History

The CDC’s Morbidity and Mortality Weekly Report (MMWR) describes the men as having other unusual infections as well, indicating that their immune systems are compromised. Two of the give young men have already died by the time the report is published.

This edition of the MMWR marks the first official reporting of what will become known as the AIDS epidemic. The initial five-patient series was reported to the CDC by Dr. Michael Gottlieb, a member of the Council of Advisors to the AIDS Monument.

Today, Dr. Gottlieb is an Associate Clinical Professor of Medicine at UCLA’s David Geffen School of Medicine and still treats patients exclusively at APLA (AIDS Project Los Angeles) Health.

Following Gottlieb’s report to the CDC, he and his team would publish a more detailed report in the New England Journal of Medicine December 10,  1981.

Now it is known that HIV originated much earlier, in 1920, likely in the Democratic Republic of Congo around when HIV crossed species from chimpanzees to humans. Up until the 1980s, we do not know how many people were infected with HIV or developed AIDS.

While sporadic cases of AIDS were documented prior to 1970, available data suggests that the epidemic started in the mid- to late 1970s. By 1980, HIV may have already spread to five continents (North America, South America, Europe, Africa and Australia), and in this period, between 100,000 and 300,000 people could have already been infected

News stories in the Associated Press, the Los Angeles Times, and the San Francisco Chronicle capture the attention of the gay community and medical personnel nationwide.

In response to the outpouring of reports and concerns to the CDC, the Task Force on Kaposi’s Sarcoma and Opportunistic Infections is created to identify risk factors and to develop a case definition for the as-yet-unnamed syndrome.

After completing a three-year fellowship at the University of California San Francisco, Dr. Volberding was ready to become a cancer specialist under renowned virologist Dr. Jay Levy.  Instead, he would find himself on a lifelong journey of treating people living with HIV/AIDS and fighting the spread of the virus.

Dr. Volberding remembers his first patient with clarity.

“Twenty-two-year-old man, grew up in the Deep South, and as I recall he was estranged from his family,” Dr. Volberding tells the San Francisco Examiner almost 35 years later. “He ended up in San Francisco working basically sex for food, and had innumerable previous sexually transmitted infections.”

The man died within a few months, without his family present, Dr. Volberding recalls.

Around this same time, two doctors in the Bronx start to see HIV/AIDS symptoms in their patients.  Dr. Gerald Friedland sees cases of Pneumocystis pneumonia in injection drug users, and becomes one of the first to see the connection between IV-drug use and HIV transmission.

Pediatric immunologist Dr. Arye Rubenstein begins to identify the immunodeficiency of his pediatric patients, the children of drug addicts, as a symptom of what would be eventually called AIDS.

Dr. Rubenstein, who has been seeing this particular kind of immunodeficiency in children and sometimes in their mothers in his Bronx practice since the late 1970s, is one of the first to connect pediatric cases to the new disease affecting homosexual men.

These doctors who treat some of the first known cases of HIV/AIDS go on to do important, transformative work in the fields of treatment, research and public health policy.

In 1983, Dr. Volberding would establish what would make San Francisco General Hospital the model for HIV care: the country’s first AIDS treatment center (Ward 86).  Later the same year, he would join the medical team at Ward 5B, the first in-patient clinic for AIDS patients in the world.

Dr. Volberding would continue to treat HIV/AIDS patients until 2012, when he would become Director of the UCSF AIDS Research Institute.  Volberding would also become Co-Director of the Center for AIDS Research.

Dr. Friedland also would dedicate his life to AIDS treatment and research.  Following 10 years of working with HIV/AIDS patients in the Bronx, Dr. Friedland would become Director of the HIV/AIDS Program at Yale and Professor of Medicine and Epidemiology and Public Health at Yale School of Medicine.

Dr. Friedland would also become involved in HIV/AIDS international research aimed at providing access to antiretroviral therapy in developing regions of the world.  The major focus of his work becomes the integration of HIV and TB care and treatment in co-infected patients in South Africa.

In 2018, on the occasion of delivering the keynote address at the 13th annual International Conference on HIV Treatment and Prevention, Dr. Friedland would tell TheBodyPRO:

“Many of these people living with HIV, I have cared for, for decades.  I know them extremely well. They know me.  We have gone through this together and have this close collegial relationship as a partnership, so it’s a wondrous pleasure to continue to provide.”

