History

Like pnuemocytis carinii pneumonia (PCP), Kaposi’s Sarcoma (KS) is associated with people who have weakened immune systems.

Dr. Friedman-Kien told New York magazine:

“In February 1981, I saw a young man who was perfectly healthy except for a number of spots on his skin.  I’d never seen anything like it, so I did a biopsy.  Under the microscope, the cell structure was clear: it was Kaposi’s sarcoma.”

Dr. Friedman-Kien continued:  “A week later, another physician sent me another patient, also a gay man in his late thirties, also with disseminated KS.”

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Source:

New York magazine, “Fighting AIDS” by Janice Hopkins Tanne, January 12, 1987

POZ magaine, “A Look Back at the Year a Rare Cancer Was First Seen in Gay Men” by Joseph Sonnabend, M.D., July 13, 2020

The New York Times, “Rare Cancer Seen in 41 Homosexuals” by Lawrence K. Altman, July 3, 1981

The 35-year-old, white gay man from New York City was transferred from a Connecticut hospital to the NIH in Bethesda, Maryland after researchers at the National Cancer Institute, an NIH branch that studied immunodeficiency diseases, heard about his case.

Almost immediately after the new disease emerged on the medical scene, researchers recognized that patients with this unnamed syndrome often developed a rare cancer called Kaposi’s sarcoma as well as other tumors, such as high-grade B-cell lymphomas. As a result, some of the earliest AIDS patient care and research was performed by cancer specialists at the NIH and elsewhere.

The man admitted to the NIH was, for privacy purposes, referred to as “Patient D.”  He came to the NIH from Hartford Hospital, where he had been hospitalized for two months with neumocystis carinii pneumonia, lymphocytopenia, cytomegalovirus, herpes simplex II, Candida esophagitis, and Mycobacterium avium tuberculosis of the lung, bone marrow, and esophagus.

The patient had been healthy through adulthood until February 1981, when he began experiencing fatigue and weakness, followed by weight loss and fever.

Thomas A. Waldmann, M.D., one of the NIH doctors who was first to examine “Patient D” said in a 1990 NIH interview:

“The pattern that we observed in our patient was the kind of pattern one saw in Hodgkin’s disease patients who were profoundly anergic [i.e., a condition in which the body fails to react to an antigen], or in patients with a form of profound immunodeficiency called ‘severe combined immunodeficiency of infancy,’ where the patient cannot make an effective cellular or antibody immune response. What we were seeing was an acquired form of cell-mediated immunity.”

Dr. Waldmann said the medical team performed every test they could think of to try to determine the cause of Patient D’s condition, to no avail.

“We were all groping, trying to understand what was going on,” Dr. Waldmann recalled.  “In that era, one couldn’t be fatalistic, even when someone was in an apparently irreversible state. One had to assume that somehow one might be able to reverse the immunodeficiency and with that bring into control the infectious disease.”

Members of the NIH’s Metabolism Branch joined forces to study the patient’s cells in a variety of tests.  Once doctors determined that Patient D suffered from a rare case of cytomegalovirus retinitis, the National Eye Institute became involved, photographing and studying Patient D’s deteriorating eyesight.

In addition to the research, the doctors were scrambling to find a treatment that Patient D would respond to, but these treatments failed to reverse the course of the symptoms.  In fact, it would later be discovered that chemotherapy, the traditional treatment for many forms of cancer, would be ineffective for (and even harmful to) AIDS patients because of their weakened immune systems.

“At the end, the patient had massive cerebral necrosis and autolysis. We had a great number of people involved in treating all the different systems,” Dr. Waldmann said in 1990.  “His disease continued, and the patient finally died on October 28, 1981 of hypotension and respiratory failure, with multisystem involvement.”

An autopsy of the body revealed an even wider spectrum of infectious diseases, including massive necrosis, encephalitis, and degeneration of the brain.

AIDS researcher and early human immunodeficiency virus (HIV) drug developer Robert Yarchoan, M.D., recalled the gravity of the moment:

“AIDS showed us that something that no one ever worried about before suddenly could become a major problem for the country and for mankind.  And when HIV was identified as the cause of AIDS, it became apparent that, in addition to persons known to have AIDS, thousands of people in the United States were already infected with this new virus without knowing it.  Moreover, at this time, infection with HIV was in most cases fatal.”

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Sources:

National Cancer Institute, “How Cancer Research Led to AIDS Breakthroughs,” August 26, 2021

National Institutes of Health, “Dr Thomas Waldmann Oral History 1990,” interview of Dr. Waldmann on March 14, 1990 by interviewers Dennis Rodrigues, Program Analyst, and Dr. Victoria Harden, Director of the NIH Historical Office.

The short item advised gay men experiencing progressive shortness of breath to see their physicians.

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Source:

Bay Area Reporter, “Health Shorts: ‘Gay Men’s’ Pneumonia,” July 2, 1981

The MMWR article, “Follow-Up on Kaposi’s Sarcoma and Pneumocystis Pneumonia,” reported that CDC received information on 70 additional cases of KS and/or PCP since its July 3 edition, making a total of 108 known cases.

News of the article alarms the gay community for its indication that the new disease is spreading and that the outcome of those infected was likely to be a quick and brutal death.

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Source:

Morbidity and Mortality Weekly Report, “Follow-Up on Kaposi’s Sarcoma and Pneumocystis Pneumonia,” August 28, 1981

Overseen by Bay Area dermatologist Dr. Marcus Conant, the Kaposi’s Sarcoma clinic was also staffed by oncologist Dr. Paul Volberding, Dr. Constance Wofsy and Dr. Donald Abrams.  Collectively, the physicians guided much of the early response to AIDS in San Francisco.

Dr. Conant would go on to create the San Francisco AIDS Foundation (first called the Kaposi’s Sarcoma Research and Education Foundation) to address both the need to go into the community, which was still in denial about the disease, and the need to find non-government funding sources.

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Sources:

University of California Libraries, “Marcus A. Conant Papers: 1981-1993”

American College of Physicians, “Dr. Volberding was at the Forefront of the AIDS Epidemic,” December 2017

The New York Times, “Constance Wofsy, 53, Doctor Who Directed an AIDS Program,” June 9, 1996

San Francisco Chronicle, “The Good Doctor: He’s been in on the AIDS Battle Since the Beginning,” August 12, 2001

Drs. Marc Conant, Alvin Friedman-Kien, and James Groundwater stationed themselves at the entrance of the annual meeting of the American Academy of Dermatology and distributed to incoming attendees a pamphlet they hastily put together about Kaposi’s sarcoma, a rare form of skin cancer that was being diagnosed in previously healthy young men in San Francisco and New York City.

Held on Dec. 5-10, the conference drew thousands of dermatologists in the United States and Canada to San Francisco to hear the latest developments in their medical field.  The pamphlet was likely the first information that most conference attendees received about Kaposi’s sarcoma (KS) and its role in the yet-unnamed disease of AIDS.

“At that point in time, not many people knew about this problem, and it wasn’t getting a whole lot of attention,” Dr. Groundwater later recalled for the San Francisco AIDS Oral History Project.  “I don’t think the seriousness of it was widely appreciated — the potential for major problems in the future.”

Dr. Groundwater said he wrote the copy for the brochure and used photographs of a patient’s KS lesions so dermatologists could see how the disease manifested.  The patient was Ken Horne, the first KS case to be reported to the Centers for Disease Control.  Horne had died on November 30, 1981, just days before the conference.

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Source:

University of California Libraries, “The San Francisco AIDS Oral History Series | The AIDS Epidemic in San Francisco: The Response of Community Physicians, 1981-1984,” interview with James R. Groundwater, M.D., conducted by Sally Smith Hughes, Ph.D. in 1996

At the conference, researchers debate whether the opportunistic infections were being caused by one or more transmissible or immune-suppressing agents.

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Source:

National Institutes of Health, “Timeline (1981-1988)”

In the summer of 1982, life-threatening opportunistic infections and Kaposi’s sarcoma were reported among 32 Haitian migrants to the United States.  The CDC stated in its Morbidity and Mortality Weekly Report that most were heterosexual men with no known risk factors who had migrated from Haiti within the past two years.

The MMWR also mentioned that the CDC received reports of KS cases in Port-Au-Prince, and the combined reports indicated “an epidemiologically distinct pattern of illness” that occurred via heterosexual transmission.

Years later, in its report “AIDS: The Early Years and CDC’s Response,” the CDC conceded that by publicly reporting these cases as “Haitian entrants,” the CDC inadvertently contributed to the stigma associated with “AIDS labeling.”  This stigma would be endured by thousands of Haitian migrants fleeing poverty and political persecution in the 1980s and 1990s.

