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You Can Watch this at this link on my website

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You Can Watch this at this link on my website

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This lecture is for education purposes for Glasgow Caledonian University - all rights reserved and footage is used under the creative commons licence only. https://videopress.com/v/kOmRcRu8?preloadContent=metadata

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HIV can affect anyone who has engaged in a behavior that can transmit HIV. Learn more.

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Panic, Paranoia, and Public Health — The AIDS Epidemic's Lessons for Ebola

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Panic, Paranoia, and Public Health — The AIDS Epidemic's Lessons for Ebola

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The Wire S01E05 Gameroom Vikings - WARNING THIS SCENE INCLUDES PROFANITY AND DISCUSSIONS OF DRUG USE

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The Wire S01E05 Gameroom Vikings - WARNING THIS SCENE INCLUDES PROFANITY AND DISCUSSIONS OF DRUG USE

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If you manage your condition properly by taking your medicine correctly and avoiding illness, you should be able to live a near-normal life.
As well as taking HIV treatment, there are many things you can do to improve your general health and reduce your risk of falling ill.

These include:

This page covers:

other ways HIV may affect your life

getting support

telling people about your HIV

pregnancy

the risk of opportunistic infections

financial support

Other ways HIV may affect your life

you will not be able to donate blood or organs

you will not be able to join the armed forces

you may have difficulty getting life insurance to cover a mortgage loan - but life insurance is not compulsory when taking out a mortgage unless it's an endowment mortgage, and there are now specialist life insurance policies for people with HIV

there are some countries you will not be able to visit

Psychological impact of HIV

Getting support

As HIV is a long-term condition, you'll be in regular contact with your healthcare team, who will review your treatment on an ongoing basis.

Developing a good relationship with your healthcare team means you can easily discuss your symptoms or concerns. The more the team knows, the more they can help you.

People with HIV are seen at a specialist HIV clinic, which is usually part of a sexual health or infectious diseases clinic at your local hospital.
Find local HIV support services
Psychological support

Being diagnosed with HIV can be extremely distressing, and feelings of anxiety or depression are common.

Your healthcare team can provide you with counselling so you can fully discuss your condition and concerns.

You may find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your HIV clinic will have information about these.

Some people find it helpful to talk to other people who have HIV, either at a local support group or on an internet chatroom.
Want to know more?

Telling people about your HIV

Telling your partner and former partners

If you have HIV, it's important your current sexual partner and any sexual partners you've had since becoming infected are tested and treated.

Some people can feel angry, upset or embarrassed about discussing HIV with their current or former partners. Discuss your concerns with your GP or the clinic staff.

They'll be able to advise you about who should be contacted and the best way to contact them, or they may be able to contact them on your behalf.

They'll also advise you about disclosing your status to future partners and how you can reduce the risk of transmitting the virus to someone else.

Nobody can force you to tell any of your partners you have HIV, but it's strongly recommended that you do.

Left untested and untreated, HIV can have devastating consequences, and eventually lead to serious illness and death.

Telling your employer

People with HIV are protected under the Equality Act (2010).

There's no legal obligation to tell your employer you have HIV, unless you have a frontline job in the armed forces or work in a healthcare role where you perform invasive procedures.

If you work in a healthcare role, you'll need to be monitored by your occupational health team and HIV doctor to ensure you're not putting yourself and patients at risk of infection.

The Equality Act 2010 also places restrictions on the health questions employers can ask during a job application process.

Employers are allowed to ask health questions only after an offer of employment has been made to help them decide whether you can carry out tasks essential for the job.

If you're asked a question you think is not allowed under the Equality Act 2010, you can tell the employer or the Equality and Human Rights Commission. The GOV.UK website has more information about questions an employer can ask about health and disability.

If you're an employee with HIV, you may worry that your HIV status will become public knowledge, or you'll be discriminated against if you tell your employer.

On the other hand, if your boss is supportive, telling them may make it easier for adjustments to be made to your workload or for you to have time off.

The organisations listed below have lots of information, and can advise you on these and other work-related issues.
Want to know more?

Pregnancy and HIV

Advice for pregnant women

HIV treatment is available to prevent a pregnant woman passing HIV to her child.

Without treatment, there's a 1 in 4 chance your baby will become infected with HIV. With treatment, the risk is less than 1 in 100 (<1%).

Advances in treatment mean there's no increased risk of passing the virus to your baby with a normal delivery.

But for some women, a caesarean section may still be recommended, often for reasons not related to your HIV.

Discuss the risks and benefits of each delivery method with the staff at your HIV clinic. The final decision about how your baby is delivered is yours, and staff will respect that decision.

If you have HIV, do not breastfeed your baby as the virus can be transmitted through breast milk.

Conception

If you or your partner has HIV, options may be available that allow you to conceive a child safely. You should ask your HIV doctor for advice.

If you have HIV and become pregnant, contact your HIV clinic.

This is important because:

some HIV treatments can be harmful to your unborn baby, so your treatment plan will need to be reviewed

additional medicines may be needed to prevent your baby contracting HIV

Want to know more?

Opportunistic infections

Infection risk

You'll be at risk of developing infections you would not normally be at risk of if your immune system has been damaged by the HIV virus.

These opportunistic infections, as they're called, happen when you have a very weak immune system.

But if you take your HIV treatment, the likelihood of developing these is low.

The 4 main types of opportunistic infections are:

People with advanced HIV also have a higher risk of developing some forms of cancer, such as cancer of the lymphatic system (lymphoma).

Pneumonia

Bacterial pneumonia can develop as a complication of other infections, such as flu. It can be treated with antibiotics. Left untreated, pneumonia can be fatal.

Everyone with a long-term condition such as HIV is encouraged to get a flu jab each autumn to protect against seasonal flu.

It's also recommended they have a pneumoccocal vaccination, which protects against a serious chest infection called pneumococcal pneumonia.

Pneumocystis pneumonia (PCP)

Pneumocystis pneumonia (PCP) is a fungal infection of the lungs, which can be life threatening if not treated promptly.

Before advances in HIV treatment, PCP was the leading cause of death among those with HIV in the developed world.

Symptoms of PCP include:

a persistent dry cough

shortness of breath

difficulty breathing

fever (in some cases)

Report any symptoms of PCP straight away as the condition can suddenly worsen without warning.

PCP can be treated with antibiotics. If your CD4 count drops below 200, you may be given antibiotics to take every day until your CD4 count rises above 200.

Tuberculosis (TB)

Tuberculosis (TB) is another bacterial infection. Globally, it's one of the leading causes of death for people who are HIV positive.

The bacteria responsible for causing TB can sometimes pass from one person to another through the air. But many people who have TB are not infectious.

TB can be treated using antibiotics, but some strains of bacteria have developed antibiotic resistance and these can be more difficult to treat.

Candidiasis (thrush)

Candidiasis is a fungal infection that's common in people living with HIV. It causes a thick, white coating to appear on the inside of the mouth, tongue, throat or vagina.

Candidiasis is rarely serious, but it can be both embarrassing and painful. It can be treated with antifungal creams and tablets.

Tell the staff at your HIV clinic if you have repeated bouts of candidiasis as it could be a sign of a low CD4 count.

Cancer

People with advanced HIV have an increased risk of developing some types of cancer.

It's estimated someone with untreated late-stage HIV infection is 100 times more likely to develop certain cancers compared with someone without the condition.

The 2 most common cancers to affect people with HIV are:

lymphoma - cancer of the lymphatic system, a network of glands that makes up part of our immune system

Kaposi's sarcoma - this causes lesions to grow on your skin, and can also affect your internal organs

HIV treatment is important in reducing your risk of cancer and long-term conditions, such as cardiovascular and respiratory disease. If you smoke, giving up is also important in reducing this risk.

Money and financial support

Money

If you have to stop work or work part time because of HIV, you may find it difficult to cope financially.

But you may be entitled to one or more of the following types of financial support:
Want to know more?

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If you manage your condition properly by taking your medicine correctly and avoiding illness, you should be able to live a near-normal life. As well as taking HIV treatment, there are many things you can do to improve your general health and reduce your risk of falling ill.

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The recent 23rd International AIDS Society conference, also known as AIDS 2020, presented the latest research towards the development of an HIV cure and vaccine.

A Brazilian man who has spent 15 months off antiretrovirals without, so far, HIV being detected in any test may represent the first case of a functional cure without the risks of a stem cell transplant. However, experts caution against reading too much into this case, as it involved only a single individual and extensive testing for traces of HIV at various sites in the man's body have not yet been carried out. Our coverage includes a video interview with Dr Andrea Savarino, one of the scientists involved, as well as a commentary by NAM's Gus Cairns, who asks whether someone has just been cured of HIV with a cheap, simple drug regimen?

Leading researchers debated whether gene therapy or immunotherapy is more likely to lead to an HIV cure. We have proof of concept for a gene therapy approach in the cases of two men who have been cured following stem cell transplants from donors with a mutation in the gene for CCR5. However, some experts believe that an immune therapy approach is more likely to deliver long-term remission of HIV and could be delivered at scale, noting that immunotherapies are already being used to treat cancers.

To eliminate a disease or a condition in an individual, or to fully restore health. A cure for HIV infection is one of the ultimate long-term goals of research today. It refers to a strategy or strategies that would eliminate HIV from a person's body, or permanently control the virus and render it unable to cause disease. A 'sterilising' cure would completely eliminate the virus. A 'functional' cure would suppress HIV viral load, keeping it below the level of detection without the use of ART. The virus would not be eliminated from the body but would be effectively controlled and prevented from causing any illness.

A unit of heredity, that determines a specific feature of the shape of a living organism. This genetic element is a sequence of DNA (or RNA, for viruses), located in a very specific place (locus) of a chromosome.

A type of experimental treatment in which foreign genetic material (DNA or RNA) is inserted into a person's cells to prevent or fight disease.

A small subset of people living with HIV who are able to control HIV replication in the absence of antiretroviral treatment for an unusually long period of time (also known as HIV controllers). However, because HIV continues to replicate even in elite controllers, ART is recommended for elite controllers who have declining CD4 counts or who develop HIV-related complications. Around half of elite controllers can also be described as long-term non-progressors.

Cells from which all blood cells derive. Bone marrow is rich in stem cells.

The combination of injectable antiretroviral therapy soon after infection and vesatolimod (a novel immune-activating drug) quickly suppressed viral load and delayed antibody responses to the virus in a monkey study, suggesting a possible role for vesatolimod in a cure strategy.

Scientists working towards a cure are trying to better describe the 'latent reservoir' of HIV DNA in elite controllers - individuals living with HIV who control HIV replication without taking antiretroviral therapy - in order to understand these individuals' natural control of the virus. They reported that elite controllers have low levels of intact provirus (virus able to replicate), and these are associated with having receptor molecules on the surface of their immune cells that are less responsive to HIV infection.

The biotech firm Moderna is devising an HIV vaccine that induces cells to make their own virus-like particles that look like HIV to the immune system. They hope this will 'educate' the system to recognise the broadest possible number of variants of HIV, and the parts of them that are most universal. Data presented from a challenge study - in which the vaccine was tested against viral infection in animals - included some disappointing and some encouraging results.

Click on the links to find out more.

You can also read about the top 5 stories on COVID-19 in people with HIV, top 5 stories on HIV treatment and top 10 stories on HIV prevention from AIDS 2020.

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Top 5 HIV cure and vaccine stories from AIDS 2020

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The recent 23rd International AIDS Society conference, also known as AIDS 2020, presented the latest research towards the development of an HIV cure and vaccine. A Brazilian man who has spent 15 months off antiretrovirals without, so far, HIV being detected in any test may represent the first case of a functional cure without the risks of a stem cell transplant.

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Hi There,

Welcome to the accompanying Padlet for the AIDS introduction lecture.  Attached here are a number of videos, resources and academic sources.  Remember if you are using some of these in your essays or other work for references then you should be using academic work not websites where ever is possible.  The links here are designed to give you background information.  Refer to the reading lists on Blackboard and within the handbook for guidance.

Thanks
Simon
Dr. S. Walker

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The film glosses over the bigotry Mercury faced as a queer man with HIV. AP Photo

Millions of people tuned in to the Oscars to see "Bohemian Rhapsody," the biopic of Queen frontman Freddie Mercury, compete for best picture, which "Green Book" ended up winning.

There were a lot of people cheering against "Bohemian Rhapsody." The film has been dogged by accusations of homophobia, and the film's director, Bryan Singer, was accused of rape and sexual abuse.

But as a gay historian, I keep coming back to something else - the tragic history that's glaringly absent from this movie.

Mercury, along with all the other men and women who tested positive for HIV in the 1980s, was a victim not just of a pandemic but of the failures of his own governments and of the scorn of his fellow citizens. The laughable initial response to the HIV pandemic helped seal Mercury's fate.

None of that is in the movie.

Governments turn their backs

In the early 1980s, when an epidemic of HIV first struck a few population centers in the U.S., U.K. and elsewhere, governments mounted almost no public health response.

Doctors initially noticed the virus in groups of people who happened to already be stigmatized for other reasons: men who had sex with men, drug users and, due to racism, Haitians and Haitian-Americans.

The prejudiced initial public health response assumed that many of these people were getting the virus because of whatever was already supposedly wrong with them. Gay men, the thinking went, were getting it because of "risky" behaviors like having lots of partners. HIV was not, therefore, a threat to most straight people. The medical profession's view of HIV was so colored by the idea that it was intrinsically gay that at first they named the virus " GRID," an acronym for "gay-related immunodeficiency."

That was bad science, as we know now. Especially in the absence of good public health information about how to have safer sex, your risk of contracting any sexually transmitted infection goes up when you have more partners. But there was nothing about gay sex in particular that caused AIDS. Lots of straight people had multiple partners in the 1970s and 1980s, but initially, by chance, some communities of gay men were hit harder.

Governments and the general public quietly left people with HIV to their fate. As one activist pointed out, two years into the crisis, the U.S. government had spent more to get to the bottom of a series of mysterious poisonings in Chicago that killed seven people than to research AIDS, which had already killed hundreds of people in the U.S. alone.

The first report of HIV in the U.K. was in 1981. There was no test for the virus until 1985, and there was no really effective treatment until 1996. In 1985, Prime Minister Margaret Thatcher tried to block a public health campaign promoting safe sex; she thought it would encourage teenagers to have sex, and, she claimed, they were not at risk of infection.

All told, it was an absurd response to the major public health catastrophe of our time and to a disease that would go on to kill 36 million people around the world - about as many as died in World War I.

Glossing over the era's homophobia

All this left Mercury and other queer men in a terrible place. Without good public health information, and with research lagging, they were unnecessarily exposed to the virus. Diagnosed in 1987, Mercury didn't live long enough for the development of antiretroviral combination treatment that could have saved his life.

He faced not just a deadly disease but vitriolic prejudice against people with HIV and AIDS. Two years before he was diagnosed, a Los Angeles Times poll found that a majority of Americans wanted to quarantine HIV-positive people; 42 percent wanted to close gay bars. As Mercury fought to keep making music as he grew sicker and sicker, the lead singer of the then-popular band Skid Row wore a t-shirt that said, " AIDS kills faggots dead."

You won't see this in the movie, either. No one in "Bohemian Rhapsody" is overtly homophobic; when homophobia appears at all, it's in subtler forms. For example, a bandmate tells Mercury that Queen is emphatically not the openly queer disco act The Village People.

In real life, Mercury faced rampant homophobia - he never really came out publicly, and it's easy to see why. In 1988, the U.K. passed a notorious anti-gay law that declared, officially, that homosexuality shouldn't be promoted and that same-sex couples had " pretend " families, not real families. The law stayed on the books for over a decade.

The era's glam rock and disco music scenes had queer moments, but it was all predicated on everyone being straight in real life. David Bowie told the press he was queer in 1972 and then loudly took it back in 1983, saying "the biggest mistake I ever made" was telling the press "that I was bisexual."

The Village People were unique because they were unabashedly out and proud, but they weren't a hit act because of that. They were a hit because the straight public either didn't realize it or didn't want to know.

Ask yourself: When you danced to " YMCA " at your high school talent show, did you know it was about gay culture? I'm going to guess the answer is no.

The same was true of Queen. How many of the rock fans who packed stadiums to see them play "We Are the Champions" knew that the heroic singer was not just a rock god, but a fabulous queer icon, too? Not many.

In the 1980s, Mercury ditched his glam rock look and cut his hair in a style popular in gay subculture, donning a black leather jacket and sporting an enviable, gorgeous mustache. Many fans hated it. In the U.S., they threw razors onstage.

No one to blame but himself?

When Mercury died in 1991, his bandmates felt it necessary to do a TV interview to dispute what the media was saying - that Mercury had brought AIDS upon himself with his decadent partying.

The movie also quietly makes it seem as if Mercury's debauchery was to blame for his fate.

In the film, Mercury abandons the band to make a solo album in Munich with his diabolical boyfriend, who lures him into a shady queer world. His ex-girlfriend rescues him and he returns to the band. But by then, it's too late: He has HIV.