The other doctor working in New York City in 1981, Dr. Rubenstein, would decide to remain in the Bronx, caring for children with HIV AIDS.

He would receive a grant in 1983 from the National Institutes for Health to study the incidence of AIDS in women and children. In 1986, Dr. Rubenstein would establish that transmission of AIDS can occur in utero, and his breakthrough findings are published in the journal Clinical Immunology and Immunopathology.

By this time, Dr. Rubsenstein has treated more than a hundred HIV-infected children, and in the summer of 1985, he would open a day care center for pediatric AIDS patients at Albert Einstein College of Medicine in the Bronx.  He would become Chief of the Division of Allergy & Immunology at Children’s Hospital at Montefiore and Professor of Pediatrics, Microbiology & Immunology at Albert Einstein College.

In a 1987 interview with New York magazine, he would speak fondly of the parents, many of them former IV-drug users, of his pediatric patients:

“Many come from a low socioeconomic group, they’re poor, the family may have broken up, they may have used drugs, and now their child has AIDS because they gave it to him.  You wouldn’t be surprised if they threw up their hands, but many don’t.  They become the best parents in the world.  They straighten out their lives, they spend hours with their kids. They give up longing for material things and look for spiritual and religious values.”

At the event in Bethesda, the clinicians discuss Kaposi’s sarcoma and other opportunistic infections, and begin to develop recommendations for further studies in epidemiology, virology, and treatment.

The mothers of at least three of the children have disclosed that they use drugs and/or engage in sex work.  Dr. Rubinstein recognizes that the children are showing signs of the same illnesses affecting gay men, but his diagnoses are dismissed by his colleagues.

A few months later, GMHC volunteer Rodger McFarlane sets up an information and counseling hotline on his home phone — and receives 100 phone calls the first night.

“A Cluster of Kaposi’s Sarcoma and Pneumocystis carinii Pneumonia among Homosexual Male Residents of Los Angeles and Orange Counties, California” describes a potential sexually transmitted agent as being the link to outbreaks of KS, Pneumocystis carinii pneumonia, and other infections recently found among young gay men.

The report describes a study of 19 case subjects from June 1, 1981 to April 12, 1982 involving biopsy-confirmed KS and/or PCP among previously healthy homosexual male residents in southern California.

Following a report of possible associations among the KS/PCP case subjects in Los Angeles and Orange counties, interviews were conducted with the eight subjects still living and with seven of the close friends of the 11 subjects who had died.

Through these interviews, the CDC was able to collect data on sexual partners for 13 of the 19 subjects. The study considered “sexual contact” to be established if the KS/PCP case subjects was reported to have “exposure” to another person that was either substantiated or not denied by the other person involved in the relationship (or by a close friend of that person).

Within five years of the onset of symptoms, nine of the KS/PCP case subjects had had sexual contact with others who had KS or PCP.  They consisisted of seven case subjects from LA County who had sexual contact with other patients from LA County, and two case subjects from Orange County had sexual contact with one patient with KS who resided outside California.

Four of the nine KS/PCP case subjects had been exposed to more than one patient who had KS or PCP. Three of the nine KS case subjects developed their symptoms after sexual contact with persons who already had symptoms of KS.  One of these three subjects developed symptoms of KS about nine months after sexual contact, another subject developed symptoms 13 months after contact, and a third subject developed symptoms 22 months after contact.

The other four KS/PCP case subjects in the group of 13 had no known sexual contact with reported cases. However, one KS case subject had an apparently healthy sexual partner in common with two persons with PCP; one KS case subject reported having had sexual contact with two friends of the non-Californian with KS; and two PCP case subjects had most of their anonymous contacts (greater than or equal to 80%) with persons in bathhouses.

The editorial note to the report included these points:

• An estimated 185,000-415,000 homosexual males lived in LA County in 1982.
• If one assumes each homosexual male in LA County has between 13 and 50 different sexual partners per year during 1977-1982, “the probability that seven of 11 patients with KS or PCP would have sexual contact with any one of the other 16 reported patients in LA County would seem to be remote.”
• With this same assumption, “the probability that two patients with KS living in different parts of Orange County would have sexual contact with the same non-Californian with KS would appear to be even lower.”
• Thus, observations in LA and Orange counties imply the existence of an unexpected cluster of cases.

