History

“I want to be especially blunt about the political aspects of Kaposi’s sarcoma,” said Rep. Waxman, according to the Washington Blade.  “This horrible disease afflicts members of one of the nation’s most stigmatized and discriminated-against minorities…. There is no doubt in my mind that if the same disease had appeared among Americans of Norwegian descent or among tennis players — rather than among gay males — the responses of the government and the medical community would have been different.”

Rep. Waxman made an effort to involve the gay community of his district by holding the hearing at the LA Gay Community Services Center (now the Los Angeles LGBT Center).  But the media largely overlooked the event, and the coverage that did appear was within the LGBTQ press.

The San Francisco newspaper The Sentinel published a very short blurb three days later, titled “House Holds Cancer Hearings.”  The paper would quote an unnamed subcommittee staffer saying the Centers for Disease Control “should not have to nickel and dime” for research funding.

The short article appeared next to a column written by gay nurse Bobbi Campbell, who wrote about going to the Shanti Project to get emotional support for his KS.

Speaking at the hearing, Dr. James Curran, head of the Center for Disease Control’s Task Force on Kaposi’s Sarcoma and Opportunistic Infections, estimated that tens of thousands of people were already infected by the disease.

On the 40th Anniversary of the CDC’s first report on what would become known as AIDS, reporter Karen Ocamb wrote the Washington Blade article “AIDS @40: White House laughs as gays try to save themselves,” recalling the House hearing chaired by Rep. Waxman.

“Like so many others in California, lesbian feminist Ivy Bottini had high expectations for the federal government to finally intervene in the growing AIDS crisis after the first congressional committee hearing on the mysterious new disease,” Ocamb wrote.  “She was upset.  Her friend Ken Schnorr had died just before the hearing and Bottini had to explain to Ken’s distraught mother that he had not been abused at the hospital — the purple bruises on his body were KS lesions.”

Ocamb goes on to cite perhaps one of the most egregious examples of the Reagan administration’s homophobic callousness toward people with AIDS, which happened just weeks after Reps. Waxman and Phillip Burton (D-San Francisco) introduced a bill to fund AIDS research.

On Oct. 15, 1982, White House Press Secretary Larry Speakes was holding a press conference, during which reporter Lester Kinsolving asked Speakes about the new disease called AIDS.  After indicating that he didn’t know what AIDS was, Speakes dismisses the question and makes light of it, saying, “I don’t have it. Do you?”

When this response elicits chuckles from the members of the press corps, Speakes continues in this vein (“There has been no personal experience here, Lester”) to draw more laughter.

“The exchange goes on like that.  For another two years,” Ocamb wrote.

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Sources:

Washington Blade, “AIDS at 40: White House Laughs as Gays Try to Save Themselves” by Karen Ocamb, June 23, 2021

The Atlantic, “The Heroic Story of How Congress First Confronted AIDS” by Joshua Green, June 8, 2011

The transcript of the press briefing, which is in the Ronald Reagan Presidential Library, is a sharp reminder of how governmental officials and journalists viewed the LGBTQ community.

On Dec. 1, 2015, Vanity Fair debuted a short documentary by Scott Calonico about this now-infamous exchange.

President Reagan would not mention AIDS until 1985, and then it would be in response to a reporter’s question at a press conference.  He would not give a major speech about the epidemic until mid-1987 — at which point 20,849 people in the U.S. would already be dead.

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Sources:

The Washington Post, “How Attitudes toward AIDS have Changed, in the White House and Beyond” by Juliet Eilperin, December 4, 2013

Washington Blade, “AIDS at 40: White House Laughs as Gays Try to Save Themselves” by Karen Ocamb, June 23, 2021

Vanity Fair, “The Reagan Administration’s Unearthed Response to the AIDS Crisis is Chilling” by Richard Lawson, December 1, 2015

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Sources:

www.HIV.gov, “A Timeline of HIV and AIDS”

AIDS United, “Our Timeline: Past and Future”

On Page 22, the Times gives its report on the alarming cases of babies and young children who are born with the AIDS virus and subsequently left at New York hospitals.  The article carries no byline.

The article also exposes the discrepancy between the total number of pediatric AIDS cases nationwide being reported by the Centers for Disease Control (18) and the numbers of infants and children being treated by doctors in the NY metro area alone (more than 63).

In the article, New York pediatric immunologist Arye Rubinstein, M.D., blamed the CDC’s low case number on the federal government’s “unduly strict” definition of AIDS.  Because of this narrow definition, the CDC counted only children who had a malignancy or opportunistic infections.

Dr. Rubinstein told the Times that he was treating several patients whose symptoms did not fall within the CDC definition but most definitely were indications of infection by the AIDS virus.  The article cites Dr. Rubinstein’s pediatric AIDS caseload as consisting of 44 patients.  James Oleske, M.D, of St. Michael’s Hospital and the Newark College of Medicine was cited with a caseload of 18 pediatric patients and six more suspected cases.

In the years to come, Dr. Rubinstein would become very vocal about CDC case totals being undercounted and the need for the CDC to broaden its definition of pediatric AIDS — and he wasn’t the only doctor in the field to do so.  Finally in 1985, the CDC would broaden its defnition of AIDS, based on recommendations developed at the Conference of State and Territorial Epidemiologists, and the CDC would modify the definition again in 1987 and 1993.

Between July 1983 and June 1985, a total of 33,831 blood donations were screened by Standord.  Of those donations, 586 were shown to have low CD4 counts and were discarded as possibly infected.

Stanford retained the serum samples from the 586 donations and years later, when a test became available, screened them specifically for HIV.  Dr. Engleman found that 1.9% of these donations were HIV positive — which translates to approximately 33 HIV-infections that were avoided.

As the first blood bank in the U.S. to screen donated blood for HIV/AIDS indicators, the new policy eliminated donations from people with low CD4 T cells.  The loss of CD4 T cells in AIDS is what renders patients susceptible to a wide range of infectious diseases.  Thus, the screening was considered a surrogate test, not necessarily identifying the presence of HIV/AIDS but instead identifying indicators of possible HIV/AIDS infection.

The new screening system came about due to an increasing awareness in the San Francisco medical community of AIDS and a skeptical view toward existing blood protection practices.  In the spring of 1983, Stanford Hospital treated two patients with AIDS.  Both had received transfusions at Bay Area institutions and neither had been identified as being in a high-risk group.

“At this point, my colleagues and I at Stanford Blood Center felt that the presence of the presumed etiologic agent for AIDS in the local blood supply could not be ignored,” recalls Ed Engleman, MD, of the Stanford Blood Center.  “Because of the potential lethality of this infection, we felt that self-deferral should not be relied upon as the sole means of protecting the blood supply.”

The self-deferral practice that Dr. Engleman refers to is the U.S. Public Health Service’s then-recommendation of relying on donors to voluntarily identify themselves as a member of a high-risk group.  Blood centers around the country commonly implemented the PHS recommendation with an information sheet provided to prospective donors that described AIDS risk groups and requested that donors exclude themselves if they met the definition of risk.

“It was predictable that this approach wouldn’t work very well,” says Dr. Engleman.  “First, it relied entirely on donor self-deferral.  Second, the PHS definition of homosexual AIDS risk behavior was vague, making it possible for a prospective donor with a history of homosexual activity to feel that he personally was not at risk for AIDS and to proceed with blood donation.”

Stanford University Blood Bank’s screening procedure was costly and had to be performed manually, but Stanford found it relatively easy to implement because it was already conducting immunological research and had access to a flow cytometer and the appropriate laboratory setting.

Around this time, the American Red Cross, American Association of Blood Banks, and the Council of Community Blood Centers released a joint statement estimating the risk of getting AIDS from transfusion as “one in a million.”  This was an overly optimistic view, it turned out.

Just a few years later, when the first HIV antibody test was made available in 1985, an estimated one in 700 units of blood donations in U.S. metropolitan areas were found to be infected with HIV.  In San Francisco, the frequency was closer to one in 100.

“We estimate that the total number of transfusion-related HIV transmissions that occurred from 1983 to 1985 was at least 10,000-20,000,” Dr. Engleman says.  “It seems evident that most of these cases could have been avoided had our test been used.”

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Source:

Morgan MacDonald, 27, of Vero Beach, Florida, was brought to San Francisco in a chartered Lear jet after being discharged from Shands Hospital at the University of Florida at Gainesville.  MacDonald told Dr. Mervyn Silverman, San Francisco’s public health director, that he was transported to California against his will.

Shands Hospital in Gainesville, Florida, spent $7,000 for a private jet to fly MacDonald to San Francisco last week and leave him on a stretcher at the office of a city-funded AIDS foundation.  He was immediately transferred to the AIDS ward at San Francisco General Hospital.

Dianne Feinstein, then-Mayor of San Francisco, sent a telegram to Gov. Bob Graham of Florida, asserting that a hospital there dumped an unwanted AIDS patient by having him flown to San Francisco.  She called the incident “outrageous and inhumane.”

Gov. Graham’s press secretary said Florida’s Department of Health and Rehabilitative Services would investigate the matter.

Virginia Hunt, Shands’ public relations director, defended the hospital’s actions, saying MacDonald no longer needed hospital care and the hospital was unable to find a Florida nursing home for him.  She contended that the AIDS Foundation in San Francisco agreed to give Mr. MacDonald 30 days’ free housing.

But Dr. Silverman said the Florida hospital had made contact with both the City of San Francisco and the AIDS Foundation and ”played us one off against the other.”

Silverman said MacDonald was free to return to Florida, but said his condition was acute and it was essential that he receive proper care.

MacDonald would die 21 days later at San Francisco General Hospital’s AIDS Ward.  MacDonald was said to have no family. Before his hospitalization, he lived in a religious commune in Florida.

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Source:

The task force reviewed several pilot tests performed at blood banks in areas with donors at high risk for hepatitis B core antibody (anti-HBc), which appears at the onset of symptoms in acute hepatitis B and persists for life.  Scientific data suggested that anti-HBc was found commonly in HIV-infected individuals.

Data showed:

• 5-18% of blood and plasma donors had a positive test for anti-HBc;
• 84% of homosexual males tested positive for anti-HBc; and
• 96% of IV drug users tested positive for anti-HBc.

The discussion at the December BPAC meeting had stipulated that ”cost-benefit analysis and disease prevalence must be considered in the decision regarding whether or not to use the test,”  However, the task force could not agree upon the true cost of the test, with estimates as low as $2.50 per test for plasma collectors and as high as $12.00 per donation for whole blood collections

Additional costs were the blood that would be discarded and the recruitment of new donors.  With the task force unable to agree on the costs and the benefits of using the anti-core test as a surrogate for high-risk donors, the majority decided to oppose the adoption of screening procedures.

The study also finds that some employers are requiring gay men to present medical documentation proving that they do not have the AIDS virus, and that gay men are experiencing verbal harassment that is generated by AIDS paranoia and ignorance.

A coalition effort of the San Francisco Human Rights Commission, the San Francisco AIDS Foundation, the Shanti Project, and the San Francisco Department of Public Health’s Aids Activities Office, the AIDS Discrimination Reporting Project released a report of its study of AIDS-related discrimination complaints.  Participants in the survey were largely gay men, some of whom were living with HIV/AIDS and some of whom were not but still experienced AIDS-related discrimination.

“Discrimination ranged from employers requiring a physician’s statement denying that an employee had AIDS to actual termination and eviction,” the report stated.