In real life, Mercury didn't break up the band, he wasn't the first of the bandmates to make a solo album and, of course, partying doesn't cause AIDS.

I hope someday, someone makes a better Freddie Mercury biopic, one that accurately depicts the historical moment he lived in and the challenges he dealt with. He deserves it.

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The Freddie Mercury story that goes untold in 'Bohemian Rhapsody'

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Millions of people tuned in to the Oscars to see "Bohemian Rhapsody," the biopic of Queen frontman Freddie Mercury, compete for best picture, which "Green Book" ended up winning. There were a lot of people cheering against "Bohemian Rhapsody." The film has been dogged by accusations of homophobia, and the film's director, Bryan Singer, was accused of rape and sexual abuse.

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Abstract

Introduction

The history of HIV/AIDS policy making offers important lessons for both scholars and practitioners, illuminating enduring patterns that may well continue to shape national policy choices in-and beyond-the HIV/AIDS arena. Thus far, however, only the first decade of US policy history has been well documented. A number of studies highlight individual debates and controversies from more recent years, but none attempts to characterise or explain the broader trajectory of AIDS-relevant policy making after 1990. This article helps fill the gap in our understanding by constructing a macro-level account of national policy debates and outcomes from 1981 to 2015. Encompassing the roles of community organisations, state and local governments, national and regional advocates, public health leaders and politicians, this account focuses on what happened in the arena of national HIV/AIDS policy, and why.

In discussing the well-documented period 1981-90, I rely largely on the excellent work of prior scholars and journalists, including Dennis Altman, Ronald Bayer, Jennifer Brier, Steven Epstein, David Kirp, Sandra Panem and Randy Shilts. To reconstruct the largely un-catalogued history of US HIV/AIDS policy making after 1990, I employ and triangulate three forms of data. The first comprises more than 20,000 news stories from The New York Times ( NYT) and Kaiser Daily HIV/AIDS Report. Read in tandem with select legislative histories, the NYT and Kaiser reporting offers a detailed view of unfolding policy processes, including not only successful legislative proposals, but proposals that failed; proposals that never drew legislative attention; executive and regulatory actions; public controversies; and advocates' attempts to raise issues to public attention. The second comprises more than 70 original, semi-structured interviews I conducted in 2005 and 2010-12 with policy makers and advocates who played key roles in the formulation of federal HIV/AIDS policy across various administrations (see Table 1 for a listing of informants' roles). Policy documents produced by governmental and non-governmental stakeholders help to round out insights into policy making dynamics gleaned from the interviews. Thirdly and finally, the paper draws at select points on parallel data from the United Kingdom, including: news articles from The Guardian, The London Times, The Financial Times, and Parliament Publications Database; 55 semi-structured interviews I conducted with key policy makers and advocates who contributed to HIV/AIDS policy decisions in the UK; and British government and advocacy documents.

A number of organising principles might have emerged from analysis of these policy trends. The state of research into HIV/AIDS prevention, testing and treatment could logically be expected to exert a strong guiding influence-and scientific developments do in fact impact policy deliberations. They are not determinative, however, as treatments are sometimes generated but not delivered, and prevention programmes are sometimes proven effective but not used. Similarly, the distribution and growth of the epidemic influences the course of policy debates without consistently determining outcomes: the needs of some highly-affected populations are addressed more promptly or consistently than others. Economic cycles exert their influence on policy as well, since discretionary programmes are often squeezed when federal budgets are tight. Yet the impact of economic factors is simultaneously constrained by policy: where there is no political will to deliver a service, or no mechanism in place to do so, the hypothetical availability of funds does not matter.

Instead, the clearest organising principle to emerge is the alternating cycle of Republican and Democratic presidencies. As the following account reflects, technological, epidemiological and fiscal factors interweave with political and ideological factors in determining outcomes; there is no mono-causal account of HIV/AIDS policy making to be had. However, the presidential administrations-with their contrasting social, economic and cultural worldviews, as espoused within the USA's strongly entrenched two-party political tradition-emerge as the factor that most markedly shapes policy into discrete periods, influencing the reception of scientific data, the relative attention paid to various populations, and budget allotments. Accordingly, the periodisation of my account reflects the ascendance of the political and ideological in shaping national responses to HIV/AIDS.

The Long Road to Action: 1981-1989

The earliest chapter of the American AIDS policy story is most often told as a tale of delayed and limited national leadership. Since this period has already been well documented and analysed, I will limit my treatment of it here. Nevertheless, a review of developments from 1981 to 1989 is crucial to understanding the epidemiological trajectory of HIV/AIDS, the growth in public awareness and fears, and the rise of HIV/AIDS interest groups and activism. This review sets the stage for understanding the dramatic way that new treatment regimens would affect both medical prognosis and popular conceptions of the disease. A review of the Reagan years is also vital to establishing the central role that presidential administrations (and their parties' key constituencies) play in shaping discrete periods of national response to HIV/AIDS.

The CDC also began making grants to community-based organisations (CBOs), in order to bolster prevention efforts among high-risk populations. Gay men's health educators had already demonstrated the efficacy of candid, pro-sex approaches implemented at the community level, but social conservatives went on the attack, demanding and winning, inter alia, the 1988 Helms Amendment. This legislation required federally-funded programmes to emphasise abstinence and barred them from producing materials thought to 'promote or encourage, directly or indirectly, homosexual sexual activities'. In place until 1992, the Helms Amendment forced most large, federally-funded CBOs to work directly contrary to public health expertise-for example by deleting pictures of genitals from their materials and omitting discussion of anal sex.

Turning Points: 1990-1992

The passage of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in 1990 opened the next major chapter of the American HIV/AIDS policy story, which saw the transition from a nascent, largely reactive national response to a more forward-looking approach institutionalised broadly across the federal government. The CARE Act aimed to address the critical problem of financing treatment for HIV/AIDS patients, a significant proportion of whom were under- or uninsured, particularly as HIV became increasingly concentrated in poorer communities. Employment-based private insurance, the cornerstone of the US health care system, was failing people with HIV. Private insurance companies dumped HIV-positive patients from their rolls or used 'catastrophic illness' exemptions to refuse to cover AIDS-related costs. Many other patients lost coverage when they became too sick to work. Medicaid quickly became the largest single payer for HIV/AIDS treatment in the nation. Individuals with HIV/AIDS had to qualify for Medicaid, however, in one of three specific ways: they were extremely poor prior to their illness; they 'spent down' all their resources after becoming sick, until they were extremely poor; or they survived the two-year waiting period after diagnosis of full-blown AIDS, allowing them to receive Medicaid. The traditional combination of private insurance and Medicaid thus left significant gaps, not only in who was covered but in the periods of illness for which they were covered.

Hospital care for the US uninsured has traditionally been financed through cost-shifting mechanisms and charitable donations, but by 1990 it was clear these were wholly inadequate for addressing AIDS, particularly in urban centres. In the mid-1980s, policy advocates had pushed for a federal response to the treatment financing problem, and various legislative fixes had been proposed-and failed-in Congress. Now, however, the fiscal strain began to jeopardise the availability and standard of care for people without HIV, as long-solvent urban hospitals went bankrupt under the strain of treating uninsured AIDS patients and hospital closures loomed. This fact initiated a crucial shift in political discourse, and AIDS treatment financing came to be understood as a general problem that the US government should address.

Beyond the fiscal crisis and the newly emerging discourse of generalised risk it engendered, two other factors enabled passage of the CARE Act. First, breakthroughs in medical treatment shifted the issue of AIDS treatment financing from one focused on palliative and supportive care to a more compelling one about effective treatments that could save lives. Second, policy advocates distanced the bill from gay men and drug users by marshalling and reenergising a pre-existing discourse of AIDS' 'innocent victims'-a move that helped build public and congressional support. The name of the legislation reflects this strategy: Ryan White was an Indiana teenager who contracted HIV during routine treatment for haemophilia and died of AIDS in 1990.

During the brief, transitional period of 1990-92, the ideas and impetus for key HIV/AIDS policy decisions continued to originate largely outside federal government and represented the fruits of a decade's worth of investigation and activism. Adopted primarily through Congressional action, these changes were possible in the context of a presidential administration that, while still largely passive on HIV/AIDS, was less committed to the hard-line social and economic conservatism that made action on the crisis so difficult under President Reagan. Beyond seeking to protect the uninfected population, the federal government now acknowledged a specific responsibility to address the needs of people with HIV/AIDS.

Leadership and Resistance in the Clinton Years: 1993-2000

In 1993, William Jefferson Clinton became the first Democratic president to confront the HIV/AIDS epidemic. The Clinton campaign had pledged a stronger response on AIDS, and experienced policy advocates hoped his administration would galvanise a systematic and aggressive federal approach. The next eight years would, indeed, witness more proactive executive leadership, as well as the rapid expansion of federal HIV/AIDS programme budgets. Yet policy making during the Clinton years would also be constrained by competing political demands from the Left and the Right, particularly after the 1994 mid-term elections.

Prevention policy changed as well. For instance, in a quiet move that would have profound effects, the CDC instituted a new 'community planning' process that allowed community grantees to make local decisions in allocating their federal prevention funds, provided they employed evidence-based interventions and met inclusion, representation, and parity requirements. Not all prevention policy making was so smooth, however, as needle exchange once again became a hotly-debated, partisan issue, exemplifying the push-and-pull dynamic of these years.

A Conservative Turn in the Bush Years: 2001-2008

Finally, the CARE Act was changed substantially during the course of its third reauthorisation. Although delayed by Hurricane Katrina and war in Iraq, the 2006 reauthorisation process was long and, once again, contentious. With a Republican Congress and presidency, conservative views gained new traction on two long-standing controversies: geographical funding distributions and local control. With regard to the first, the final legislation increased proportional allocations to rural and Southern states, while still limiting to 5 per cent the amount that early epidemic centres could lose. With regard to the second, the approved legislation reduced local control over spending and curtailed support services through a new requirement that 75 per cent of CARE Act funds go to 'core' medical services, such as physician visits and medication.

Reversals and Reforms under the Obama Administration: 2009-2016

The Obama administration also moved in new directions. Under Director Jeffrey Crowley, the White House Office of National AIDS Policy (ONAP) engaged a wide range of stakeholders to construct a comprehensive national strategy on HIV/AIDS. The resulting document, National HIV/AIDS Strategy for the United States (2010), set specific targets for four key objectives: reducing new HIV infections; increasing access to care and improving health outcomes for people with HIV; reducing HIV-related health disparities; and achieving a more coordinated national response to the epidemic. An Implementation Plan was released alongside the Strategy, and each relevant federal agency devised an operational plan to facilitate implementation. The Strategy was received with enthusiasm across multiple sectors of HIV/AIDS work. It also brought considerable media attention to the domestic epidemic. However, it was not accompanied by new budget allocations, limiting implementation to actions that could be taken by reassigning existing funds. One such objective, reflected in the fourth Strategy goal, involves streamlining the cumbersome and overlapping federal requirements with which community agencies and service providers must contend. ONAP itself spearheaded efforts to increase coordination, for instance, through the introduction of common requirements for grantee reporting.

The 2010 National HIV/AIDS Strategy also shone a spotlight once more on treatment access. The 2009 CARE Act reauthorisation helped preserve treatment services for those without quality health insurance. However, the policy change likely to have the most impact on treatment access is not an HIV-specific law, but the 2010 Patient Protection and Affordable Care Act (ACA). Analysts estimate that up to 70 per cent of people with HIV who were uninsured before the ACA now qualify for Medicaid, and many of the remaining 30 per cent are gaining access to private insurance. This has profoundly increased the consistency of access to health care and medications. In 2008, nearly 150,000 Americans (or 10 per cent of HIV-positive Americans) were reliant on the troubled ADAPs. Under the ACA this population is rapidly moving out of a chronically underfunded, HIV/AIDS-specific programme, into more reliable, regular structures of health care provision.

In 2015 the Strategy was revised to reflect substantial advancements in AIDS science and to note progress on goals made to date. The 2015 report also offered updated goals for 2020, and annual reports continue to assess the nation's progress toward Strategy goals. While the long-term legacy of the Strategy cannot yet be determined, it is clear that the Obama years witnessed decreasing infection rates. It also paid increased attention to the HIV-related needs of highly affected US populations that previously had been neglected. During the Obama years, there was growing recognition of the role stable housing can play in preventing new infections and improving the lives of people living with HIV. In addition, there were improved efforts to ensure HIV-positive individuals are diagnosed and linked to treatment, so that they can achieve viral suppression and overall health.

Conclusion

HIV/AIDS policy can be read as a series of responses to the concrete challenges of a health crisis: preventing the virus's spread, ensuring equitable access to treatment and facilitating research into aetiologies, treatments and cures. But HIV/AIDS policy is also a malleable political product-a resource used to wage broader social and ideological battles, as well as an instantiation of those battles. As a result, rather than evolving into a comprehensive policy that integrates the concerns of various American publics, federal HIV/AIDS policy has pursued a zig-zagging course, based on the issues that resonate best with the current party in power. Under Democratic administrations, central concerns of the political Left come to the fore: providing for the disadvantaged, expanding the health care social safety net and combatting the discrimination and stigmatisation of marginalised groups. Under Republican administrations, the epidemic is viewed through central concerns of the political Right: trimming government-funded social programmes, emphasising personal responsibility and protecting citizens and society from the negative impacts of behaviours coded as immoral.

Public health experts often view Democratic presidential administrations and Congresses as easier contexts in which to advance their preferred policy choices, particularly since Conservative leaders are more likely to accord the same weight to ideological discourses about sexuality and drug use as to scientific consensus in their policy making. So, for instance, most prevention experts strongly advocate the comprehensive approaches to sex education that research finds most effective, and such programmes generally thrived during the Clinton and Obama administrations. Under Republican administrations, prevention efforts have focused on abstinence, and grant guidelines have had a chilling effect on programmes promoting more frank and holistic approaches. Similarly, socially-conservative legislators have been steadfast in their opposition to needle exchange, which they see as conveying permission to engage in immoral behaviour. Thus, despite strong scientific consensus that needle exchange programmes reduce HIV transmission without increasing drug use, a ban on federal funding for needle exchange was enacted during the Reagan years and affirmed during the conflict-ridden Clinton administration.

This is not to say that members of the political Left never elevate their own concerns over the science-based recommendations of public health experts. Notably, in the early 2000s, the CDC determined that routine testing would benefit both those with HIV (by setting them on a road to effective treatment) and those without HIV (by clarifying the HIV status of one's partner(s)). Nevertheless, HIV/AIDS activists resisted the transition to routine testing, out of fears that marginalised groups would face coercive testing and that individuals who tested positive would face (further) stigma and discrimination. Leaders on the political Right were less concerned about stigmatisation and more concerned with insulating the broader American public from a disease affecting primarily marginalised groups. Thus, routine testing was a relatively easy policy to implement during the Republican-led George W. Bush years.

In this fourth decade of the HIV/AIDS epidemic, state-of-the-art medical treatment has converted HIV from a short-term death sentence to a manageable, chronic disease-at least for those Americans with access to diagnosis and treatment. With no cure yet in hand, however, significant challenges remain, including, first and foremost, in the arena of treatment financing. The Affordable Care Act positions mainstream health insurance to provide comprehensive care to people with HIV for the first time, and could-if fully implemented over the long-term-bring the decades-long pursuit of HIV/AIDS-specific financing mechanisms to an end. However, the election of Republican President Donald Trump and a Republican-dominated Congress in 2016 complicates that forecast, raising the real possibility that the ACA will be dismantled, de-funded or radically revised. Even if all the provisions of the ACA were retained and implemented, challenging treatment finance questions would remain: how much should pharmaceutical companies be allowed to charge for AIDS therapies? Will mainstream health insurance markets be able to absorb the high cost of HIV/AIDS treatment? How can both medical resources and financial burdens be distributed equitably?

Beyond the treatment arena, we should expect that prevention programmes will remain particularly susceptible to political attack, since they necessarily involve politicised choices about which populations to target and how to communicate on sensitive topics. Compared to treatment and prevention, HIV/AIDS research is so far maintaining momentum: HIV/AIDS has become a major area of publicly-funded research, driven by well-established institutions that set strategic priorities and push the field aggressively forward. However, recent congressional audits illustrate the specific vulnerability of social and behavioural research on aspects of HIV/AIDS critical to stemming transmission rates and ensuring quality care for infected individuals.

Heading into the future, then, US HIV/AIDS policy advocates still have a full agenda: to continue identifying emergent problems and bringing them to policy makers' attention; to be prepared for intense debate concerning policies that aid marginalised groups, expand government programmes, or tread the dangerous moral ground of sex and drugs; and to find the political allies and policy making windows that make it possible to advance public health.

Funding

This work was supported by a National Science Foundation Dissertation Improvement Grant, a Wellcome Trust Travel Grant and the Reed Foundation's Ruth Landes Memorial Research Fund.

