To mark World AIDS Day, we reflect on the progress achieved since 1981, when the Centre for Disease Control and Prevention first reported on what would come to be known as Acquired Immunodeficiency Syndrome – AIDS
Published on Avert.org on 30 November 2021
Research findings from Project SIDA were instrumental in forming much of our current understanding of HIV and AIDS. The project was the brainchild of Peter Piot and Joseph McCormick, and began in 1983 after they visited Kinshasa, DRC, to investigate a surge in cases of Kaposi’s sarcoma and cryptococcal meningitis. It was one of the biggest HIV and AIDS research projects at the time and provided vital evidence that HIV could be acquired sexually, through blood transfusions, and that it could affect anyone and everyone. This extremely important finding helped to cement the truth of how HIV is (and isn’t) transmitted.
Treatment for HIV began with the landmark approval of zidovudine (also known as azidothymidine or AZT) in 1987. AZT helped stop HIV from replicating itself in the body and prolonged the lives of people with advanced HIV and AIDS-defining illnesses, but it came with harmful side-effects. Treatment has advanced substantially since then – in 1996 highly active antiretroviral therapy (HAART) was adopted quickly in rich countries, decreasing the rate of AIDS-related deaths and hospitalisations by 60-80%. This was followed by the approval of the first combination antiretroviral therapy (ART) pill Combivir in 1997, making it easier for people with HIV to adhere to treatment. Since then, a ground-breaking 2011 study proved that using treatment as prevention can provide dual benefits – helping to treat people with HIV and reducing transmission rates at the same time.
Funding and resourcing the response to HIV over the past four decades has involved a level of investment and commitment never seen before with the new exception of COVID-19). In 1996, UNAIDS brought together several United Nations organisations to form a unified approach to HIV and AIDS. By the end of 2001, the Global Fund to Fight AIDS, Tuberculosis and Malaria was set up and within five years it had distributed more than US $30 billion to communities across the world. In 2003, the creation of the United States President’s Emergency Plan For AIDS Relief (PEPFAR) promised US $15 billion to help address HIV, with a strong focus on high burden countries in sub-Saharan Africa.
Breaking through the stigma, discrimination and fear that stopped people from learning the facts of HIV has been a vital part of the response so far, especially for increasing the numbers of people testing and getting treatment. With a new generation coming to sexual maturity the need for relevant, accessible information remains as important as ever to prevent the cycle of HIV continuing.
A new tool was added to the HIV prevention arsenal in 2006 when voluntary medical male circumcision (VMMC) was found to reduce sexual transmission of HIV from women to men by 60%, making it the only one-off intervention that reduces the risk of HIV infection while being highly cost-effective.
Another important moment in HIV prevention came in 2010 when a trial proved that pre-exposure prophylaxis (PrEP) – which uses a course of drugs usually used to treat HIV – was effective in providing protection against HIV infection. This was further supported by convincing results in the UK’s PROUD study in 2015 and many other studies since.
Alongside this, the strengthening of prevention of mother-to-child transmission programmes in sub-Saharan Africa was a huge achievement for countries with generalised epidemics. As for what comes next, there is optimism around the potential of the PrEP vaginal ring, which was endorsed by the World Health Organization earlier this year. More recently, long-lasting injectable treatments have been approved for use in some countries too.
In 2017, the “Undetectable = Untransmittable” slogan is used to spread awareness that those who take antiretroviral treatment regularly, and have achieved an undetectable viral load as a result, cannot pass on the virus to others. This helps to address stigma towards people with HIV.
As is made clear in the latest UNAIDS report: Confronting Inequalities, the HIV epidemic has always been linked to and fuelled by inequalities, and continues to heavily affect marginalised groups. Over the past 40 years, many activists and organisations like GMFA (now known as HERO) and Treatment Action Campaign (TAC) have helped to break down barriers in the HIV response, highlighting the inequalities faced by those affected by the epidemic and speaking out for marginalised groups, including women, LGBT+ people, sex workers, people who inject drugs, and others.
There is much more to do to ensure that marginalised populations who are disproportionately affected by HIV are able to access the support and services they need without fear of stigma, discrimination or recrimination.
Each of the Sustainable Development Goals (SDGs) set by the United Nations General Assembly in 2015 came with specific targets to be achieved by 2030. One key global target was to end the AIDS epidemic by 2030.
While the progress made towards this and the related UNAIDS targets has been promising, it’s clear we need to strengthen efforts if we are to end AIDS as a public health threat over the next nine years. Infection rates are falling but not as quickly as they need to.
It’s vital that we adapt to the needs of a new generation and optimise resourcing, health information and policies to stem the flow of new infections and improve the health outcomes of everyone living with HIV. A key part of this is addressing the inequalities that drive HIV transmission and prevent those affected by HIV from getting the care and support they need.
You can find much more information about the defining moments of the HIV response over the past 40 years on our interactive timeline.
Photo credit: iStockphoto.com/martinedoucet/YakubovAlim