The report was authored by Chris van Stone and Jackie Winnow of the San Francisco Human Rights Commission.

Dr. David Blatt and Dr. David Moore — known in the Chicago medical community as “the two Davids” — founded Unit 371.  The HIV/AIDS unit became renowned for its compassionate approach to care.

Dr. Moore modeled Unit 371 after San Francisco General Hospital’s Unit 5A.  During a visit to Unit 5A, he noticed that AIDS patients were “clustered” in one unit of the hospital, which allowed the patients to receive treatment and care from professionals trained in their specialized needs.

Dr. Moore thought this was a novel and efficient approach to HIV/AIDS healthcare, and much better than the standard approach of having to educate healthcare professionals in individual units across the hospital about how to care for AIDS patients.

In October 1982, Dr. Moore was still new to practice when he saw his first patient, a personal friend who had come to him with the symptoms of AIDS. What followed were, in his words, “13 years of slow-motion carnage,” according to Health ENews of Advocate Aurora Health.

A gay man himself, Dr. Moore and his medical and life partner, Dr. Blatt, decided to spearhead what would be the first dedicated AIDS unit in the Midwest.

“It was a different time. There was so much fear then,” Dr. Blatt says. “The news media was calling it the ‘gay cancer’ and there was very little knowledge or education on what it was or how it was transmitted. There was a lot of panic and discrimination.”

Dr. Moore says they felt compelled to do something.

“This was us. This was our community and neighborhood. We were in this risk group. It was affecting our friends, our patients and we needed to take action,” he said.

For Unit 371, Drs. Moore and Blatt also incorporated the policy of San Francisco’s Unit 5A of allowing partners, family, and friends unlimited visitation time with patients, according to America 250.

“Within the Illinois Masonic Medical Center, Unit 371 became the preferred unit for HIV-positive patients who did not need to be admitted to the intensive care unit,” wrote Jade Ryerson in America 250.

The unit started with 23 beds, with nine rooms dedicated to hospice care.  But when the AIDS crisis worsened and the number of patients swelled, many of the single rooms were converted to accommodate two patients. Staff reserved private rooms for patients who were dying or could pass on an infection.

“But what really set Unit 371 apart were the personal relationships between staff and patients,” according to Ryerson.  “It was common for Unit 371 staff to sit on patients’ beds, offer hugs, joke around, or become friends and socialize outside of the unit. This closeness was especially meaningful for patients who were rejected by family and friends after being diagnosed.”

Drs. Blatt and Moore, who met while doing their residencies at Chicago’s Cook County Hospital, continued to oversee Unit 371 for about fifteen years.

Straight from nursing school, M.K. Czerwiec became a Unit 371 nurse in 1994.

“The death rate on Unit 371 was higher than any other hospital unit because, for so long, AIDS was a fast-moving, terminal disease,” Czerwiec told Windy City Times in 2011. “In a month, we could lose 30 patients.”

In 2017, Czerwiec would publish a graphic novel, Taking Turns, about her experiences working at Unit 371.

The House Appropriations Committee also urges President Reagan to appoint a coordinator for the AIDS effort, “in other words, an AIDS czar.”

“Nine agencies have been engaged in this effort. … What we need is a well-coordinated, well-planned effort, with one person running the show,” said Rep. Silvio Conte, (Mass), the senior Republican on the House Appropriations Committee.

The National Institutes of Health would receive $140.6 million, the Centers for Disease Control would receive $45.6 milion and $3.5 million would go to the Alcohol, Drug Abuse and Mental Health Administration.

During debate on the appropriations bill, the House accepted an amendment by Rep. Robert Dornan (R-Calif.), that would allow the surgeon general to use some funds to close bath houses “that may be responsible for transmitting AIDS.”

The Public Health Council resolution went beyond recommendations made by Gov. Mario M. Cuomo and State Health Commissioner David Axelrod by defining “high-risk sexual activity” to include oral sex.

Mayor Edward I. Koch announced that the new regulation takes effect immediately and is to be enforced by NYC Health Department inspectors who will enter bathhouses in uniform and undercover.

The National Gay Task Force opposes the regulation, citing discriminatory practices.

“This appears to be an unequal application of law” because many experts say AIDS can be transmitted by heterosexual activity, said Ron Najman, a spokesman for the National Gay Task Force. “They are concentrating on the homosexual aspect.”

The long-simmering transatlantic feud over who will receive royalties on a test for the AIDS virus has erupted into a legal battle, with French scientists seeking recognition in the U.S. courts for their claim that they discovered the virus before their American counterparts.

The Pasteur Institute ‘s suit also seeks the right to grant permission to sell the blood test without being sued by the U.S. for counterfeiting, and the right to share in royalties collected by the U.S. for sales of blood tests by U.S. licensees.

The French scientists were the first to publish a paper on the virus, said Dr. Robert C. Gallo, the U.S. scientist credited with discovering HIV. But he asserts in an interview with the Los Angeles Times, “I was the first to suggest it was a retrovirus.”

“We had this virus in 1982. We didn’t publish on purpose because we didn’t understand it well enough to stick our necks out. To me, ‘discovery’ is a complicated word. Who first reported discovery of a virus?  They did.  But if the idea comes first — that was us.”

In July 1994, U.S. health officials would concede for the first time that American researchers used a virus obtained from French competitors to make the first American AIDS test kit. At that time, the U.S. would announce the signing of an agreement that would give the French a bigger share of royalties from worldwide sales of AIDS tests.

The contract would end the long-standing and sometimes acrimonious dispute that strained relations between the two countries.

The majority opinion, by Justice Byron White, reasoned that the Constitution did not confer “a fundamental right to engage in homosexual sodomy.”  A concurring opinion by Chief Justice Warren E. Burger cited the “ancient roots” of prohibitions against homosexual sex, quoting William Blackstone’s description of homosexual sex as an “infamous crime against nature,” worse than rape, and “a crime not fit to be named.”

The case arose on August 3, 1982, when a police officer who had been admitted to the home of Michael Hardwick in Atlanta witnessed him and a male companion in a bedroom engaging in sex.  The officer had been executing a warrant for Hardwick’s arrest for failing to appear in court on a charge of public drinking (it was later determined that the warrant was invalid because Hardwick had already paid the $50 fine).  The officer promptly arrested both men for violating Georgia’s antisodomy statute.

In its decision, the Court ruled that while the “right to privacy” protects intimate aspects of marriage, procreation, contraception, family relationships, and child rearing from state interference, it does not protect gay sodomy because “no connection between family, marriage, or procreation on the one hand and homosexual activity on the other has been demonstrated.”

In the first Congressional hearing to address anti-gay violence, Kevin Berrill of the National Gay and Lesbian Task Force (now called the National LGBTQ Task Force) told members of the House Subcommittee on Criminal Justice that in addition to battling the AIDS epidemic, the gay community was also contending with rampant and deadly antigay violence.

“There is disturbing evidence that the AIDS and antigay violence epidemics may now be following the same menacing curve,” Berrill said.  “For inasmuch as AIDS has spread, so has the fear and hatred that spawns violence.”

Berrill went on to criticize the federal government for viewing widespread violence against gay men and lesbians as “just a gay problem and therefore not of concern to all society.”  He bitingly referred to this passive policy as the same one the government has adopted to address HIV and AIDS.

In its study on antigay violence, the Task Force surveyed more than 2,000 community members in eight cities.  Berrill also presented data from local governments which confirmed the Task Force’s findings.  At the time, the federal government did not collect data on violence against LGBTQ community members.

“The toll of antigay violence cannot be measured solely in terms of these statistics,” Berrill told the Congress members.  “These numbers do not measure the anguish, fear and loss experienced by Dee, who is still recovering from burns caused by acid thrown at her face when she was leaving the Los Angeles Gay Community Center.  Or by Robert from New Jersey, where assailants beat him, extinguished cigarettes in his face, and then tied him to the back of a truck, dragging him in tow.  Or by the family and friends of Charlie Howard of Maine, who was thrown off a bridge to his death by three teenagers.”

Berrill called on Congress to initiate federal studies on antigay violence and pass tougher laws to combat violent crimes targetting gays and lesbians.  He also urged the repeal of all sodomy laws (which were still on the books of most states), and called for the passage of legislation prohibiting discrimination on the basis of sexual orientation.

Also testifying that day was Diana Christensen, executive director of the Community
United Against Violence in San Francisco, who told the subcommittee the following:

“Is the increase in antigay violence an indicator of an AIDS-related backlash?  At this point, I believe that AIDS and homosexuality have become synonymous in the American public’s mind.  For the homophobic mind, AIDS is simply another justification for violence.”

David Wertheimer, executive director of the New York City Gay and Lesbian Anti-Violence Project (which would become the NYC Anti-Violence Project) also provided the highlights of his 20-page testimonial submitted to the subcommittee.  Founded in 1980 to provide support services to lesbian and gay survivors of homophobic violence, the organization became a city-wide, nonprofit service
provider in 1983.

Wertheimer reported that between 1984 and 1985, reported cases of violence “began to mushroom,” and the organization’s caseload increased 41%.  In the current year — 1986 — violence was reported even more frequently, with between 40 and 60 new cases each month.

He explained that in the past, cases typically were in the form of antigay and antilesbian verbal harassment in a public place, or in the form of menacing behavior or even assault.  A new form of violence had emerged recently, Wertheimer said, one that now represented 28% of the Anti-Violence Project’s caseload.

“AIDS-related violence — that is violence that may begin with verbal and menacing acts that are specifically related to AIDS,” he said.  “For example, someone might start an attack by saying, ‘I hate faggots. You faggots give us AIDS.’  Or a lesbian might find notes on her door saying ‘Lesbians, dykes, you give us AIDS. Get out of the building.'”

Wertheimer told the Congress members that antigay violence can result in death.  The organization reported seven antigay homicides in 1985, and 15 such homicides in the first nine months of 1986.

Also providing testimony was Dr. Gregory M. Herek, assistant professor of psychology at
the City University of New York and a member of the American Psychological Association’s Committee on Lesbian and Gay Concerns.

“A growing body of scientific data, including my own empirical research, shows that individuals’ irrational fears surrounding AIDS — such as fear of transmission through casual contact — are highly
correlated with their level of homophobia,” Dr. Herek said.  “I interpret this finding to mean that reducing AIDS hysteria requires confronting its roots in homophobia, and that eliminating homophobia will require education about AIDS. Unfortunately, the U.S. Justice Department has sanctioned discrimination based on fears of AIDS-contagion, and has thereby fueled fears about AIDS
and probably contributed to public homophobia.”

Rep. Barney Frank (who in 1987 would become the first member of Congress to be openly gay) also spoke for the Congressional record in support of raising awareness about anti-gay violence.

The report, issued by U.S. Surgeon General C. Everett Koop, M.D., also calls for a nationwide education campaign that includes early sex education in schools, increased use of condoms, and voluntary HIV testing.

“By the end of 1991, an estimated 270,000 cases of AIDS will have occurred with 179,000 deaths within the decade since the disease was first recognized,” Dr. Koop states in the report’s preface.

“In the year 1991, an estimated 145,000 patients with AIDS will need health and supportive services at a total cost of between $8 and $16 billion.”

The two main functions of WHO’s program were: (1) to provide global leadership and ensure international collaboration
and cooperation; and (2) to provide support to national programs to prevent and control AIDS, according to The Fourth Ten Years of the World Health Organization.

WHO established a global commission on AIDS and a management committee to support and guide the program.  As part of the new program, a special public information service was launched to satisfy the increasing media interest in HIV/AIDS and to ensure that accurate and timely information was being disseminated to the public.