Acknowledgements

The author wishes to thank Julia Adams, Renee Anspach, Gene Deerman, Anne Esacove, Lisa Fein, Sandra Tanenbaum, Edna Viruell-Fuentes, and the anonymous reviewers for their helpful comments on prior drafts of this paper, and Roz Galtz and Megan Hils for their excellent editorial assistance.

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Fighting an Epidemic in Political Context: Thirty-Five Years of HIV/AIDS Policy Making in the United States

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The history of HIV/AIDS policy making offers important lessons for both scholars and practitioners, illuminating enduring patterns that may well continue to shape national policy choices in-and beyond-the HIV/AIDS arena. Thus far, however, only the first decade of US policy history has been well documented.

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On this page:

Can gay men give blood?

Gay and bisexual men are not automatically prevented from giving blood.

However, all men must wait 3 months after having oral or anal sex with another man before donating.

This rule applies to every man, regardless of their sexual orientation, whether they're in a stable relationship or whether they use protection such as condoms or pre-exposure prophylaxis (PrEP).

If you are taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) you will be unable to give blood. If you stop taking PrEP or PEP, you will need to wait 3 months before you can give blood.

We appreciate that any deferral is disappointing if you want to save lives by giving blood.

We recognise that people want to be considered as individuals as much as possible. The FAIR (For the Assessment of Individualised Risk) steering group is currently researching a more individualised donor selection policy.

Why is there a 3-month wait after sex?

The 3-month wait is to reduce the risk of any very recently acquired infections not being detected on screening and further tests. This applies to all donors whose partners may be at a higher risk of blood borne infections.

The reason a delay period exists is due to a combination of two things:

Increased risk of infection

At a population level, men who have sex with men are at an increased risk of acquiring certain infections through sex.

The gap between getting an infection and being able to detect it

We test every blood donation but there is a small possibility that very recent infections don't get picked up but may still be passed on through blood.

This is because there is a period of time (called a window period) between getting an infection and it showing up reliably on tests.

If someone gives blood during the window period, their blood could contain an infection that could be passed on to the people who receive their blood.

Blood donation rules

Safety is at the forefront of everything we do, and this is the reason we have one of the safest blood supplies in the world.

The strict guidelines and testing we follow are to protect both donors and patients. We are also regularly inspected by independent regulators.

The Government set the three-month wait based on advice from an expert committee called SaBTO (Advisory Committee on the Safety of Blood, Tissues and Organs). Read the SaBTO report about the medical and scientific reasoning behind the wait.

SaBTO advice covers a wide-range of topics, known as risk factors, that might stop you from giving blood, either for a short time, a temporary deferral or permanently.

These include:

lifestyle and sexual activity

travel

illness and medical conditions

getting a tattoo or piercing

The rules are there to protect the seriously ill people who need blood transfusions.

Questions we ask before you donate

To assess whether it's safe to give blood, we ask everyone the same questions about these risk factors before they donate.

This health questionnaire is the first step in an important line of checks and tests we take to limit the chances of infections reaching vulnerable patients.

We trust people to answer these questions about their medical history and lifestyle as fully and honestly as possible.

Research into more personalised questions

We want as many people as possible to be able to donate safely.

So, we're currently part of the FAIR steering group to explore whether a more individualised donor selection policy could be used which would take your personal circumstances into account in more detail.

We're working with a range of people and LGBT+ groups including:

National AIDS Trust

Stonewall

Freedom to Donate

Terrence Higgins Trust

epidemiology and psychology experts

This is a big piece of research and we hope to report our findings towards the end of 2020.

Previous changes to blood donation rules

Blood donation rules have evolved over the years as the understanding and evidence about risks improves.

pre-2011 - men who have sex with men were not able to give blood

2011 - a 12-month wait was introduced

November 2017 - a 3-month wait for men who have sex with men was introduced following changes to SaBTO guidance

We have some of the world's most progressive rules about who can and can't give blood. Internationally, some countries don't allow men who have sex with men to give blood or have a 12-month delay.

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On this page: Gay and bisexual men are not automatically prevented from giving blood. However, all men must wait 3 months after having oral or anal sex with another man before donating. This rule applies to every man, regardless of their sexual orientation, whether they're in a stable relationship or whether they use protection such as condoms or pre-exposure prophylaxis (PrEP).

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In the mid-80s, HIV/Aids terrified the world because of a lack of understanding as well as misinformation.

In April 1987, Princess Diana opened the UK's first purpose built HIV/Aids unit that exclusively cared for patients infected with the virus, at London Middlesex Hospital.

In front of the world's media, Princess Diana shook the hand of a man suffering with the illness.

She did so without gloves, publicly challenging the notion that HIV/Aids was passed from person to person by touch.

She showed in a single gesture that this was a condition needing compassion and understanding, not fear and ignorance.

John O'Reilly was a nurse on the ward at the time of the Princess of Wales' visit.

He spoke to Witness about a landmark moment in the fight against HIV/Aids.
Witness: The stories of our times told by the people who were there.

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How Princess Diana changed attitudes to Aids

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In the mid-80s, HIV/Aids terrified the world because of a lack of understanding as well as misinformation. In April 1987, Princess Diana opened the UK's first purpose built HIV/Aids unit that exclusively cared for patients infected with the virus, at London Middlesex Hospital.

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Emerging in the 1980s, acquired immune deficiency syndrome (AIDS) ravaged minoritized communities across the country and in the process transformed the United S

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Your access to the NCBI website at www.ncbi.nlm.nih.gov has been temporarily blocked due to a possible misuse/abuse situation involving your site. This is not an indication of a security issue such as a virus or attack.

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A still from the 'tombstone' public health campaign.

If you remember the 1980s, you will likely summon up the image of the Grim Reaper or a black tombstone when asked to think about AIDS. Those images, embedded in our collective memory by two iconic Australian and British public health campaigns of that decade, reveal how AIDS has been both a medical and a cultural epidemic since it was first clinically observed in the US in 1981. In the words of American scholar Paula Treichler, AIDS has always partly been an "epidemic of meanings".

As we commemorate another World AIDS Day and remember all those who have died, we must remind ourselves of all that is still left to do to eradicate HIV. We must also remember the role culture plays in shaping our understanding of the virus and those living with it.

If we take into account the highly homophobic social context in which news of the condition first started circulating, then its cultural dimensions become all the more important. We must consider what AIDS meant to people in the 1980s and 1990s, and what HIV still means today, at a time when antiretroviral therapies are being used successfully to manage existing infections and prevent new ones.

Take, for instance, these 1987 public service announcements, produced in the US for the State Health Division of Oregon:

These videos highlight some of the key features of the publically-funded AIDS awareness campaigns of the 1980s and early 1990s. Even if we ignore the fact that governments only publicly acknowledged AIDS years after the first known patients (homosexual men) started dying, these and other films of the time are evidence of the impact a homophobic mainstream culture had on the ways AIDS was dealt with in public.

Despite the fact that homosexual men had been one of the demographics most affected by the condition, these campaigns still refused to address homosexuals directly and communicate clearly to them ways in which homosexual sex could be made safer. Instead, they preferred to deal in visual metaphors and allusions aimed at an abstract general public.

Marked by a fear, on the part of the Thatcher and Reagan governments, that speaking directly to homosexuals could be seen as endorsing "deviant" homosexual behaviour, the often moralistic - and publicly-funded - health campaigns released during the peak of the Western AIDS crisis ignored the specific realities of those most affected by the epidemic.

Not only that, but health campaigns and news stories often played with metaphors that were not only deeply sexist and homophobic, but also inspired by the language of warfare. They also mostly chose to endorse celibacy or monogamy rather than educate people about risk-management and safer sex.

A fatal price

In Oregon's "Revolver" video, for example, promiscuity is posited as the ultimate cause of AIDS. Further, the penis is represented by a gun and the (infected) semen by killer bullets, associating HIV transmission, in most cases unintentional, with murder.

Or consider the image below. Published in the popular science magazine Discover, in December 1985, medical illustrations and considerations about human anatomy are used to portray the rectum as "vulnerable" and the vagina as "rugged ... designated to withstand the trauma of intercourse". As a result, the article concluded "AIDS ... is now - and is likely to remain - largely the fatal price one can pay for anal intercourse."

Paula Treichler, 'AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification.' October 43 (1987), 38.

Even in the realm of art, the earliest representations of HIV and AIDS weren't any less problematic. When, in 1988, American photographer Nicholas Nixon included portraits of men living with AIDS in his show Photographs of People at the Museum of Modern Art (MoMA) in New York, activists were quick to respond with anger.

In the photos, which led activist group ACT UP New York to protest against the show, emaciated bodies of sick men are portrayed in a way that could be seen as objectifying them. In one image included in the show, the subject - Donald Perham - is depicted as an "AIDS body", deprived of individuality or agency, his whole existence violently reduced by the camera to the syndrome that would eventually kill him. The photograph tells us nothing about him apart from his name and the health condition that will eventually destroy him. He is portrayed as a living corpse.

A new visual vocabulary

Despite the many counter-narratives of HIV and AIDS that artists and activists have been producing since the 1980s, this mainstream visual imaginary still informs how we picture HIV today and sustains the stigma that remains associated with the virus. While many recent films and TV productions such as How To Survive a Plague (2012), Dallas Buyers Club (2013), The Normal Heart (2014), or 120 BPM (2017), have been revisiting the early years of the AIDS crisis and looking at it from afar, we need a new visual vocabulary to make sense of the virus today, at a time when treatment has made HIV a manageable and untransmittable condition.

Read more: How HIV became a treatable, chronic disease

Further, if AIDS became such a defining spectre haunting gay men during the 1980s and the early 1990s, we need to think about the ways in which gay masculinities and sexual practices are today being shaped and represented in the age of antiretroviral therapies.

That is, in part, the aim of my new research project, funded by a fellowship of the Arts and Humanities Research Council, which will look at contemporary representations of masculinity in "post-AIDS" gay pornography. The hope is that it will help us to understand the ways in which the AIDS crisis and its aftermath have impacted the lives, identities, and sexual practices of gay men, rather than just see it in terms of tombstones and grim reapers.

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AIDS: homophobic and moralistic images of 1980s still haunt our view of HIV - that must change

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The tombstone, revolver and grim reaper imagery of the 1980s and early 1990s have cast a long shadow.

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The New York Times had a spotty record of covering the AIDS epidemic in the early 1980s - and gay culture in general. Times staffers reflect on the paper's past, and what we can learn from it today.
Any newspaper must, by definition, aspire to be the "paper of record," and yet when it came to this newspaper's coverage of gay people and AIDS in the early '80s - when the disease was morphing into a national crisis, and when rights that had been won a decade earlier, after the Stonewall Riots, were once again being jeopardized - The Times's own record was checkered at best. Information about the spread of illness was often scant, judgmental or distressingly vague - even while reporters on the Science desk were trying their best with an ever-evolving story. The social and emotional toll of AIDS and the resulting queer movement were, when covered, often buried in the back of the newspaper (on a page called Styles of the Times), far from national news stories that were deemed important enough for the front page. Famously, it would take President Ronald Reagan more than four years to acknowledge the disease publicly. And it took until 1983 for The Times to run an article about the disease on Page A1, two years after the first reports of symptoms.

When T Magazine chose to devote an issue to the cultural relevance of New York City in the years between 1981 and 1983, it was inevitable that gay people and the disease that disproportionately decimated them would play a major role in our coverage, from the birth of gay literature to the hundreds of creative leaders who changed the culture only to then die prematurely. But we also wanted to re-examine the ways in which The New York Times itself dealt with these issues as they were happening. To reread these articles today is to be struck by how confused and scared and defensive many people must have felt, even those acting from a place of journalistic remove: In Frank Rich's laudatory 1985 review of Larry Kramer's "The Normal Heart," for instance, there's a strange addendum noting that "a spokesman from The New York Times said yesterday that charges in 'The Normal Heart' that The Times suppressed news about AIDS are untrue." To reread these articles is also to be reminded how news coverage shapes perceptions and policies, particularly when it comes to oppressed communities. So we asked six members of the L.G.B.T.Q. community who work for The Times (across various ages and beats) to reflect and report on what the paper got right and wrong in those years, and what we might learn from that troubling history today. - Kurt Soller

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From July 3, 1981, the first article in The New York Times mentioning a "rare cancer." Inset: Jeremy W. Peters

Like most children of the 1980s, I can't remember a time when I wasn't hearing about AIDS. I was in my early teens during the height of the epidemic, and it permeated almost everything in my young consciousness: school, culture, sports and the evening news. This was when the Indiana teenager Ryan White was dying, basketball star Magic Johnson announced he'd contracted H.I.V., Tom Hanks won the Oscar for playing an infected gay man in 1993's "Philadelphia" and the disease became the leading cause of death among Americans aged 25 to 44. At school, the AIDS lexicon was drilled into our heads. We knew by then that you couldn't get it from a toilet seat or a kiss. But we were constantly reminded how we could get it: "Unprotected sex" and "dirty needles" would fill in the blanks on many a health class pop-quiz about "risk behaviors."

I think the disease's ubiquity and the involuntary nature of how we came to know about it was why I was so struck, some 30 years later, when I first came across the 1981 New York Times article that alerted readers to a strange new condition. " Rare Cancer Seen in 41 Homosexuals," read the headline. The story was on Page A20, not exactly prime print real estate, and ran the day before the Fourth of July. The article went on to describe the initial hypotheses doctors were making about this sudden outbreak of a rare cancer, Kaposi's sarcoma - hypotheses that would turn out to be tragically wrong, such as how it might not be contagious or that "there was no apparent danger to nonhomosexuals." It was a bit disorienting to read early, inchoate descriptions of symptoms that soon none of us would mistake. There was the malfunction of T cells that one doctor found in nine of the victims, which was connected to "severe defects in their immunological systems." And the descriptions of telltale AIDS disfigurement: "It appears in one or more violet-colored spots anywhere on the body."

I recently talked to the reporter who wrote that article, my colleague Lawrence K. Altman, a physician with training in epidemiology, who told me what a hindrance it was in those first years of AIDS that people struggled to find the right language. This was true, he said, not just for the government officials and doctors talking about the disease on television and in print, but also for the journalists who had to explain it. In doing so, they often employed the same euphemisms, like "bodily fluids," to substitute for words like semen, leaving the impression that saliva from a kiss might infect you.

AIDS has always been scary to me. But this shed light on a different kind of fear that I hadn't quite contemplated, the kind that gay men before me must have felt as they watched this plague kill their friends and were left wondering whether they would be next. For my generation, it was the known that was so terrifying. We knew that if you somehow caught the disease it might be a death sentence. But we also knew how you caught it and therefore how to avoid it. The fear of the unknown, it dawned on me, would have been far worse.

The flier, sleek and disarming, showed up one day on newsroom bulletin boards in the summer of 1992. It was an invitation in search of a guest list.

"We're having a party.
We'd love to invite you.
But we don't know who you are."

It was the first time that gay people working at The New York Times had publicly advertised one of their pride parties, which had been happening for six years. "The idea that a bunch of gay people from The Times would get together and have a party was remarkable, after so many years of hiding," said Richard J. Meislin, a former reporter and editor, who kept his sexuality secret until the 1980s, when other queer people at the newspaper started to come out.

It wasn't easy to be gay at The Times when Meislin started in 1975 as a copy boy. Many employees felt that A.M. "Abe" Rosenthal, the paper's editor, was homophobic. And the publisher at the time, Arthur "Punch" Sulzberger, had his own blind spots, according to his son. "Abe was part of the challenge. It was one of the issues my father struggled with as well," said Arthur Sulzberger Jr., the publisher since 1992, who recently handed over the reins to his son, A.G. "The way [gay people] were being treated by being forced to be hidden was antithetical to the values of the company and the values of journalism."

For this essay, I spoke with five current and former Times staffers who were among the first people to come out at the paper in the 1980s and beyond, including Donna Cartwright, who in 1998 became the first newsroom employee to come out as transgender. I read Samuel G. Freedman's oral history chronicling the work of Jeffrey Schmalz, who died of AIDS-related causes in 1993 and transformed the paper's coverage of the disease. I watched a video of his memorial service.

What emerged was a picture of a newsroom that often forced its L.G.B.T. journalists to choose between their career ambitions and their desire to have an openly queer life. The Times spent much of the 1980s figuring out how to cover gays as real people with newsworthy problems. It was also deeply unsure of how to deal with its gay employees, whose sexuality may have seemed, to those in management, to be at odds with the pedigree the institution wanted to uphold.

Meislin, for instance, never had control of his own story: He was outed by AIDS, even though he didn't have the disease. After arriving in Mexico City as a correspondent in 1983, he got sick with a mysterious ailment that made his joints ache. The paper sent an editor to check on him, because some people thought he'd contracted H.I.V. He hadn't, and though Meislin recovered within weeks, word of his sexuality reportedly got to Rosenthal's desk. Two and a half years later, Meislin was called back to New York City, cutting short his prestigious stint abroad. "The perception in the newsroom was that I was brought back because I was gay," he said. "And it's one that I shared."