From April 1, 1980 through June 20, 1982, 19 Haitian patients were admitted to Jackson Memorial Hospital in Miami with evidence of opportunistic infections (including Pneumocystis carinii pneumonia, cryptococcal meningitis or fungemia, toxoplasmosis, and esophageal candidiasis) and one patient also had Kaposi’s sarcoma.  Seventeen were men and two were women.  At the time the CDC released its MMWR, 10 of the 19 Haitian immigrants in Florida had already died.  Their average age was 28 years old.

From July 1, 1981, through May 31, 1982, 10 Haitian residents of Brooklyn, New York — all men, aged between 22 and 37 years old — were diagnosed with opportunistic infections (including Pneumocystis carinii pneumonia, cryptococcal meningitis or fungemia, toxoplasmosis, and esophageal candidiasis).  Five of the 10 immigrants in Brooklyn had already died.

The remaining three cases were reported from health officials in California, Georgia, and New Jersey.

The CDC warned medical officials and doctors who care for Haitian patients to “be aware that opportunistic infections may occur in this population.”

The MMWR article also includes the first case definition for AIDS: “A disease at least moderately predictive of a defect in cell-mediated immunity, occurring in a person with no known cause for diminished resistance to that disease.”

Today, AIDS is defined as a set of symptoms (or syndrome) caused by the HIV virus. A person is said to have AIDS when their immune system is too weak to fight off infection. This is the last stage of HIV, when the infection is very advanced.

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Source:

Mortality and Morbidity Weekly Report | Centers for Disease Control and Prevention, September 24, 1982

In the 10 months leading up to the conference, the number of known AIDS cases in Canada had grown from one to 14.  So the issue of AIDS was on the minds of many health officials and medical practitioners attending conference hosted by the CPHA’s new Sexually Transmitted Diseases division.

At the conference, Dr. Marc Steben told participants that, due to a dearth of information from the medical community, gay men had resorted to passing information about the new disease amongst themselves.  Dr. Steben would go on to dedicate much of his career to HIV/AIDS treatment and become co-president of HPV Global Action, based in Montréal.

According to An Annotated Chronology of the History of AIDS in Toronto: The First Five Years, 1981-1986 by Mark L. Robertson, there was wide speculation among health officials at the conference as to the cause of AIDS.  Poppers, promiscuity, and specific sexual acts were discussed as possible candidates.

At the time of the conference, 14 AIDS cases had been reported in Canada and 10 people had already died.  Eleven of the cases were reported in Montreal, and one each in Vancouver, Toronto, and Windsor.  Medical officials were reviewing four more cases that they expected to be AIDS.

Many of the conference attendees were also aware of the publication in the gay weekly Body Politic of two articles: “Living with Kaposi’s” by Michael Lynch and “The Real Gay Epidemic: Panic and Paranoia” by Bill Lewis.

In the first article, Lynch wrote an extensive profile of gay men living with Kaposi’s Sarcoma in New York City.  Lynch expressed his concern with the NYC community’s eager embrace of the medical community and its discourses of pathology.

“Gays are once again allowing the medical profession to define, restrict, pathologize us,” Lynch wrote in the November 1982 edition of Body Politic.  “What used to be a psychiatric pathology is now an infectious one … This panic could never have set in so quickly and so deeply if within the hearts of gay men there weren’t already a persistent anti-sexual sense of guilt ready to be tapped.”

In his article, Lynch called for a response to AIDS from people who were exclusively gay.  Lynch was an American-born English professor who settled in Toronto.  He would die of AIDS-related illness on July 9, 1991.

His article in Body Politic was accompanied by a shorter piece by Bill Lewis which argued against panic and urged readers to look at the disease through a lens of science.

“Until recently, the cause of the collapse of the immune system was baffling, and everything gay men did that straight men didn’t was dragged forth as a possible cause,” Lewis wrote.  “Abundant sex, poppers, fisting, drugs, ingestion of too much sperm, staying up too late — all have been put forward as an explanation.”

Lynch said that these things failed to make sense as explanations, because none could explain cases of AIDS among nearly celibate gay men, hemophiliacs or children.

According to This is Public Health: A Canadian History, CPHA’s director of the AIDS Education and Awareness Program, David Walters, described Canada’s initial public health response to HIV as “fragmented confusion.”

Canada was facing an economic recession and inadequate healthcare funding from different branches of government.  This, along with a lack of coordination efforts at the local level and a general resistance to anything involving the needs of the gay community, contributed to a reluctance by public health officials to take action in the early years of the epidemic.

According to Walters, “There seemed to be no safe ground in talking about homosexuality, condoms and needles at national or provincial levels.  This reluctance resulted in foot-dragging and unclear messages about needed commitment to educational programs.”

The CDC report provides background on the infant cases:

• the mother of one infant was a prostitute and IV drug user;
• two were the children of Haitian immigrants; and
• one was the child of an IV drug-using woman who had died of AIDS.

Although the nature of the immune function described in the four cases was unclear, the report suggests that the infants likely were infected with the AIDS virus and that the death of one of the mothers from Pneumocystis carinii pneumonia was probably secondary to AIDS.

The CDC further stated that although the etiology of AIDS remained unknown, a series of epidemiological observations suggested the condition of the infants was caused by an infectious agent.

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Source:

Mortality and Morbidity Weekly Report, “Unexplained Immunodeficiency and Opportunistic Infections in Infants — New York, New Jersey, California,” December 17, 1982

At the conference, scientists from the CDC recommended that blood banks begin implementing donor screening measures, such as questioning donors about risk behaviors and running blood donations through a series of tests.  Faced with daunting data and the same uncertainties, the blood banks and the plasma companies came away from the conference with different plans..

Playing down the extent of the risk, leaders of the blood banks would decide that the CDC’s evidence did not show conclusively that HIV was a blood-borne disease, and they would decline to screen out potentially infected donors.  The blood bank physicians questioned the validity of the CDC data, which correlated of anti-HBc to AIDS cases among a cohort of homosexuals who attended an STD clinic.

By contrast, the plasma companies concurred with the CDC that there was a good chance HIV was being transmitted by their products.  They moved very quickly to switch the source of their supply and introduced new methods to inactivate viruses in plasma derivatives.  However, they also decided to keep older product batches on the market, and commercial plasma ended up infecting more people than did donated blood.

Getting blood or plasma out of one person and safely into another is a complex process.  Blood banks, such as the Red Cross, obtain almost all of their supply from voluntary donors.  They process and then distribute freely donated blood to hospitals, which they charge for their services.

Every year, about 14 million units of blood are donated in the U.S.  The American Red Cross collects about 45% of the total, blood banks about 42%, hospitals 11%, and the small remainder is imported.  About 3.6 million people receive transfusions of these products every year.

In the 1970s, blood collection and transfusion had a number of risks associated with it, in particular the prevalence of hepatitis in the supply.  In late 1982, when evidence began to show that a new disease might be spreading through blood products, things became more complicated.

The blood bank scientists accepted that HIV/AIDS appeared to be a threat to the blood supply, but found it difficult to measure the risk.  U.S. surveillance systems were ill-equipped to identify diseases with a long incubation period such as AIDS.

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Sources:

National Institutes of Health | National Library of Medicine, “HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking” (National Academies Press, 1995)

The Emergence of HIV in the U.S. Blood Supply: Organizations, Obligations, and the Management of Uncertainty by Kieran Healy (Kluwer Academic Publishers, 1999)

An American Red Cross interoffice memo blasts the CDC after its January 4 meeting, stating, “CDC is likely to continue to play up AIDS.”

The memo goes on to say;  “It has long been noted that CDC increasingly needs a major epidemic to justify its existence.  To the extent the [blood supply] industry sticks together against CDC, it will appear to some segments of the public at least that we have a self interest which is in conflict with the public interest, unless we can clearly demonstrate that CDC is wrong.”

Donor screening issues arose in mid to late 1982, when cases of AIDS in hemophiliacs were first reported, including the first transfusion-associated AIDS case in an infant.

Between December 1982 and December 1983, there were two critical events that presented opportunities for the blood services community to enact new donor screening and deferral policies to reduce the threat of HIV transmission through blood and blood products.

The first, which occured on January 4, 1983, was at the Public Health Service meeting convened by the CDC.  This meeting was widely publicized, and over 200 people attended, including representatives of the FDA, NIH, the National Hemophilia Foundation, the National Gay Task Force, blood banks, and the plasma fractionation industry.

This was where the blood services community first received data on the possibility of a transmissible agent within its blood supply.  CDC scientists recommended that blood banks implement specific donor screening measures (such as questioning donors about their risk behaviors and running blood donations through a series of tests).