Specifically, the Special Programme on AIDS sought to:

• raise awareness;
• formulate evidence-based policies;
• provide technical and financial support to countries;
• initiate relevant social, behavioral, and biomedical research;
• promote participation by nongovernmental organizations; and
• champion rights of those living with HIV.

With technical and financial support from WHO, AIDS programs rapidly began to be established in nations throughout the world.  WHO puts forth the idea that a global response was vital not only for national interests but also because “ultimately AIDS cannot be stopped in any one country unless it is stopped in all countries.”

At the global level, the program was responsible for strategic leadership, developing consensus, coordinating scientific research, exchanging information, assuring technical cooperation and mobilizing and coordinating resources.  During 1986 and 1987, a total of 127 countries sought WHO’s collaboration on a national response to AIDS, according to The Fourth Ten Years of the World Health Organization.

Founded in 1948, WHO is the United Nations agency that connects nations to promote health, keep the world safe and serve vulnerable populations.  On January 1, 1996, the UN would launch UNAIDS to consolidate its global AIDS response.

In a few months, the FDA would go on to issue treatment IND (investigational new drug) regulations on May 22 to permit new drugs to be used to treat patients before clinical trials are completed where no alternative therapy exists for a “serious disease.”

In its explanation of the regulations, the FDA mentions advanced cases of AIDS as the first example of an immediately life-threatening disease, but did not include AIDS in its list of examples of serious diseases.  It explained that some diseases, like multiple sclerosis, are not serious at earlier stages, and that the Treatment IND regulations would not apply to drugs intended to treat those earlier stages of disease.

The workshop kicks off with a large press conference, where Dr. Koop announces that AIDS is a growing menace to the nation’s children and reiterates his call for early sex education as part of the general effort to halt its spread.  He recommends that sex education start in kindergarten and include information about AIDS.

”It’s the responsibility of parents, and it should begin before children go to school,” Dr. Koop says.

He mentions that parents are often reluctant to discuss sex with their children, and so the burden falls upon schools, churches and synagogues to teach children and youth about sex and AIDS.

The new AIDS Commission would replace the three-year-old AIDS task force formed by Supervisor Ed Edelman and Los Angeles Mayor Tom Bradley.  The Supervisors said they would appoint to the commission activists in the fight against AIDS as well as county officials.

The unanimous vote by the five-member LA County Board of Supervisors followed an April 14, 1987 editorial by the Los Angeles Times calling for the supervisors to approve the proposal for a county AIDS commission.

“Such a commission could be of great assistance to the Board of Supervisors in the weeks ahead when major budget decisions and major policy shifts will be before the board,” wrote the LA Times editorial board.  “And the commission could reassure the community that the AIDS problems in this region are being addressed.”

Supervisor Ed Edelman told the Los Angeles Times that the new commission would help to coordinate efforts by various county departments in the local effort to prevent the spread of HIV/AIDS.  At the time, local efforts were concentrated in educational, mental health and hospice programs.

According to the LA Times, the total number of confirmed AIDS cases in Los Angeles County in May 1987 was 2,965, making the county the third most impacted region in the U.S.  Only San Francisco and New York had more AIDS cases.

In its editorial, the LA Times criticized LA County for failing to organize “the basic services required to handle the rapidly rising caseload of AIDS patients.”

The LA Times pointed out that while in-patient care was available at some of the larger county facilities, there were virtually no home-care, day-care, nursing-facility or hospice programs offered by the county.  As time ticked by of the lives of people living with AIDS, the county supervisors were withholding funds from critical programs until there was more state and federal money to supplement the county budget.

“With the advice of the task force, the AIDS Project Los Angeles and other professionals, the supervisors can quickly organize an effective commission to see that not another minute is wasted,” the LA Times wrote.

Rabbi Allen Freehling would be the first Chair of the AIDS Commission, and the appointed commissioners would include Rand Schrader, an openly gay Los Angeles Municipal Court judge who would serve as Chair of the Commission from 1989 to 1991.

amFAR event attendees “boo” Reagan when he says he asked the Department of Health and Human Services “to add the AIDS virus to the list of contagious diseases for which immigrants and aliens seeking permanent residence in the United States can be denied entry.”

Attendees also shout out their opposition when the president says he is ordering testing for active members of the military, those seeking care at veterans’ hospitals, applicants for marriage licenses, and federal prisoners.

Among the event attendees are amfAR Founder and National Chairperson Elizabeth Taylor and amfAR President Dr. Mervyn Silverman.

After Reagan speaks, Taylor tries to move ruffled feathers by telling the audience, “While there are differences of opinion on AIDS testing,” Reagan’s remarks are ”basically in concurrence with what we all hope and pray for,” namely a cure for the disease.

AmfAR advocates for voluntary, confidential testing accompanied by intense counseling, adds Dr. Silverman.

After the event, U.S. Surgeon General Dr. C. Everett Koop said he ”found no fault with the speech” and that he considered it reasonable to test Federal prisoners and immigrants and to offer the test to marriage applicants.  He also said he was embarrassed by the reaction of some in the audience.

“I never heard anyone boo the President before,” Dr. Koop said.

The study, commissioned by the 10,000-member Chicago-based organization, also predicts that future life insurance policies could add $30 billion to $60 billion to the total, depending on whether applicants are screened for the AIDS virus.

The study bases its findings on statistics from the Centers for Disease Control, which suggests that 15% of those infected with the AIDS virus develop the fatal disease after five years and up to 36% are stricken after seven years.

Manufactured by MicroGeneSys of West Haven, Conn., the vaccine would move forward to clinical trials supervised by the National Institute of Allergy and Infectious Diseases.  Just months ago, NIAID Director Dr. Anthony Fauci said that the FDA was considering several candidate vaccines and that human trials could begin in 1987.

In early 1993, MicroGeneSys would pull the vaccine, called VaxSyn, from National Institutes of Health trials because the pharmaceutical company could not agree with the NIH over the dosing schedule. The vaccine has already been selected for inclusion in a $20 million U.S. army trial program.

Today, there is no vaccine available to prevent HIV infection or treat those who have it.

However, scientists are still working to develop one. NIH is investing in multiple approaches to prevent HIV, including a safe and effective preventive HIV vaccine. These research efforts include two late-stage, multinational vaccine clinical trials called Imbokodo and Mosaico.

The Helms Amendment was incorporated into the $129 billion Labor, Health and Human Resources and Education appropriations bill for fiscal 1988, and contained $310 million for AIDS education efforts overseen by the Centers for Disease Control.

Sen. Jesse Helms (R-North Carolina) initially proposed that none of the money allocated to the CDC could be used for material or activities that promote, encourage or condone homosexuality, illegal drug use or any sexual activity outside marriage.  During floor debate, Sen. Helms displayed sex-positive comic books created by the Gay Men’s Health Crisis in New York and announced that federal money helped to pay for GMHC’s education program.

″If the American people saw these books, they would be on the verge of revolt,″ claimed Helms.

The senator said he showed the comic books to President Reagan and complained that the GMHC had received $674,679 in federal funding to produce the pamphlets. According to Helms, President Reagan looked at a couple of pages, ″shook his head, and hit the desk with his fist.″

Helms then admitted that the comic books were not paid for with federal funds, but said taxpayer dollars did pay for a series of educational sessions he contended were equally offensive.  He said the sessions included assignments to write a personal ad for publication in a gay newspaper and list alternatives to high-risk sex, as well as instruction in the use of safe sex photos.

″I may throw up,″ Helms announced in the Senate chambers.

At the recommendation of the LA County Commission on AIDS, the supervisors and the county Department of Health Services took action at its meeting to expedite $1.5-million in funding for local hospice and home care programs.

The AIDS Commission also recommended March 1 deadline for implementing the program, which would provide those needing care with an alternative to hospitalization.  At Supervisor Ed Edelman’s recommendation, the Supervisors ordered county staff to investigate Barlow Hospital as a potential location to house a fully integrated AIDS-care facility, according to the LA Times’ coverage of the board meeting.

Meanwhile, cases of AIDS continued to grow at a troubling rate.  The LA Times reported that in October 1987, the county reported 192 new cases of AIDS and most were receiving care from hospitals.  Because of the lack of alternative care facilities, most deaths in the county due to AIDS-related illnesses were reported to occur in hospitals, away from home and hospices.

Between May 26 and June 30, 1988, the Centers for Disease Control mail the pamphlet Understanding AIDS to every U.S. household.  Approximately 126 million copies were distributed, reaching at least 60% of the population.

The brochure was produced in Spanish as well as English, and its purpose was 3-fold: to clarify how AIDS is transmitted; to emphasize that behavior, not identification with risk groups, put people at risk; and to stimulate informed discussions about AIDS at all levels of society.

In conjunction with the mailing, the CDC initiated contacts with state health departments and manufacturers of AIDS testing kits.  In anticipation of increased requests for information that the brochure would generate, the CDC added up to 1,000 operators to the National AIDS Information Line.

The impact of the campaign on AIDS-related behavior was not fully assessed.  Extensive message pretesting and other marketing techniques designed to improve the effectiveness of the brochure, however, helped Understanding AIDS achieve an increase in awareness and concern about AIDS nationwide.

During the process of the campaign, the CDC learned a number of lessons, including the importance of setting a deadline, doing formative research, and achieving a consensus on scientific knowledge.

The HRSA-funded projects are expected to demonstrate effective ways to:

• reduce mother-to-child transmission of HIV;
• develop coordinated, community-based, and family-centered services for infants and children living with HIV; and
• develop programs to reduce the spread of HIV to vulnerable populations of young people.

As the first comprehensive federal AIDS bill, it establishes the Office of AIDS Research at the National Institutes of Health (NIH) and the AIDS Clinical Trials Group.

With the approved FDA licensing, Intron A and Roferon A (human alpha interferon injection) can now be medically administered to patients for the treatment of KS.

The FDA reported that up to 45% of KS patients receiving large doses of alpha interferon ”responded with a significant reduction in the size of their tumors.”  Dr. Kathryn C. Zoon, an F.D.A. official, said that alpha interferon works best in people in the early stages of the disease.

Under the coordination of National Institute of Allergy and Infectious Diseases, the program would issue contracts to doctors for the treatment and data collection regarding thousands of AIDS patients, health officials said.  The program has received a $6 million budget for its first year.

Dr. Anthony S. Fauci, director of NIAID, told the New York Times that the program’s aim was to expand federal research opportunities to doctors and patients who were not affiliated with existing clinical trials.  Dr. Fauci said the program was seeking to involve more Black and Hispanic people, as well as intravenous drug users and sex workers.

In the program, patients using potentially effective but unapproved therapies would be monitored.  The opportunity for patients to receive access to experimental drugs in community settings would be another component of the program, according to health officials.

The legislation, proposed by anti-gay Republican Sen. John Doolittle, include:

• Penalties — SB 1007, which adds three years to prison sentences of those convicted of some sex crimes if they know they are HIV-positive when they commit the crime;
• Prostitutes—SB 1007, which makes it a felony for a prostitute to continue working after knowing he or she has been exposed to the AIDS virus; and
• Donors—SB 1002, which makes it a felony to donate blood, semen, breast milk or body organs to another person if the donor knows that he or she is infected with the AIDS virus.

Also going into effect is Democratic Sen. Gary K. Hart’s bill, SB 2847, which allows physicians to tell other medical personnel if a patient has AIDS so they can protect themselves.