The CDC then puts forth the hypothesis that infectious agents are being sexually transmitted among homosexually active males.

“Infectious agents not yet identified may cause the acquired cellular immunodeficiency that appears to underlie KS and/or PCP among homosexual males. If infectious agents cause these illnesses, sexual partners of patients may be at increased risk of developing KS and/or PCP,” the CDC report posits.

The CDC proposes another hypothesis:  “Sexual contact with patients with KS or PCP does not lead directly to acquired cellular immunodeficiency, but simply indicates a certain style of life. The number of homosexually active males who share this lifestyle may be much smaller than the number of homosexual males in the general population.”

The CDC goes on to suggest the possibility of exposure to “some substance (rather than an infectious agent)” leading to immunodeficiency among homosexual males that share a particular style of life.

The report cites a New York City-based report suggesting a connection between amyl nitrite (commonly referred to as “poppers”) and an increased risk of KS.  This hypothesis would later be scientifically disproved.

The article, “Epidemiologic Notes and Reports Pneumocystis carinii Pneumonia among Persons with Hemophilia A,” is the first report of immunosuppression in patients with hemophilia who have no other known risk factors for AIDS.

The first dedicated funding for AIDS research and treatment will be approved by Congress almost a year later, in July 1983.

CDC’s report, “Current Trends Acquired Immune Deficiency Syndrome (AIDS): Precautions for Clinical and Laboratory Staffs,” introduces precautions for medical personnel working with people exhibiting signs of AIDS.  The report notes that “airborne spread and interpersonal spread through casual contact do not seem likely.”

The following year, U.S. researcher Robert Gallo announces he has found the “probable” cause of AIDS, the retrovirus HTLV-III.  The two viruses — HTLV-III and LAV — turn out to be one and the same, and in May 1986 it becomes officially known as the human immuno-deficiency virus, or HIV.

Barre-Sinoussi made her discovery while under French virologist Luc Montagnier, and both would go on to win the 2008 Nobel Prize in Physiology or Medicine for identifying the AIDS virus.  Barre-Sinoussi’s discovery ultimately led to the development of anti retroviral medications that have turned AIDS from a death sentence to a manageable chronic disease.

Barré-Sinoussi dedicated her career as a scientist and as an activist to halting the spread of AIDS.  Being on the front lines of the AIDS devastation was, she admitted, “very tough psychologically.”  The pressure was so intense that, once antiretroviral therapy was discovered in 1996, Barré-Sinoussi fell into a depression, and pulled back from her public commitments. But she soon returned to the fight, often travelling around the world to meet with political leaders and healthcare providers seeking solutions to local epidemics.

“Like everybody, I have some times in my life when I’m pessimistic,” she said.  “I wonder whether I should continue … Then I go and have a trip to Africa or Southeast Asia and have a small meeting with people affected by HIV, and I forget my mood. I say, ‘OK, let’s go on. Let’s continue. This is real life. Don’t think about yourself.'”

She currently directs the Regulation of Retroviral Infections Unit at the Pasteur Institute, which is still looking for a vaccine or a functional cure.

APLA moves into a converted motel built in 1955, located at 937 Cole Street in Hollywood.

Held at the Beverly-Wilshire Hotel, the MECLA breakfast event also features presentations by Dr. Joel Weisman (APLA Co-Chair), Dr. Michael Roth of UCLA’s Department of Allergy and Immunology, Assemblymember Burt Margolin, and Mark Feldman, founder of the “Phooey on AIDS” emergency healthcare fund, according to a report from Pat Rocco.

Ward 5B is the answer to a petition organized by psychiatric nurse Cliff Morrison, demanding compassionate, holistic care for AIDS patients in San Francisco.  By August, the ward’s 12 beds are fully occupied.

Run by Morrison and an all-volunteer team, Ward 5B allowed patients to create their own family made up of friends and partners. The nurses recognized that many of the patients were isolated from their families or had long-term, though not legal, partners.