Some participants in the Atlanta meeting and others in key decision-making roles expressed reservations about the validity of the CDC data and indicated that they did not believe the CDC to be a credible source of information regarding AIDS.  Following the conference, American Red Cross officials would encourage colleagues to resist recommendations from the CDC.

The ensuing resistance by blood banks to implementing the CDC’s donor screening measures is now viewed as a critical failure on their part in the effort to limit transmission of HIV early on in the epidemtic.

The second critical event would occur in December 15-16, 1983, when the Blood Products Advisory Committee of the FDA would convene a meeting to discuss all possible options of surrogate marker tests for HIV.  This meeting is notable for being the CDC’s second attempt to address the need to implement blood screening as a means to implement safeguards to the blood supply.

In the year between the two meetings, blood banks would continue to collect donations from unscreened members of the public.

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Source:

HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking by the U.S. Institute of Medicine  Committee to Study HIV Transmission Through Blood and Blood Products (National Academies Press, 1995)

The following year, U.S. researcher Robert Gallo announced he had found the “probable” cause of AIDS, the retrovirus HTLV-III.  The two viruses — HTLV-III and LAV — turned out to be one and the same, and in May 1986 it became 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.

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Sources:

The Nobel Prize, “Women Who Changed Science: Francoise Barré-Sinoussi”

CNN, “HIV discovery ‘will change your life forever’” by Jen Christensen, June 4, 2013

Nature magazine, “The discovery of HIV-1” by Sonja Schmid, November 28, 2018

PBS News Hour, “How the Discovery of HIV Led to a TransAtlantic Research War” by Dr. Howard Markel, March 24, 2020

Pastuer Institute | The Research Journal, “Françoise Barré-Sinoussi and Her Research on the HIV-1 VIrus,” July 17, 2018

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.

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Source:

The publication lasts for two years, until mainstream scientific journals begin expediting publication for articles on AIDS.

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Source:

In the CDC Report “Current Trends Update: Acquired Immunodeficiency Syndrome (AIDS) — United States,” CDC identifies all major routes of HIV transmission — and rules out transmission by casual contact.

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Source:

Dr. Arthur J. Ammann traveled from San Francisco to New York City for an immunology conference hosted by the New York Academy of Science to report his research on pediatric AIDS patients, which discovered that HIV/AIDS can also be transmitted in utero – from mother-to-infant, and through blood transfusions.

Some conference attendees responded to Dr. Ammann’s presentation with indifference and rejection. Dr. Ammann said, “People just don’t want AIDS to affect infants, they just don’t believe it.”

Included in the nay-sayers was his former mentor, Robert A. Good, M.D., who had served as president of the American Association of Immunologists and more recently as director of the Sloan-Kettering Institute for Cancer Research.

“Bob Good got up and said that he didn’t think that we were seeing AIDS in children, that he had seen this immunodeficiency with CMV [cytomegalovirus virus] before,” Dr. Ammann recalled for the San Francisco AIDS Oral History Series.  “I quickly responded, because I had looked up all the literature. I said, ‘If it’s been seen before, no one’s ever reported it.'”

Dr. Ammann said his early theory about pediatric AIDS was reinforced by a meeting he had with Arye Rubinstein, M.D., a New York City immunologist working with pediatric patients, who told him that he was receiving the same immediate resistance to his own case reports.

As the lead pediatric AIDS practitioners on the West Coast and East Coast, respectively, Drs. Ammann and Rubinstein did not let the initial rejection from the medical community deter them from their work.  In fact, both would be later recognized for their important discoveries.

Dr. Ammann would serve as director of research for the Pediatric AIDS Foundation, a board member and President of amfAR, and on the Presidential National AIDS Task Force on Drug and Vaccine Development.  In 1997, he would found Global Strategies for HIV Prevention to address the inequity of HIV prevention services provided around the world.

In a 1988 article for The San Francisco Chronicle, Dr. Ammann would draw nationwide attention to the issue of pediatric AIDS when he predicts that at least 20,000 children will contract AIDS in the next four years.  Sadly, his prediction would be borne out.  By 1992, about 5,000 cases of pediatric AIDS would be reported to the CDC, with the actual number of HIV-infected children to be estimated at about 20,000.

In 2017, Dr. Ammann would publish a first-person account of the pediatric HIV/AIDS crisis, Lethal Decisions: The Unnecessary Deaths of Women and Children from HIV AIDS.  Dr. Ammann would die four years later, in San Rafael, California on August 15, 2021, at the age of 85.

Dr. Arye Rubinstein would also dedicate his life to the care of children and women with HIV.

The National Institutes for Health would award a grant to Dr. Rubinstein for the  first study of AIDs in women and children. In 1986, he established that transmission of AIDS can occur in utero, and he published his findings in the journal Clinical Immunology and Immunopathology.

By 1985, Dr. Rubinstein would estimate that he had treated about 100 children with the AIDS virus at his practice based out of Albert Einstein College of Medicine in the Bronx.

At the time, New York public health policy dictated that pediatric AIDS patients be confined to hospitals, so misunderstood was the nature of the virus.  So Dr. Rubinstein decided to open a day care center at Albert Einstein College for the families of pediatric AIDS patients, and successfully petitioned the City of New York for the funding to build it.

He would take personal risks to come to the defense of his pediatric patients’ parents, many of whom had a history of drug use and sex work, and were not equipped to navigate the backlash of fear and anger directed at them.

“I was almost assaulted after testifying in court in Brooklyn,” recalled Dr. Rubinstein in an 2011 edition of Einstein Magazine. “The parents in one school wanted to remove children who were infected, but I testified that HIV was not transmitted through casual contact.  The parents got very upset, to the point where I had to be hauled out of the courtroom through a back door.”

In 1986, Dr. Rubinstein and colleagues would show that IV gamma globulin helps prevent infections and T-cell attrition in children with AIDS, significantly improving survival rates.  Later the same year, he would demonstrate that in pregnant women with HIV, transmission of the virus often occurs in utero and not just at delivery or through breast-feeding.

In the April 1987 edition of Pediatric Research, he would co-author a paper about the increase in AIDS cases of women whose only known risk factor was heterosexual contact with HIV-positive men.  In another pediatric publication, he would report that the leading cause of death in 1987 for women between the ages of 24 and 35 was AIDS.

In 1989, Dr. Rubinstein would launch a summer camp in the Catskills for children with HIV and their families (many more similar camps would open in the 1990s).  He currently is chief of the Division of Allergy & Immunology at Children’s Hospital in Montefiore and Professor of Pediatrics at Albert Einstein College of Medicine.

At the December 15-16 meeting, the FDA’s Blood Products Advisory Committee facilitates a discussion of the options for HIV surrogate marker tests.  This conference is a follow-up to the one held in January 1983, where blood bank scientists remained unmotivated to begin blood screening.

After the January meeting, an American Red Cross interoffice memo stated, “CDC is likely to continue to play up AIDS.  It has long been noted that CDC increasingly needs a major epidemic to justify its existence.”

In the year between the two meetings, blood banks would continue to collect donations from unscreened members of the public.  The initial resistance by blood banks to implement the CDC’s donor screening measures is now viewed as a critical failure on their part in the effort to limit transmission of HIV early on in the epidemtic.

At the December 1983 meeting, industry representatives proposed the creation of a task force to deliberate the details of a recommendation made at the meeting by Dr. Dennis Donohue, director of the FDA’s Division of Blood and Blood Products.  Dr. Donohue proposed that hepatitis B anti-core testing be incorporated for routine plasma screening, since it would identify 90% of all potentially infectious or high-risk donors.

While Dr. Donohue was not enthusiastic about the task force approach, which was generally seen as the industry’s way to delay screening requirements, he agreed to it.

The conference brought together AIDS researchers conducting studies on the human immunodeficiency virus (HIV), which was then a new discovery.

At the time, no effective antiviral drugs for HIV/AIDS existed and research subjects typically died of AIDS-related illnesses within 10 years of infection with the virus.  Researchers worldwide were scrambling to find a way to stop the AIDS virus from replicating within the body, according to the National Institutes of Health’s website for its Cancer Research Center.

The 1983 discovery of the AIDS virus by Luc Montagnier, M.D. at the Pasteur Institute in Paris (which was confirmed in 1984 by Robert Gallo, M.D. of the U.S. National Cancer Institute) had researchers all over the world searching for an effective treatment and cure to counter the quick spread of the new disease.  Still more scientists were engaged with developing a vaccine for HIV — something that still eludes them to this day.

In December 1984, scientists at the forefront of this research gathered in southern California to try to answer the life-and-death questions of the day:

• Was HIV alone responsible for AIDS, or was it activated by a combination with other factors in the way that other viruses — like Epstein-Barr virus or Cytomegalovirus — did.
• What was the relationship of HIV to Kaposi’s sarcoma (since Kaposi’s sarcoma in AIDS could not be explained on the basis of the underlying immune deficiency)?
• Where and how did the virus originate?
• What were the clinical, cellular, and/or serological markers that determined the outcome of HIV infection?

