In a speech given on December 1, 2006, World AIDS Day, Kofi Annan declared HIV/AIDS to be the greatest challenge of our generation. This dreaded infectious disease has claimed the lives of over 25 million people worldwide and infected 40 million more. In the United States alone, 1.2 million are infected with the HIV virus and more than 500,000 have died. No virus has been as well studied or understood as the human immunodeficiency virus, yet we are far from controlling this pandemic.
When the first reference to AIDS was published in the CDC’s Morbidity and Mortality Weekly Report on June 5, 1981, physicians were taken aback by the presence of pneumocystis pneumonia in five previously healthy young men. As more and more cases of unusual opportunistic infections were identified, the medical community felt helpless in the face of this challenge. No one had any idea what was causing this disease, how it was transmitted, or how it could be treated. Before long, pioneers in dealing with this disease discovered that it was transmitted through sexual contact, blood products, and needle sharing and could begin to discourage people from behavior that put them at risk. HIV was identified as the disease-causing agent in early 1984. The next year, the first test to detect antibodies to HIV was developed and the US blood supply was declared to be free of contamination. The numbers of new HIV infections in the US reached their height in the 1980’s at approximately 160,000. Since the 90’s, however, prevention and education efforts have stabilized infection rates around 40,000.
Doctors had nothing to offer their patients until AZT, a nucleoside analog, was approved by the FDA in 1987. By the end of the decade, the first candidate vaccine began testing, the first comprehensive needle exchange program was established, and the Americans with Disabilities Act was expanded to include people living with HIV/AIDS. The CDC announced measures that could be taken to prevent HIV infection and to avoid some of the opportunistic infections common among people with AIDS. While they offered hope, none of these efforts really changed the reality for people living with the disease, and by 1994-1995, AIDS was the leading cause of death among Americans aged 25 to 44. The death sentence for AIDS patients was finally lifted in 1995 when highly active antiretroviral therapy was introduced with the first protease inhibitor, saquinavir. The following year, the FDA approved the first non-nucleoside reverse transcriptase inhibitor, nevirapine, and a viral load test to measure levels of HIV in the body. Since then, these developments have led to a 70% reduction in AIDS-related deaths. While new treatments have revolutionized the face of the AIDS epidemic, drastic changes in epidemiology and populations infected have altered the way people view the disease. Originally seen as a highly stigmatized disease of the gay community and feared for its mystery and lethality, AIDS is now recognized as a controllable disease that preys on men, women, and children alike. Homosexual contact remains the highest mode of transmission in the US, but heterosexual contact has grown significantly as a mode of transmission. Women constituted 8% of new HIV cases in 1985, but rose to account for 27% of new cases in 2005. HIV is slowly becoming a plague of the minorities. Blacks disproportionately constitute over half of new HIV infections while the incidence among whites is decreasing.
Despite the many breakthroughs that have been made to alter the HIV epidemic, many challenges remain. Stigma still persists as a major debilitating factor of this illness. Over a quarter of a million people are living with HIV but do not know they are infected. While it is no longer the leading killer, AIDS remains the sixth leading cause of death in this country. There are currently 29 drugs on the FDA’s list of drugs approved for the treatment of HIV/AIDS, but a cure or an effective preventative vaccine remain elusive. The American public finally realized that this disease could not be ignored and has recently embraced it more than ever before. Billions of dollars have been allocated towards HIV programs in the US and abroad. Nonetheless, HIV/AIDS will continue to pose the greatest challenge to our generation as we strive to halt transmission, provide diagnosis and treatment to those in need, and develop a cure to this deadly virus.