The ward was one of the first units in the country that allowed visitors at any time.

In response to growing concerns about the potential for AIDS transmission in healthcare settings, CDC publishes occupational exposure precautions for healthcare workers and allied health professionals.

Heckler also announces the development of a diagnostic blood test to identify HTLV-3 and expresses hope that a vaccine against AIDS will be produced within two years.

Dr. Gallo and his research colleagues developed a process to mass-produce the retrovirus for the purpose of developing the tools needed to identify, treat and cure the disease that has afflicted more than 4,000 Americans to date.

The announcement follows the announcement by the Pasteur Institute in Paris of its discovery of LAV, which they say causes AIDS.

Heckler said she thought the two viruses ”will prove to be the same.”

The report includes the following “recommendations for the individual” judged most likely to have an HTLV-III infection:

The CDC, which began investigating the mysterious and often-fatal disease in 1981, initially identified Haitian immigrants, intravenous drug users, hemophiliacs, and homosexual or bisexual men as groups at high risk for HIV/AIDS.

The CDC’s weekly reports of AIDS statistics included all four groups, but starting in April 1985, Haitians were no longer included as a separate listing.

The April 1985 report cited a total of 9,405 cases of AIDS reported in the U.S.  Of those cases, 285 (about 3%) were Haitians, said Dr. Walter Dowdle, director of the Center for Infectious Diseases. Previously the rate for Haitians had been as high as 5%. By contrast, about 75% of the cases were of males who identified as homosexual or bisexual.

”The Haitians were the only risk group that were identified because of who they were, rather than what they did,” he said.

An international committee of scientists is proposing that the AIDS virus be called by a new name: human immunodeficiency virus, or HIV.

For several years, the HIV-1 Western blot would be considered the “gold standard” for laboratory diagnosis of HIV-1 infection, but is no longer recommended. The two main reasons for this are the inability of the Western blot to detect acute infection and the potential to misclassify HIV-2 infection as an HIV-1 infection.

A report in Nature in June 1993 would conclude that researchers need to “reappraise” the use of the Western blot antibody tests as a diagnostic and epidemiological tool for HIV infection.

The report emphasizes the need for healthcare workers to consider all patients as potentially infected with HIV and/or other blood-borne pathogens and to adhere rigorously to infection-control precautions for minimizing the risk of exposure to blood and body fluids of all patients.

The CDC defines healthcare workers as “persons, including students and trainees, whose activities involve contact with patients or with blood or other body fluids from patients in a healthcare setting.”

Universal precautions are listed in the report, along with precautions for invasive procedures, dentistry, dialysis, laboratory procedures, and autopsies and mortuary work.

Dr. Joseph Sonnabend, Callen’s doctor, would later write about treatment to prevent PCP with “a drug that had been known to prevent this kind of pneumonia since 1977.”

The doctor would blame NIH Director Dr. Anthony Fauci for the delay in this treatment being available on a widespread basis, saying that Dr. Fauci “wanted data from a clinical trial of Bactrim for PCP prophylaxis in AIDS before he would recommend its use.”

Dr. Sonnabend says he refuses to wait for the NIH to collect data and reach its conclusions, revealing that he is already prescribing Bactrim (also known as Septra, Septrin or co-trimoxazole) and Dapsone to patients he routinely deems to be at risk for PCP, with positive results in his patients.

Years later, looking back at this time, Dr. Sonnabend would write:  “People were dying of PCP at a terrifying rate; I and some other physicians could not wait for these recommendations.”

The guidelines are a response to recently enacted legislation, the “AIDS Amendments of 1988” in the HOPE Act of 1988, passed by Congress and signed by President Ronald Reagan on Nov. 4, 1988.

The legislation calls for the Secretary of Health and Human Services, acting through the Director of the CDC, to “develop, issue, and disseminate guidelines to all health workers, public safety workers (including emergency response employees) … concerning methods to reduce the risk in the workplace of becoming infected with the etiologic agent for AIDS, and circumstances under which exposure to such etiologic agent may occur.”