Conference presentations also included work on identifying characteristics of early-stage AIDS and various treatment theories, and the specific ways in which HIV and AIDS exhibited in infants.

The Los Angeles Times covered the conference in its “Orange County” section under the headline “AIDS May Not Always Kill, Experts Report at Conference.”

A positive result on ELISA (an enzyme-linked immunosorbent assay) must be confirmed by a second test for a person to receive a definitive diagnosis of HIV infection.

Today, many single-test options are available to test for HIV (Human Immunodeficiency Virus), including an FDA-approved, at-home test called OraQuick.  Approved in 2012 for sale to anyone age 17 and older, the OraQuick In-Home HIV Test tests fluid from the mouth and delivers results in 20 to 40 minutes.  The kit does not require sending a sample to a lab.

HIV screening is covered in the U.S. by health insurance without a co-pay, as required by the Affordable Care Act.  Some testing sites offer free tests for those without medical insurance coverage.

The FDA still regulates the tests that detect infection with HIV.  An estimated 1.1 million people in the U.S. are living with HIV, and about one in seven don’t know they have it, according to the CDC.

The CDC recommends that everyone between the ages of 13 and 64 years old be screened for HIV at least once as part of their routine health care. More frequent testing is recommended for people who have a higher risk of infection because of behaviors such as having sex without condoms, having sex with multiple partners, or injecting drugs using shared needles.

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.

The CDC’s Morbidity and Mortality Weekly Report recommends that HIV-infected women delay pregnancy until more is known about the risks of transmission, and advised new mothers to avoid breastfeeding.

Transmission of the virus during pregnancy or labor and delivery is demonstrated by two reported AIDS cases occurring in children who had no contact with their infected mothers after birth.

With studies on the subject of pediatric AIDS just beginning, the rate of perinatal transmission of HIV from infected pregnant women is unknown and the limited amount of available data suggests a high rate.

However, the report contends that perinatal transmission (from an infected mother to her newborn) is not inevitable.

Of three children born to women who became infected with HIV by artificial insemination from an infected donor, all were in good health and negative for antibody to the virus more than 1 year after birth.  Another child, born to a woman living with AIDS, was HIV-negative and healthy at birth and at 4 months of age.

In December 1985, a total of 217 cases of AIDS have been reported among children under age 13, and 60% of them have died.

The meeting’s main conclusion was that the risk of transmitting HIV by factor VIII or factor IX concentrates, commonly used to treat hemophilia, could be reduced or eliminated with proven methods of screening for HIV antibodies and inactivation, according to The Fourth Ten Years of the World Health Organization.

The meeting, which included scientists from 15 countries, also presented goals for WHO’s Program on AIDS, including the creation of a global surveillance system to monitor HIV infection as well as deaths from AIDS-related illness.

Representing the U.S. were Kenneth J. Bart, M.D., the health director for the U.S. Agency for International Development; William C. Bartley, the international health attaché for the U.S. Mission to the United Nations; and Walter R. Dowdle, Ph.D., director of infectious disease at the Centers for Disease Control and Prevention, according to the meeting report.

Created by the Robert Wood Johnson Foundation, the AIDS Health Services Program seeks to replicate Ward 86’s San Francisco Model of HIV Care nationwide — but with an emphasis on tailoring programs to meet the needs in local context.

The goals of the program are to develop community-based services for persons with AIDS and to determine factors that facilitate or impede service.

The foundation starts with nine projects located in 11 communities: Atlanta, Dallas, Fort Lauderdale, Miami, Nassau County (NY), New Orleans, Newark, Jersey City, Seattle, and West Palm Beach.

The AIDS epidemic in each site varies substantially.  Lack of health insurance represents a problem for the majority of clients in states having the most restrictive Medicaid policies (Atlanta, New Orleans, and Dallas) and in communities where a large proportion of clients enter the program before their condition progresses to AIDS (Miami, Fort Lauderdale, and West Palm Beach).

Between 1987 and 1990, the average annual population with AIDS in program sites increase 126% (with increases ranging from 91% to 175%). During that period, the average increase in the number of persons alive with an AIDS diagnosis in these eleven cities is 191%, ranging from 181% to 257%.

The men and women attempting to build a network of coordinated services for persons with HIV/AIDS find themselves with an extremely difficult task.  As the epidemic progresses, there is a substantial increase in the scope of the epidemic as well as change in the racial, sex, and risk-group composition of HIV-infected persons.

Program staff have to cope with confusing state and federal policy, complicated by changes in medical treatment and in the conceptualization of AIDS. In 1986, AIDS is still perceived as an acute, fatal illness, and policies for expanding terminal care benefits are the focus of discussion. However, soon the focus would shift to early intervention and ongoing treatment programs for a new chronic disease.

The report, titled Perspectives in Disease Prevention and Health Promotion: Public Health Service Guidelines for Counseling and Antibody Testing to Prevent HIV Infection and AIDS, reflects the strong stance by the CDC against the unauthorized disclosure of personal information and inappropriate discrimination against those who seek to be tested.

Per the guidelines, health agencies should endeavor to provide ready, confidential access to HIV testing to those most at risk of HIV infection.

As examples, the report cites programs offering counseling and testing to gay men, IV-drug users, persons with hemophilia, the sexual and/or needle-sharing partners of these persons, and patients of sexually transmitted disease clinics.

The report also addresses the issue of false-positive HIV test results and its impact, stating that most false-positives are due to human error and more precautions should be used by medical personnel to ensure the accuracy of results.

“All laboratories should anticipate the need for assuring quality performance of tests for HIV antibody by training personnel, establishing quality controls, and participating in performance evaluation systems,” the report advises.

In a response to reports that some doctors are refusing to treat patients who are HIV-positive , the AMA advises physicians that it is unethical to deny care in such situations if the care required is within the doctor’s normal range of practice.

AMA ethics council also tells physicians that if a patient carrying the AIDS virus refuses to discontinue dangerous sexual practices, a doctor should notify public health authorities and even take it upon himself to directly inform individuals who may be in danger of infection.

The new AMA strictures conflict with California law, under which it is illegal for a doctor, without the patient’s consent, to tell anyone a person has tested positive for the AIDS virus or has AIDS.

The AMA states that no evidence exists that large numbers of doctors have refused to treat patients who tested positive for the AIDS virus.

But an AMA spokesperson concedes, “There have been physicians who have chosen to make public statements that they will not treat HIV-positive people. Those statements have generated tremendous amounts of discussion and debate.”

In the study, published in the May issue of The Journal of the American Dental Association and reported widely in the media, the researchers tested saliva from three healthy men aged 35, 40 and 42. Researchers determined that the subjects were not infected by HIV and they were not known to be at high risk of infection.

The researchers said the finding might help explain why no cases have been documented in which the AIDS virus was transmitted from person to person through saliva.

The research was led by Philip Fox, M.D., who cautioned that the study results do not eliminate the possibility of HIV infection from oral sex or deep kissing.  Dr. Fox explained that the virus could enter the bloodstream through cuts in the mucous membranes that line the mouth or it might be able to infect cells on the surface of mucous membranes.

In 1999, researchers at the University of Texas Medical Branch at Galveston would conduct a study that confirmed the results of the 1988 research.

UT researchers Samuel Baron, Joyce Poast and Miles W. Cloyd sought to confirm the results of Fox’s 1988 study and subsequent studies that showed that proteins in saliva seem to neutralize or disable the AIDS virus, Published in the Archives of Internal Medicine, the UT study would indicate that saliva inactivates more than 90% of the HIV-infected blood cells by breaking the virus apart into non-infectious components.

NIH established the Office of AIDS Research (OAR), which then launched the AIDS Vaccine Evaluation Group (AVEG) to oversee the first study of an experimental AIDS vaccine.

At the time, researchers and the medical community were hopeful that a vaccine would be quickly developed and rolled out to the general public.  But in spite of the optimism expressed by many, Dr. Anthony Fauci published a Public Health Report that warned that developing a HIV vaccine would be difficult.  Dr. Fauci listed the following as issues that complicate the development of an effective AIDS vaccine:

– the lack of “an appropriate animal model for AIDS,”

– the absence of a defined protective immune response in persons infected with HIV,

– the long latent period between initial infection and the development of symptoms,

– the existence of multiple strains of HIV, and

– the spread of HIV by way of cell-associated virus.

