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HIV/AIDS: the story on HearLore | HearLore
HIV/AIDS
The first documented case of what would become a global pandemic occurred in 1959 in the Congo, yet the world remained unaware of the virus for decades. This retrovirus, now known as HIV, silently invaded the human population in west-central Africa during the early-to-mid 20th century, evolving from a simian immunodeficiency virus found in chimpanzees. The jump from animals to humans likely happened through bushmeat hunting practices, where the virus had to mutate repeatedly to survive in a new host. By the time the first well-documented human case appeared in 1959, the virus had already established a foothold that would eventually spread to Haiti and then to the United States around 1969. The earliest retrospective case in the United States involved a 16-year-old male named Robert Rayford, who presented with symptoms in 1966 and died in 1969, long before the medical community understood what was killing him. The virus exploited the chaos of colonial cities and the rise of mass vaccination campaigns using unsterilized needles to spread rapidly through populations that lacked immunity. By 1978, the prevalence of HIV-1 among gay male residents of New York City and San Francisco was estimated at 5 percent, suggesting that several thousand individuals in the country were already infected before the first official report.
The Year The World Changed
On the 5th of June 1981, the U.S. Centers for Disease Control and Prevention published a report describing five cases of a rare lung infection called Pneumocystis carinii pneumonia in young, previously healthy men. This was the first clinical recognition of what would be named AIDS, but the initial cases were so unusual that the CDC did not have an official name for the disease. They referred to it by the diseases associated with it, such as lymphadenopathy, or the disease after which the discoverers of HIV originally named the virus. At one point, the CDC referred to it as the 4H disease, as the syndrome seemed to affect heroin users, homosexuals, hemophiliacs, and Haitians. The term GRID, which stood for gay-related immune deficiency, had also been coined, but after determining that AIDS was not isolated to the gay community, it was realized that the term was misleading. The term AIDS was introduced at a meeting in July 1982, and by September 1982 the CDC started referring to the disease as AIDS. The initial cases were a cluster of injecting drug users and gay men with no known cause of impaired immunity who showed symptoms of Pneumocystis carinii pneumonia, a rare opportunistic infection that was known to occur in people with very compromised immune systems. Soon thereafter, a large number of homosexual men developed a generally rare skin cancer called Kaposi's sarcoma, alerting the CDC to a new infectious syndrome.
Common questions
When and where did the first documented case of HIV occur?
The first documented case of HIV occurred in 1959 in the Congo. This retrovirus silently invaded the human population in west-central Africa during the early-to-mid 20th century before spreading to Haiti and the United States around 1969.
When was AIDS first officially recognized and named by the CDC?
The U.S. Centers for Disease Control and Prevention published the first report on AIDS on the 5th of June 1981. The term AIDS was introduced at a meeting in July 1982, and the CDC started referring to the disease as AIDS by September 1982.
Who discovered the virus that causes AIDS and when was it renamed HIV?
Two research groups led by Robert Gallo and Luc Montagnier declared the discovery of the virus in 1983. In 1986, the virus was renamed HIV after the groups realized their isolated viruses were the same.
What is the economic impact of AIDS on affected countries and households?
AIDS reduces the gross domestic product of the most affected countries due to the lack of human capital and increased healthcare spending. A study in Côte d'Ivoire showed that households having a person with HIV/AIDS spent twice as much on medical expenses as other households.
How many people were living with HIV globally as of 2022 and 2023?
As of 2022, 39 million people globally were living with HIV, and 29.8 million people were accessing antiretroviral therapy. In 2023, about 39.9 million people worldwide were living with HIV.
Which region has the highest number of people living with HIV and AIDS-related deaths?
Eastern and southern Africa have the largest proportion of people living with HIV, with 20.6 million people representing 54.6 percent of the global total. This region also had the highest rate of adult and child deaths due to AIDS in 2020, with 310,000 deaths.
In 1983, two separate research groups led by Robert Gallo and Luc Montagnier declared that a novel retrovirus may have been infecting people with AIDS, and published their findings in the same issue of the journal Science. Gallo claimed a virus which his group had isolated from a person with AIDS was strikingly similar in shape to other human T-lymphotropic viruses, which his group had been the first to isolate. Gallo's group called their newly isolated virus HTLV-III. At the same time, Montagnier's group isolated a virus from a person presenting with swelling of the lymph nodes of the neck and physical weakness, two characteristic symptoms of AIDS. Contradicting the report from Gallo's group, Montagnier and his colleagues showed that core proteins of this virus were immunologically different from those of HTLV-I. Montagnier's group named their isolated virus lymphadenopathy-associated virus. As these two viruses turned out to be the same, in 1986, LAV and HTLV-III were renamed HIV. The discovery of the virus was a pivotal moment, but it did not immediately lead to a cure. The virus is a retrovirus that primarily infects components of the human immune system such as CD4+ T cells, macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells, weakening the immune system and allowing opportunistic infections to take hold. The mechanism of CD4+ T cell depletion differs in the acute and chronic phases, with the bulk of cell loss occurring during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body.