Speaking from the Oval Office in the White House, President Ronald Reagan focused his farewell speech on the following topics:

– the Economic Recovery Tax Act (1981), which cut taxes for workers and corporations but also grew the federal deficit from $70 billion to $175 billion;

– the series of U.S.-Russia summits, which took steps toward ending the cold war; and

– the U.S. invasion of Grenada in 1983, the first military action since the Vietnam War.

In his speech, Reagan took credit for the country’s economic recovery from the 1981-82 recession and for raising the profile of the U.S. on the world stage.  With underlying themes of global power, patriotism and “what it means to be an American,” Reagan spoke about many threats and challenges the country faced during his eight years in office.  But he neglected to mention one of the biggest threats facing the U.S. population:  the AIDS crisis.

From 1981 to 1989, a total of 26,223 people in the U.S. died of AIDS, and 102,706 people were diagnosed with HIV.  More than 95% of those diagnosed with AIDS between 1981 and 1987 died.   And on this day when Reagan left office, the U.S. was no closer than it was eight years ago to announcing a cure or vaccine.

Reagan took office for his first term in January 1981, and immediately set about cutting the federal budget in all areas except defense.   In 1982 and 1983, the Reagan administration would continue its attempts to shrink the federal government by imposing major funding reductions for the National Institutes for Health, the Centers for Disease Control and Prevention, Department of Health and Human Services and Medicaid.  As a result, several public health programs were eliminated just as the AIDS crisis was gaining ground.

From the start, the Reagan administration kept the new disease at arm’s length, avoiding any public acknowledgement of it.  In the first years of the epidemic, researchers at the CDC referred to the disease in reports and media accounts as “Gay Related Immune Disorder,” or GRID, which caused many — including political operatives in the Reagan administration — to believe that this was an exclusively gay disease.

Some religious leaders used this as an opportunity to condemn homosexual activity and suggest that the disease was punishment.  Jerry Falwell, founder of the ultra-conservative Moral Majority, proclaimed AIDS to be “the wrath of God upon homosexuals,” a view that spread into public opinion.

“The sexual revolution has begun to devour its children,” said Catholic columnist Patrick Buchanan, who would work in Reagan’s White House from 1985 to 1987.

Influenced by religious leaders and his own conservative advisors, Reagan decided that AIDS was a moral issue and one that would not impact his supporters — even after the CDC retitled the disease “AIDS” in September 1982 and started reporting on cases in populations outside the gay community.

Meanwhile, the U.S. Surgeon General — who was charged with the responsibility of “providing Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury” — was prevented from addressing the nation’s most urgent health crisis, according to the NIH’s tribute to C. Everett Koop, M.D..

“If ever there was a disease made for a Surgeon General, it was AIDS,” said Dr. Koop, who served two terms as U.S. Surgeon General under President Reagan.

According to the NIH, President Reagan and his domestic policy advisers held the view that homosexuals and intravenous drug users brought the disease upon themselves by engaging in conduct they deemed immoral.  Those afflicted with the disease were, in their view, “in greater need of moral reform than of new health information or policies.”

From 1983 to 1985, Koop was excluded from the Executive Task Force on AIDS established by his immediate superior, Assistant Secretary of Health Edward Brandt.  In advance of press conferences, Brandt instructed journalists to not ask Dr. Koop about AIDS and that the Surgeon General would not answer questions about it.

First Lady Nancy Reagan and her son, Ron Reagan Jr. both tried to convince the president to take a more active approach, according to Karen Tumulty, a political columnist for The Washington Post who wrote The Triumph of Nancy Reagan, in 2021.

“We’d start mentioning it, bringing it up as a topic, starting to get it into his head,” Ron Jr. was quoted in Tumulty’s book, which was excerpted in The Atlantic.

The First Lady knew more about the AIDS crisis than her husband, likely because she was kept informed by her son, a dancer with the Joffrey Ballet in New York City.

“I’m in New York; I’m dancing; I know people who are HIV-positive,” Ron Jr. told Tumulty.  “Dancers, fashion designers, people like that.  I would talk to her about people, how many people, who these people were. And she began to understand that this is a big deal. This is a crisis. She began to sense that pretending this isn’t happening is not a good way to go.”

In the summer of 1985, the epidemic hit close to home when actor Rock Hudson, a longtime friend of the Reagans, went to France to seek treatment for AIDS-related illnesses.

On July 24, Hudson’s publicist sent a telegram to the Reagans at the White House, asking for their help in getting Hudson admitted to the hôpital d’instruction des armées Percy (“Percy Training Hospital of the Armies”), a military hospital near Paris.  The hospital had initially refused to admit Hudson because he was not a French citizen, according to various reports.  The White House referred the matter to the U.S. embassy in France.

Months later, on September 17, 1985, President Reagan finally mentioned AIDS publicly when responding to a reporter’s question, calling it a “top priority.”  He called for Congress to allocate $120 million in funding for AIDS research, and Congress responded by upping the budget to nearly $190 million.

On October 2, 1985, Hudson died of complications from AIDS at the age of 59.  Amid growing calls from the public for Reagan to do more about the disease, the president began asking his White House physician to provide him with information about AIDS, according to Tumulty.

“Some of the president’s more conservative advisers contended that AIDS should be viewed as the consequence of moral decay rather than as a health issue,” Tumulty wrote.  “Many of Reagan’s allies on the right were more concerned with identifying and isolating those who had AIDS than treating and caring for them.”

On May 31, 1987, President Reagan delivered the keynote address at the amfAR dinner before hundreds of people, some of whom were living with AIDS.  His speech was repeatedly interrupted by catcalls and hissing.

“There was good stuff in it, but not enough,” Parvin told Tumulty.

In late June 1987, Reagan created the President’s Commission on the HIV Epidemic.  But the 13-member panel nearly collapsed in its first few months because of poor leadership and internal feuding.  Packed with conservatives whose views did not conform with mainstream scientific thinking about the disease, the commission also included Frank Lilly, an openly gay geneticist at Albert Einstein College of Medicine and a board member of the Gay Men’s Health Crisis, and members of the medical community.

“Time went by, and nothing happened,” Glaser wrote later.  “It was almost unimaginable, but the White House took the report and put it on the shelf.  Hope for thousands of Americans and people around the world sat gathering dust in some forgotten corner of some forgotten room.”

When Reagan left office on this day in 1989, he left behind the slashed budgets of public healthcare programs and a public largely bewildered by the nature of AIDS and the ways in which people could protect themselves.  In the eight years he was president, a total of 56,223 people died of AIDS-related illness and 102,706 people were infected with HIV.

Jaserson’s civil action against the salon, a test case for the West Hollywood’s new HIV discrimination ordinance, is on appeal, with support from Los Angeles, Santa Monica and the American Civil Liberties Union.

At the meeting, witnesses testify on the problems facing AIDS patients and what the government is doing in response.

The meeting is facilitated by June Osborn, M.D., who would chair the commission from its inception through 1993.  Dr. Osborn, who serves on WHO’s Global Commission on AIDS, has extensive experience advising the CDC and the FDA on vaccines for diseases such as influenza, hepatitis, and polio.  Osborn would go onto write numerous articles and give many speeches on AIDS and HIV public healthcare policy.

The National Commission on AIDS consists of 15 members: five appointed by the Senate, five by the House, two by President George W. Bush, and the secretaries of Health and Human Services, Defense, and the Veterans Administration.

Perhaps the most recognizable member of the National Commission on AIDS, is former NBA star Earvin ‘Magic’ Johnson.  However, Johnson would resign from the commission in September 1992, writing to President Bush:  “I cannot in good conscience continue to serve on a commission whose important work is so utterly ignored by your administration.”

Johnson’s resignation is preceded by another six months earlier of Harlon D. Dalton, a Yale Law School professor who is the only other African American appointed to the commission.  In March 1992, Dalton would complain about the lack of action from black politicians, saying, “Any high-visibility politician can point to the one time a year where [AIDS] is mentioned. But there haven’t been any votes there. Gay black men don’t exist, black men don’t vote and babies don’t vote.”

At its first meeting, Chair Osborn gives recognition to Rep. J. Roy Rowland, who she refers to as “the Father of the Commission.”  Rep. Rowland is the principal sponsor of the legislation that created the commission on Nov. 4, 1988.

Other members include:

• Dr. David E. Rogers, head of the New York City Mayor’s Task Force on AIDS and New York State’s AIDS Advisory Council
• Diane Ahrens, Minnesota local government official
• Rev. K. Scott Allen, a Baptist minister, coordinator of the AIDS Interfaith Network in Dallas
• Don C. Des Jarlais, a NY physician who advocates for needle-exchange programs
• Eunice Diaz, community affairs director of White Memorial Medical Center in Los Angeles
• Mary D. Fisher, appointed by Bush to replace Magic Johnson in October 1992
• Donald S. Goldman, New Jersey attorney, author on ethical issues involved in AIDS treatment
• Larry Kessler, executive director of AIDS Action Committee of Massachusetts
• Charles Konigsberg, Jr., director at the Kansas Department of Health and Environment
• Belinda Mason, journalist who dies of AIDS-related illnesses in September 1991

The commission was established by a statute enacted November 4, 1988, with the aim of “promoting the development of a national consensus on policy concerning AIDS.”. It produced several reports over the next 4 years.

The commission approaches its work through numerous hearings, covering the following topics:

• healthcare, treatment, and international aspects of the HIV epidemic;
• Federal, State, and Local responsibilities;
• the Southern California epidemic;
• social and human issues;
• Executive and Legislative branch issues;
• current research and clinical trials;
• HIV epidemic in the Commonwealth of Puerto Rico;
• African American communities;
• Pediatric and Adolescent HIV;
• Lesbian, Gay, and Bisexual communities among Asians, Asian Americans, and Pacific Islanders;
• Women and HIV disease and civil rights;
• religious communities response; and
• risks of transmission in healthcare settings.

In its supporting report, the Health Resources and Services Administration notes that only six states have Medicaid program waivers for the treatment and care of people with HIV/AIDS: California, Hawaii, New Mexico, New Jersey, Ohio and South Carolina.  The waiver services cover case management, personal care and adult day care in five of the six states.

States with these programs report that the AIDS-specific waiver enables them to establish a uniform system of services, a network of treatment options, and greater access to home and community-based care for people with AIDS, the report states.

Perhaps most importantly, the programs expand financial eligibility for those needing care and treatent.

The newly announced HRSA grant program provides funding so that all states can adopt and strengthen programs that target AIDS-specific services to those who need them.

A small number of the medical negligence lawsuits have been settled for large amounts of money, and another 300 lawsuits are headed to trial, mostly in San Francisco, New York and Los Angeles, the Los Angeles Times reported.

While eight years has passed since the first medical reports made connections between transfusions and AIDS, legal cases are only beginning to surface because of the lag time between becoming infected with HIV and onset of physical symptoms.  An estimated 26 million people received transfusions between 1977 and 1985, years when the AIDS epidemic spread largely unchecked.

Legal experts expect thousands more cases to be filed in the courts over the next few years as more people discover that they were given tainted blood during the early years of the AIDS epidemic.

In one case, a 5-year-old Arizona boy was awarded $28.7 million — believed to be the largest such award — and several other jury verdicts have been in the range of $12 million.

“These awards are far higher than in other types of cases, because the jury tries harder because of the disease, because they have all personally felt that fear,” attorney Duncan Barr told the LA Times.  Barr had defended San Francisco’s Irwin Memorial Blood Bank in several cases.

