History of AIDS

These are some of the most important events that have occurred in the history of AIDS up to 1986. This is one of a group of HIV/AIDS history pages. Other HIV/AIDS history pages can be found in our HIV and AIDS history and pictures section. We do not know exactly how many people developed AIDS in the 1970s, or indeed in the years before that, neither do we know, and we probably will never ever know, where and how the AIDS virus HIV originated. But what we do know is:

The major remarkable characteristic of this first period was silence, for the human immunodeficiency virus (HIV) was unknown at that time and its transmission and thus its spread was also not accompanied by signs or symptoms saliently visible enough to be noticed. While rare, sporadic case reports of AIDS and sero-archaeological studies have documented human infections with HIV prior to 1970 too but the available data suggests that the current dreaded & deadly disease started in the mid- to late 1970s. By 1980, HIV had spread to at least five continents (North America, South America, Europe, Africa and Australia). During this period of silence, size of spread of HIV subsisted and grew bigger since it was unrestrained due to absence of awareness or any preventive action and approximately 100,000-300,000 persons may have been infected.

Kaposi's Sarcoma (KS) was observed to be a rare form of relatively compassionate form of cancer that tended to occur in elderly population but by March 1981 no less than eight cases of a more dangerously aggressive forms of KS had cropped up amongst young gay men in New York. Almost at about the same time there was a perpetual increase, in both California and New York, in the number of reported cases of a rare lung infection Pneumocystis carinii pneumonia (PCP). This increase in PCP was noticed sometime in the month of April, at the Centers for Disease Control (CDC) in Atlanta where a drug technician, Sandra Ford, observed a high number of requests for the drug pentamine, used in the treatment of PCP. In June, the CDC published a report about the occurrence, without identifiable cause, of PCP in five men in Los Angeles. This report is occasionally referred to as the "beginning" of AIDS, but it might be more precise to portray it as the beginning of the general awareness of AIDS in the United States of America.

Dr. Conant and Dr Volverg discussing Kaposi's Sarcoma. Circa 1981

A few days later, following these reports of PCP and other rare life-threatening opportunistic infections, the CDC formed a Task Force on Kaposi's Sarcoma and Opportunistic Infections (KSOI). Around this time a number of theories emerged about the probable causes of these opportunistic infections and cancers. Earlier theories included infection with cytomegalovirus, the use of amyl nitrite or butyl nitrate "poppers", and "immune overload". There was so little known about the transmission and spread of what seemed to be a new emerging disease, there was concern about contagion, and whether the disease could by passed on by people who had no apparent signs or symptoms. Knowledge and the information about this disease Which was believed to be true at that time, was changing so fast that, certain assumptions which were made at this time were revealed to be baseless just a few months later.

The disease still did not have any name associated with is, with different groups referring to it differently. The CDC generally referred to it by reference to the diseases that were occurring, for example lymphadenopathy (swollen glands), although on some occasions they referred to it as KSOI, the name already given to the CDC task force while in contrast to this some still linked the disease to it's initial occurrence in gay men, with the Lancet calling it the 'gay compromise syndrome', whilst at least one newspaper referred to it as GRID (gay-related immune deficiency), and another newspaper described it as 'gay cancer'. The disease was also called 'community-acquired immune dysfunction'. In June a report of a group of cases amongst gay men in Southern California suggested that the disease might be caused by an infectious agent that was sexually transmitted. By the beginning of July a total of 452 cases, from 23 states, had been reported to the CDC. Later in July the first reports appeared that the disease was occurring in Haitians, as well as haemophiliacs. By August the disease was being referred to by it's new name of AIDS. The word AIDS was an abbreviation of Acquired Immune Deficiency Syndrome. An anagram of AIDS, SIDA, was created for use in French and Spanish. The doctors thought 'AIDS' suitable because people acquired the condition rather than inherited it; because it resulted in a deficiency within the immune system; and because it was a syndrome, with a number of manifestations, rather than a single disease. Still very little was known about transmission and public anxiety continued to grow.