The Stigma Of Silence
AIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV-infected people, and the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment. The NAMES Project AIDS Memorial Quilt was conceived in 1985 to celebrate the lives of those who had died of AIDS when stigma prevented many from receiving funerals. One of the first high-profile cases of AIDS was the American gay actor Rock Hudson, whose diagnosis in 1985 brought the disease into the public eye. The stigma has been further divided into instrumental AIDS stigma, which is a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness, and symbolic AIDS stigma, which is the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease. In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice. The controversy surrounding the disease also extended to religion, with some religious authorities publicly declaring their opposition to the use of condoms. In 2011, the BBC reported that some churches in London were claiming that prayer would cure AIDS, and the Hackney-based Centre for the Study of Sexual Health and HIV reported that several people stopped taking their medication, sometimes on the direct advice of their pastor, leading to many deaths.
The Economics Of Loss
HIV/AIDS affects the economics of both individuals and countries, causing the gross domestic product of the most affected countries to decrease due to the lack of human capital. Before death, people with AIDS will not only be unable to work, but will also require significant medical care. It is estimated that as of 2007 there were 12 million AIDS orphans, many of whom are cared for by elderly grandparents. Returning to work after beginning treatment for HIV/AIDS is difficult, and affected people often work less than the average worker. Unemployment in people with HIV/AIDS is associated with suicidal ideation, memory problems, and social isolation. Employment increases self-esteem, sense of dignity, confidence, and quality of life for people with HIV/AIDS. By affecting mainly young adults, AIDS reduces the taxable population, in turn reducing the resources available for public expenditures such as education and health services not related to AIDS, resulting in increasing pressure on the state's finances and slower growth of the economy. This causes a slower growth of the tax base, an effect that is reinforced if there are growing expenditures on treating the sick, training to replace sick workers, sick pay, and caring for AIDS orphans. At the household level, AIDS causes both loss of income and increased spending on healthcare, with a study in Côte d'Ivoire showing that households having a person with HIV/AIDS spent twice as much on medical expenses as other households.
The Undetectable Future
Without treatment, the infection can interfere with the immune system, and eventually progress to AIDS, sometimes taking many years, but effective treatment for HIV-positive people involves a life-long regimen of medicine to suppress the virus, making the viral load undetectable. An HIV-positive person who has an undetectable viral load as a result of long-term treatment has effectively no risk of transmitting HIV sexually, a concept communicated by campaigns by UNAIDS and organizations around the world as Undetectable = Untransmittable. As of 2022, 39 million people globally were living with HIV, and 29.8 million people were accessing antiretroviral therapy. The desired outcome of treatment is a long-term plasma HIV-RNA count below 50 copies per milliliter, and levels to determine if treatment is effective are initially recommended after four weeks. Once treatment is begun, it is recommended that it is continued without breaks or holidays. The effectiveness of treatment depends to a large part on compliance, and reasons for non-adherence to treatment include poor access to medical care, inadequate social supports, mental illness and drug abuse. Even if there are signs of retinopathy, it may reverse as CD4+ T cell counts increase, and reversal of HIV retinopathy is a helpful sign of positive response to antiretroviral therapy in AIDS patients. But if HIV treatment is delayed it may lead to permanent visual loss.
The Global Disparity
Among persons living with HIV, the largest proportion reside in eastern and southern Africa, with 20.6 million people, representing 54.6 percent of the global total. This region also had the highest rate of adult and child deaths due to AIDS in 2020, with 310,000 deaths, accounting for 46.6 percent of global AIDS-related deaths. Sub-Saharan African adolescent girls and young women, aged 15 to 24 years, account for 77 percent of new infections among this age-range globally. Here, in contrast to other regions, adolescent girls and young women are three times more likely to acquire HIV than age-matched males. Despite these statistics, overall, new HIV infections and AIDS-related deaths have substantially decreased in this region since 2010. In 2023, 630,000 people died from HIV-related causes, an estimated 1.3 million people acquired HIV, and about 39.9 million people worldwide were living with HIV. The United States' National Institutes of Health and the Gates Foundation have pledged 200 million dollars focused on developing a global cure for AIDS, but the disease remains a pandemic, with the worst-affected European countries in 2009 and 2012 estimates being Russia, Ukraine, Latvia, Moldova, Portugal and Belarus, in decreasing order of prevalence.