Plaintiffs have argued that the blood banks ignored scientific warnings about the threat of HIV-contaminated blood, failed to screen out high-risk donors through questionnaires that identified high-risk behavior, and refused to perform tests for other diseases that were often present in HIV-infected donors.

In Los Angeles County, health officials said 194 adults and 36 children have contracted AIDS through transfusions.

The American Red Cross, which collects half the nation’s blood supply, would not comment to the LA Times on how many lawsuits have been filed against it over allegedly tainted blood transfusions.

The Blood Council of Community Blood Centers released a statement saying that most centers were insured only for $2 million to $5 million a year for the years in question, and if the centers run out of insurance funds, they may be forced to increase the cost of blood sales to hospitals or go bankrupt.

The CDC’s report ecommends that healthcare workers who are HIV-positive “should not perform exposure-prone procedures unless they have sought counsel from an expert review panel and been advised under what circumstances, if any, they may continue to perform these procedures.”

The CDC goes on to say that HIV-positive healthcare workers should notify prospective patients of the worker’s HIV status before they undertaking exposure-prone invasive procedures.

The report cites the case of Dr. David Acer, a dentist with AIDS who likely transmitted HIV to five of his 850 patients.

Although this was the only cluster of health care worker-to-patient transmissions of HIV in the U.S., the report concerning Dr. Acer immediately set off public debate on the effectiveness of existing safeguards of the public’s health, whether it was appropriate for HIV-positive health care workers to practice, and the public’s right to know the HIV status of their physicians.

Harvard University, which is co-sponsoring the conference with the World Health Organization, announces that because of “continuing uncertainty” of the country’s policy toward HIV-positive individuals, it will not hold the 1992 conference in Boston.  Weeks later, Harvard would announce that the next conference would be held in Amsterdam.

The Boston site of the meeting is canceled, because of Bush Administration requirements that short-term visitors to the U.S. declare whether they are infected with the AIDS virus.  The policy bans travel to the U.S. by foreigners infected with the virus, unless they get a waiver.

Two months earlier, the 1991 International AIDS Conference in Florence closes with officials and participants marching to the U.S. Consultate to protest the American travel ban.

Almost 20 years later, the ban on HIV-positive immigrants and travelers to the U.S. would be lifted by an executive order by President Barack Obama.

As part of a new movement in the criminal justice system toward “problem-solving courts,” the Manhattan Criminal Court Project sought to curb the spread of the AIDS virus by sex workers and intravenous drug users by providing them with information about HIV and ways to avoid infection and transmission.

Low-level misdemeanor offenders sentenced to the program would meet in Room 1600-A of the Manhattan Criminal Court to learn about HIV transmission and addiction recovery.

Of the initial the 200 participants in the pilot project, 92% completed the classes, called the Treatment Readiness Program, according to The New York Times. In addition to sessions informally titled “AIDS 101” and “Drugs 101,” the program included field trips to longer-term substance-abuse programs.

As part of the study, some people convicted of prostitution and minor drug violations still received the traditional sentence of community service along with the opportunity to participate in the Treatment Readiness Program — but only 70% of them attended the first day of classes and less than 50% appeared for the second.

The project was, in part, the brainchild of Justice Gustin L. Reichbach, a radical night court judge who was elected to the bench in 1990.  After three months of presiding over a court that saw an endless stream of prostitution cases and minor drug offenses, Reichbach became concerned that every night he returned to the streets sex workers who appeared to be sick from AIDS, drug use, or both, according to The Times.

He reached out to the Gay Men’s Health Crisis and arranged for the organization to set up a table outside the courtroom to distribute condoms, conduct HIV testing and provide counseling.  More importantly, the GMHC connected Reichbach to someone who was far more focused than GMHC on the spread of HIV among sex workers: Dr. Joyce Wallace.  The infectious disease specialist operated a “care van” that travelled the sex work districts of Manhattan and Brooklyn, and provided an array of services for sex workers, from HIV and sexually transmitted infections (STI) testing and clean needles to basic primary care and food coupons.

Dr. Wallace became an enthusiastic participant in Reichbach’s plan to get sex workers to HIV and drug recovery resources.  In early March, Reichbach began ordering women convicted of prostitution to “36 hours off the street to think about what we’re doing here,” according to The New Yorker.  He also offered the offenders the opportunity to have an on-the-spot meeting with Dr. Wallace, receive free condoms, and learn about AIDS prevention and addiction recovery.  Many of the sex workers would agree to sit down with Dr. Wallace, and then proceed to her van, which was parked outside the courtroom, to receive a free HIV test.

Soon after, on March 28, 1991, The Daily News published a front-page story about it under the headline “The Condom Court.”  Displeased with the media attention, Reichbach’s supervisors transferred him to the civil courts.  (There, he continued to generate headlines by sentencing a slumlord to be confined to one of her properties until she successfully addressed a list of dangerous violations.)

Meanwhile, Dr. Wallace continued what she and Judge Reichbach started and, with  a $115,000 grant from the Medical and Health Research Association of New York, she created an alternative sentencing program for offenders at-risk for HIV.  Fourteen months later, on May 28, 1992, the Manhattan Criminal Court Project was launched.

The asylum-seekers from Haiti were picked up at sea from the U.S. Coast Guard and placed at Camp Bulkeley, a detention camp for HIV-positive people in Guantanamo Bay that did not have appropriate medical care for people infected with the virus.

Despite pleas from military officials at the Guantanamo Bay Naval Base, INS officials rejected the requests to allow four ailing Haitian refugees to leave Camp Bulkeley and come to the U.S. for HIV treatment, according to reporting by Philip J. Hilts of The New York Times.

In Camp Bulkeley were 222 men, women and children who tested positive for HIV; all had passed initial INS interviews in their applications for asylum. Among them, according to the NYT article, were 15 whose T-cell counts were low enough to designate them as having AIDS (which today is called “Late-stage HIV”).

Also in camp were 55 relatives, mostly children, who were not HIV-positive.

Navy Col. Stephen Kinder, the commander at Guantanamo, and camp doctors requested that the INS allow at least four detainees to be released to U.S. hospitals, because Camp Bulkeley could not provide adequate care.  Camp doctors expected several patients to die within the next six months.

The U.S. continued to keep the 277 Haitians at the detention camp, because the U.S. Justice Department determined early in 1992 to enforce the Bush Administration’s ban on allowing anyone infected with HIV to enter the U.S.

In a 53-page ruling that strongly rebuked the Bush and Clinton administrations, Judge Sterling Johnson Jr. of the Eastern District of New York also ruled that Immigration and Naturalization Service (INS) officials acted illegally when they tried to process the Haitians’ claims for asylum without allowing their legal counsel to participate in the process.

The trial followed a year of hunger strikes by the refugees at Camp Bulkeley and collaboration with human rights activists and lawyers, according to The Washington Post‘s coverage of the ruling.

During the trial, U.S. officials conceded that the medical facilities at Camp Bulkeley were not equipped to treat patients with HIV or AIDS “under the medical care standard applicable within the United States itself.”

Still, INS officials repeatedly refused requests to transfer HIV-positive refugees to U.S. hospitals, one official actually saying to members of the media, “They’re going to die anyway, aren’t they?”

Judge Johnson’s opinion claimed the HIV detention center at Guantanamo Bay violated federal law.  He characterized the attitude held by INS officials — that there is “no value in providing adequate medical care when a patient’s illness is fatal” — as “outrageous, callous and reprehensible.”

The long-awaited victory for the Haitian refugees happened just one week before the start of the 1993 World Conference on Human Rights, and by this time, the country had a new president, Bill Clinton.  During his campaign for president, Clinton had promised to shut down the Haitian refugee camp and reform the asylum application process, but after taking office in January 1993, he decided to a continue the Bush Administration’s policy of forcibly returning Haitians who try to emigrate to the U.S.

Now he risked embarrassment before world leaders gathering at the human rights conference.

So days after Judge Johnson’s ruling, President Clinton announced that it would comply with the order. All 158 Haitians held at Camp Bulkeley were flown to states in the U.S., where they were allowed to take up residency.

The Council meets for the first time on this day in 1995.

PACHA focuses on programs, policies, and research that address HIV/AIDS, including the consideration of common co-morbidities of those infected with HIV as needed to promote effective HIV prevention and treatment.

The Council continues to exist and provide advice for each successive Presidential Administrations.

UNAIDS takes an innovative approach, bringing together various UN organizations to coordinate advocacy for global action on the epidemic.

The launch of UNAIDS involved “a long series of meetings, reports, working groups, whispered conversations and angry confrontations in corridors and telephone calls around the world,” according to UNAIDS: The First 10 Years.

With a staff of 91 in the Geneva-based Secretariat and 10 in various regions, the fledgling organization quickly learned how to act on its ambitious agenda.

Political advocacy was high on UNAIDS’ list of priorities.  By June 1996, UNAIDS staff had met with political, economic and social leaders in more than 50 countries to brief them on UNAIDS’ mandate and work.

Sally Cowal, Director of External Relations at UNAIDS, would be worried about not having a medical background.

“But as I came to understand more about the epidemic,” Cowal says, “it became clear to me that the political motivation around it, the need to overcome denial and complacency, were probably as important as anything we could do.”

Among its fast-track approvals are:

• the first HIV home testing and collection kit (May 14)
• a viral load test, which measures the level of HIV in the blood (June 3)
• the first non-nucleoside reverse transcriptase inhibitor (NNRTI) drug, nevirapine (June 21)
• the first HIV urine test (August 6)

President Clinton would dedicate the new Dale and Betty Bumpers Vaccine Research Center on June 9, 1999.

In 1993, 200 Haitian asylum-seekers were confined to Camp Bulkeley at the American naval base at Guantanamo Bay.  Under a judge’s order, they were finally allowed into the U.S., with most of them settling in Miami and New York City.

According to reporting in The New York Times, the vast majority of them had not won the political asylum they sought.  Twenty of them had already died, while others lived lives of quiet desperation, unable to get work and dependent on dwindling social programs.

Earlier in 1998, three New York social service agencies lost a total of $600,000 in federal grants that were used to fund housing, health care, counseling, and legal counseling for Haitian refugees, wrote reporter Garry Pierre-Pierre for the NYT.

“The pie is getting smaller, and people are less sympathetic toward refugees and immigrants,” Gabrielle Kersaint told the NYT.  Kersaint oversaw the Haitian Women’s Program, one of the organizations whose financing was eliminated.

The initiative invests an unprecedented $156 million to improve the nation’s effectiveness in preventing and treating HIV/AIDS in racial and ethnic minority communities.

The funding is spread across three broad categories: technical assistance and infrastructure support; increasing access to prevention and care; and building stronger linkages to address the needs of specific populations.

The majority of the funding would be sourced from the omnibus federal budget passed the week before, and the remainder “was redirected from other discretionary spending programs,” according to President Clinton in his announcement.

The move came in response to a call from Rep. Maxine Waters (D-CA), chair of the Congressional Black Caucus, who argued that “AIDS is a public health crisis in the black community.”

Although blacks constitute only 12% of the population, they comprise more than one third of all HIV/AIDS cases and 43% of new cases, according to the Kaiser Family Foundation.

In May 1998, the Congressional Black Caucus called on Health and Human Services Secretary Donna Shalala “to declare an AIDS state of emergency because of the unchecked spread of the disease in the nation’s minority community.”

