Medical treatment can delay the onset of AIDS, but HIV infection eventually results in a syndrome of symptoms, diseases, and infections. The diagnosis of AIDS requires evidence of HIV infection and the appearance of specific conditions or diseases beyond just the HIV infection. Only a licensed medical provider can make an AIDS diagnosis. A key concept is that all people diagnosed with AIDS have HIV, but an individual may be infected with HIV and not yet have AIDS.
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Unresolved Questions About Hiv Origins And Emergence
The discovery of the main HIV/SIV phylogenetic relationships permits explaining broad HIV biogeography: the early centres of the HIV-1 groups were in Central Africa, where the primate reservoirs of the related SIVcpz and SIVgor viruses exist similarly, the HIV-2 groups had their centres in West Africa, where sooty mangabeys, which harbour the related SIVsmm virus, exist. However, these relationships do not explain more detailed patterns of biogeography, such as why epidemic HIV-2 groups only evolved in the Ivory Coast, which is one of only six countries harbouring the sooty mangabey. It is also unclear why the SIVcpz endemic in the chimpanzee subspecies Pan troglodytes schweinfurthii did not spawn an epidemic HIV-1 strain to humans, while the Democratic Republic of Congo was the main centre of HIV-1 group M, a virus descended from SIVcpz strains of a subspecies that does not exist in this country. It is clear that the several HIV-1 and HIV-2 strains descend from SIVcpz, SIVgor, and SIVsmm viruses, and that bushmeat practice provides the most plausible cause of cross-species transfer to humans. However, some loose ends remain.
It is not yet explained why only four HIV groups spread considerably in human populations, despite bushmeat practices being widespread in Central and West Africa, and the resulting human SIV infections being common.
S: Act Up Is Aids Activism
The myth: The most famous AIDS activism was the only AIDS activism. Activist group ACT UP seized the streets and defined the strategies of civil disobedience, smart graphics, and actionslike throwing the ashes of loved ones who had died of HIV on the White House lawnthat unforgettably channeled its rage.
The truth: While ACT UP may have increased the epidemic’s visibility, it wasn’t the only form of effective campaigning. Activism that focused on scientific research throughout the 1980s ultimately paid incalculable dividends in the form of antiretroviral medications that, when used in combination, effectively stop the virus from copying itself. But this was just one part of AIDS activism, which also included less visible, but no less important, efforts to address the social factors putting people at risk.
Why it matters: “Activist work in the U.S. is still divided treatment and research advocacy work and folks who do work along social determinants like mass incarceration and housing,” Kenyon Farrow, director of U.S. Policy for the Treatment Action Group, explained at a recent discussion on the history of HIV activism. Splitting agendas sometimes means splitting scant resources, resulting in half a solution to a complex problem.
Pop Culture Opens Up Conversations
In 1985, actor Rock Hudson became the first major public figure to announce he had AIDS. Before he died that same year, he donated $250,000 to help establish the organization later known as amfAR, the Foundation for AIDS Research. Friend and actress Elizabeth Taylor was the national chairperson until her death in 2011.
In 1987, Princess Diana also made international headlines after she shook hands with an HIV-positive man.
Pop culture icon Freddie Mercury, singer for the band Queen, passed away from AIDS-related illness in 1991. Since then, many other public figures have revealed that theyre HIV-positive, including:
- tennis star Arthur Ashe
- former basketball star and entrepreneur Magic Johnson
- Pedro Zamora, a cast member on MTVs The Real World: San Francisco
- actor Charlie Sheen, who announced his status on national television in 2015
- hairstylist and television personality Jonathan Van Ness
- actor and singer Billy Porter
Milestone: The First Vaccine Trials Fall Short
The first HIV vaccine trial, using the AIDVAX vaccine, failed to reduce infection rates among study participants. It was the first of many vaccine trials that ultimately failed to achieve reasonable levels of protection for either people with HIV or those hoping to avoid the disease.
Meanwhile, the next generation nucleotide-class drug, Viread , was approved by the FDA. The drug, which was shown to be effective even in people with deep resistance to other HIV medications, was quickly moved to the top of the U.S. preferred treatment list.
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Who Benefits From Preexposure Prophylaxis
People who may benefit from preexposure prophylaxis include anyone who:
- is in a relationship with an HIV-positive person who has a detectable viral load
- has sex with men and women
- regularly has sexual partners of unknown HIV status, especially if they inject drugs
- has had anal sex without a condom or barrier method in the past 6 months
- has contracted a sexually transmitted infection in the past 6 months
- has injected drugs, been in drug treatment, or shared needles in the past 6 months
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 .31 Regionally, the South accounted for more than half of HIV diagnoses in 2019.32
- 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.33,34 Nine of the top 10 states by rate are in the South.35
- 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.36
|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.|
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Strains And Symptoms Of Hiv
There are two different types of HIV: HIV-1 and HIV-2. HIV-1 is further divided into four groups groups M, N, O, and P. HIV-1 is the most common form, and group M causes about 90% of all HIV-1 cases. HIV-2 is primarily only found in West Africa and, according to The Origins of AIDS by Jacques Pepin, the types have undergone so many mutations that the gene sequences of HIV-1 and HIV-2 differ by more than 50%.
According to Avert, while HIV-2 progresses more slowly and is less infectious than HIV-1, without treatment both types of HIV will eventually progress to AIDS. It’s also possible to be infected with more than one strain, which is known as “superinfection,” though this is incredibly rare and occurs in less than 4% of infections.
In the first stage of HIV, people with HIV experience flu-like symptoms within two to four weeks of being infected with the virus, including fever, muscle aches, and swollen lymph nodes. Afterward, the virus enters into a latent stage and though it’s still present in the body, many people don’t suffer from any symptoms although they’re still infectious.
Without treatment, HIV eventually weakens the immune system to the point where it’s no longer able to fight infections, a condition known as AIDS. At this stage, symptoms include pneumonia, rapid weight loss, and neurologic disorders. However, symptoms vary depending on which opportunistic infections have occurred as a result of the weakened immune system.