The report states that, as of September 1988, a total of 3,182 (5.1%) of the 61,929 adults reported to be living with AIDS are employed in a healthcare setting.  Of the healthcare workers with AIDS, the means of HIV acquisition is “undetermined” for 5% of them (169 workers), suggesting that infection occurred in the workplace.

Of these 169 health-care workers with AIDS, 44 are interviewed directly or have other background information available about their cases.  The occupations of these 44 are:

• nine nursing assistants
• eight physicians, four of whom are surgeons
• eight housekeeping or maintenance workers
• six nurses
• four clinical laboratory technicia)ns
• two respiratory therapists
• one dentist
• one paramedic
• one embalmer
• four others who did not have contact with patients

Eighteen of these 44 health-care workers report parenteral (i.e., not delivered via the intestinal tract) and/or other non-needle-stick exposure to blood or other body fluids from patients in the 10 years preceding their diagnosis of AIDS.  None of the exposures involve a patient with AIDS or known HIV infection.

The CDC report describes the first known case of clinical transmission of HIV:  19-year-old Kimberly Ann Bergalis underwent a molar extraction in December 1987; about two years later, she would test positive with a strain of HIV related to that of her dentist.

Kimberly’s dentist, Jeffrey Acer, would be villified in the press, even in the years following his death in September 1990.  He would be openly called a lunatic and a murderer, and accused of deliberately infecting his patients (which is in no way supported by facts).

Reported to the CDC by the Florida Department of Health and Rehailitative Services (HRS), the case describes Bergalis as having no identified risk factor for HIV infection and that, at some time following an extensive dental procedure with Dr. Acer, she became infected with an HIV strain related to the one that he had.

In an open letter to his patients, Dr. Acer says: “I am a gentle man, and I would never intentionally expose anyone to this disease. I have cared for people all my life, and to infect anyone with this disease would be contrary to everything I have stood for.”

The CDC suggests that during the dental procedures, “higher titers of virus may have been present in the dentist’s blood and he may have been more likely to transmit virus than earlier in the course of his HIV disease.”

Following the notification, two more of 591 former patients tested at county health clinics would test positive with a strain similar to Dr. Acer’s.  In addition, a third infected patient would be identified by the Florida Department of Health and Rehabilitative Services (HRS) and a fourth would contact the CDC directly to report that she was HIV-infected and a former patient of the dentist.

The Florida HRS would then reach out to 1,100 additional persons who potentially were patients of Dr. Acer to offer counseling and HIV-antibody testing.  Of them, 141 are tested, and all results are negative.  In addition, none of the dentist’s 14 employees test positive for HIV.

Staff members of the dental office tell the HRS that barrier precautions had been introduced into the practice by early 1987 and that all staff, including the dentist, wore latex gloves and surgical masks for patient-care activities. Staff report that they changed gloves and washed their hands between most patient contacts; occasionally, however, they washed gloves rather than changed them between patient contacts.  Additionally, staff report that by 1987 all surgical instruments were autoclaved.

According to medical records reviewed by the CDC, Dr. Acer was diagnosed with symptomatic HIV infection in late 1986 and AIDS in September 1987.  While he is in practice, he has no record of peripheral neuropathy, dementia, thrombocytopenia or other bleeding disorder, hand dermatitis, or injury.

Dr. Acer would close his practice in 1989 after his T-cell (CD4 lymphocyte) count drops under 200, and he would die on Sept. 30, 1990 at the Hospice of Palm Beach County at West Palm Beach with his parents at his side.

Kimberly Bergalis would spend her final years advocating for the mandatory testing of medical professionals.  She is described as “the one AIDS patient the AIDS community will not embrace, a frightening and hostile new public symbol of an epidemic the AIDS community thought it had tamed.”

Larry Gostin, professor of health law at Harvard University, tells The Washington Post in September 1991, “What Kimberly Bergalis symbolizes is … that AIDS is to be feared and that it can be contracted easily in health-care settings. She has created fear.”

Still, Bergalis is a sympathetic victim to many, and would go on to testify to Congress in a 20-second statement  that becomes the world’s headline:

“I’d like to say that AIDS is a terrible disease that you must take seriously. I did nothing wrong, yet I’m being made to suffer like this. My life has been taken away. Please enact legislation so that no other patient or health care provider will have to go through the hell that I have. Thank you.”