“This is a national crisis,” said caucus chair Waters. “We will not rest until it is understood as one, until it is considered as one and worked on as one.

When a Congressional body declares a “state of emergency,” it typically results in raising public awareness about the issue and alerts government leaders that more money and energy should be directed toward addressing the issue.

Sources:
California Healthline, May 12, 1998 and October 28, 1998
Photo courtesy of the William J Clinton Presidential Library & Museum

WHO estimates that 33 million people are living with HIV worldwide, and that 14 million have died of AIDS.

In his address, President Clinton calls for concerted international action to combat infectious diseases in developing countries.  The President asks for foundations, pharmaceutical companies, international agencies, and other governments to join in this task.

Firmly planted at the center of AIDS activism for 15 years, Gendin is credited for having promoted constructive changes in government policy that would improve the lives of HIV-positive people. His activism was pivotal in reforming the FDA drug approval process to expedite HIV and AIDS patients’ access to more effective anti-retroviral treatments.

He was involved with ACT UP (New York and Rhode Island chapters), Sex Panic!, Community Prescription Service, and the Radical Faeries.  He also wrote a widely read column in POZ magazine. In this column, he shared the toll AIDS took on his body in graphic details and other personal experiences.

“Stephen was a willing guinea pig, his body a non-stop experimental laboratory for new treatment strategies.  His curiosity and courage contributed to what we have all learned about anti-retroviral treatment,” wrote Sean Strub, POZ Magazine’s founder and advisory editor.

Strub said he met Gendin in 1988, shortly after Gendin graduated from Brown University.  In ACT UP/New York, they worked together on the fundraising committee.  In 1990, Strub hired Gendin to work for his company, and for ten years they collaborated on various projects, including fundraising for community non-profits, publishing POZ magazine and launching the Community Prescription Service.

As a co-founder and the chief executive of the Community Prescription Service, Gendin oversaw the organization’s mail-order pharmacy service that distributed medication and information for people with HIV and AIDS, according to the New York Times.

Following Gendin’s death, POZ posted this video tribute to the legendary activist.

The meeting also calls for the creation of an international “global fund” to support efforts by countries and organizations to combat the spread of HIV through prevention, care, and treatment, including the purchase of HIV medications.

In April of 2002, The Global Fund approves its first round of grants to governments and private-sector organizations in the developing world. The grants total $600 million for two-year projects.

Created in 1998 by President Bill Clinton in response to urging from the Congressional Black Caucus, the Minority AIDS Initiative (MAI) originally focused on building organizations and infrastructure in communities of color to address the epidemic.  In the 1990s, people of color continued to be disproportionately impacted by HIV, according to the Los Angeles Times.

Starting in 1999, the MAI under President Clinton received an annual budget of $156 million dedicated to raising awareness of HIV and improving access to treatment programs in minority communities, according to the U.S. National Institutes of Health. The program was part of a larger $865 million increase in government spending on anti-AIDS programs.

But in 2003, the U.S. Supreme Court decided to take on Affirmative Action.  And President Bush used the public awareness raised around the hotbed issue to take a side in the case, urging for SCOTUS to rule unconstitutional any public policies that favored minority individuals or groups.

Even though the Supreme Court would in Grutter vs. Bollinger (2003) decide in favor of student admissions policies that prioritize underrepresented minority groups, President Bush moved forward with new policies to curtail federal funding to minority-led projects, including those prioritized by Clinton’s MAI.

“That simple change decimated many of the minority-led HIV organizations. To this day, it is still being used as the reason change is impossible,” said Paul Kawata, the executive director of the National Minority AIDS Council.

Kawata added: “An unintended consequence is that 10 years after the MAI was gutted, people of color became the majority of new cases and the majority of people living with HIV.”

The conference involves nearly 1,000 participants from the American Indian, Alaska Native, Native Hawaiian, First Nations, and U.S. Territorial Pacific Islander communities.

The WHO/UNAIDS guidelines state that in addition to expanding access to HIV testing, “equal efforts must be made to ensure that a supportive social, policy and legal framework is in place to maximize positive outcomes and minimize potential harms to patients.”  The recommended framework includes social mobilization, health care provider training, a strong monitoring and evaluation system and laws and policies against discrimination based on HIV status, risk behavior or gender.

In a response to the WHO/UNAIDS guidelines, Human Rights Watch pointed out that “few countries have strong legal frameworks in place and enforced, and that in many regions and countries resources are inadequate.”

HRW presented the following facts that could undermine the WHO/UNAIDS guidelines:

• Worldwide, less than 10% of injecting drug users have access to HIV prevention.
• About the same percentage of pregnant women living with HIV in Africa has access to the medicine necessary to prevent transmission to their infants.

“The United Nations set a goal of universal access to HIV prevention and treatment by 2010, but currently only an estimated 2 million of the 7 million people living with HIV in urgent need of treatment are receiving it,” HRW stated.

The legislation budgets $48 billion for PEPFAR to operate an additional five years and also contains a rider that gives the U.S. Department of Health and Human Services the authority to admit HIV-positive travellers to the U.S. on a “case-by-case” basis.

The a multiyear Act Against AIDS campaign is designed to reduce HIV incidence in the U.S. through raising awareness about HIV prevention.

The CDC simultaneously launches the Act Against AIDS Leadership Initiative (AAALI) in an effort to increase HIV-related awareness, knowledge, and action within Black communities across the U.S.

FDA announces that it has approved the 100th antiretroviral drug under the President’s Emergency Plan for AIDS Relief (PEPFAR).  Of the more than 100 products that have received either full or tentative FDA approval under the program, 29 are branded drugs and 71 are generics.

This achievement reflects a five-year-old regulatory process designed to fast-track the delivery of cheap HIV drugs to the developing world through the PEPFAR program.

The FDA process was launched in May 2004, in response to a call from activists, clinicians and members of Congress to use the WHO’s pre-certification drug list to make purchases of generic medications for PEPFAR-funded programs.  Instead, a process was devised to allow the FDA to certify generic antiretrovirals (ARVs) for PEPFAR purchase, even if the branded drug was still protected by U.S. patent laws.

HHS Secretary Kathleen Sebelius said in a statement, “This milestone exemplifies the dedication, caring, and hard work of all who strive to better the lives of those infected with or affected by HIV/AIDS.”

When applicable, Federal funds may be used for personnel, equipment, syringe disposal services, educational materials, communication and marketing activities and evaluation activities, and evaluation. Some HHS programs may still contain partial or complete bans on the use of funds for needle exchange programs.

“The Affordable Care Act is one of the most important pieces of legislation in the fight against HIV/AIDS in our history,” according to The Centers for Disease Control and Prevention.

Historically, people living with HIV and AIDS in the U.S. had a difficult time obtaining private health insurance and had been particularly vulnerable to insurance industry abuses.  Consistent with the goals of the Obama Administration’s National HIV/AIDS Strategy, the Affordable Care Act made considerable strides in addressing these concerns and advancing equality for people living with HIV and AIDS.

As of this day, insurers were no longer able to deny coverage to children living with HIV or AIDS.  The parents of as many as 17.6 million children with pre-existing conditions no longer had to worry that their children would be denied coverage because of a pre-existing condition.

Insurers also were prohibited from cancelling or rescinding coverage to adults or children because of a mistake on an application.  And insurers could no longer impose lifetime caps on insurance benefits. Because of the law, 105 million Americans no longer had a lifetime dollar limit on essential health benefits.

These changes to healthcare immediately improved access to insurance for people living with HIV/AIDS and helped people with these conditions retain the coverage they had.

At the 18th International AIDS Conference on July 18-23, the Centre for the AIDS Programme of Research in South Africa’s (CAPRISA) presented the results of its 004 study of antiretroviral-based microbicides, a vaginal gel that significantly reduces a woman’s risk of being infected by HIV and genital herpes.

The study shows the microbicides to be safe and effective in reducing risks of new HIV infections among women by 39%. Women who use the microbicides as directed have even higher rates of protection (54%) against HIV infection.

The microbicide containing 1% tenofovir — an antiretroviral drug widely used in the treatment of HIV — was considered to have the potential to prevent over half a million new HIV infections in South Africa alone over the next decade.

The study involved 889 women at high risk of HIV infection at an urban and a rural site in KwaZulu-Natal, South Africa. Overall, 98 women out of the 889 became HIV positive during the trial — with 38 in the tenofovir gel group and 60 in the placebo gel group.

Out of the 434 women who tested negative for herpes at the start of the trial, 29 became infected in the tenofovir group and 58 became infected in the placebo group. The reduced rates of HIV and herpes infections among the women who used the tenofovir gel were considered statistically significant.

The session recognizes critical milestones, including three decades of the pandemic and the 10-year anniversary of the 2001 UN General Assembly Special Session on HIV/AIDS and the resulting Declaration of Commitment . At the Meeting, the U.S. joined with other partners in launching a global plan to eliminate mother-to-child transmission of HIV and keep mothers alive.

Speaking before the National Institutes of Health, Clinton delivered remarks on the future of the global HIV/AIDS epidemic, reflected on the past 30 years of the epidemic, and outlined a vision for turning the tide on HIV/AIDS.

“Our efforts have helped set the stage for a historic opportunity, one that the world has today: to change the course of this pandemic and usher in an AIDS-free generation,” Clinton said.

“Now, by an AIDS-free generation, I mean one where, first, virtually no children are born with the virus; second, as these children become teenagers and adults, they are at far lower risk of becoming infected than they would be today thanks to a wide range of prevention tools; and third, if they do acquire HIV, they have access to treatment that helps prevent them from developing AIDS and passing the virus on to others.”

Clinton’s speech was considered to be the Obama’s administration’s first effort to publicly set an ambitious goal to eradicate the disease.  Following her remarks, administration officials scrambled to suggest ways that the initiative could be funded, including diplomatic pressure on governments in developing countries to spend more of their own money and political pressure on wealthy nations to contribute more.

During her speech, Clinton also introduced comic performer and talkshow host Ellen DeGeneres as a new Special Envoy for Global AIDS Awareness.

Clinton’s full speech is available here.

Dr. Eric Goosby, the Obama administration’s global AIDS coordinator, said this was only the first of several speeches that administration officials planned to make on AIDS in the next few months.

Conference organizers had refused to convene the event in the U.S. until the Federal government lifted the ban on HIV-positive travelers entering the country.

The Commission concludes that progress on MDG6 (Combating HIV/AIDS, Malaria, and Other Diseases) has been limited, given that the number of women living with HIV globally continues to increase. The report notes several key challenges: adolescent/young women’s particular vulnerability to HIV; the need to increase access to healthcare services; and the challenges of structural gender inequalities, stigma, discrimination, and violence.

The new regulations will provide a framework for clinical studies on transplanting organs from HIV-positive donors to HIV-positive recipients.

By the end of 2017, the U.S. will commit sufficient resources to support antiretroviral therapy for 12.9 million people, provide 13 million male circumcisions for HIV prevention, and reduce HIV incidence by 40% among adolescent girls and young women within the highest burdened areas of 10 sub-Saharan African countries.

The funds can now be used to support a comprehensive set of services, but they cannot be used to purchase sterile needles or syringes for illegal drug injection.

The announcement coincides with the 36^th anniversary of the Centers for Disease Control and Prevention’s first report of the initial cases of what would become known as AIDS.

U.S. Department of Health and Human Services made the website name change to reflect major scientific advances transforming a nearly always fatal disease to a condition that can be controlled and prevented from progressing to AIDS.