“When HIV was discovered and established as the cause of AIDS in 1983–1984, many people believed that a vaccine would be easily developed and rapidly deployed.  After all, vaccinologists had been very successful in developing vaccines for a whole range of viral diseases,” José Esparza of the Bill and Melinda Gates Foundation wrote in 2013.  “However, the paradigm that allowed the development of most existing viral vaccines, which is based on the recreation of the protective immunity that develops after natural infection, does not work in the case of HIV.”

By 2003, the first wave of vaccine trials would end in negative results and failure.

Still today, scientists continue their quest to develop a vaccine.  Extensive studies are underway to determine how HIV is able to avoid the immune responses spurred by vaccines.  In an article for the Association of American Medical Colleges, David Diemert, M.D. explained the challenge.

“From the very second HIV infects a person, it starts to escape from the immune response,” said Dr. Diemert, clinical director of vaccine research at the George Washington University School of Medicine and Health Sciences.

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 recommend a regimen of two compounds to prevent the onset of PCP: trimethoprim-sulfamethoxazole and pentamidine.  The CDC bases its recommendations on a study of 60 adults living with AIDS, which suggest that those who received treatment have fewer episodes of PCP and lived longer, compared with untreated patients.

Trimethoprim-sulfamethoxazole, a combination of the antibiotics sulfamethoxazole and trimethoprim, commonly causes side effects in patients that include nausea, vomiting, diarrhea, and loss of appetite.

Pentamidine, given as an aerosol in a nebulizing device, commonly causes adverse effects including coughing, difficulty breathing, difficulty swallowing, and chest pain or congestion.

The Public Health Service recommends physicians to start this treatment with:

• any HIV-infected adult patient who has already had an episode of PCP, and
• those whose CD4+ cell count is less than 200/mm3 (or less than 20% of total lymphocytes).

CD4+ cells would soon be referred to as “T-helper” or “T4 cells,” because one of their main goals is to send signals to other kinds of immune cells, which then destroy infectious particples.

Patients with CD4+ cell counts of less than 100/mm3 (or less than 10%), as well as patients with oral thrush or persistent fever, are at particularly high risk for PCP, the report states.

According to HIV.gov, a healthy T cell count should be between 500 and 1,600 T cells per cubic millimeter of blood (cells/mm3).

In a front-page article by Gina Kolata in The New York Times, Dr. Fauci calls for a new system that would allow patients far greater access to experimental drugs.

This marks a major turnaround in government policy, which restricts access to experimental drugs with the reasoning that patients would have no reason to join a clinical trial if they could get a drugs by other means.

In a column by Victor F. Zonana, the LA Times publishes newly released data that indicate that AIDS cases and deaths are rising dramatically and reaching new populations.  New cases recorded between January and November 1989 (the most recent months data was available) of full-blown AIDS in Los Angeles County totaled 2,274, up 28% from a year earlier.

In addition, planning documents for LA County estimated that by 1992, the cumulative total number of cases would more than double, to at least 19,000, and could rise to as high as 44,000 cases.

Zonana, the LA Times columnist, posed the question:  “Will [LA County] go the way of San Francisco, widely praised as a model of compassionate and cost-effective AIDS care?  Or will Los Angeles resemble New York City, the third major center of the epidemic, where people are dying in the streets as the unchecked spread of the virus among drug addicts fills public and private hospitals beyond capacity?”

Zonana wrote that one of the unique challenges facing the LA community was the large population of Latinos, some of whom were undocumented and disconnected from health services, and the potentially adverse impact of Roman Catholic Church’s unyielding stand against the use of condoms.

Torie Osborn, then-director of the Gay and Lesbian Community Services Center (now the Los Angeles LGBT Center), expressed her concerns that members of the Latino community were particular at risk of HIV infection as a result of these church teachings.

“In the past two months, our clinic has found 45% (infection rates) among gay and bisexual Latinos,” said Osborn, compared to 17% among Anglo gays.  “The figure just leaps out at you … it is really alarming.”

The following are selected AIDS statistics through Sept. 30, 1989 for New York, Los Angeles and San Francisco, the three major centers of the epidemic which together accounted for 34.5% of the nation’s AIDS cases.

The data shows that Los Angeles has more than twice as many female cases and three times as many pediatric cases as San Francisco, even though its total caseload is only 11% higher.

New York

Total cases: 22,571
Total deaths: 12,246
Children under 13: 536
Adult women: 2,934
Gay/bisexual contact: 10,916
Heterosexual IV drug use: 6,166
Reported new cases: 4,081
Year-to-date Total White cases: 39%
Year-to-date Total Black cases: 33%
Year-to-date Total Latino cases: 27%
Projected net municipal outlay*: $229.6 million

Los Angeles

Total cases: 8,063
Total deaths: 5,306
Children under 13: 70
Adult women: 244
Gay/bisexual contact: 6,474
Heterosexual IV drug use: 325
Reported new cases: 1,928
Year-to-date Total White cases:65%
Year-to-date Total Black cases: 16%
Year-to-date Total Latino cases: 18%
Projected net municipal outlay*: $20.5 million

San Francisco

Total cases: 7,277
Total deaths: 4,706
Children under 13: 22
Adult women: 91
Gay/bisexual contact: 6,164
Heterosexual IV drug use: 159
Reported new cases: 1,458
Year-to-date Total White cases: 82%
Year-to-date Total Black cases: 7%
Year-to-date Total Latino cases: 8%
Projected net municipal outlay*: $19.9 million

*for AIDS prevention and care, current fiscal year; does not include private contributions, state and federal expenditures or payments from private insurers.

The sources for the LA Times data were the Department of Geography, California State University, Northridge and Los Angeles County Department of Health Services.

The CDC issues a report reviewing the PHS recommendations for the management of occupational exposures that may place workers at risk of acquiring HIV infection, with a focus on those administering AZT treatment.

A report from the Centers for Disease Control announces that HIV infection emerged in the 1980s as a leading cause of death in the U.S., and now HIV infection is the number one cause of death among men aged 25-44 years.

The CDC bases this assessment on data obtained from death certificates filed in all 50 states and the District of Columbia.  Statisticians suspect the magnitude is greater than indicated in the report.

The report also notes that HIV infection is more severely advancing to death for blacks and hispanics than other racial/ethnic groups.

“These differences probably reflect social, economic, behavioral, or other factors rather than race/ethnicity directly,” the report states.  “The social and cultural context of HIV infection must be addressed through prevention efforts designed to meet the needs of specific communities.”

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The Women’s Interagency HIV Study establishes a multi-center, prospective, observational cohort study of women living in the U.S. who are either HIV-infected or at risk for HIV acquisition.

The program would play an important role in the National Institute of Allergy and Infectious Diseases’ effort to understand the current epidemiology of HIV infection, disease progression, treatment use and outcomes, and related co-morbidities among U.S. residents with HIV.

Understanding differences in HIV disease and treatment outcomes between women compared to men, and in different racial and ethnic groups, is a critical public health goal.  The clinical research consortium is an integral part of the NIAID portfolio of research on HIV in women.

The guidelines follow a report to the CDC about a case of HIV transmission from a screened, antibody-negative donor to several transplant recipients.

Titled, Guidelines for Preventing Transmission of Human Immunodeficiency Virus Through Transplantation of Human Tissue and Organs. the report seeks to reduce “the already low risk of HIV transmission by transplantation of organs and tissues.”

FDA says the test, which uses fluid from the mouth instead of blood, will be available only from doctors and will be administered only by people trained to do so.

“As long as a positive test is followed up with a blood test and as long as there is appropriate counseling available, it is a reasonable thing to do,” Dr. Jeff Lawrence tells The New York Times.  Dr. Lawrence is a consultant to the American Foundation for AIDS Research.

Studies show that for every 100 people infected with HIV, the oral-fluid-based test will miss one or two, and for every 100 people who are not infected, test results will be incorrectly positive for approximately two people.

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.

In the CDC’s Morbidity and Mortality Weekly Report, the total number of persons in the U.S. reported to have AIDS climbs to 501,310.

According to the report, the rates per 100,000 population for reported AIDS cases in 1994 are:

• 48 in the Northeast,
• 31 in the South,
• 29 in the West, and
• 13 in the Midwest

However, during 1988-1992 and 1993-October 1995, the largest numbers of cases (65,926 and 86,462, respectively) were reported from the South, which also accounted for the largest proportionate increase of reported cases (31%).

The first international AIDS conference in two years, the event is one of the more eagerly anticipated scientific meetings in years. Data on promising new drug treatments for AIDS, insights into the ways HIV infects cells, and the mechanisms of “host resistance” to that attack are scheduled to top the agenda.

Remarkable gains in using combinations of costly new and old drugs promise to slow the progression of AIDS and to allow many people infected with HIV to live longer and healthier lives, conference presenters announce to attendees.

With 15,000 delegates, journalists and commercial exhibitors in attendance, it is the largest conference so far.  The theme is “One World, One Hope.”