Soon, the Senate would pass a bill, sponsored by North Carolina Sen. Jesse Helms, that requires healthcare workers to reveal their HIV status or face imprisonment.

Bergalis would die of AIDS-related illness on Dec. 8, 1991 at the age of 23.

The condom, which is ma nufactured by Chartex International, becomes available over the counter at most major drug stores in Southern California, under the name Reality Female Condom.

Although the female condom gives women more options for birth control, it is slow to catch on with the general public.

Donna Diaz, a representative of Planned Parenthood of Los Angeles, tells California State University’s campus newspaper that the female condom is not popular because it is “more awkward to use” than the male condom.

“It’s not as effective as the male condom and it’s very inconvenient to use,” she says.

However, Holly Sherman, spokeswoman for The Female Health Company — which markets and distributes the condom — disagrees, saying the female condom provides protection from disease on genital areas because there is “less skin touching skin” and the chance of transmitting a disease is less likely.

The female condom has a sheath material and a flexible inner ring, and is inserted similar to a diaphragm.  A woman squeezes the ring and inserts it as far as possible into the vagina. The ring then covers the cervix. Its sheath material holds the condom in place. The outer ring lines the vaginal wall and helps cover the lips of the vagina.  The sexual partner must stay within the confines of the female condom or it’s ineffective.

In a report, the CDC revises its case definition of AIDS to emphasize the clinical importance of the CD4+ T-lymphocyte count in the categorization of HIV-related clinical conditions.

In the same MMWR, CDC adds three new conditions — pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer — to the list of clinical indicators of AIDS.  These new conditions mean that more women and injection drug users are expected be diagnosed with AIDS.

Following a workshop to develop recommendations for the use of AZT with HIV-infected women who are pregnant, the Public Health Service determines that AZT administered to a selected group of HIV-infected women and their infants is successful in reducing the risk of HIV transmission by approximately 66%.

In its report, the Public Health Service states that because the clinical status of many HIV-infected women may differ from that of the women in the trial, the recommendations should be tailored to each woman’s clinical situation.

“The potential benefits, unknown long-term effects, and gaps in knowledge about her specific clinical situation must be discussed with the woman,” the report states.  “This information is intended to provide a basis for discussion between the woman and her healthcare provider so that the woman can weigh the risks and benefits of such therapy and make informed decisions about her treatment.”

In a precursor to a full report that would be published in the August edition of Clinical Infectious Diseases, the CDC announces that healthcare providers can prevent opportunistic infections in HIV-positive people by adhering to a set of guidelines.

The set of recommendations are rated according to the strength of the recommendation and the quality of evidence supporting the recommendation.  The guidelines address prevention techniques for adults, adolescents and children.

The drug, saquinavir, manufactured by Hoffmann-La Roche, is a member of the new class of drugs called protease inhibitors that attack the ability of the HIV virus to reproduce. It does so by inhibiting an enzyme called protease that is crucial to HIV reproduction.

The first antiretroviral therapies developed for people with HIV are nucleoside reverse-transcriptase inhibitors (NRTIs), but these drugs would prove to be only partially effective. The addition of an orally administered protease inhibitor reduces HIV plasma concentrations and increases T-cell (CD4+) counts to levels that enable patients to have fairly normal life expectancies.

This combination — two nucleoside analogs and a protease inhibitor — is now considered the cornerstone of active antiretroviral therapy.

Dr. Ho’s approach to HIV treatment involves placing patients on new, more aggressive treatment regimes earlier in the course of their infection in hopes of keeping them healthier longer.

“We set up several studies in mid-1995, and by mid-1996 we were able to show that for the first time we could drop the virus down so that it’s not detectable and keep it down for a year or more,” Dr. Ho tells Frontline in a series of interviews in 2005-2006.  “That was what was later hailed as the major advance in HIV therapeutics.”

Unlike other antibody tests for HIV, this blood test can be stored at room temperature, requires no specialized equipment, and may be used outside of traditional laboratory or clinical settings, allowing more widespread use of HIV testing.

The new test provides a result in about 20 minutes, while the fastest test currently in use takes 90 minutes.  In practice, however, most people who seek AIDS testing aren’t given their results for a week or more after they provide a blood sample.