In its announcement to the public, HHS points out the fact that there were more people living with HIV in the U.S. than people living with AIDS.

In the lead-up to the name change, the U.S. Department of Health and Human Services gathered the following input from community organizations:

• “NMAC (National Minority AIDS Council) applauds the name change from AIDS.gov to HIV.gov, which honors the past while recognizing the power of words and acknowledging that their meanings change over time… The name change reflects the program’s longstanding and ongoing commitment to listen to the HIV community.”
• “Changing its name from AIDS.gov to HIV.gov is a reflection of AIDS.gov’s commitment to respond to the changing dynamics of the HIV/AIDS epidemic and an acknowledgement of the many scientific and treatment advances we’ve made in recent years. This name change is consistent with the forward thinking we’ve come to expect and depend on from this site.”
  — Phill Wilson, President and CEO, Black AIDS Institute
• “The Latino Commission on AIDS welcomes renaming AIDS.gov to HIV.gov to focus on preventing the spread of HIV and reaching people at risk for, and living with, HIV with love and compassion.”
  — Guillermo Chacón, President, Latino Commission on AIDS, and Founder of the Hispanic Health Network

HHS also collected input from its federal partners:

• Anthony S. Fauci, M.D., Director of the National Institute of Allergy and Infectious Diseases:
  “Much progress has been made in HIV/AIDS research since the disease was first recognized in 1981.  The website AIDS.gov has been a valuable resource for those seeking information about HIV/AIDS, and its name change to HIV.gov appropriately reflects our evolution in transforming the pandemic, even as work remains to bring about an end to HIV.”
• Laura Cheever, M.D., Sc.M., Associate Administrator of HRSA’s HIV/AIDS Bureau:
  “The shift to HIV.gov is important because the face of the epidemic is changing.  What was once a deadly disease is now a manageable, chronic condition, if there is access to testing, high-quality HIV primary medical care, medication, and essential support services, such as those provided by the Ryan White HIV/AIDS Program.”
• Jonathan Mermin, M.D., M.P.H., Director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention:
  “The shift to HIV.gov is proactive and inclusive, and it sends a strong, supportive message to the 1.1 million people across America who are living with HIV.  The number of annual HIV infections in the U.S. fell 18% between 2008 and 2014, but progress has not been the same for all communities. HIV.gov will deliver current science, accurate information, and links to effective resources for the people who need them most.”

The U.S. alone pledged up to $4.3 billion to the Global Fund, which was created in 2002 to address the AIDS, TB and malaria epidemics, which claimed 4 million lives that year alone, mostly in poor countries.

The Global Fund mobilizes and invests billions of dollars each year to support programs run by local experts in more than 100 countries.  In partnership with governments, civil society, technical agencies, the private sector and people affected by the diseases, the Global Fund seeks to overcome funding barriers.

Following the announcement from the G8, the Bill and Melinda Gates Foundation released a statement supporting the funding commitment.

“There is now a critical test for G8 governments: to follow through on the commitments announced this year, and in previous years, by translating what they have agreed into actual financial outlays that support the efforts of poor countries and communities to overcome poverty and disease,” the foundation said.

In 2018, the Global Fund helped finance the distribution of 131 million insecticide-treated nets to combat malaria, provided anti-tuberculosis treatment for 5.3 million people, supported 18.9 million people on antiretroviral therapy for AIDS, and since its founding saved 32 million lives worldwide.

G8 members make up most of the world’s largest economies and include: Canada, France, Germany, Italy, Japan, Russia, the United Kingdom, and the United States.

Operating under the U.S. Department of Health and Human Services, the Office of HIV/AIDS and Infectious Disease Policy hosted its first “listening session” at the 2018 U.S. Conference on AIDS in Orlando, Florida.

The call for input was part of the HHS plan to receive ideas on priorities and issues to be addressed as it begins work to update the National HIV/AIDS Strategy and the National Viral Hepatitis Action Plan, both of which are set to expire in 2020.

Joined by colleagues from the HHS Office of HIV/AIDS and Infectious Disease Policy, the listening session was convened at a special event during the U.S. Conference on AIDS.  Among the many comments offered during the session, the HHS staff heard about:

• The importance of addressing housing, incarceration, and other social determinants of health;
• The need to be strategic in the scale-up PrEP;
• Concerns that issues of aging and HIV be addressed;
• Concerns that adequate funding be provided to enact strategies contained in updated plans;
• The importance of focusing on HIV and hepatitis disparities if we are to end the epidemics;
• Expectations that funding and support for programs currently in place will be continued, particularly the Ryan White HIV/AIDS Program; and
• A desire for new forms of accountability for progress.

The Ending the HIV Epidemic: A Plan for America proposed leveraging new biomedical prevention and treatment options and data to reduce the number of new HIV infections in the U.S. by 75% in 2025 and by 90% in 2030, said Brett P. Giroir, M.D., HHS Assistant Secretary for Health.

“In short, we will diagnose all people as early as possible, treat rapidly and effectively, protect those at highest risk, respond to any outbreaks with an overwhelming force, and we’re going to create a public health workforce throughout this country with a specific goal of reducing new diagnoses by 75% within 5 years and 90% within 10,” Giroir said.

Experts on the subject expressed skepticism based on the administration’s attitude in the past toward HIV/AIDS.

“This pledge is nothing more than an empty gesture following a series of actions that have ignored the needs of the communities most affected by HIV,” said Scott Schoettes, HIV project director at civil rights group Lambda Legal.

Claiming the Trump administration had left HIV risk groups more exposed, activists pointed to the president’s recent acts of cutting research funding for HIV/AIDS and attempts to roll back healthcare access for vulnerable groups.  Trump also had publicly stated his support for medical staff who wanted to refuse treatment to LGBT+ patients on religious grounds.

“President Trump once again presented a broad-strokes narrative that people with HIV and AIDS, including LGBTQ Americans, simply can’t trust,” tweeted Sarah Kate Ellis, chief executive of U.S. LGBT+ advocacy organisation GLAAD.

The city’s “HIV Zero” initiative also seeks to ensure no members of the community have an elevated risk for acquiring HIV or encounter discrimination based on HIV status, sexual orientation or gender identity.

The four goals of the initiative are to:

1. Expand access to healthcare for people living with HIV and people currently at an elevated risk
   for acquiring HIV;
2. Reduce new HIV infections;
3. Reduce HIV-related disparities and health inequalities; and
4. Slow disease progress from HIV to Stage 3 (AIDS).

West Hollywood’s “HIV Zero” strategic plan is primarily focused on Los Angeles County Public Health Department surveillance data related to West Hollywood residents in order to determine the success
in meeting epidemiological benchmarks. However, progress is also informed by data sources that may
expand beyond West Hollywood’s boundaries.

Of the 2014 West Hollywood population of 35,053, more than 2,500 residents were people living with HIV.  Of those HIV-positive in the city, 87% were over 35 years old, 99% were male, and 68% were White.  New HIV diagnoses were concentrated almost exclusively among men who have sex with men.

For men in West Hollywood, the number of diagnosed per 100 (0.4) and living with HIV per 100 (12.9) was extremely high, compared to Los Angeles County, where HIV diagnoses was 0.03 per 100 men and living with HIV was 0.9 per 100.

These disparities help clarify why the West Hollywood HIV Zero Initiative was so critical.

In its final recommendation statement, the U.S. Preventive Services Task Force urges clinicians to screen for HIV in everyone aged 15 to 65 years and all pregnant people.  In addition, younger adolescents and older adults at increased risk for HIV should also be screened.

The Task Force additionally recommends that clinicians offer PrEP (pre-exposure prophylaxis) to people at high risk of HIV.

In its report, the Task Force notes that while HIV infection rates have been going down, rates among some groups are on the rise, most notably among young adults.

Created in 1984, the U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine. The Task Force works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

The Task Force makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms.  It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The Task Force does not consider the costs of providing a service in this assessment.

The report provides the results of a CDC analysis of HIV trends in America from 2010 to 2016 and shows that after about five years of substantial declines, the number of HIV infections began to level off in 2013 at about 39,000 infections per year.

The data analysis suggests that the number of new HIV infections remained stable from 2013 (38,500) to 2017 (37,500).  However, in 2017, an estimated 85.8% of infections were diagnosed.

The CDC researchers conclude that accelerated efforts to diagnose, treat, and prevent HIV infection are needed in order to achieve the U.S. goal of at least 90% reduction in the number of new HIV infections by 2030.

In a comprehensive review of federal data, the U.S. Health Resources and Services Administration reported the outcomes of all clients served by RWHAP Parts A–D during from 2014 through 2018.  The report provided a strong level of positive outcomes and a hopeful look at the challenges of reaching certain populations in the U.S.

Among the hardest populations to reach are those living at or below 100% of the federal poverty line (32% of clients), lacking in healthcare coverage (20%) and housing that is temporary or unstable (13%).

Serving more than half a million people each year, the Ryan White HIV/AIDS Program (RWHAP) was created in 1990 and currently is funded annually at more than $2 billion.

HRSA’s Ryan White HIV/AIDS Program is divided into five parts:

• Part A funds medical and support services to counties/cities that are the most severely affected by the HIV/AIDS epidemic:
• Part B administers funds for states to improve the quality, availability, and organization of HIV health care and support services, and includes grants for the AIDS Drug Assistance Program:
• Part C administers funds for community-based organizations to provide comprehensive primary health care and support services in an outpatient setting for people with HIV through Early Intervention Services program grants;
• Part D administers funds for community-based organizations to provide outpatient, ambulatory, family-centered primary and specialty medical care for women, infants, children and youth with HIV; and
• Part F funds support clinician training, dental services, and dental provider training, as well as the development of innovative models of care to improve health outcomes and reduce HIV transmission.

The HIV Surveillance Annual Report for 2019 released on this day presented statistics that included that an estimated 57,700 persons were living with HIV (PLWH) in Los Angles County, with about 11% of them (an estimated 6,400 people) unaware of their status of being HIV positive.*

The county’s annual HIV report also included statistics showing:

• Of the newly diagnosed cases in 2019, the largest gaps in knowledge of HIV-positive status existed for younger persons (about 50% of persons aged 13-24 years and 33% of persons aged 25-34 years were not aware of their HIV-positive status);
• HIV diagnoses rates increased between 2015-2018 for persons experiencing homelessness;
• About 16% of newly diagnosed cases were determined to be Stage 3 HIV (i.e., AIDS).
• Compared with the year before, the overall number of newly diagnosed cases of HIV dropped slightly in 2019;
• Overall death rates for people in LA County with diagnosed HIV have also declined over time;
• The following disparities in HIV diagnosis by population and location exist in LA County:
  • Rates of new HIV diagnosis are higher among males than females; and
  • Black people had higher rates of HIV diagnosis compared with other race/ethnicity
    groups, and also higher rates of transmission risk due to unmet need for HIV treatment.

Black males are disproportionately impacted by HIV in LA County, compared with males in other race/ethnicity groups, according to the report.  According to county health department statistics, Black men represented approximately 4% of the county’s population, but represent 17% of people living with HIV (PLWH). In contrast, Latinx men represented 24% of the population and 40% of PLWH; white men represented 16% of the LAC population and 24% of PLWH.

The county also reported that 75% of persons newly diagnosed with HIV in 2018 were linked to care within one month of diagnosis. Among persons diagnosed through 2018 and living at year-end 2019, 7 in 10 were engaged in care, 5 in 10 were retained in care, and 6 in 10 were virally suppressed.