While it seems that AIDS may finally become a managable disease in developed countries, less developed nations are struggling to scrape together the resources to provide necessary treatment and services to people with HIV and AIDS.

Data would be released at the conference that estimate a total of 21.8 million people to be currently living with HIV/AIDS, the vast majority of whom live in developing countries.

Ending the 16-year incline of cases, 1996 data shows that AIDS-related deaths dropped 23% from 1995 to 1996.

Experts credit the downturn with the availability of aggressive new therapies that keep infected patients healthier, as well as the possibility that fewer people are becoming infected in the first place.

The positive trends do, however, mask a troubling development: cases among women and heterosexuals who do not use drugs, particularly minorities, are on the rise.

African-American women are particularly at risk. In 1994, officials at the Centers for Disease Control reported that black women were almost 15 times as likely as white women to test positive for HIV.

”My new cases among women are often young women, coming in with a first pregnancy who are being tested as part of that pregnancy and finding out that they are HIV-positive,” said Dr. Mary Young, who treats AIDS patients at Georgetown University here.

“The gay community has done a wonderful job of getting the message out. But I don’t know that we target young African-American women very well.”

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.

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.”

In an article published in the scientific journal Philosophical Transactions B titled “The Evolution of HIV-1 and the Origin of AIDS,” researchers Paul M. Sharp and Beatrice H. Hahn demonstrated that HIV-1 can be traced via evolutionary comparisons to SIV-infected chimps and gorillas in west central Africa.

Sharp and Hahn described in their paper the four lineages of HIV-1 that resulted from cross-species transmissions from chimps (and possibly gorillas) to humans.  Their research was supported by grants from National Institutes of Health and the Bristol Myers Freedom to Discover program.

“The conclusion that HIV-1 was derived from a virus infecting chimpanzees is particularly interesting, because chimpanzees and humans are so closely related,” Sharp and Hahn wrote. “This raises a number of questions, such as the origin of the chimpanzee virus, whether adaptation of SIVcpz to infecting chimpanzees rendered the virus more capable of infecting humans and whether SIVcpz infection of chimpanzees is pathogenic.”

In the January 2000 article “AIDS as a Zoonosis: Scientific and Public Health Implications,” Sharp, Hahn and two additional researchers theorized how the virus was able to be transmitted from chimpanzees to humans.  Since transmission requires “exposure to infected blood and body fluids,” they propose that it was likely that infection in humans occurred during the practice of hunting and butchering chimps.  Even though the opportunity for chimp-to-human transmission existed for hundreds of years, the Congo in the early 20th Century, then under colonization by the Dutch, had a set of circumstances that for the first time allowed the virus to spread from humans to other humans.

Since workers in the bushmeat industry usually operated in a remote area in the southeast corner of Cameroon, Sharp and Hahn were able to identify this region as the likely location of the first notable spread of the disease.  Around 1920, HIV infections occurred in humans in “at least a dozen independent transmissions” from chimps.  From there, these infected people spread the virus as they travelled by the Sangha River to the largest city to the south, the Congolese capital city of Kinshasa (which was then under Dutch colonization).

“During the early part of that century, the destabilization of social structures by invading colonial powers, the origin and rapid growth of major conurbations, and the widespread use of injections may all have contributed to provide an unprecedented opportunity for dissemination of blood-borne viruses,” Sharp and Hahn wrote.

In October 2018, historian Thomas F. McDow would reference much of Sharp and Hahn’s research in an article for Origins delving into how the spread of HIV was linked to the socio-political impact from Africa’s colonization and the globalization of the economy in the early 20th century.

In “A Century of HIV,” McDow wrote:  “The story of HIV is a story of globalization. The expanding connections of the 20th Century spread the disease, yet the limitations and inequalities of global public health allowed the disease to ravage populations even after scientists discovered effective drug treatments.”

McDow credited research scientists with being able to pinpoint the origin of HIV from blood samples and a lymph node dating back to the late 1950s and stored in a Congolese laboratory.

“This virus began its career in humans at a time when the forests and riverine landscapes of Equatorial Africa became increasingly connected to the global economy,” McDow wrote.  “While the people who lived in these forests had traded and been connected to wider regional networks for a very long time, the scope and scale of these interactions changed at the end of the nineteenth and beginning of the twentieth centuries.”

In 1884, major European nations convened the Berlin Conference (also known as the Congo Conference), and determined which countries would control the trade routes in Central Africa, according to McDow.  Eight of the 14 countries represented at the conference — Germany, Belgium, Spain, France, the United Kingdom, Italy, Portugal, and the Ottoman Empire — set about laying claim to various African territories.

Under the control of European companies, the Sangha river basin became the world’s main producer of ivory and rubber.  To support their industry, the European colonists modernized the infrastructure of their territories and built links to previously unconnected regions.  Two towns on opposite sides of the Congo River, Kinshasa and Brazzaville, attracted Africans from remote parts of the continent with the promise of work and wages.

Meanwhile, Africans continued to live in impoverished conditions and workers were brutally exploited for decades, according to McDow.  As indigenous African workers began to rebel and refuse to accept to be treated poorly by the colonists, more wealth and opportunity began to come their way — but just a little.

“In the 1940s and 1950s, the creative energies of these towns produced the lively sounds of rumba, music inspired in part by Latin American sound and driven by the distinctive Congolese guitar playing,” wrote McDow.  “But the same venues and impulses that attracted the youth to hear people like Wendo Kolosoy croon ‘Marie Louise’ created conditions for the spread of the virus through heterosexual intercourse.”

During this time, records showing the uptick in sexually transmitted diseases like Hepatitis B suggests that HIV was also likely spreading during this time.  Then came the 1960s, a time hailed as “The African Decade” when people in the colonized territories fought for and won their independence.

The United Nations Education, Science, and Cultural Organization (UNESCO) and the Congolese government responded the region’s lack of skilled workers among its indigenous people by recruiting teachers and doctors to work in the Congo, according to McDow.  Belgians and Haitians made up the largest groups of expatriate professionals.

“While in Congo, however, some contracted HIV and subsequently returned home with the deadly, unknown virus,” he wrote.  “The earliest cases of HIV in the United States are connected to Haiti, and the Haitian-Congo link seems to have helped the disease cross the Atlantic.”

All of these events leading up to the June 1981 Morbidity and Mortality Weekly Report by The Centers for Disease Control are the “pre-history of AIDS,” according to McDow.

“Looking back, doctors can see that a small number of unexplained medical cases in the west … were early cases of AIDS,” wrote McDow.

Among these early cases are:

• In 1939-1959, cases of Pneumocystis pneumonia were reported in Western Europe in infants born prematurely.  Researchers state that the most likely cause was a retrovirus closely related to HIV (or a mild version of HIV) brought to Europe and originating from Cameroon, a former German colony. The epidemic started in 1939 along the German-Polish border in the Free City of Danzig and then spread to nearby countries, like Germany, Switzerland and The Netherlands, in the 1940s and 1950s.
• On June 28, 1959, Antonio Ardouin, a 49-year-old Jamaican-American shipping clerk, died in New York City of Pneumocystis carinii pneumonia. Gordon Hennigar, who performed the postmortem examination of the man’s body, found the case to be so unusual, he preserved Ardouin’s lungs for later study. Hennigar has been quoted as saying that he believes Ardouin likely died of AIDS.
• On May 15, 1969, Robert Rayford, a 15-year-old Black youth, died at St. Louis City Hospital with no immune system to fight the infection that ravaged his body for more than a year.  An autopsy revealed widespread Kaposi’s sarcoma, and a 1988 test of autopsy tissue specimens showed evidence of nine distinct HIV proteins.
• In 1976, Arvid Noe, a Norwegian sailor, died; it was later determined that he contracted HIV/AIDS in Africa during the early 1960s.  His wife and daughter also died of AIDS-related illnesses.
• On June 28, 1978, a Portuguese man known as Senhor José (“Mr. Joseph”) died.  Later confirmed as the first known infection of HIV-2, he was believed to have been exposed to the disease in Guinea-Bissau in 1966.
• In 1978-79, eight people from New York and San Francisco participated in a Hepatitis B virus study, and about 40 years later, their reconstructed blood samples tested positive for HIV.  A 2016 re-testing of samples from the Hep B studies identified five HIV cases from New York and three from San Francisco.  From their data, researchers estimate the virus’ entry into the U.S. at about 1970.  “You see a very telltale pattern of extensive genetic diversity in New York City, suggesting that New York City was the key hub of diversification for the virus,” researcher Michael Worobey told PBS News Hour in 2016.  ““Restricted genetic diversity in San Francisco, suggesting San Francisco was a later dispersal out of this New York City hub.”
• In 1979, a five-year-old girl died in New Jersey after suffering from symptoms of AIDS since birth; later her stored tissues tested positive for HIV-1.  The girl’s mother was described as an intravenous-drug user who had multiple male sex partners.
• On December 24, 1980, Rick Wellikoff, a Brooklyn grade-school teacher, died at the age of 37 of various infections that overwhelmed his immune system.  Strong evidence suggests that he died of AIDS.
• On January 15, 1981, Nick Rock, a New York City bartender and friend of Rick Wellikoff, died after months of suffering from seizures, heart attacks and Kaposi’s sarcoma.