Cartwright, who started at the Times in 1977, said that episode was one of many reasons she didn't come to terms with her gender identity sooner. "If you lived openly as a gay person you were sticking your neck out."

Rosenthal, who died in 2006, denied that Meislin's move had anything to do with his sexuality in an interview with Michelangelo Signorile for The Advocate 26 years ago. "People who are used to being discriminated against will sometimes take certain acts as being discriminatory when they're not," he told the magazine.

Nancy Lee, who eventually became the paper's picture editor, didn't dare put a photo of her girlfriend at her desk when she arrived in 1980. "That was to risk everything," said Lee, who is now the executive editor of The New York Times News Service & Syndicate.

David W. Dunlap, a former Metro reporter and current Times historian, said he added a pullout couch to the Washington apartment he was sharing with his boyfriend during his first job as a clerk to the columnist James Reston in 1975. The idea, he said, was to give the impression that the couch was definitely the place where his roommate slept.

To me, those stories are unavoidably personal. I started at The Times as a clerk to a columnist in 2012, while I was figuring out that I was a lesbian. I never came out to him, because I wasn't sure I wanted him to know. After I left and returned as a reporter three years later, I put a photo of my girlfriend at the time next to my computer.

The path to my comfort, I now know, was paved by people like Lee, who decided to show up to New York's pride parade in the late 1980s with other closeted Times staffers. "We weren't wearing any New York Times gear, but we knew we were at risk," she said. "People were photographing it. You could end up on the news." They had their first pride party in 1987. Sulzberger Jr., then an editor, had started meeting with his gay colleagues several years earlier. "He would take us to lunch and say 'I know you're gay and don't worry about it, you're going to be fine,'" Dunlap said.

In the fall of 1986, Max Frankel replaced Rosenthal as executive editor. Months later, Sulzberger Jr. became assistant publisher, signaling the rise of an avowed progressive on L.G.B.T. issues. The parties doubled, and then tripled in size. AIDS began to kill Timesmen like Robert Barrios, a copy editor; J. Russell King, who helped edit the front page; and Schmalz, who wrote dozens of stories about the epidemic.

The Times had stepped up its coverage of the crisis, but staffers still took issue with the language the paper used to talk about gays. The gay and lesbian caucus, formed by employees in 1993, put out regular bulletins that occasionally addressed language issues. They wanted to be called gays, not homosexuals. (The Times had started to allow the word gay to be used in this context as an adjective in 1987, but the caucus said it should also be used as a noun.) They also asked that the newspaper stop referring to "admitted homosexuals" when it really meant openly gay. "The term connotes confession, criminality and shame," one bulletin said. The point was to get the company to stop insulting a chunk of its readers - and its employees.

Progress happened quickly after the caucus revved up, thanks partly to Sulzberger Jr.'s determination to get The Times out in front of the issue. The company began offering spousal benefits to gay couples in 1994. And in 1998, Cartwright judged the newsroom ready to handle her own coming out, typed and printed on yellow paper and tacked onto more than a dozen bulletin boards throughout the building. "I have decided to resolve a longstanding conflict in my life by beginning to live full time as a woman," the letter said. Cartwright, a former copy editor, remembers hurrying back to her desk after posting the last copy and walking by the clump of people reading what she'd written. Someone looked at her, and smiled. She started showing up to work as Donna six weeks later.

"The only part that was difficult was getting people to stop calling me 'he' and 'him,'" she said. She told someone in human resources, who reminded staff of Cartwright's pronouns, but it just kept happening. One day she realized that she was just being too polite: "One time when someone referred to me as 'he' I got visibly angry about it, and that worked, so I did it a couple of times." She didn't have many problems after that.

The Times gave Cartwright a key to a bathroom on the 11th floor of the building. After she had gender reassignment surgery, she began to use the ladies' room.

When I told her that The Times still doesn't have gender neutral bathrooms, she caught her breath. "They may have decided that I was a unicorn," she said. She suggested quietly letting the paper's leaders know that "The Times is kind of behind the times on this." If asking nicely doesn't work, Cartwright said, we could always get visibly angry. It worked for her.

In July 1981, The New York Times reported that 41 gay men in New York and California had been diagnosed with a mysterious cancer. It took almost two years, right before Memorial Day weekend in 1983, for The Times to finally dedicate front-page space to the story. Under the headline, " Health Chief Calls AIDS Battle 'No. 1 Priority,'" readers of The Times would learn about a growing catastrophe. There were 558 dead in the United States. There were more than 1,400 cases reported. The fatality rate was through the roof.

The front page of The Times has long held a sacred place in the media. Back then, seven or eight stories, filed from Washington and around the world, would set the day's agenda. For decades, TV morning-news producers have used the front page as a guide to mapping out top stories. And yet roughly 700 editions of the paper had come and gone before AIDS, quickly turning into a full-fledged crisis, had earned a spot on Page One. It was never lost on AIDS activists just how vital the paper was - and for how long it did not pay serious attention to the disease.

"Are you kidding?" emailed Larry Kramer, the activist and writer. "The front page of The New York Times is the most important real estate in the world for getting any issue out. As The Times goes, so will every other news outlet all over the globe."

So why was The Times seemingly indifferent to the story for so long?

The paper's Science desk, which was responsible for reporting on outbreaks at the time, was overtaxed in the early 1980s, and it did not help that identifying the cause of AIDS was a slow burn. "Science news was running as fast and freely as Trump is today," said Lawrence K. Altman, the Times reporter who wrote the rare cancer story and still works at the paper. He cited stories the desk covered about President Reagan and Pope John Paul II getting shot, along with advances being made with the artificial heart.

If the burden was then on other sections at the paper, top editors were less than enthusiastic about surfacing the story. "There were strong messages that you got that were not written on any whiteboard," said David W. Dunlap, a reporter in the Metro section at the time. "You knew to avoid it. It was a self-reinforcing edict: Don't write about queers."

And then there was Kramer's perspective: "Every friend I had from those days is now dead because it was no secret that Abe Rosenthal hated homosexuals," he said, referring to the paper's executive editor at the time. "This is the chief reason why I hate The New York Times."

By the time The Times did give AIDS front-page attention, it did so with a bit of a stiff arm. Though public health officials were now going on the record to discuss the disease's devastation, there was reluctance to discuss whom it affected most. In that first front-page story, it took seven paragraphs - which appeared after the jump, or inside the paper - to mention how hard it was hitting gay men.

Max Frankel, the former editorial page editor at the paper, which operated separately from the newsroom, said this was in keeping with the paper's ethos at the time: "They were being squeamish for some reason," Frankel said, speaking of the newsroom. "Their squeamishness was actually damaging to the public understanding of what was going on."

Frankel, who would take over the newsroom in 1986 as executive editor, said the editorial department was quicker than the news columns to describe "anal intercourse" as a means of spreading the disease. "Whatever their rules were down there, we said we're going to do it our way," he said. "That was the approach."

On June 16, 1983, AIDS would land on Page One for a second time, under the headline " Homosexuals Confronting a Time of Change." The story, which ran longer than 3,000 words, examined a wave of anxiety hitting New York gay men, and took a broader look at what their lives had been like since the Stonewall Riots in 1969.

By that point, the death toll was fast approaching 600 people.

Newspapers can be funny places. Writers know. Take the premium placed on brevity, concision and economy. Saying more with less, it's called. Good advice. Maddening rigorousness. Depends on the day. But sometimes it hits a snag. In order to say "SYTYCD," for instance, it's probably helpful to use "So You Think You Can Dance?" first. The show needs a proper name before a concise one. For three decades, though, newspapers - this newspaper - made an exception. There's nothing more concise than AIDS. It names a larger disease: acquired immune deficiency syndrome. But, really, "AIDS" gets the job done. Only, it was an improper name. And so it often went unused, since it named an impropriety.

When the choreographer Alvin Ailey died in December of 1989, his obituary made the front page. The headline was accurate but bloodless: " Leading figure in modern dance." (Cristal: leading bubbly wine of France.) But it was the cause of death that was cause for concern: "Dr. Albert Knapp, Mr. Ailey's physician, attributed his death to terminal blood dyscrasia, a rare disorder that affects the bone marrow and red blood cells." AIDS would have been the more economic choice. Ailey died of AIDS. But terminal blood dyscrasia? Rare disorder? They tell a story - of tremendous suffering, certainly, but of intense trepidation, too.

Search for the Times obituary of anyone who we now know died of AIDS during the 1980s (and beyond). You'll often find they died of something else. "Hospitalized earlier this month for a neurological disorder, but the cause of his death was not immediately disclosed" ( Michel Foucault, 1984). "Died at 1:30 A.M. of viral encephalitis, an inflammation of the brain, after having slipped into a coma several days ago" ( Perry Ellis, 1986). Saying less with more.

Medically, it's not really AIDS that kills you. AIDS acts as a doorjamb for other diseases to traipse in and ravage a body. But the average obituary noted what traipsed but omitted what made the traipsing possible. "AIDS-related" rarely appeared - nor did coverage of the deaths of black people and Latinos.

Occasionally, things would be called as they were. When the incandescent light of underground theater Ethyl Eichelberger died in 1990, one of his leading ladies "said that he had AIDS and had committed suicide by slashing his wrists."

The exceptions to euphemism are notable: Women, for instance, even a trans woman, like the actress Elizabeth Eden, who died in 1987. When the art critic, actress and advice columnist Cookie Mueller died at 40, in 1989, her brief notice in the paper named the cause as "pneumonia resulting from AIDS," which was the same explanation for Eden's cause of death.

Newspapers can be funny places. So can people. The omission of AIDS wasn't necessarily an editorial judgment. It's often up to the families and friends and physicians of the deceased to state how they died. In a real power move, the dying could name their cause of death. To see Roy Cohn die in "Angels in America" is to know that. Liver cancer was his preferred cause of death, not the complications from AIDS that actually killed him. That was for homosexuals, a label he swore he was too good for. AIDS killed people. But it also threatened to kill pride. Families, friends and co-workers died of embarrassment. No one wanted to go to an AIDS funeral. Hence the euphemisms and the workarounds. There was only so much they could cover up, of course, since lots of people went to too many AIDS funerals.

And so a disease of the body spawned a disease of good - appallingly good - manners. The shame of AIDS endured, in part, because we were too uptight, too judgmental, too fearful to call it by its name. But this paper - and to some extent the culture - has shaken free of those old misgivings. Being on the other side of a crisis helps with that. When the theater composer Michael Friedman died of AIDS-related causes last year at 41, the paper not only said so, it devoted a long and searching story, by Michael Paulson, to the matter of how and why.

Oskar Eustis, the artistic director of the Public Theater, told Paulson that Friedman's death was "a real warning shot across the bow for anybody who thinks this disease isn't deadly any more." People were speaking of distress - and they were in distress about a disease that still kills. Writing in The New York Times Magazine last year, Linda Villarosa detailed how the disease is still ravaging black gay and bisexual American men at rates higher than anyplace else on the planet. And when she did, she said AIDS.

The Mine Shaft, closed by the New York City Department of Health in Nov. 1985. Inset: Adam Nagourney. Credit... Yvonne Hemsey/Getty Images

It was a world that thrived in the shadows of New York - late at night, hidden on dark streets behind barely-marked doorways, typically guarded by a man sitting on a stool under a light bulb. What took place inside ranged from questionable to outright illicit: the full-service bar that kept serving drinks after 4 a.m., the open use of cocaine and marijuana and, in many cases, the anonymous and often marathon sexual encounters among gay men. Sex clubs, bathhouses, back rooms, movie theaters, after-hours bars, dance clubs - places like Alex in Wonderland and the Mine Shaft and the New St. Marks Baths, all part of New York in the 1970s and early 1980s. This was a culture that was known to some of gay New York, but arguably not most of it. And it certainly was not known to most of straight New York.

The AIDS epidemic changed all that. Almost overnight, as panic spread and Governor Mario M. Cuomo issued regulations in late 1985 to close down establishments where unsafe sexual activity took place, this underground world came crashing to the surface. A battery of city inspectors, police officers and reporters went in undercover to see for themselves what was going on behind those doors - and shared their findings with the public. "The Case for Closing Bathhouses: Night Visit by Post Reporter Reveals Shocking Evidence," read a New York Post headline over a 1985 story that described, in considerable detail, what the reporter saw and heard as he moved through the dark warren of a bathhouse. It was part of stream of columns and editorials - not to mention grainy video from local news cameras that had been secreted into the clubs - that was turning up the pressure on public officials.

And while The New York Times was sluggish on reporting the first stirrings of the AIDS epidemic, it quickly jumped on the train as the story became something of a frenzy: voyeuristic and yet significant at the same time. "Guests paid a $12 'membership' fee and were asked to sign a form pledging to engage only in 'safe sex' involving no exchange of bodily fluids," read a 1985 Times report on a club known as the Hell Fire that catered to a straight and gay crowd with an interest in sadomasochism. "Signs on the walls listed the club rules, which included 'no bullwhips, electric prods or animals' and 'no touching without permission.'"

These were uncomfortable times for many of the people drawn into this: There were the city inspectors who spent hours compiling firsthand reports that were detailed if at times unnerving. ("Two of the inspectors said they heard sounds of whipping and moaning, but did not investigate 'for reasons of personal safety,' a 1985 Times story said.) There were the elected officials, who had to explain - and justify - evolving policies as they navigated a politically fraught epidemic transmitted by sexual activity, with terrifying questions around every corner.

It was challenging for news organizations as well, drawn to the story for legitimate reasons (a health crisis) and perhaps less noble reasons (sensationalism) as they struggled with just how explicitly detailed the reports needed to be. And no less discomfited were many in the city's gay and lesbian community, concerned that raising the curtain on a world that most people did not know existed could threaten the gay rights movement after a decade of progress. Some gay leaders decried the city crackdown as an assault on privacy. "Consensual sexual activity by adults out of public view should always be beyond the eye and the arm of government," said Thomas B. Stoddard, the executive director of the Lambda Legal Defense and Education Fund, in 1988. Others considered it a legitimate response to a health emergency. "Is compulsive sexuality freedom?'" Jim Fouratt, one of the city's earliest gay activists, said a few weeks before the city cracked down. "I would argue it's not. All we got was a lot more alienated sexually, and a lot more disease."

Cuomo, whom I covered at the time as a Daily News reporter based in Albany, would seem at times astonished - even ashen-faced - as he learned about this side of New York from inspectors and aides struggling to advise the governor about which kind of sexual practices the state might regulate. Down in the city, Mayor Edward I. Koch was already facing criticism that he was slow to act in combating the epidemic; gay political leaders contended that it was because the mayor, who never married and lived in Greenwich Village, was gay. (At various points in his life, Koch said he was not, or would not answer the question.)

As the mayor and governor were at odds about what to do (sound familiar?), Cuomo's health advisers, after much debate, recommended shutting down establishments that permitted unsafe-sex practices. City Hall pushed back, as many of Koch's aides argued that a crackdown would simply push this kind of behavior into darker corners, making it harder to regulate. Cuomo finally moved, essentially ignoring the mayor as he issued state regulations that would close clubs that permitted these kinds of activities, and leaving it to cities to enforce. Koch resisted at first, contending the order was poorly drafted and difficult to implement: He was obviously aware of how many gay activists viewed this as a civil rights issue, a setback at a time when gay rights seemed to be on the advance.

But Koch's resistance did not last for long: On November 7, 1985, the city closed down the Mine Shaft, the start of a march of enforcement, reported with the exquisitely detailed stories about what had led authorities to act. "In graphic depositions written by city inspectors, a portrait emerged of a dark place with black walls, back rooms, open cubicles without doors and the accouterments of sadomasochism," wrote one story. "They reported seeing many patrons engaging in anal intercourse and fellatio - the 'high risk' sexual practices cited in the state rules." And that was from The Times, which was relatively restrained compared with the rest of the coverage. New York would never quite be the same.

In the mid-2000s, the Thursday section was even nicknamed " Thursgay Styles" by the creative underclass, for its effete coverage of men's fashion and unabashed objectification of the male body. Maybe it was the mandate to cover fashion, night life and subculture, but by the time the Styles section ran its first report on a same-sex commitment celebration in 2002 (two years before same-sex marriage was legalized in Massachusetts), its gay-centric reputation was hard to dispute.

But that wasn't always the case.

At the dawn of the Reagan years, when "Dynasty" introduced one of the first gay characters on prime-time TV, but before Madonna released "Like a Virgin," the Styles of the Times page (yes, it was a single page back then) ran just three articles between 1981 and 1983 that examined gay life in general. That's not counting, of course, the (often closeted) gay characters who flitted in and out of "Notes on Fashion," a weekly column by John Duka, a reporter who went on to help start the publicity firm KCD, before dying from AIDS-related complications in 1989.