The OraQuick Test requires that a person prick his finger and use a wire loop to capture a drop of blood. The drop is then put in a vial containing a diluting solution.

Then a paper tab attached to a cap is lowered into the solution. A dark line appears on the tab if it makes contact with certain universal blood proteins. If antibodies to HIV are present, a second dark line appears.

Public health officials are hopeful that the test will substantially increase the number of people seeking testing, and decrease the fraction who, once tested, never return for the results.

Conducted by the University of Illinois at Chicago and supported by the U.S. National Institute for Allergy and Infectious Diseases and the Canadian Institute of Health Research, the analysis of the clinical trial confirmed the importance of established risk factors for HIV and identified practices (such as circumcision) that warrant further investigation.

The study’s researchers said their goal was to “determine whether male circumcision had a protective effect against HIV infection, and to assess safety and changes in sexual behaviour related to this intervention.”

After compiling data from 2,784 men aged 18-24 years in Kisumu, Kenya, the researchers concluded that male circumcision significantly reduces the risk of HIV acquisition in young men in Africa.

“Where appropriate, voluntary, safe, and affordable, circumcision services should be integrated with other HIV preventive interventions and provided as expeditiously as possible,” the report stated.

The National Institutes of Health announce these results from its iPrEx study, supporting the concept of pre-exposure prophylaxis (PrEP) in a targeted population.

In its report Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access, the World Health Organization (WHO), UNAIDS, and UNICEF announce that improved surveillance data is providing a better worldwide picture of the epidemic than previously thought.

The data also indicates a decline in the numbers of new infections and people dying from AIDS-related illnesses, due in part to HIV-prevention programs and antiretroviral therapy.

The report also announces that, for the first time, the prospect of a microbicide that contains antiretroviral medicine is providing additional hope to the women in sub-Saharan Africa, who continue to bear a disproportionate burden of the HIV epidemic in this region.

Days later, the Obama administration announces new goals for PEPFAR (the President’s Emergency Plan for AIDS Relief), saying it is “the beginning of the end of AIDS.”

“Today is a remarkable day,” President Barack Obama says in a White House statement.  “Today, we come together, as a global community, across continents, faiths and cultures, to renew our commitment to ending the AIDS pandemic – once and for all.”

Researchers from the University of New South Wales in Australia release the results of a study that show that people living with HIV who are taking antiretroviral therapy (ART) have an increased risk of cardiovascular disease.

“Although the health and survival of PLHIV have improved with effective ARTs, people living with HIV are at substantially greater risk of developing other comorbidities, such as cardiovascular disease, compared with uninfected people,” the researchers conclude.

Due to the prevelance of cardiovascular disease and its cause of deaths worldwide, this poses a significant issue for people living with HIV, particularly as they get older, according to the researchers.

Published by the CDC and subsequently in JAMA, the American Medical Association’s journal, a report by Jacek Skarbinski, M.D., and Eli Rosenberg, M.D. announces that persons living with HIV who are retained in care and have achieved viral suppression are 94.0% less likely to transmit HIV than HIV-infected undiagnosed persons.

“Unfortunately, too few persons living with HIV have achieved viral suppression,” the report concludes. “These estimates of the relative number of transmissions from persons along the HIV care continuum highlight the community-wide prevention benefits of expanding HIV diagnosis and treatment in the United States.”

The report recommends the implementation of improvements at each step of the continuum to reduce HIV transmission.

“Through stronger coordination of efforts among individuals, HIV care providers, health departments, and government agencies, the United States can realize meaningful gains in the number of persons living with HIV who are aware of their status, linked to and retained in care, receiving ART, and adherent to treatment,” state the researchers.

It will provide data on the use of newer HIV medications during pregnancy, helping to ensure that women living with HIV and their infants receive the best available treatments.

The research shows that early and sustained ART reduces the onset of AIDS-defining cancers and — to a lesser degree — other cancers in HIV-positive people.

But the long-term study, which followed nearly 150,000 veterans over the years of 1999-2015, also found that the cancer risk for HIV-positive patients with long-term viral suppression still was greater than the risk of cancer for HIV-negative patients.