HIV-infected persons who achieve sustained viral suppression have effectively no risk of passing HIV to others (i.e., undetectable = untransmissible).

“Several steps are required to achieve viral suppression among HIV-infected persons beginning with HIV diagnosis, timely linkage to care, engagement in care, retention in care, and adherence to HIV antiretroviral drugs,” the report states.

The HIV Surveillance Annual Report 2019, which is published by the Division of HIV and STD
Programs in the county’s health department, also included HIV surveillance data reported to the health department since the beginning of the HIV epidemic through December 31, 2019.  This HIV surveillance data is used by the county and area organizational partners in HIV healthcare to inform prevention, care, and treatment programs.

_ _ _ _ _ _ _

*The number of people living with HIV was determined using a mathematical model developed by the Centers for Disease Control and Prevention.

Healthcare insurance companies are now barred from discriminating against customers with pre-existing conditions, and they can no longer impose annual limits on coverage.

Goals set by LA County’s EHE initiative aligned with federal goals set by the HHS Office of Infectious Disease and HIV/AIDS Policy, including targets to reduce new HIV transmissions and acquisitions in the county by 75% in five years (by 2025) and by 90% in ten years (by 2030).

To reach these ambitious goals, county officials stated it would work with “critical contributors, partners and stakeholders” on increasing access to HIV care.  The county also said it would adjust its HIV data collection efforts to better track deliverables around the federal EHE initiative’s “four EHE pillars,” which are:

1) Diagnosing people living with HIV as early as possible;
2) Treating people living with HIV rapidly and effectively to achieve viral suppression;
3) Preventing new HIV transmissions using proven interventions; and
4) Responding quickly to HIV outbreaks and delivering prevention and treatment services to people
who need them.

“We are also guided by an overarching strategy to ensure that the interventions address and eliminate health inequities, that considers long-standing racial inequities that contribute to HIV-related disparities, that focuses on the communities and sub-populations most impacted by HIV, and
prioritizes a client-centered, people first approach to this endeavor,” said Mario L. Perez, the director of the county’s Division of HIV and STD Programs in the Department of Public Health.

The Ending the HIV Epidemic Plan for Los Angeles County followed specific goals and guidelines set by the HHS Office of Infectious Disease and HIV/AIDS Policy, which updated the country’s HIV/AIDS strategy in 2020 in the absence of a Presidential Advisory Council on HIV/AIDS (PACHA) under the Trump administration.

From its founding in 1995 until Trump dissolved the council in 2017, PACHA advised the White House on HIV/AIDS policies.  Council members offered recommendations on the National HIV/AIDS Strategy, a five-year plan responding to the epidemic.  The 2015 strategy was due to expire in 2020, so the HHS Office of Infectious Disease and HIV/AIDS Policy stepped in to update the HIV National Strategic Plan with new short-term goals.

On January 15, 2021, the HHS released the HIV National Strategic Plan for the United States: A Roadmap to End the Epidemic 2021-2025.  This plan was replaced by the National HIV/AIDS Strategy (2022-2025) in December 2021.

According to data released by the Health Resources and Services Administration’s Bureau of Primary Health Care, 93% of the nearly 200 health centers throughout the U.S. participating in the Ending the HIV Epidemic initiative were able to hire staff dedicated to HIV outreach, testing, linkage to care and treatment, and PrEP services.  These advances were made in the first eight months of the program, which allocated a total of $54 million to the health centers in February 2020.

“The early results achieved by these health centers are truly encouraging,” said Harold J. Phillips, Senior HIV Advisor and COO of the Ending the HIV Epidemic (EHE) Initiative in the HHS Office of Infectious Disease and HIV/AIDS Policy. “The work of these health centers on three of the four EHE pillars – prevent, diagnose, and treat – will support each of their communities in moving toward the goal of reducing new HIV infections by 75% by 2025 and by 90% by 2030.”

Between March and November 2020, more than 573,000 individuals were tested for HIV; 2,260 individuals tested positive for HIV and received follow-up within 30 days; and nearly 50,000 individuals at health centers were prescribed PrEP, according to the HRSE.

The HRSE data also indicated that:

• 93% of the health centers hired dedicated staff for a total of 389 full-time equivalent employees working on HIV outreach, testing, linkage to care and treatment, and PrEP services;
• Over 573,000 individuals were tested for HIV;
• 2,260 individuals tested positive for HIV and received follow-up within 30 days; and
• Nearly 50,000 individuals at health centers were prescribed PrEP]

These nine Los Angeles County-area health centers received grant funds for the EHE Initiative:

• APLA Health & Wellness ($261,233),
• AltaMed Health Services ($417,912),
• The Clinic Inc. ($263,355),
• Los Angeles LGBT Center ($278,196),
• St. John’s Well Child & Family Center ($305,039),
• Venice Family Clinic ($264,541),
• Valley Community Healthcare ($274,893),
• Watts Healthcare ($288,576), and
• Bartz-Altadonna Community Health Center ($256,071)

A total of 35 health centers in California received awards, totaling $9,972,545 in funding.

President Joe Biden, HHS Secretary Xavier Becerra, and Secretary of State Antony J. Blinken release messages recognizing the 40th anniversary. Other events and activities are held across the country to remember the lives that were cut short by this terrible disease and celebrate the resilience and dignity of the more than 38 million people with HIV worldwide.

On this day, the Foundation for The AIDS Monument held its ceremonial groundbreaking at the future site of STORIES: The AIDS Monument in West Hollywood Park.  Among the community members who attend the event is Dr. Michael Gottlieb, one of the authors of the June 1981 CDC report announcing the first five cases of an illness subsequently defined as acquired immunodeficiency syndrome (AIDS).

The five men described in the report were between the ages of 29-36 and resided in the Los Angeles area, and by the time the report was published, two had already died.  The relatively brief report gave scant information about this new medical phenomenon, including the following:

• The patients did not know each other and had no known common contacts or knowledge of sexual partners who had had similar illnesses.
• Two of the five reported having frequent homosexual contacts with various partners.
• All five reported using inhalant drugs, and one reported parenteral drug use (i.e., injected or implanted drugs).

According to 2020 data released by Los Angeles County’s health department, there was still a long way to go before the county could meet its Ending the HIV Epidemic (EHE) targets for the years 2025 and 2030.

Earlier this year, LA County set goals of no more than 450 new HIV diagnoses in 2025 and no more than 180 new HIV diagnoses 2030, according to the HIV Surveillance Annual Report 2021 released on this day.  The most recent number of 1,505 new diagnoses shows that LA County still had much work to do.

The county’s annual HIV report also included statistics showing:

• An estimated 57,005 persons were living with HIV (PLWH) in 2020, with about 9% of them (about  5,100 people) unaware of their status of being HIV positive*;
• Of the newly diagnosed cases in 2020, the largest gaps in knowledge of HIV-positive status existed for younger persons (about 40% of persons aged 13-24 years and 20% of persons aged 25-34 years were not aware of their HIV-positive status);
• HIV biobehavioral surveys conducted by the county confirmed that transgender women had the highest HIV positivity rate (1 in 3 were HIV positive) compared to other risk populations; and
• Though the number of HIV-positive pregnant women had decreased over time, the number of perinatal HIV transmissions is increasing (four infants who acquired HIV perinatally in 2020).

County statistics also revealed disparities in HIV diagnosis by population and location.  Rates of new HIV diagnosis are higher among males than females; and young males aged 20-29 years had the highest rates of new HIV diagnosis.  Also, Black people continued to have higher rates of HIV diagnosis compared with other race/ethnicity groups.

Also, the COVID-19 pandemic complicated access to HIV healthcare and treatment for many, according to the report.

Access to routine HIV care services decreased in 2020, and consequently, the county saw a reverse in progress along key steps in the HIV care continuum for people living with diagnosed HIV. Compared with 2019 achievements, the percentages decreased for people diagnosed with HIV receiving care and becoming virally suppressed in 2020.

The new data showed that LA County was behind in meeting goals set up by the National HIV/AIDS Strategy for linkage to and retention in HIV care.

For linkage to HIV care within one month for newly diagnosed people, the federal goal for 2020 was set at 85%, while LA County fell a bit short with only 77% linked to care in 2019.  If the county were to meet the federal targets for 2025, it would need to raise this number to 95% in five years.

For retention in HIV care for persons with diagnosed HIV, the federal goal for 2020 was set at 90%, while the county was able to retain in care only 44% of people diagnosed with HIV — significantly below the NHAS target.

The county also recorded an estimated 39% of priority populations to be prescribed PrEP in 2020, with a long way to go in order to achieve its Ending the HIV Epidemic (EHE) goal of 50% in 2025.

Created in 2020, Ending the HIV Epidemic in the U.S. is a federal plan that aims to reduce new HIV infections in the US by 75% by 2025 and by 90% by 2030. In February 2020, the U.S. Department of Health and Human Services awarded 57 high-burden states and counties (including LA County) with hundreds of millions of dollars to expand HIV prevention and care activities.

_ _ _ _ _ _ _

*The number of people living with HIV was determined using a mathematical model developed by
the Centers for Disease Control and Prevention.

The National HIV/AIDS Strategy (2022-2025) was released on Biden’s first World AIDS Day commemoration as President.  During his campaign, Biden pledged to update and implement the nation’s comprehensive HIV/AIDS strategy to “aggressively reduce new HIV cases, while increasing access to treatment and eliminating inequitable access to medical and support services,” according to White House officials.

The National HIV/AIDS Strategy provided the framework and direction for the Biden Administration’s policies, research, programs, and planning through 2025, with the goal of ending the HIV epidemic in the U.S. by 2030.

The new National HIV/AIDS Strategy:

• Incorporated the latest data on HIV incidence, prevalence and trends;
• Expanded the focus on addressing the social determinants of health that influence an individual’s HIV risk or outcomes;
• Encouraged reform of state HIV criminalization laws; and
• Added a new focus on opportunities to engage the private sector in novel and important ways in the nation’s work to end the HIV epidemic.

President Biden also announced that the U.S. would host the 2022 Global Fund to Fight AIDS, Tuberculosis, and Malaria Replenishment Conference.  However, the conference would ultimately be hosted by the neighbor to the north, Canada.

In his first six months in office, President Biden reestablished the White House Office of National AIDS Policy (ONAP), which was largely inactivate during Trump’s tenure in the White House.

Part of the strategy to end the HIV epidemic in the U.S. by 2030, “I am a Work of ART”  encourages people with HIV who are not in care for HIV to seek care, stay in care, and achieve viral suppression by taking antiretroviral therapy (ART).

The Centers for Disease Control and Prevention estimates the overall viral suppression rate in the United States is 53%. Therefore, a key strategy to prevent new HIV transmissions is increasing the proportion of people with HIV who are virally suppressed.

“When taken as prescribed, ART allows people with HIV to protect their health as well as the health of others,” said Assistant Secretary for Health Rachel Levine, M.D.

The launch of “I am a Work of ART” coincided with the release of  $115 million in grants from Health Resources and Services Administration to 60 Ending HIV Epidemic (EHE) recipients.

The top two EHE grant awards are $13.1 million to New York City (Bronx, Kings, Queens and New York counties), and $6.1 million to Los Angeles County.

Additional counties in California which received EHE grant awards include:  Sacramento County ($2.1 million), San Francisco ($2 million), San Diego County ($2 million), Riverside – San Bernardino counties ($2 million), Alameda County ($1.5 million), and Orange County ($1.2 million).