By 1982 a number of AIDS specific voluntary organizations had been set up in the USA. They included the San Francisco AIDS Foundation (SFAF), AIDS Project Los Angeles (APLA), and Gay Men's health Crisis (GMHC). In November 1982 the first AIDS organization, the 'Terry Higgins Trust', was formally established in the UK, and by this time a number of AIDS organizations were already producing safer sex advice for gay men. In December a 20-month old child who had received multiple transfusions of blood and blood products died from infections related to AIDS. This case provided clearer evidence that AIDS was caused by an infectious agent, and it also caused additional concerns about the safety of the blood supply. Also in December, the CDC reported the first cases of possible mother to child transmission of AIDS. By the end of 1982 many more people were taking notice of this new disease, as it was clearer that a much wider group of people was going to be affected. When it began turning up in children and transfusion recipients, that was a turning point in terms of public perception. Up until then it was entirely a gay epidemic, and it was easy for the average person to say 'So what?' Now everyone could relate. It was also becoming clear that AIDS was not a disease that just occurred in the USA. Throughout 1982 there were separate reports of the disease occurring in a number of European countries. Meanwhile in Uganda, doctors were seeing the first cases of a new, fatal wasting disease. This illness soon became known locally as "slim".

The number of people who could potentially become infected again expanded in the beginning of 1983, when it was reported that the disease could be transmitted heterosexually from men to women. At about the same time the CDC convened a meeting to consider and decide how the transmission of AIDS could be prevented, and in particular to consider the new evidence that AIDS might be spread through blood clotting factor and also through blood transfusions. Hemophiliacs were largely at risk because the blood concentrate that some hemophiliacs used, exposed them to the blood of up to 5,000 individual blood donors. In the UK there were public concerns about the blood supply with references in newspapers to "killer blood". The media more generally started to take notice of AIDS, with the screening of a TV Horizon programme, "the killer in the village", and a number of newspaper articles on the subject of the "gay plague". In May 1983, doctors at the Institute Pasteur in France reported that they had isolated a new virus, which they believed to be the cause of AIDS. People did not bother and very little notice was taken of this announcement at the time, but a sample of the virus was sent to the CDC. A few months later the virus was named lymphadenopathy-associated virus or LAV, patents were applied for, and a sample of LAV was sent to the National Cancer Institute. But while developments were being made by various scientists in different parts of the world, there was at the same time an increasing concern about the transmission, and not just in relation to the blood supply. A report of AIDS occurring in children suggested quite incorrectly the possibility of casual household transmission. AIDS transmission became a major issue in San Francisco, where the Police Department equipped patrol officers with special masks and gloves for use when dealing with what the police called 'a suspected AIDS patient. There was considerable fear about AIDS in many other countries as well. As anxiety continued, the CDC tried to provide reassurance that the children had probably become infected from their mother and that casual transmission did not occur.