The simulations are consistent with 840,000 actual HIV DNA sequences contained in a global public HIV database, according to the study published in Nature Microbiology.

The simulations could allow state health departments to track the spread of HIV and provide a powerful new tool to help prevent new HIV infections.

“We looked for special genetic patterns that we had seen in the simulations, and we can confirm that these patterns also hold for real data covering the entire epidemic,” said Thomas Leitner, a computational biologist at Los Alamos and lead author of the study.

HIV is particularly interesting to study in this manner, Leitner noted, as the virus mutates rapidly and constantly within each infected individual.  The changing “genetic signatures” of its code provide a path that researchers can follow in determining the origin and time frame of an infection, and the computer simulations are now proven to be successful in tracking and predicting the virus’s movements through populations.

The study followed 3,700 MSM in New South Wales, Australia, who were taking PrEP with high levels of adherence.

As the first empirical study to test PrEP’s population-level effectiveness, the program found that HIV infections declined in the study cohort and also statewide in Australia’s most populous state, New South Wales.

The report concludes that rapid, targeted, high-coverage PrEP implementation is effective to reduce new HIV infections at the population level.

Less than a year later, Andrew Grulich, MD, head of the HIV Epidemiology and Prevention Program at the Kirby Institute at UNSW Sydney, would present follow-up data supporting the initial study at the 10th International AIDS Society Conference on HIV Science in Mexico City.

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The research project seeks to examine the safety and use of two HIV prevention tools — PrEP and a vaginal ring — for young women and girls under the title “REACH” (Reversing the Epidemic in Africa with Choices in HIV prevention).

One in four new infections in sub-Saharan Africa were women and girls aged 15-24 – despite making up 10% of the population.

“Women in less-developed countries disproportionately bear the burden in terms of ill health when facing food insecurity or a shock or disaster like drought that impacts the ability to get food or harvest food,” said Kelly Austin, associate professor of sociology at Lehigh University.

Essentially, lack of resources can lead to sexual assault, marriages of economic necessity and the resultant transmission of HIV.

Conducted for 1.5 years, the study would go on to show that the vast majority (97%) of the 247 participants used the vaginal ring and daily oral PrEP some or all of the time.  Fewer than 3% of participants would use neither of the products, according to laboratory tests for adherence.

“In many ways, these results exceeded even our own expectations, yet at the same time, it’s not surprising to find that these young women have the capacity and desire to protect themselves against HIV,” explains Gonasagrie (Lulu) Nair, MBChB, MPH, REACH protocol chair, Centre for Medical Ethics and Law, Faculty of Medicine, at Stellenbosch University in South Africa.  “They simply need to feel empowered and have the agency to make choices based on what they feel is right for them.”

Nina Martinez, 35, is the living donor. She donated her kidney to an anonymous recipient after the friend she had hoped to give it to died last fall. Martinez acquired HIV when she was 6 weeks old through a blood transfusion and was diagnosed at age 8.

“I wanted to show that people living with HIV were just as healthy.” Martinez says in a news conference held to announce the medical break-through. “Someone needed that kidney, even if it was a kidney with HIV. I very simply wanted to show that I was just like anybody else.”

Martinez first learned of the opportunity for her to donate a kidney in 2013, when the HIV Organ Policy Equity Act (HOPE Act) passed in Congress.  Yet, until she saw a storyline on the medical drama Grey’s Anatomy a few months later, she didn’t realize where her own life would intersect with kidney donation.

The HOPE Act was introduced on February 14, 2013, in the Senate by Sens. Barbara Boxer (D-CA), Tammy Baldwin (D-WI), Tom Coburn (R-OK), and Rand Paul (R-KY) and in the House by Rep. Lois Capps (D-CA).  The Senate passed the legislation by unanimous consent, and about six months later, the House passed it by unanimous consent.

The doctors at Johns Hopkins say the recipient is doing well.

“This is the first time someone living with HIV has been allowed to donate a kidney, ever, in the nation, and that’s huge,” says Dorry Segev, M.D., Ph.D., professor of surgery at Johns Hopkins.  “A disease that was a death sentence in the 1980s has become one so well-controlled that those living with HIV can now save lives with kidney donation — that’s incredible.”