Dr. Pépin, an epidemiologist and HIV/AIDS expert based in Quebec, traced the AIDS virus back to a single bush hunter in Central Africa in 1921.  He used medical reports and technical data dating back to France’s colonization of African territories to piece together the beginnings of a disease that would eventually leap from continent to continent and kill more than 40 million people worldwide.

“Either a hunter got injured with his knife when he cut out the ape to bring the carcass back to the village so that the chimp’s blood became in contact with his own blood, or the same type of accident occurred during the actual cooking of chimpanzee meat,” he said in an interview with Cambridge University Press, the publisher of his book.

“Three other potential modes of transmission from chimp to man, which have been proposed over the years, can now be rejected,” he added, “since there is nothing to sustain these other hypotheses.”

In a 2012 interview with medical journalist Mark Cardwell for the Canadian magazine University Affairs/Affairs University, Dr. Pépin said he got the idea for The Origins of AIDS in 2008 when he was at the Méditerranée Infection Foundation in Marseilles, France to research sleeping sickness in the Central African Republic.

“On my first day there, to my amazement, I suddenly understood, while looking at the health systems annual reports, the scope of the colonial-era public health interventions that required the administration of massive amounts of IV drugs over the whole of central Africa and throughout several decades,” he said.

Dr. Pépin told Cardwell it took four years to research and write The Origin of AIDS, and an additional year to edit the manuscript with the publisher.

“The book sheds new light on the pivotal role French colonialism played in spreading HIV from likely a single bush hunter infected with a simian immunodeficiency virus in central Africa in the early 1920s to large swaths of Africa and beyond,” Cardwell wrote in his 2012 article “The Story of the Origins of AIDS.”

Dr. Pépin’s book describes the conditions in turn-of-the-century French West Africa that created the ideal petri dish for a new disease.

At the Berlin Conference of 1884-1885, France was one of several European countries to lay claim to colonial territories in Africa.  In the decades to come, the urbanization of central Africa, inferior health policies, and the rise of prostitution all led first to the persistence of HIV in the population in the 1930s-1950s, and then eventually to its spread.

After about 50 years of managing an enterprise that involved extracting the area’s natural resources while ruling over its indigenous peoples, the French introduced a medical program in the 1930s that routinely used unsterilized syringes and employed other shoddy practices in the treatment of tropical diseases.  Dr. Pépin contended that these were the conditions in which HIV was able to take hold and then propagate.

In The Origins of AIDS, Dr. Pépin also explained how the construction of a railroad line across the African jungle resulted in the creation of sprawling government-run camps that were unsanitary and dangerous. Among the camp residents, according to Dr. Pépin, were health-compromised workers and prostitutes from across the colonial territories.

Dr. Pépin said he took research results from molecular biologists working under Beatrice H. Hahn, M.D. and scientists led by Michael Worobey, M.D., and used this to inform his own research drawn from colonial archives and European libraries.

“I conducted epidemiological studies which documented that several blood-borne viruses were indeed transmitted during several medical interventions in different parts of Africa,” Dr. Pépin said.

Dr. Pépin started his career in the early 1980s as a medical officer in a Zaire bush hospital.  After returning to Canada to complete his education in medicine, he returned to Africa as a clinical researcher at the Medical Research Council Laboratories in a tiny West African country called The Gambia.  This is where he began researching HIV and its interaction with sexually transmitted diseases.

“In the course of my investigations, I met most of the few hundred Senegalese prostitutes who charged their Gambian brothers rock-bottom prices for a few moments of pleasure,” Dr. Pépin wrote in the forward of the 2021 edition of The Origins of AIDS.

Using statistical approaches applied to HIV-1 sequence data from central Africa, the international team of researchers showed that from the 1920s, Kinshasa (formerly known as the Dutch-colonized city Leopoldstad) was the site of early HIV transmission.  The researchers validated their location and dating estimates by using the earliest HIV-1 archival sample, also from Kinshasa.

From Kinshasa, the virus spread in the early 1960s to other areas of the Congo via rail links, according to the report titled “The early spread and epidemic ignition of HIV-1 in human populations.”  HIV then spread from Africa to Haiti when Haitian teachers, brought to the Congo in the 1960s and 1970s to assist with Congolese independence, returned home.

An estimated 4,500 Haitians were in the Congo in the 1960s, and that number grew in the 1970s, according to Thomas F. McDow, a historian of Africa and the Indian World at the Ohio State University. .

From those early events, a pandemic was born.

The Science article references much of the work presented in “Phylogeny and the origin of HIV-1,” published in April 2001 in Nature by researchers Andrew Rambaut, David L. Robertson, Oliver G. Pybus, Martine Peeters, and Edward C. Holmes.

Authors of the 2014 Science article included Rambaut, Pybus and Peeters, as well as Nuno R. Faria, Marc A. Suchard, Guy Baele, Trevor Bedford, Melissa J. Ward, Andrew J. Tatem, João D. Sousa, Nimalan Arinaminpathy, Jacques Pepin, David Posada, and Philippe Lemey.

Subsequent data releases show that early therapy for people living with HIV also prevents the onset of cancer, cardiovascular disease, and other non-AIDS-related diseases.

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.”

The FDA’s approval of Cabenuva (cabotegravir and rilpivirine, in an injectable formulation) made it the first time an injectable, extended release, complete HIV treatment regimen was available in the U.S.

For many HIV-infected adults who were virologically suppressed on a stable antiretroviral regimen, Cabenuva replaced their daily oral antiretroviral regimen with a once-a-month injection.

“This approval will allow some patients the option of receiving once-monthly injections in lieu of a daily oral treatment regimen,” said John Farley, M.D., M.P.H., director of the Office of Infectious Diseases in the FDA’s Center for Drug Evaluation and Research. “Having this treatment available for some patients provides an alternative for managing this chronic condition.”

The FDA also approved Vocabria (cabotegravir, tablet formulation), which is taken in combination with oral rilpivirine (Edurant) for one month prior to starting treatment with Cabenuva to ensure the medications are well-tolerated before switching to the extended-release injectable formulation.

The safety and efficacy of Cabenuva were established through two randomized, open-label, controlled clinical trials in 1,182 HIV-infected adults who were virologically suppressed (HIV-1 RNA less than 50 copies/milliliter) before initiation of treatment with Cabenuva, according to the FDA. Patients in both trials continued to show virologic suppression at the conclusion of each study.  Cabenuva and Vocabria were granted Fast Track and Priority Review designation by the FDA.

In March 2022, the FDA would approve the use of Cabenuva for adolescents, extending the treatment option to HIV-infected people as young 12 years old, as long as they weigh at least 77 pounds and are already on a stable antiretroviral regimen, with no history of treatment failure, nor known or suspected resistance to either cabotegravir or rilpivirine

Up until this day, the vaccines available in the U.S. — made by Pfizer and BioNTech, Moderna, and Johnson & Johnson — have been authorized on “an emergency basis” but had yet to be fully approved.

A fully approved COVID vaccine was particularly important to members of the HIV community, because people with HIV have higher rates of certain underlying health conditions, particularly if they are aged 50 or older.

Older age and underlying health conditions can make people more likely to become seriously ill if they get COVID-19, according to the Centers for Disease Control and Prevention. This is especially true for people with advanced HIV or people with HIV who are not on treatment.

While the CDC determined that COVID-19 vaccines are safe for people with HIV, concerns about the general safety of the vaccine were common.

The Pfizer-BioNTech vaccine, which was marketed as Comirnaty, was the first COVID-19 vaccination to receive full review and approval from the U.S. regulatory agency. The FDA would approve the vaccine’s use in children aged 5-11 the following October.

The company’s clinical trial included approximately 44,000 participants and found the vaccine to be 91% effective in preventing COVID-19 disease.

Comirnaty was developed from technology licensed from the National Institutes of Health, according to a U.S. government website.

“National Institute of Allergy and Infectious Diseases (NIAID) inventors and their collaborators had already developed a stabilized prefusion coronavirus spike protein that could be used as a vaccine antigen to cause neutralizing antibody responses,” stated the NIH in its feature on Comirnaty.  “NIH’s ongoing research allowed for BioNTech/Pfizer to quickly develop a vaccine and bring it to market based on NIH technologies.”