Using language that betrays the era's ignorance and discomfort with gay sex, the first Styles piece in that time period, published on May 30, 1983, explored the " special emotional difficulties of AIDS victims." While other sections of the paper covered the science of the disease and, to a much lesser extent, the political ramifications, Styles addressed its emotional toll. In addition to the shock and stigma of a diagnosis, the piece also touched on the fear that people with H.I.V. could somehow "spread AIDS to family, friends or partners." A second article covered the second annual convention of what is now known as PFLAG (the Parents, Families and Friends of Lesbians and Gays) in New York, "where 125 parents of homosexuals from all over the country gathered" to combat prejudice.

But it is a third article, " Of Herpes, AIDS and Fear Of Sex," that reveals the most about the Style section's coverage of queer people in the early 1980s. Published on July 18, 1983, under the rubric "Relationships," it begins with a pointed question: Has the fear of AIDS and herpes led to a decline in promiscuity? Granted, the thesis does adhere to a certain editorial logic. It's the kind of "if true" story that editors - such as I (an editor at Styles) - might propose based on a hunch: If AIDS has led to a fear of sex, then it stands to reason that some people, especially gay men, are having less sex.

The problem was, there was no definitive evidence to support that claim, only the opinions of public health officials who, when asked, were quick to poke holes in the story. They invoked the word "speculation" three times. A hospital supervisor in Brooklyn was even quoted saying the opposite: "We are continuing to see tremendous amounts of sexual activity among adolescents."

So why was this piece published in the first place? One could argue that The Times, which proudly bills itself as a family newspaper, is puritanical to a fault. But it also has to do with simple arithmetic: In 1983, there were few, if any, openly gay reporters on staff, and hardly anyone to challenge stereotypes about gay people. It would take until the next decade before the floodgates would open at The Times, and openly gay men and women would assume positions of leadership in the newsroom. But even that, more than two decades later, hasn't stopped many gay people from debating what, exactly, Styles - and the rest of the Times - gets right about their lives.

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Six Times Journalists on the Paper's History of Covering AIDS and Gay Issues (Published 2018)

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The New York Times had a spotty record of covering the AIDS epidemic in the early 1980s - and gay culture in general. Times staffers reflect on the paper's past, and what we can learn from it today.

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Journal of the International AIDS Society

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The rise of exceptionalism in the West

In the early 1980s, when previously healthy, mostly homosexual young men began dying, the unknown cause and rising numbers of deaths combined with homophobia to generate a response of blame and fear. Extreme religious right-wing advocates spoke of divine punishment for "sinful" lifestyles [ 3]. The disease was initially termed the gay-related immunodeficiency disease (GRID), or "the gay plague" [ 4]. Homosexual men were openly discriminated against when they tried to access health services.

As haemophiliacs, women and children in the West increasingly presented with the same symptoms, it became clear that the cause of illness was not related to sexual orientation. In 1983, the human immunodeficiency virus (HIV) was identified as the cause of AIDS. The realization that HIV could spread to the general public, and that it was linked to the life-giving and pleasurable acts of sexual intercourse, resulted in increased hysteria. Governments, the media and scientists sought a quick response: "A sense of urgency defined the problem, and the public information materials developed in this period often emphasized danger at the expense of clear information about prevention measures" [ 5]. Even as information about modes of transmission (unprotected sexual intercourse, injecting drug use, and from mother to infant) became more accurate, the original fear and stigma prevailed.

The gay rights movement, building on the momentum it had gained in the preceding decades, began campaigning for HIV/AIDS to be viewed as a human rights issue. Advocates argued that infection was not the only risk; if found positive, individuals also faced harmful discrimination [ 6]. In this, they were supported by public health officials, who feared that stigma would prevent those at risk from getting tested, and those infected from accessing health services:

Avoiding compulsory measures such as isolation and quarantine, which were so much a part of the public health tradition, was all the more crucial, since the people with increased risk -- gay and bisexual men, drug users, and their sexual partners -- were already socially vulnerable... Policies and practices that appeared to threaten such persons could only drive the epidemic underground and make it more difficult to work with the populations within which HIV was spreading [ 7].

Recognizing the unique needs of populations at risk of HIV infection, an exceptionalist alliance, including the gay community, liberal and left-wing parties, and the healthcare and psychosocial professions, was formed to advocate for a unique response. Bayer writes, "The embrace of exceptionalism must be understood in broad political terms, as representing in large measure, a singular victory on the part of gay men, their community-based organisations and their allies" [ 8]. The alliance promoted the empowerment of those groups most at risk, and the assurance that their rights would be protected.

During the 1980s, public health adopted a human rights framework that took societal-based vulnerability into consideration and increasingly became involved in societal transformation efforts [ 5]. HIV/AIDS was positioned as not only a health condition, but also as a social issue that required a political, as well as a medical, response [ 4]. The scientific establishment's control on public health was challenged, and a new type of public health initiative was called for: one that provided counselling, protected privacy, and empowered the patient. Lazzarini summarizes:

Descriptively, exceptionalism posited that in the early years of the HIV epidemic, HIV was considered so different, so "exceptional" in comparison to other communicable diseases that advocates and public health officials agreed that HIV policy should cater to the uniqueness of the epidemic rather than treat it like all other communicable diseases. Supposedly, the argument goes, public fear was so great, the political power of gay men so substantial, and concern over stigmatization so real, that public health authorities abandoned "traditional" approaches to communicable disease control in favor of a civil liberties approach [ 9].

This public health approach helped contain the epidemic among those groups most at risk, and meet, to varying degrees, their specific needs. New infections in the United States fell from approximately 130,000 in 1984 to about 60,000 in 1991 [ 10]. The feared general epidemic never occurred in the West.

The hysteria surrounding HIV/AIDS faded; the media and public policy lost interest. The human rights approach that had previously been revolutionary was integrated into existing public health traditions that included education, technical solutions and regular testing. In 1991, Bayer wrote, "As AIDS has become less threatening, the claims of those who argued that the exceptional threat would require exceptional policies have begun to lose their force" [ 11]. Highly affected communities continued to advocate for the rights of people living with HIV and AIDS (PLHIV) and against stigma, but much of the sense of urgency among the general public was lost.

When antiretroviral treatment (ART) was unveiled at the 1996 International AIDS Conference in Vancouver, Canada, AIDS was transformed into a treatable disease. The advent of treatment shifted Western priorities of response: "The availability of more advanced antiretroviral therapies has made it possible to treat effectively those with HIV infection, thereby increasing the importance of early identification and tracking. These developments establish a strong case for moving beyond HIV exceptionalism and treating HIV antibody tests like other blood tests" [ 12].

As technical solutions of testing and treatment gained priority, the social movement that had spurred the early HIV/AIDS response continued to fade from public awareness. This shift was assisted by a rapid fall in the price of the drugs. Had they remained expensive, AIDS exceptionalism would have been perpetuated. As Casaratt and Lantos noted, "Medical therapy has become more effective but also prohibitively expensive. A medical tragedy has been transformed into a financial crisis and society has responded by establishing special programs and sources of funding for AIDS. These manoeuvres parallel earlier approaches to HIV testing and reporting that have collectively come to be known as exceptionalism" [ 13]. The mobilization of resources to make treatment available in the West altered HIV/AIDS from a lethal disease to a manageable chronic illness. By 2000, AIDS exceptionalism, as it had originally been conceived, was over.

Throughout the rise and fall of Western AIDS exceptionalism, the growing global epidemic remained largely ignored by the international community [ 14]. During the 1980s, reports from Africa of similar diseases and symptoms were ignored [ 15]. There were few attempts, and even resistance, to linking HIV/AIDS to "slim disease", as it was called in central Africa [ 14]. When the African AIDS epidemic was finally recognized, in the late 1980s, little international attention or resources were forthcoming. In 1990 and 1991, only 6% of the total global spending for HIV prevention went to the developing world [ 16]. For international organizations, after the first fears of a Western rampant unstoppable epidemic were allayed, HIV/AIDS was not a priority.

The Global Programme on AIDS in the World Health Organization (WHO) lacked both the funding and capacity to respond to the epidemic. Outside of WHO, HIV/AIDS was not on the agenda of other United Nations (UN) agencies. International responses between 1986 and 1996 were characterized by denial, underestimation and over-simplification [ 17]. AIDS exceptionalism was originally a Western-focused phenomenon that advocated for the rights of those most affected and became a decreasing public force as effective treatment was rolled out in North America and Europe.

International exceptionalism

In 1996, UNAIDS was formed as a joint programme of UN agencies engaged in the AIDS response [ 17]. In 1998, it published its first set of comprehensive data on HIV/AIDS, demonstrating the global scale of the epidemic, and increasing awareness about the generalized epidemic in parts of sub-Saharan Africa. Such data provided an information arsenal for those advocating for increased resources for HIV/AIDS in mid- and high-prevalence developing countries [ 17]. UNAIDS, adopting public health rhetoric from the early AIDS response in the West, stressed the need for comprehensive responses that reached beyond a medical approach, and began advocating for increased funding for AIDS programmes [ 18]. During the same period, donor countries began to scale up international aid contributions. General overseas development assistance increased from US$53.6 billion in 2000 to US$61.1 billion in 2003 [ 19]. This aid was targeted towards issues perceived as "global", such as poverty, debt relief and communicable diseases.

HIV/AIDS gained prominence among these issues through the language of securitization and globalization. In 2000, US Vice President Al Gore said, "It [HIV] threatens not just individual citizens, but the very institutions that define and defend the character of a society... It strikes at the military, and subverts the forces of order and peacekeeping" [ 20]. The US National Intelligence Council then produced The Global Infectious Disease Threat and Its Implications for the United States [ 21]. Six months later, the UN Security Council passed Resolution 1308, stating, "The HIV/AIDS pandemic, if unchecked, may pose a risk to stability and security" [ 22]. In 2001, UN Secretary General Kofi Annan called for a "war chest" of $7-10 billion to address the global HIV/AIDS crisis [ 23].

The Pretoria-based Institute for Security Studies wrote, "The severe social and economic impact of HIV/AIDS, and the infiltration of the epidemic into the ruling political and military elites and middle classes of developing countries may intensify the struggle for political power to control scarce state resources. Such dynamics, even singularly, have the potential to lead to political instability" [ 24].

It was argued that HIV/AIDS could hinder processes of democratization by undermining social development and intensifying the struggle for resources. It was further suggested that AIDS orphans could contribute to social unrest as they made likely recruits for terror and rebel groups: "Bluntly put, those who are orphaned may be indifferent to prevailing norms and values, may look for salvation to millenarian and fundamentalist beliefs of one kind or another, and may ultimately do this with assistance from a Kalashnikov or a bomb" [ 2].

While there was little evidence to actually link HIV/AIDS prevalence and security issues [ 25], the discourse of global threats drew international attention to the epidemic. Barnett and Prins write, "The combination of AIDS, orphans and terror begins to take on an independent life, perhaps regardless of either the strength of the evidence or the precise value of the parallel" [ 25]. HIV was seen as a virus that could have widespread repercussions for the most affluent and powerful, even though risk of infection and disease spread in these populations had abated. The epidemic was positioned as a homogenous issue with impacts for both the developed and developing world.

However, as policy and activists spoke of a global HIV/AIDS epidemic, it became apparent that, like many diseases that are expensive to treat, how this epidemic was experienced differed drastically by region. ART, available from 1996, proved effective in curbing AIDS deaths in those regions that could afford the high costs of medications (originally more than $25,000 per patient per year). In those countries with mid to high HIV/AIDS prevalence, ART remained unaffordable, even while costs dropped to about $10,000 per patient per year by 2000 and to less than $100 by 2010. A mid to high disease burden combined with lack of health resources in much of the developing world, making the benefits of ART beyond the reach of most domestic health budgets. While AIDS had become a chronic disease in the West, in most of the developing world. it was still a death sentence.

What made this discrepancy unique was the international mobilization that occurred around it, positioning the inequity of treatment access for people living with HIV and AIDS (PLHIV) as an international human rights cause. The International AIDS Conference in Durban in 2000 called for treatment to be rolled out in the developing world and for prices of ART be cut. Activists in South Africa demanded that their government provide universal access to ART, despite political resistance and denial. The governments of India and Brazil took on the World Trade Organization, arguing for compulsory licensing that would enable them to manufacture cheaper generic medications. Activists in the United States, largely led by the PLHIV organization, ActUp, began a sustained campaign against the US government's support for pharmaceutical companies' patent legislation [ 26].

Arguments that ART could not be provided in the developing world due to limited capacity and poverty were challenged by the successful implementation of such programmes by health organizations like Médecins Sans Frontières [ 27]. Researchers found that people living in poverty adhered to medication regimes just as consistently, if not more so, as those living in the developed world. Economists argued that the benefits of ART (keeping populations healthy for longer) outweighed the costs of treatment [ 28], adding further fuel to the human rights argument.

In 2002, Botswana implemented the first universal access programmes in sub-Sahara Africa. In 2003, the South African Government gave in to local and international pressure and announced its public treatment programme. The World Health Organization launched the "3 × 5" campaign, aiming to place 3 million people on treatment by 2005. In 2006, 111 countries committed to achieving universal access to prevention, treatment, care and support by 2010 [ 29].

The development of international AIDS programmes combined with a favourable political environment to create a new discourse of AIDS exceptionalism. At the 2001 UN General Assembly Special Session on AIDS, 189 nations agreed that HIV/AIDS was a national and international development issue of the highest priority [ 30]. This translated into increased international funding for HIV/AIDS programmes. In 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria was established. In 2003, US President George W Bush pledged $15 billion toward PEPFAR. In 2004, Kofi Annan prioritized HIV/AIDS, stating, "AIDS is a new type of global emergency--an unprecedented threat to human development" [ 30].

In 2004, at the Copenhagen Consensus, a policy think tank in Denmark, a panel of eight prominent economists ranked controlling HIV/AIDS as the number one economic priority in terms of a cost-benefit analysis in health and nutrition [ 14]. UNAIDS Executive Director Peter Poit encapsulated the exceptionalist point of view, saying, "This pandemic is exceptional because there is no plateau in sight, exceptional because of the severity and longevity of its impact, and exceptional because of the special challenges it poses to effective public action" [ 31]. The world had realized the size and impact of the AIDS epidemic, and was treating it as an emergency.

The end of AIDS exceptionalism?

Arguments against exceptionalism began to gain attention in 2007. The amount of funding allocated to HIV/AIDS was called into question, as were the types of programmes being implemented. Three important books put forward new arguments. Chin and Pisani focused on the Asian experience, suggesting that scientists, UNAIDS and AIDS activists accept certain myths about HIV epidemiology to maintain the political profile of AIDS, and their own jobs [ 32]. Pisani spoke of resources for HIV/AIDS programmes disappearing down an "ideological drain" [ 33]. They suggested the epidemic was overstated, and money and resources were being deployed in situations where HIV would not spread anyway. Epstein's The Invisible Cure focused on the African epidemic, suggesting that one of the main drivers of the epidemic in hyper-epidemic countries was concurrent sexual partnering, but that such sensitive social issues had not been openly or adequately addressed, despite the resources mobilized for curbing the epidemic [ 34].

The strongest argument against AIDS exceptionalism has centred on the claim that responses undermined health systems in developing countries. In a series of opinion pieces in the British Medical Journal, Roger England argued that HIV/AIDS was not the "global catastrophe" claimed by "AIDS exceptionalists", and that donor aid for HIV/AIDS was disproportionate to the contribution of HIV/AIDS to the global disease burden [ 35]. England asserted that it would have been more cost effective to put the money into bed nets, immunization and dealing with childhood diseases. He accused UNAIDS of creating "the biggest vertical programme in history", which diverted human resources from the public sector, created additional reporting requirements and poorly coordinated donor activities for governments to cope with, and removed national control over spending priorities [ 36]. He wrote:

It is no longer heresy to point out that far too much is spent on HIV relative to other needs and that this is damaging health systems. Although HIV causes 3.7 percent of mortality, it receives 25 percent of international healthcare aid and a big chunk of domestic expenditure... Until we put HIV in its place, countries will not get the delivery systems they need [ 36].

England and others' commentaries highlighted that many diseases and health issues (such as malaria, under-nutrition and respiratory disorders) resulted in more deaths than those related to AIDS in many parts of the world, but were receiving less funding. Whether or not this neglect was because of the prioritization of the AIDS response or due to other factors was hotly contested.

UNAIDS and WHO responded defensively, noting that those against AIDS exceptionalism attributed the UN agencies more power than they had to address the epidemic [ 37]. Research and policy looked to justify the role of HIV/AIDS programmes within broader health and development frameworks. Yu et al argued that HIV/AIDS funding actually increased access to other health resources in many underserved areas [ 38]. A 2007 report by the Institute of Medicine, charged with monitoring PEPFAR, suggested that the vertical HIV/AIDS programme could contribute to improving overall health outcomes [ 39]. These debates have been engaged with in more detail elsewhere [ 40]; here, they indicate that the exceptionalism that was attributed to HIV/AIDS as a global issue was called into question and, occasionally, outright attacked.

The emergence of the most recent exceptionalism debate is concurrent to a shift in donor country spending and priorities. Some donor countries have begun redirecting HIV/AIDS funding; in 2009, the UK Department for International Development reassigned a portion of its AIDS funds to maternal and child mortality programmes and health system strengthening [ 41]. Médecins Sans Frontières reports that The Netherlands cut its HIV/AIDS spending by $70 million [ 27].

As these changes take place, proposals are emerging to reorganize disease-specific funds in new ways. Sachs and Pronyk argue that the Global Fund should increase its mandate to include health systems, maternal and child mortality and neglected tropical diseases [ 42]. Similarly, Ooms et al argue for transforming the Global Fund from a disease-specific fund into a "Global Health Fund" [ 43]. HIV/AIDS is being positioned as one of many health issues requiring global resources. The current and potential impacts for HIV/AIDS programmes resulting from changes in funding patterns have been well discussed [ 27]; here, they represent a current shift away from prioritizing HIV/AIDS as a global issue.

The current AIDS epidemic and response

While the debate on the global exceptionality of AIDS continues, HIV/AIDS will prevent many sub-Saharan African countries from achieving the Millennium Development Goals (MDGs) [ 44]. In high-prevalence countries (those with more than 10% of adults infected: Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Swaziland, Zambia and Zimbabwe), AIDS is the leading cause of death [ 27]. The epidemic has been found to decrease gross domestic product, create food security threats, and negatively impact human resources. The consequent orphaning has created new social costs for the state and for the household to bear; the number of orphans due to AIDS in sub-Saharan Africa increased from 6.5 million in 2001 to 11.6 million in 2007 [ 45]. AIDS is the leading cause of death for women worldwide [ 46], directly impacting MDG three (to promote gender equality and empower women) and goal five (to improve maternal health). The direct link between HIV/AIDS and development in Africa remains.

The number of new HIV infections each year remains unacceptably high, and models of effective prevention programmes are few and far between. In the endemic countries, mass behaviour-change campaigns, such as the ABC (Abstain, Be Faithful and Use Condoms) strategy, have failed to achieve their intended impacts. Advocates are stressing the need to address the systemic contributors to risk and vulnerability.

In South Africa, where one of the largest epidemics continues to unfold, Venter writes that prevention efforts are failing: "500 000 South Africans are infected each year, and there is no sign that this is letting up. In 8 to 10 years' time, as they enter the AIDS stage, these 500 000 South Africans will need ARVs, and this will continue forever until a prevention strategy that works is implemented" [ 47].

In Western countries, though the epidemic is concentrated in specific population groups, infection rates among these groups are stable (but not declining). El-Sadre et al write from the American perspective:

For the past decade, however, progress has been stalled. It had been anticipated that effective antiretroviral therapy, with its suppressive effect on viral replication, would reduce the overall rate of new infections, but this expectation has not been realized. More than half a million Americans became infected with HIV in the past decade, including about 56,000 in the past year [ 10].

The authors advocate for interventions that "address the socioeconomic milieu in which HIV transmission occurs" [ 10]. The social-political and human rights approaches that originally motivated for an exceptional response remain relevant to prevention, but are over-shadowed by technical solutions, such as testing and treatment.

Meanwhile, more than half of those in need still do not have access to treatment, and treatment is posing new challenges for sustainable funding. Most countries with mid to high prevalence cannot afford the cost of treatment without international aid; as aid is reduced or cancelled, treatment programmes are threatened, drug resistance develops and large numbers of PLHIV die. In countries like Uganda, patients are being turned away from treatment clinics due to lack of resources; 300,000 Ugandans in need of treatment are denied their right to health [ 48]. These numbers will continue to grow if both effective prevention and sustainably funded treatment programmes are not forthcoming.

The gap between resources required to implement HIV/AIDS programmes and those available has continued to grow over the past three years [ 49]. In 2009, UNAIDS and WHO predicted that the $25.1 million needed for HIV/AIDS programmes in 2010 would not be forthcoming [ 49]. The total amount of Global Fund grants recommended for funding in 2009 was 35% lower than in 2008 [ 27]. In 2010, US President Barrack Obama increased funding to PEPFAR only minimally, allocating less to the Global Fund than in previous years, and causing HIV/AIDS groups to express concern that the amount allocated would not be enough to reach the targeted number of PLHIV in need of treatment [ 50].

De Waal writes, "Normalization in the sense of adjusting reality to take account of the miseries of AIDS can be found in many places, when it is looked for. Even the statistics become numbing, and when lower-than-expected HIV prevalence is reported, as recently in Kenya and Zimbabwe, it can give the impression that things are 'not so bad' - when 7 to 10 percent of an adult population is living with HIV" [ 3]. While it may be that international opinion has become numbed by the persistence of the AIDS epidemic, it remains, to varying degrees in different regions, a prevalent and lasting feature of the global health landscape.

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In the history of public health, HIV/AIDS is unique; it has widespread and long-lasting demographic, social, economic and political impacts. The global response has been unprecedented. AIDS exceptionalism - the idea that the disease requires a response above and beyond "normal" health interventions - began as a Western response to the originally terrifying and lethal nature of the virus.

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To click on it - then click the top right (download) and then open.

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Rock Hudson was everything a romantic leading man could be in the 1950s and '60s - hunky, clean-cut, extraordinarily handsome - so much so that he ascended to a place where he was considered the "king of Hollywood" and lived in a Beverly Hills mansion nicknamed "The Castle."

But as author Mark Griffin points out in his exhaustive and empathetic biography "All That Heaven Allows" (Harper, 496 pp., ★★★ stars out of four), the actor paid a heavy personal price for his pre-eminence.

Deeply closeted in an era where an openly gay man could never be a celluloid hero, Hudson - a matinee idol of the first order who wooed Elizabeth Taylor, Lauren Bacall, Gina Lollobrigida and Doris Day onscreen and starred most successfully and famously in films like "Giant" and "Pillow Talk" - spent his life and career hiding in plain sight.

That's the narrative thrust of this onscreen/offscreen examination of Hudson: "Long before he landed in Hollywood, he understood that if he wanted to be accepted, the very essence of who he was would have to be edited out of the frame."

And that's exactly what Hudson did, until the public disclosure of his AIDS diagnosis shortly before his death in 1985 at age 59, cast him in a new role as the face of a global and much misunderstood pandemic.

Griffin fills in what's left to say in between the lines with an impressive list of interviews with movie star friends, acquaintances and co-stars and digs deep into private journals and correspondence.

Among the themes and highlights, most of them known but gaining heft in detail:

1. Hudson's childhood was brutal.

He was born Roy Scherer Jr. in Winnetka, Illinois, in 1925. Hudson's biological father abandoned his mother, Katherine, and his stepfather, Wallace Fitzgerald, was physically abusive - including, Hudson once said, when he told Fitzgerald he wanted to be an actor. "From an early age," Griffin writes, "he learned that you could talk about pretty much anything - except what you truly felt and what you really wanted. Like a father."

2. His brief marriage to Phyllis Gates was meant to keep scandal sheets at bay.

Gates, secretary to Hudson's notoriously predatory agent, Henry Wilson - the man who "invented" Rock Hudson - may or may not have known Hudson was gay. What is known is that the public was openly wondering why Rock Hudson wasn't married and Confidential Magazine was intent on exposing him. "Henry Wilson knew that there was only one way to silence all of the rumors about Hudson's homosexuality," Griffin writes. "It was time for Rock to get married. And fast."

3. Many of the characters Hudson played were deeply conflicted.

Whether Hudson was playing the hero, the lover or even the science experiment, many of the characters were, on some level, conflicted. Griffin speculates that it's more than likely that Douglas Sirk, who directed Hudson in such films as "Magnificent Obsession," "All That Heaven Allows" and "Written on the Wind," "certainly knew the score about Hudson, (and) nudged his leading man toward characters who are in the throes of an identity crisis."

4. He may have fathered a child during his days in the Navy.

In 2014, a woman named Susan Dent sued Hudson's estate claiming to be Hudson's daughter and wanting "no financial remuneration but only an order establishing paternity." According to Griffin, Hudson's adoptive sister had a letter from Hudson to a friend that "tells his friend everything." Furthermore, Griffin says, "more than one individual interviewed for this book insisted that while Hudson was in the Navy he fathered two daughters - by two different mothers - though no evidence has been produced to support these claims."

5. When his AIDS diagnosis was still a secret, Hudson informed former lovers anonymously.

It fell to one of Hudson's closest friends, George Nader, to deliver the news, which took the form of an anonymous letter sent to four people with whom Hudson had sexual relations before his diagnosis. The letters, which were mailed by Nader from Palm Springs so recipients would not trace them back to Hudson, read as follows: "We recently had sex together and I have been informed by my doctor that I may have AIDS. Please go to your doctor and have a check-up." According to Nader's partner, Mark Miller, "Only one person ever responded ..." It was a 22-year-old man from New York whom Hudson had a fling with. The man found out the next day he had AIDS, and, having guessed the identity of the correspondent, sold his story to one of the tabloids for $10,000. "He died six months later," according to Miller, who added, "His name was Tony."

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New Rock Hudson biography reveals the secrets the closeted star tried to hide

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Rock Hudson was everything a romantic leading man could be in the 1950s and '60s - hunky, clean-cut, extraordinarily handsome - so much so that he ascended to a place where he was considered the "king of Hollywood" and lived in a Beverly Hills mansion nicknamed "The Castle."

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Today, if someone is diagnosed with HIV, he or she can choose among 41 drugs that can treat the disease. And there’s a good chance that with the right combination, given at the right time, the drugs can keep HIV levels so low that the person never gets sick.

That wasn’t always the case. It took seven years after HIV was first discovered before the first drug to fight it was approved by the U.S. Food and Drug Administration (FDA). In those first anxious years of the epidemic, millions were infected. Only a few thousand had died at that point, but public health officials were racing to keep that death rate from spiking — the inevitable result if people who tested positive weren’t treated with something.

As it turned out, their first weapon against HIV wasn’t a new compound scientists had to develop from scratch — it was one that was already on the shelf, albeit abandoned. AZT, or azidothymidine, was originally developed in the 1960s by a U.S. researcher as way to thwart cancer; the compound was supposed to insert itself into the DNA of a cancer cell and mess with its ability to replicate and produce more tumor cells. But it didn’t work when it was tested in mice and was put aside.

Two decades later, after AIDS emerged as new infectious disease, the pharmaceutical company Burroughs Wellcome, already known for its antiviral drugs, began a massive test of potential anti-HIV agents, hoping to find anything that might work against this new viral foe. Among the things tested was something called Compound S, a re-made version of the original AZT. When it was throw into a dish with animal cells infected with HIV, it seemed to block the virus’ activity.

The company sent samples to the FDA and the National Cancer Institute, where Dr. Samuel Broder, who headed the agency, realized the significance of the discovery. But simply having a compound that could work against HIV wasn’t enough. In order to make it available to the estimated millions who were infected, researchers had to be sure that it was safe and that it would indeed stop HIV in some way, even if it didn’t cure people of their infection. At the time, such tests, overseen by the FDA, took eight to 10 years.

Patients couldn’t wait that long. Under enormous public pressure, the FDA’s review of AZT was fast tracked — some say at the expense of patients.

Scientists quickly injected AZT into patients. The first goal was to see whether it was safe — and, though it did cause side effects (including severe intestinal problems, damage to the immune system, nausea, vomiting and headaches) it was deemed relatively safe. But they also had to test the compound’s effectiveness. In order to do so, a controversial trial was launched with nearly 300 people who had been diagnosed with AIDS. The plan was to randomly assign the participants to take capsules of the agent or a sugar pill for six months. Neither the doctor nor the patient would know whether they were on the drug or not.

After 16 weeks, Burroughs Wellcome announced that they were stopping the trial because there was strong evidence that the compound appeared to be working. One group had only one death. Even in that short period, the other group had 19. The company reasoned that it wouldn’t be ethical to continue the trial and deprive one group of a potentially life-saving treatment.

Those results — and AZT — were heralded as a “breakthrough” and “the light at the end of the tunnel” by the company, and pushed the FDA approve the first AIDS medication on March 19, 1987, in a record 20 months.

But the study remains controversial. Reports surfaced soon after that the results may have been skewed since doctors weren’t provided with a standard way of treating the other problems associated with AIDS — pneumonia, diarrhea and other symptoms — which makes determining whether the AZT alone was responsible for the dramatic results nearly impossible. For example, some patients received blood transfusions to help their immune systems; introducing new, healthy blood and immune cells could have helped these patients battle the virus better. There were also stories of patients from the 12 centers where the study was conducted pooling their pills, to better the chances that they would get at least some of the drug rather than just placebos.

And there were still plenty of questions left unanswered about the drug when it was approved. How long did the apparent benefits last? Could people who weren’t sick yet still benefit? Did they benefit more than those further along in their disease?

Such uncertainty would not be acceptable with a traditional approval, but the urgent need to have something in hand to fight the growing epidemic forced FDA’s hand. The people in the trial were already pressuring the company and the FDA to simply release the drug — if there were something that worked against HIV, they said, then it was not ethical to withhold it.

The drug’s approval remains controversial to this day, but in a world where treatment options are so far advanced it can be hard to imagine the sense of urgency and the social pressure permeating the medical community at the time. AIDS was an impending wave that was about to crash on the shores of an unsuspecting — and woefully unprepared — populace. Having at least one drug that worked, in however limited a way, was seen as progress.

But even after AZT’s approval, activists and public health officials raised concerns about the price of the drug. At about $8,000 a year (more than $17,000 in today’s dollars) — it was prohibitive to many uninsured patients and AIDS advocates accused Burroughs Wellcome of exploiting an already vulnerable patient population.

In the years since, it’s become clear that no single drug is the answer to fighting HIV. People taking AZT soon began showing rising virus levels — but the virus was no longer the same, having mutated to resist the drug. More drugs were needed, and AIDS advocates criticized the FDA for not moving quickly enough to approve additional medications. And side effects including heart problems, weight issues and more reminded people that anything designed to battle a virus like HIV was toxic.

Today, there are several classes of HIV drugs, each designed to block the virus at specific points in its life cycle. Used in combination, they have the best chance of keeping HIV at bay, lowering the virus’s ability to reproduce and infect, and ultimately, to cause death. These so-called antiretroviral drugs have made it possible for people diagnosed with HIV to live long and relatively healthy lives, as long they continue to take the medications.

And for most of these people, their therapy often still includes AZT.

Contact us at letters@time.com.

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The Story Behind the First AIDS Drug, Approved 30 Years Ago

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The first AIDS drug was approved on March 19, 1987-but getting there was by no means easy. Here's the story behind the treatment.

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39.0 million [33.1 million-45.7 million] people globally were living with HIV in 2022.

1.3 million [1 million-1.7 million] people became newly infected with HIV in 2022.

630 000 [480 000-880 000] people died from AIDS-related illnesses in 2022.

29.8 million people were accessing antiretroviral therapy in 2022.

85.6 million [64.8 million-113.0 million] people have become infected with HIV since the start of the epidemic.

40.4 million [32.9 million-51.3 million] people have died from AIDS-related illnesses since the start of the epidemic.

People living with HIV

In 2022, there were 39.0 million [33.1 million-45.7 million] people living with HIV.

37.5 million [31.8 million-43.6 million] adults (15 years or older).

1.5 million [1.2 million-2.1 million] children (0-14 years).

53% of all people living with HIV were women and girls.

86% [73- >98%] of all people living with HIV knew their HIV status in 2022.

About 5.5 million people did not know that they were living with HIV in 2022.

People living with HIV accessing antiretroviral therapy

At the end of December 2022, 29.8 million people were accessing antiretroviral therapy, up from 7.7 million in 2010.

In 2022, 76% [65-89%] of all people living with HIV were accessing treatment.

77% [65-90%] of adults aged 15 years and older living with HIV had access to treatment, as did 57% [44-78%] of children aged 0-14 years.

82% [69-95%] of women aged 15 years and older had access to treatment; however, just 72% [60-84%] of men aged 15 years and older had access.

82% [64-98%] of pregnant women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to their child in 2022.

New HIV infections

New HIV infections have been reduced by 59% since the peak in 1995.

In 2022, 1.3 million [1 million-1.7 million] people were newly infected with HIV, compared to 3.2 million [2.5 million-4.3 million] people in 1995.

Women and girls accounted for 46% of all new infections in 2022.

Since 2010, new HIV infections have declined by 38%, from 2.1 million [1.6 million-2.8 million] to 1.3 million [1 million-1.7 million] in 2022.

Since 2010, new HIV infections among children have declined by 58%, from 310 000 [210 000-490 000] in 2010 to 130 000 [90 000-210 000] in 2022.