Previously, in December 2020, the Pfizer-BioNTech vaccine was granted emergency use authorization by the FDA in response to the public health emergency posed by the coronavirus pandemic. That authorization involved a review of safety data on over 37,000 participants in a randomized, placebo-controlled study.

“While millions of people have already safely received COVID-19 vaccines, we recognize that for some, the FDA approval of a vaccine may now instill additional confidence to get vaccinated,” said Dr. Janet Woodcock, the then acting FDA Commissioner. “Today’s milestone puts us one step closer to altering the course of this pandemic in the U.S.”

The FDA’s approval came amidst the spread of the highly contagious COVID-19 delta variant across the country. It also represented a turning point in U.S.’s response to COVID-19, as more private and public entities began instating vaccination requirements to stem the spread of COVID-19.

“The new vaccine was the result of months of work, robust data evaluation and a thorough, comprehensive review process that has protected more than 100 million Americans from severe COVID-19 complications,” said the American Medical Association in its newsletter.  “It is a milestone and major step forward in the worldwide effort to end this pandemic.”

Among those who adopted vaccine mandates for employees in the wake of the Pfizer-BioNTech vaccine’s FDA approval were the Pentagon and the New York City school system.

People infected with this variant were also found to undergo a twice-as-fast deterioration of their immune system, setting them on a course to potentially develop AIDS years earlier than people with other versions of HIV, according to a report in Science magazine released on this day.

HIV-1 virulence is most commonly measured by viral loads (the concentration of viral particles in blood plasma) and CD4 counts (the concentration of T cells).  Successful treatment of HIV-1 with antiretroviral drugs is indicated by the suppression of the viral load and interruption of the decline in CD4 counts that would otherwise lead to AIDS.

The study of the 109 individuals in the Netherlands with subtype-B HIV-1 found that the new variant carries more than 500 mutations scattered across its genome — though it was unclear how the mutations were able to manifest as a more severe form of the disease.

The study also finds that this variant still responds to current HIV treatments.

“Our discovery of a highly virulent and transmissible viral variant … emphasizes the importance of access to frequent testing for at-risk individuals and of adherence to recommendations for immediate treatment initiation for every person living with HIV,” wrote the lead researcher for the study, Chris Wymant, the senior researcher in statistical genetics and pathogen dynamics at the Oxford Big Data Institute.

Individuals with the variant were mostly men who have sex with men (82%), similar to non-variant HIV-positive individuals (76%). Age at diagnosis was also similar for variant and non-variant individuals; neither ethnicity nor host genotype data were available, but the place of birth was mostly recorded as Western Europe for both groups (71% for non-variant individuals, 86% for variant individuals).

A genetic sequence analysis conducted by the researchers indicated that the variant emerged some time in the 1990s from de novo mutation (an alteration as a result of a mutation on the cellular level), not recombination (the process by which chromosomes exchange genetic material).

While the variant spread quickly during the 2000s, its infection rate has been declining since around 2010 — probably as a result of the country’s access to life-saving treatment and efforts to curb HIV transmission, Wymant told Nature magazine.

The emergence of a more virulent form of HIV is “a reason to stay vigilant,” but it’s not a public-health crisis, according to Joel Wertheim, an evolutionary biologist and molecular epidemiologist at the University of California San Diego who spoke with Nature magazine.

Montagnier’s work on HIV made it possible for scientists to develop diagnostic tests and treatments that have saved countless lives.

Montagnier worked in several laboratories before landing at the Pasteur Institute in Paris in 1972, according to Heidi Ledford’s article in Nature magazine.   After developing an expertise in virology, he began to specialize in retroviruses, which are viruses with an enzyme capable of making a complementary DNA copy of the viral RNA, and then integrating it into the host cell’s DNA.

This knowledge made Montagnier the right researcher in the right place in January 1983, when a colleague sent him lymph node tissue taken from a French fashion designer thought to be in the early stages of AIDS.

When other scientists began releasing studies showing the depletion of a class of immune cells (CD4⁺ T cells) in people with AIDS, Montagnier took note.  He knew of a retrovirus that infected CD4⁺ T cells, and it was transmitted through blood and sexual activity.  He had a hunch that AIDS was caused by a retrovirus, too.

Working on Montagnier’s instincts, Françoise Barré-Sinoussi was able to isolate a new retrovirus from the lymph node biopsy.  It  was a major breakthrough for Montagnier’s virology unit at the Pasteur Institute — they had found the cause of AIDS.

Montagnier’s team — which called the viral isolates LAV, for Lymphadenopathy Associated Virus — published its research  results in Science magazine on May 20, 1983.  Four months later, Montagnier presented the results to a skeptical audience at a small, late-night session of a scientific conference at Cold Spring Harbor Laboratory in New York organized by Robert C. Gallo, M.D. a top researcher at the National Institutes of Health’s National Cancer Institute.

“Mentally, most attendants were not prepared to accept the idea of a second family of retroviruses … existing in humans and causing immune deficiency, and having no counterpart in animals!” Montagnier wrote in 2008 in his Nobel prize biography.  “This situation is not infrequent in science, since new discoveries often raise controversy.”

About a year after the Cold Spring Harbor conference, Dr. Gallo announced that he had discovered the cause of AIDS in the family of T-cell lymphotropic viruses (HTLVs), in a virus he called HTLV-III. Later, this virus was found to be virtually identical to the Pasteur Institute’s LAV, according to the Mayo Clinic’s biography of Montagnier.

The separate claims of discovery by Montagnier and Gallo culminated in a lawsuit in December 1985.  Virology icon Dr Jonas E. Salk stepped in to mediate the conflict and the two researchers finally resolved their differences.

in 1986, the AIDS virus was officially designated as human immunodeficiency virus (HIV). Both researchers were recognized and honored by the Lasker Foundation and received the 1986 Albert Lasker Medical Research Award. The Foundation cited Montagnier for “discovery of the [AIDS] retrovirus later shown to be responsible for the major new threat to world health,” and Gallo was acknowledged as the originator of much human retrovirus research.

In March 1986, Montagnier and his team announced the discovery of HIV-II, another strain of the AIDS virus.  They reported further isolates from AIDS patients, including a heterosexual couple from Africa and later from hemophiliacs, according to Robin A. Weiss and Simon Wain-Hobson in Science magazine.

Using tissue samples from key clinical researchers, Montagnier’s team was successful in developing lab tests for HIV antibodies, which enabled the development of blood tests to diagnose HIV infection.

Montagnier received many awards, including a Chevalier de la Légion d’ Honneur in 1984 and the Commandeur de l’Order National du Mérite in 1986 as well as professional honors from Switzerland, Canada, and Japan. He was honored on a stamp issued by Bhutan in 2000.

According to Nature, Montagnier spent his later years dismantling his hard-won reputation as a top scientist by opposing vaccination during the COVID-19 pandemic.

The updated maps from AIDSVu, alongside the organization’s new HIV care continuum maps stratified by race/ethnicity, show continued disparities in access to treatment and care across different geographies and communities.

AIDSVu is a project by Emory University’s Rollins School of Public Health to make HIV data widely available, easily accessible, and locally relevant to inform public health decision-making and action.  Operating since 2010, Emory University coordinates this work in partnership with Gilead Sciences, Inc. and the Center for AIDS Research at Emory University.

This year’s maps serve as a snapshot of the HIV epidemic during the beginning of the COVID-19 pandemic, which impacted resources, HIV testing, HIV new diagnoses, and data collection over the last two years.

New to this year’s report were data from Funders Concerned About AIDS that tracks philanthropic HIV funding across the U.S. These data provide insights about the use of funds granted for advocacy, social services, prevention, and treatment in Ending the HIV Epidemic (EHE) Initiative focused jurisdictions and in specific communities most impacted by HIV.

The AIDSVu website provides researchers, policymakers, and community members with a more comprehensive understanding of the HIV epidemic at the local, state, and national level.  The data displayed on AIDSVu were obtained from the CDC and compiled by researchers at the Rollins School of Public Health.  Additional data (ZIP Code, census tract, and community area/ward data) were provided by state and city health departments and compiled by researchers at the Rollins School of Public Health.

“Looking at 2020 HIV data, it is impossible to avoid the fact that COVID-19’s impact has been wide-ranging,” said Patrick Sullivan, DVM, PhD, Professor of Epidemiology at Emory University’s Rollins School of Public Health and Principal Scientist for AIDSVu.  “While we are still trying to understand the full extent of the impact COVID-19 had on testing, treatment, and care, this data will help enable that conversation,”

Dr. Sullivan also said that the maps illustrate that there is still much work to be done before the HIV epidemic can be eradicated.