AIDS-related deaths

AIDS-related deaths have been reduced by 69% since the peak in 2004 and by 51% since 2010.

In 2022, around 630 000 [480 000-880 000] people died from AIDS-related illnesses worldwide, compared to 2.0 million [1.5 million-2.8 million] people in 2004 and 1.3 million [970 000-1.8 million] people in 2010.

AIDS-related mortality has declined by 55% among women and girls and by 47% among men and boys since 2010.

Key Populations

Globally, median HIV prevalence among the adult population (ages 15-49) was 0.7%. However median prevalence was higher among key populations

2.5% among sex workers

7.7% among gay men and other men who have sex with men

5.0% among people who inject drugs

10.3% among transgender persons

1.4% among people in prisons.

Women and girls

Globally 46% of all new HIV infections were among women and girls (all ages) in 2022.

In sub-Saharan Africa, women and girls (all ages) accounted for 63% of all new HIV infections. In all other geographical regions, over 70% of new HIV infections in 2022 occurred among men and boys.

Every week, 4000 adolescent girls and young women aged 15-24 years became infected with HIV globally in 2022. 3100 of these infections occurred in sub-Saharan Africa.

Testing and treatment targets (95-95-95)

In 2022, 86% [73- >98%] of all people living with HIV knew their HIV status. Among people who knew their status, 89% [75- >98%] were accessing treatment. And among people accessing treatment, 93% [79- >98%] were virally suppressed.

Among children ages 0-14 years the 95-95-95 targets were 63% [49% - 86%], 91% [71% - >98%], 81% [63%->98%] Among women, the 95-95-95 targets were: 90% [76->98%], 91% [77->98%], and 93% [79->98%].

Among men, the 95-95-95 targets were: 83% [70-98%] of adult men living with HIV knew their HIV status, 86% [72->98%] were accessing treatment and 94% [79->98%] were virally suppressed.

Among all people living with HIV, 86% [73- >98%] knew their status, 76% [65-89%] were accessing treatment and 71% [60-83%] were virally suppressed in 2022.
Investments

At the end of 2022, US$ 20.8 billion (in constant 2019 United States dollars) was available for the AIDS response in low- and middle-income countries-around 60% was from domestic sources.

UNAIDS estimates that US$ 29 billion (in constant 2019 United States dollars) will be required for the AIDS response in low- and middle-income countries, including countries formerly considered to be upper-income countries, in 2025 to get on track to end AIDS as a public health threat.

Download the full version to view regional statistics, global and regional data

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Global HIV & AIDS statistics - Fact sheet

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Latest AIDS data, HIV data. Preliminary UNAIDS 2021 epidemiological estimates: 37.6 million [30.2 million-45.0 million] people globally were living with HIV in 2020. 1.5 million [1.1 million-2.1 million] people became newly infected with HIV in 2020. 690 000 [480 000-1 million] people died from AIDS-related illnesses in 2020.

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Mr. Reagan was in Philadelphia today to make his first major speech about aids ABC's Sheila cast went with him. President Reagan came to Philadelphia planning to address the aids epidemic. He was still at the airport when he was asked what schoolchildren should be taught about aids. I think that abstinence has been lacking in much of the education and one of the things it's been wrong with too much of our education. Is that no kind of values of right and wrong are being taught. In the east and what's taught in the schools is up to parents and local officials not the federal government. Addressing the Philadelphia college of physicians he said American medicine with federal help. Has made faster progress against aids than it did against polio or hepatitis. Battle against aids has been like an emergency room operation. We've thrown everything we have into it. We've declared aids public health enemy number one I'm determined that we'll find a cure for any. He pointed with pride to federal spending on aids research and education up from eight million dollars in 1981 to 416. Million dollars this year. But he had requested only 213 million congress added the rest. The administration has not put it some money behind its rhetoric confiding this aids epidemic. Even as of last year. With 30000 aids cases the administration was asking the congress to cut back on the funding for research to deal with aids. You have to watch over in the next year to see whether they're real money is put into education and whether the emphasis is on prevention of illness or whether it's on. Their view of morality. His critics may seem more to complain about although the president spoke out publicly on aids today he devises do not expected to do it often. And he has not weighed in on the controversial questions of aids testing and the use of condoms. Sheila cast ABC news Philadelphia.

This transcript has been automatically generated and may not be 100% accurate.

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Video: President Reagan delivers first major speech on AIDS epidemic in 1987

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Mr. Reagan was in Philadelphia today to make his first major speech about aids ABC's Sheila cast went with him. President Reagan came to Philadelphia planning to address the aids epidemic. He was still at the airport when he was asked what schoolchildren should be taught about aids.

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Those We Lost to the AIDS Epidemic (Published 2018)

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A memorial to a small fraction of the thousands of New Yorkers who died of H.I.V./AIDS-related causes.

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AIDS: Sexual Behavior and Intravenous Drug Use.

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AIDS: Sexual Behavior and Intravenous Drug Use.

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Your access to the NCBI website at www.ncbi.nlm.nih.gov has been temporarily blocked due to a possible misuse/abuse situation involving your site. This is not an indication of a security issue such as a virus or attack. It could be something as simple as a run away script or learning how to better use E-utilities, http://www.ncbi.nlm.nih.gov/books/NBK25497/, for more efficient work such that your work does not impact the ability of other researchers to also use our site. To restore access and understand how to better interact with our site to avoid this in the future, please have your system administrator contact info@ncbi.nlm.nih.gov.

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Your access to the NCBI website at www.ncbi.nlm.nih.gov has been temporarily blocked due to a possible misuse/abuse situation involving your site. This is not an indication of a security issue such as a virus or attack.

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HIV and AIDS --- United States, 1981--2000

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Actress Emma Corrin joins the The Crown season 4 cast as a young Diana Spencer, who marries Prince Charles (Josh O'Connor).

As Princess, Diana was famous for her HIV/AIDs advocacy, raising awareness and giving patients hands-on attention in high-profile photos.

Here's the story of how Princess Diana helped to de-stigmatize HIV and AIDS.

Throughout her time as Princess of Wales, Diana Spencer was famous for defying the expectations placed on a British royal. From her iconic fashion looks to her parenting style, Princess Diana's breaks with tradition have become her legacy following her untimely 1997 death. Diana is particularly well-remembered for her years of advocacy on behalf of people with HIV and AIDS. In a time when fear and misinformation ran rampant surrounding the transmission of an illness that was widely associated with gay men, even the simple act of shaking an ill patient's hand was a headline-making moment that helped educate the public on the fact that one couldn't catch the disease that way. Throughout the 1980s and 1990s, Princess Diana used her platform to bust myths about how HIV/AIDS could be contracted, and spent time with people affected by the virus around the world.

Diana's visit with AIDS patients during a 1989 trip to New York is reenacted in The Crown season 4. "In our opinion, Diana was the foremost ambassador for AIDS awareness on the planet and no one can fill her shoes in terms of the work she did," the National AIDS Trust's Gavin Hart told the BBC in the days following her fatal car accident. Here's a look at how Princess Diana helped change the way people thought about AIDS-and how her son Harry has made her mission his own.

Princess Diana's famous 1987 photo was a major AIDS education moment.

On April 9, 1987-six weeks before President Ronald Reagan would make his first public speech about the disease-London's Middlesex Hospital invited Princess Diana to open the Broderip Ward, their first dedicated ward for AIDS and HIV-related diseases.

Though AIDS had been a growing health crisis since cases were first officially reported in 1981, until around 1987 it was barely given its due in terms of research, education, and adequate testing. That's largely because it was disproportionately affecting gay men (newspapers, especially U.K. tabloids, parroted the ugly term "the gay plague" when referring to the disease in headlines). The homophobic stigma around HIV and AIDS, and who was perceived to be the face of it, only served to let it spread unchecked.

Per Time magazine, Diana was nervous about making such a public move when others were not at the time. But she resolved to go, and to be photographed shaking the 10 patients' hands without gloves.

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John O'Reilly, who was a nurse on the Middlesex Hospital AIDS ward, told the BBC in 2017 that the stigma was so severe back then that he didn't even tell people what ward he worked on. "We couldn't attract staff," he said.

"I warmed to her instantly," O'Reilly recalled of Princess Diana at the ward's opening. "She took our consultant down a peg or two, who asked 'do you know what this is?' and he was holding up an X-ray of a chest. She very politely said, 'I'm patron of the British Heart and Lung Foundation, of course I know what an X-ray is.' I thought, good on you. I like that."

Because of the public shaming surrounding the virus, even patients on the ward were hesitant to be in a photograph. Only one man, 32-year-old Ivan Cohen, consented to have his picture taken, from behind.

"This was Diana the Princess of Wales, coming in gloveless and shaking our patients' hands as well as ours," O'Reilly recalled. "That was very moving."

Princess Diana continued to raise AIDS awareness through the 1990s.

The late 1980s and 1990s found Diana supporting various AIDS charities internationally, through appearances and visits to facilities worldwide. That includes her 1989 visit to Harlem Hospital's AIDS unit during her three-day solo trip to New York City, which was seen in The Crown season 4.

In a speech at Children and AIDS Conference in 1991, she encouraged people to give handshakes and hugs of their own to those with the virus. "Heaven knows they need it," she said. "What's more, you can share their homes, their workplaces, their playgrounds, and their toys." She also addressed the fact that for many in affected populations, "AIDS is the last straw in an already heavy burden of discrimination and misfortune."

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That same year, Diana would visit AIDS hospice patients in Toronto, Canada, and in Rio de Janiero, Brazil. The later trip also included a stop at a Sao Paulo hostel for abandoned children, including kids who were HIV-positive or sick with AIDS, delivering ample hugs to residents.

Prince Harry has continued his mom's commitment to the cause.

"When that April, she shook the hand of a 32-year-old man with HIV, in front of the cameras, she knew exactly what she was doing," Prince Harry said during a 2017 speech, accepting an Attitude Legacy Award on his late mother Princess Diana's behalf. "She was using her position as Princess of Wales-the most famous woman in the world-to challenge everyone to educate themselves; to find their compassion; and to reach out to those who need help instead of pushing them away."

With Prince Seeiso of Lesotho, in 2006 Harry jointly co-founded Sentabale, a mental health charity for children and young people affected by AIDS in Lesotho Botswana, and Malawi. In 2016, he underwent two AIDS tests in front of media-the latter alongside fellow advocate Rihanna in her native Barbados-to help normalize the process of getting tested.

Prince Harry leveraged the PR moment as savvily as his mother did back in 1987: It resulted in a five-fold surge in home HIV test orders, according to awareness group the Terrence Higgins Trust via Mashable.

In a 2020 Sentabal charity dinner speech that was his first following his and Meghan Markle's split from Buckingham Palace, , "My work and commitment for this charity, that I founded 14 years ago now, will never falter."
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An Iconic Photo Captures the Moment Princess Diana Changed How People Thought About AIDS

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Actress Emma Corrin joins the The Crown season 4 cast as a young Diana Spencer, who marries Prince Charles (Josh O'Connor). As Princess, Diana was famous for her HIV/AIDs advocacy, raising awareness and giving patients hands-on attention in high-profile photos. Here's the story of how Princess Diana helped to de-stigmatize HIV and AIDS.

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Remembering Diana: Princess meets AIDS patients

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The founding and development of the charity in the 1980s.

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Editor's note: The museum is planning a special display of artifacts to go on view in 2011, commemorating the 30th anniversary of the first reports of HIV/AIDS. The museum's medical sciences collection includes artifacts such as a panel from the AIDS Memorial Quilt, an HIV test kit, anti-viral drugs, prevention posters, and red awareness ribbons.
While researching the big events in 20th century medical history for a timeline the museum is putting together, I found that the drug AZT and the HIV/AIDS epidemic are topics that especially interest me.

AZT, also called Zidovudine (ZVD) and Retrovir, was the first approved HIV/AIDS drug. It is a reverse transcriptase inhibitor. This type of medicine stops the reproduction of DNA and reduces the amount of the virus in the blood (the viral load).

AZT samples in the museum's collections

AZT was approved by the FDA on March 19, 1987. It was approved in record time with only one trial on humans instead of the standard three and that trial was stopped after nineteen weeks. The study was stopped because the patients on the placebo were dying faster and the need for a treatment outweighed the need for full testing.

Pamphlet, "100 Questions and Answers: AIDS", New York State Department of Health, July, 1991.

AZT is a controversial drug. For example, some physicians say that a patient can start taking AZT at any time. Some say the threshold is five hundred CD4 cells (T-cells) or below. Others say never take AZT. AZT is also used to reduce the transmission from mother to child during pregnancy and labor. The pro side says it reduces transmission; the con side says it may cause birth defects. Another issue is whether it makes symptoms worse. The medicine can prolong life but it might also kill healthy cells. There are stories of children dying from AZT.

Would you take a kid out of their home because someone is not giving them their meds? What if you are a mother who already had one child whom you believed had died from the drug's effects- would you give another child the drug or risk have her/him removed from the family? These are questions Valerie Emerson brought up in her 1998 custody battle. This court case was about a mother's right to keep her kid although she did not give prescribed meds. It was considered child abuse. She won her case.

Editor's Note: You can find more information on the history of HIV/AIDS around the Web:
Meecha Corbett is an intern in the Division of Medicine and Science at the National Museum of American History.

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Editor's note: The museum is planning a special display of artifacts to go on view in 2011, commemorating the 30th anniversary of the first reports of HIV/AIDS. The museum's medical sciences collection includes artifacts such as a panel from the AIDS Memorial Quilt, an HIV test kit, anti-viral drugs, prevention posters, and red awareness ribbons.

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According to both the Centers for Disease Control and the National Cancer Institute in Bethesda, Md., GRID has reached epidemic proportions and the current totals probably represent ''just the tip of the iceberg.'' Preliminary results of immunological tests have led some Federal health officials to fear that tens of thousands of homosexual men may have the acquired immune dysfunction and be at risk for developing complications such as Kaposi's cancer, infections and other disorders at some future date.

GRID is ''a matter of urgent public health and scientific importance,'' Dr. James W. Curran, a Federal epidemiologist who coordinates the Centers for Disease Control's task force on Kaposi's sarcoma and opportunistic infections, told the Congressional hearing. Opportunistic infections are those that rarely cause illness except in those whose immunological resistance has been lowered by drugs or disease.

More than human suffering is involved. Hospital costs have reached more than $64,000 per patient, and Dr. Curran said that if such costs are typical, ''the first 300 cases account for an estimated $18 million in hospital expenses alone.''

Experts currently think of GRID as a sort of immunological time bomb. Once it develops, it may stay silent for an unknown period, and then, at a later date, go on to produce Kaposi's sarcoma, an opportunistic infection, a so-called auto-immune disorder, or any combination of these.

Further, no one is certain that the immune disorder can be reversed. Many patients have survived a bout of pneumonia or other illness, only to succumb to another or to go on to develop Kaposi's sarcoma or some other fatal cancer. 'Natural' Immunity Suppressor

GRID resembles the failures of the immunological system that complicate the treatment of many chronic disorders with steroid and other drugs that suppress the immune system. The same problem occurs among recipients of transplanted kidneys and other organs who take the immunosuppressive drugs to help prevent rejection of the organ. With immunity suppressed, the body becomes vulnerable to a variety of problems, chiefly infections by organisms that otherwise rarely cause disease.

GRID, however, is the first naturally occurring outbreak of immune suppression to affect a community of free-living people, in contrast, for example,to an epidemic in a hospital. The degree of immunological suppression is extraordinary, far greater than usually observed in patients treated with immunosuppressive drugs, according to articles in medical journals and interviews with experts.

Those experts are now reporting finding a wider range of disorders than were associated with GRID when it first came to public attention last summer. These include eye damage, lupus, I.T.P. (idiopathic thrombocytopenic purpura), certain types of anemia, and other cancers, including Burkitt's lymphoma and cancers of the tongue and anus.

Doctors are also seeing many cases of a generalized lymph gland swelling throughout the body, together with weight loss, fever and thrush, a fungal infection often found in the mouth and throat.

So far, epidemiologists have found no evidence that the condition is spread from person to person like influenza or measles. Therefore, they say, the general public need not fear an epidemic. Many Causes Are Likely

Rather, Dr. Arthur S. Levine of the National Cancer Institute said, development of the syndrome seems to result from an accumulation of risk factors. Most experts say that if there is an infectious cause, it is not a single organism, but an organism acting together with another factor or factors, perhaps a drug.

Epidemiologists from the Centers for Disease Control have done studies among homosexual men with and without the immune disorder but matched in age, background and other characteristics. After testing for more than 130 potential risk factors, they found that the median number of lifetime male sexual partners for affected homosexual men was 1,160, compared to 524 for male homosexual men who did not have the syndrome. The study also found more use of sexual stimulants and illicit drugs among the GRID patients.

As further evidence against simple contagious spread, epidemiologists note that the syndrome has not spread to other family members, hospital workers or researchers on the disease.

Kaposi's sarcoma was first described in 1872 in Rumania. Until recently, it was rare in the United States, occurring chiefly in older people, usually of Italian or Jewish ancestry, and among patients receiving immunosuppressive therapy. It affected men much more commonly than women by about 15 to one. It usually developed slowly.

In recent decades, however, Kaposi's sarcoma has been found common in Africa, mainly among young people. In equatorial Africa, it accounts for 9 percent of all cancers, and in some areas it is 100 times more prevalent than in the United States. The cancer has not been linked to homosexuals in Africa, and the reasons for its high frequency there are unknown.

In its new form in this country, the course of Kaposi's sarcoma generally has been rapid and fatal. Only about 15 percent of patients treated with a combination of anticancer drugs experience any remission, as compared to the 90 percent complete response in Africa, according to Dr. Levine.

However, it is not just the cancer that is killing GRID patients. Many such patients develop infections with an often fatal parasitic illness called Pneumocystis carinii. Hitherto, that disease has been seen mainly as a complication of treatment of patients with leukemia and other cancers because their immune systems were depressed by chemotherapy.

Others succumb to cytomegalovirus infection or to a fungal infection called toxoplasmosis. By using sophisticated molecular biology tests in which the genetic messages of the various strains can be compared, scientists have found no evidence that the epidemic is due to a deadly new mutant strain.

But the list of infections diagnosed among GRID patients is long, and some of the organisms are so unusual that even the most experienced infectious disease experts have not treated a case in the past. The newest is cryptosporidiosis, a parasitic infection much more familiar to veterinarians than to physicians because it infects deer and other mammals. Why Now and Not Before?

Given the fact that homosexuality is not new, the most puzzling question is why the outbreak is occurring now, and not sometime in the past.

Scientific investigations are wide ranging, although most are focused on viruses, other organisms, drugs, or a combination of such factors.

Because homosexuals affected by GRID have reported using nitrite drugs more frequently than homosexuals who have not, some studies have focused on this class of drugs, which have come into widespread street use since the 1960's,

But although epidemiological studies have not ''totally exonerated nitrites, the scientific evidence to implicate them is quite shaky,'' according to Dr. Curran.

Some experts theorize that the immunological disorder may be triggered by the introduction of sperm or seminal fluid into the blood through sexual contact, though infection and drug reaction are still also candidates.

In studies on mice at the National Cancer Institute, Dr. Ursula Hurtenbach and Dr. Gene M. Shearer have reported that a single injection of mouse sperm into the veins of male mice produced a profound and long-lasting suppression of certain immune functions.

Dr. Lawrence D. Mass, a New York City physician, said that ''gay people whose life style consists of anonymous sexual encounters are going to have to do some serious rethinking.''

The urgent need to discover the cause of the immune system disorder and to prevent the problems it creates has been underscored by Dr. Linda Laubenstein of New York University Medical Center. Dr. Laubenstein, who said she has treated 62 such patients in the last year and who is a leading investigator of the syndrome, summarized it by saying: ''This problem certainly is not going away.''

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NEW HOMOSEXUAL DISORDER WORRIES HEALTH OFFICIALS

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According to both the Centers for Disease Control and the National Cancer Institute in Bethesda, Md., GRID has reached epidemic proportions and the current totals probably represent ''just the tip of the iceberg.'' Preliminary results of immunological tests have led some Federal health officials to fear that tens of thousands of homosexual men may have the acquired immune dysfunction and be at risk for developing complications such as Kaposi's cancer, infections and other disorders at some future date.

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AIDS: THE VICTIMS

Credit... The New York Times Archives

This is a digitized version of an article from The Times's print archive, before the start of online publication in 1996. To preserve these articles as they originally appeared, The Times does not alter, edit or update them.

Occasionally the digitization process introduces transcription errors or other problems; we are continuing to work to improve these archived versions.

More than 32,000 Americans have been diagnosed with AIDS and nearly 60 percent of them have died, sowing sorrow and fear among millions.

But the epidemic has only just begun, medical experts warn. Federal scientists project that by the end of 1991, the total number of cases will reach 270,000, with 179,000 deaths unless better treatments are found. In the year 1991 alone, some 54,000 Americans are expected to die of acquired immune deficiency syndrome, an annual loss comparable to the death toll of the entire Vietnam War.

The epidemic surfaced in 1981 as a puzzling surprise. Doctors in California and New York reported that a few dozen homosexual men had died of Kaposi's sarcoma, a rare form of cancer, and suffered abnormalities of the immune system. Physicians in New York soon realized that they had seen a number of similar, unexplained cases in the previous several years. Soon It Hit Drug Users

Ominously, more such cases were appearing in homosexual men each month. And soon, AIDS appeared among users of illegal intravenous drugs, especially black and Hispanic addicts in New York, Newark and other Northeastern cities who died of a previously rare pneumonia and other diseases brought on by the collapse of the body's disease-fighting ability.

At first, no one knew whether the incurable disorder was caused by an infectious agent or by some other factor common to the life styles of homosexual men and drug addicts.

Drawing on recent advances in the search for cancer viruses, researchers in France isolated a new virus from AIDS patients in 1983. By early 1984, American and French scientists had built a convincing case that the virus was the cause of AIDS.

''Our best guess is that the AIDS virus first infected some homosexual men, probably in New York and San Francisco, in the mid-1970's,'' said Dr. Harold Jaffe, chief AIDS epidemiologist at the Federal Centers for Disease Control in Atlanta. In the same period, research indicates, the AIDS virus was spreading in parts of Africa. The origin of the virus has not been established.

Careful analysis of disease patterns showed that in the United States the virus was spreading through sexual intercourse, most often anal intercourse between homosexual men, and in blood, as on contaminated needles shared by drug addicts and from infected mothers to their babies, before birth. Until early 1985, when a screening system virtually eliminated the danger, the virus was also spread by contaminated medical transfusions and in a clotting factor given to hemophiliacs.

In Africa and in Haiti, a small Caribbean country that for unknown reasons was also hit hard by AIDS, evidence indicated that the virus was transmitted frequently through heterosexual intercourse.

Studies found no evidence that the virus had passed from person to person through close, nonsexual daily contact in the home, school or workplace. That finding has stood the test of time. The Warnings Came Too Late

As evidence grew about how AIDS spreads, health officials issued increasingly urgent warnings about the potential dangers of homosexual intercourse and sharing of intravenous needles. Yet for many, knowledge and changes in behavior came too late. In the early 1980's, the virus swept through the homosexual community, probably infecting half or more of homosexual men in cities like New York and San Francisco. Drug addicts in the Northeast in particular were likewise invaded by the AIDS virus in enormous numbers.

As more women became infected, usually either from contaminated needles or because they had intercourse with a drug user or a bisexual man, so rose the toll among newborns. Nearly 400 children have developed AIDS after being born infected with the virus. The majority of these young victims have been black or Hispanic children from poor urban areas.

Today, Federal officials estimate, up to one and a half million Americans carry the AIDS virus in their bodies. Perhaps one-fourth of them will develop AIDS within five years of their infection, and only time will tell how many will eventually become ill. All carriers of the virus, whether they develop AIDS or not, are presumed to be infected for life and able to pass the virus to others through sexual intercourse or in blood.

With time, the disease has spread well beyond the cities where it first became entrenched; AIDS has now appeared in every state. A central concern today is how widely it has also spread, or might in the future, among heterosexuals not involved with illegal drugs.

So far, nine of ten AIDS patients in the United States have been homosexual or bisexual men or intravenous drug users. Federal experts estimate that from 4 percent to 7 percent of all adult patients were infected through heterosexual intercourse.

Of these suspected heterosexual cases nearly half, 2 percent of the nation's total cases, involve immigrants from Africa or Haiti, where vaginal intercourse is believed to be a common means of transmission. Another 2 percent of all cases involve men and women who became infected through heterosexual intercourse with a partner from a known risk group - a bisexual man, a drug addict or a person infected by blood products. In addition, officials believe, a portion of the 3 percent of the nation's cases in which the source of infection is undetermined may reflect heterosexual transmission. Urgen Calls for Education

Although there is no evidence that the AIDS virus is coursing through the heterosexual population, many experts warn that it could easily spread among those with many sex partners, prompting urgent new calls for nationwide campaigns to educate people about the risks. Research has clearly shown that the virus can be transmitted both from man to woman and from woman to man in vaginal intercourse.

By far the greatest danger, most experts believe, is to those whose lives intersect with the world of drug addiction. ''Infected drug users are the main portal of transmission to other parts of the heterosexual community, and their newborns,'' Dr. Jaffe said in an interview. If the epidemic does spread more widely, the inner-city poor will probably be the foremost victims; the black and Hispanic poor will suffer even more disproportionately from AIDS than they already do. A Global Disaster

As the United States struggles to come to terms with the unfolding tragedy, the disastrous global dimensions of the AIDS epidemic are becoming clearer. The news from Africa has grown steadily worse: the disease is rampant in ever more countries, the toll in lives is already high, and surveys reveal startling rates of AIDS virus infection - close to one in 10 adults in some cities. Evidence suggests that at least one other virus, related to the originally discovered AIDS virus, might also be causing disease in parts of Africa.

Stating that he could ''not imagine a worse health problem in this century,'' Dr. Haldan Mahler, director of the World Health Organization, recently warned that AIDS was ''knocking unpleasantly on the doors of Asia,'' and that it already had a foothold in Brazil and elsewhere in Latin America. In Europe, meanwhile, officials say that the AIDS virus has spread rapidly among drug addicts and homosexual men, and countries there are bracing for a flood of patients and deaths.

Worldwide, W.H.O. estimates, some 10 million people may already be infected with the AIDS virus. Unless powerful preventive measures are enacted, according to the international agency, as many as 100 million people could be infected within five years. ''We're running scared,'' Dr. Mahler said recently.

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AIDS: THE VICTIMS; AIDS, AN UNKNOWN DISEASE BEFORE 1981, GROWS INTO A WORLDWIDE SCOURGE (Published 1987)

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AIDS: THE VICTIMS This is a digitized version of an article from The Times's print archive, before the start of online publication in 1996. To preserve these articles as they originally appeared, The Times does not alter, edit or update them.

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What is HIV?

The human immunodeficiency virus, or HIV, is a virus that attacks the immune system, specifically CD4 cells (or T cells).

The virus is transmitted through bodily fluids such as blood, semen, vaginal fluids, anal fluids, and breast milk. Historically, HIV has most often been spread through unprotected sex, the sharing of needles for drug use, and through birth.

Over time, HIV can destroy so many CD4 cells that the body can't fight infections and diseases, eventually leading to the most severe form of an HIV infection: acquired immunodeficiency syndrome, or AIDS. A person with AIDS is very vulnerable to cancer and to life-threatening infections, such as pneumonia.

Though there is no cure for HIV or AIDS, a person with HIV who receives treatment early can live nearly as long as someone without the virus. And a study in 2019 in the medical journal, Lancet, showed that an anti-viral treatment effectively halted the spread of HIV.

Where Did AIDS Come From?

Scientists have traced the origin of HIV back to chimpanzees and simian immunodeficiency virus (SIV), an HIV-like virus that attacks the immune system of monkeys and apes.

In 1999, researchers identified a strain of chimpanzee SIV called SIVcpz, which was nearly identical to HIV. Chimps, the scientist later discovered, hunt and eat two smaller species of monkeys-red-capped mangabeys and greater spot-nosed monkeys-that carry and infect the chimps with two strains of SIV. These two strains likely combined to form SIVcpz, which can spread between chimpanzees and humans.

SIVcpz likely jumped to humans when hunters in Africa ate infected chimps, or the chimps' infected blood got into the cuts or wounds of hunters. Researchers believe the first transmission of SIV to HIV in humans that then led to the global pandemic occurred in 1920 in Kinshasa, the capital and largest city in the Democratic Republic of Congo.

The virus spread may have spread from Kinshasa along infrastructure routes (roads, railways, and rivers) via migrants and the sex trade.

In the 1960s, HIV spread from Africa to Haiti and the Caribbean when Haitian professionals in the colonial Democratic Republic of Congo returned home. The virus then moved from the Caribbean to New York City around 1970 and then to San Francisco later in the decade.

International travel from the United States helped the virus spread across the rest of the globe.
READ MORE: Pandemics That Changed History: A Timeline
The AIDS Epidemic Arises

Though HIV arrived in the United States around 1970, it didn't come to the public's attention until the early 1980s.

In 1981, the Centers for Disease Control and Prevention (CDC) 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 disease's transmission-as well as that female partners of AIDS-positive men could be infected-in 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.
READ MORE: Pandemics that Changed History
The HIV Test Arrives

In 1984, researchers finally identified the cause of AIDS-the HIV virus-and the Food and Drug Administration (FDA) licensed the first commercial blood test for HIV in 1985.

Today, numerous tests can detect HIV, most of which work by detecting HIV antibodies. The tests can be done on blood, saliva, or urine, though the blood tests detect HIV sooner after exposure due to higher levels of antibodies.

In 1985, actor Rock Hudson became the first high-profile fatality from AIDS. In fear of HIV making it into blood banks, the FDA also enacted regulations that ban gay men from donating blood. The FDA would revise its rules in 2015 to allow gay men to give blood if they've been celibate for a year, though blood banks routinely test blood for HIV.

By the end of 1985, there were more than 20,000 reported cases of AIDS, with at least one case in every region of the world.

AZT is Developed

In 1987, the first antiretroviral medication for HIV, azidothymidine (AZT), became available.

Numerous other medications for HIV are now available, and are typically used together in what's known as antiretroviral therapy (ART) or highly active antiretroviral treatment (HAART).

The regimes work by preventing the virus from multiplying, giving the immune system a chance to recover and fight off infections and HIV-related cancers. The therapy also helps reduce the risk of HIV transmission, including between an infected mother and her unborn child.

The World Health Organization (WHO), in 1988, declared December 1st to be World AIDS Day. By the end of the decade, there were at least 100,000 reported cases of AIDS in the United States and WHO estimated 400,000 AIDS cases worldwide.

HIV/AIDS in the 1990s and 2000s

In 1991, the red ribbon became an international symbol of AIDS awareness.

In that year, basketball player Magic Johnson announced he had HIV, helping to further bring awareness to the issue and dispel the stereotype of it being a gay disease. Soon after, Freddie Mercury -lead singer of the band Queen-announced he had AIDS and died a day later.

In 1994, the FDA approved the first oral (and non-blood) HIV test. Two years later, it approved the first home testing kit and the first urine test.

AIDS-related deaths and hospitalizations in developed countries began to decline sharply in 1995 thanks to new medications and the introduction of HAART. Still, by 1999, AIDS was the fourth biggest cause of death in the world and the leading cause of death in Africa.

HIV Treatment Progresses
WATCH: 30 Years of AIDs Research
In 2001, generic drug manufacturers began selling discounted copies of patented HIV drugs to developing countries, leading to several major pharmaceutical manufacturers slashing prices on their HIV drugs. The following year, the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that AIDS was by far the leading cause of death in sub-Saharan Africa.

In 2009, President Barack Obama lifted a 1987 U.S. ban that prevented HIV-positive people from entering the country.

The FDA approved pre-exposure prophylaxis, or PrEP, for HIV-negative people in 2012. When taken daily, PrEP can reduce the risk of HIV from sex by more than 90 percent and from intravenous drug use by 70 percent, according to the CDC. A major study completed in 2019 showed that over 750 gay men on an anti-viral treatment did not transmit the virus to their partners. "Our findings provide conclusive evidence that the risk of HIV transmission through anal sex when HIV viral load is suppressed is effectively zero," the paper, published in Lancet, stated.

At the end of 2019, some 38 million people were living with HIV/AIDS worldwide, and 940,000 people died from AIDS-related illnesses that year, according to WHO. Sub-Saharan Africa remains the most severely affected region, accounting for nearly two-thirds of the world's current HIV cases.

Sources:

Origin of HIV and AIDS: AVERT.
HIV Originated With Monkeys, Not Chimps, Study Finds: National Geographic.
HIV pandemic originated in Kinshasa in the 1920s, say scientists: The Guardian.
America's HIV outbreak started in this city, 10 years before anyone noticed: PBS.
HIV Testing: CDC.
About HIV/AIDS: CDC.
How HIV spread across the West: CNN.
Obama Lifts a Ban on Entry Into U.S. by H.I.V.-Positive People: The New York Times.
Global Health Observatory (GHO) data: World Health Organization.

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History of AIDS - Epidemic, Timeline & HIV | HISTORY

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HIV and AIDS began spreading among humans in the 1920s and became a public health crisis by the 1980s, before the first effective treatments emerged.

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A lot has changed about HIV/AIDS in the last 30+ years. Learn about the history of HIV/AIDS in the U.S.

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On June 5, 1981, the first published report emerged of five previously healthy young men in Los Angeles diagnosed with what would soon become known as AIDS. One year later, the first AIDS case was reported in Sub-Saharan Africa.