Reports from Europe suggested that two rather separate AIDS epidemics were occurring. In France and Belgium, AIDS was occurring mainly in people from Central Africa or those with links to the area. In the UK, West Germany and Denmark, the majority of people with AIDS were homosexual, and many had a history of sex with American nationals. In the UK, in September, people who might be particularly susceptible to AIDS were asked not to donate blood. Meanwhile, in parts of Zambia and Zaire, doctors had noted the emergence of a very aggressive form of Kaposi's sarcoma. This cancer was endemic in Central Africa, but previously it had progressed very slowly and responded well to treatment, whereas the new cases looked very different and were often fatal. Other evidence of AIDS in Africa had emerged from previously healthy African patients who were hospitalized in Belgium with opportunistic infections (such as PCP and cryptosporidosis), Kaposi's sarcoma, or other AIDS-like illnesses. All of these patients had immune deficiency similar to that of American AIDS patients. However, they had no history of blood transfusion, homosexuality, or intravenous drug abuse. In light of such reports, scientists set out to discover more about the occurrence of AIDS in Central Africa. These investigations resulted in 26 patients with AIDS being identified in Kigali, Rwanda, and 38 patients identified in Kinshasa, Zaire. The Rwandan study concluded that, "an association of an urban environment, a relatively high income, and heterosexual promiscuity could be a risk factor for AIDS in Africa". The Zairian study found there to be a strong indication of heterosexual transmission and shortly after this, the Zairian Department of Health created a national AIDS research programme. A study in Zambia reached the same conclusion as those conducted in Rwanda and Zaire that African patients with KS [Kaposi's sarcoma] seem to have an immunological and virological profile similar to that seen in American patients with AIDS". In October, the first European World Health Organisation (WHO) meeting was held in Denmark. At the meeting it was reported that there had been 2,803 AIDS cases in the USA. That meeting was followed in November by the first meeting to assess the global AIDS situation. This was the start of global surveillance by the WHO and it was reported that AIDS was present in the U.S.A., Canada, fifteen European countries, Haiti, and Zaire as well as in seven Latin American countries. There were also cases reported from Australia and two suspected cases in Japan. By the end of the year the number of AIDS cases in the USA had risen to 3,064 and of these 1,292 had died.

At the CDC researchers had been continuing to investigate the cause of AIDS through a study of the sexual contacts of homosexual men in Los Angeles and New York. They identified a man as the link between a number of different cases and they named him 'patient O' for 'Out of California'. The research appeared to show that AIDS was a transmittable disease, and the co-operation of 'patient O' contributed to the study. However a problem arose when other people read the scientific paper. And so in March 1984 the myth of Patient Zero began. Just one month later, on April 22nd, Dr Mason of the CDC was reported that he has the cause of AIDS. He was referring to the French virus, LAV, and he was basing his opinion on the findings made in the preceding weeks by the researchers at the Pasteur Institute who had discovered the virus the previous year.
 

Margaret Heckler

Dr Robert Gallo

Just one day later, on April 23th, the U.S.A.’s Health and Human Services Secretary Margaret Heckler announced that Dr. Robert Gallo of the National Cancer Institute had been successful in isolating the virus which was the cause of AIDS, that was named as HTLV-III, and also that a commercially available test for the virus, would be there in the market very soon. On the same day itself patent applications were filed covering Gallo's work, but at the same time this also justified a very clear possibility that LAV and HTLV-III were the same virus. The scientific papers documenting Gallo's discovery of HTLV-III were published on 4th May and by the 17th of May, many private companies were found applying for licenses to develop a commercial test to the Department of Health & Human Services, which would identify the evidence of the virus present in the blood. This was the test which would also be used to screen and scrutinize the supply of donated blood in the USA in its entirety. In the meanwhile a continued concern about the public health aspects of AIDS propagated amongst the people not only in the United States of America, but also, the world at large. This was particularly noted in the case in San Francisco city where every gay bath houses and private sex clubs were stopped due to which some of the gay men raised their objections against this shutting down and regarded this closure as an assault on their civil rights. By the end of 1984, there had been 7,699 AIDS cases and 3,665 AIDS deaths in the USA, and 762 cases had been reported in Europe. In the UK there had been 108 cases and 46 deaths.

In January 1985 a more number of detailed reports were published concerning LAV and HTLV-III, and by March it was absolutely clear that both the viruses were the same and in the very same month the U.S.A. Food and Drug Administration (FDA) issued licenses for the commercial production of the first blood test, for AIDS. The test would identify & disclose the presence of antibodies to LAV/HTLV-III, and it was announced that whosoever was found to have antibodies against HIV in their blood would not be allowed to donate blood at all in future. A number of social and ethical issues, as well as certain medical matters arose, that had to be primarily taken into consideration before the forthcoming test could be even used in order to ensure the safety & safekeeping of the donated blood supply. Furthermore, even more aspects needed to be considered before this test could be used more widely and the concern particularly centered in and around issues related to confidentiality and the significance of a positive test result. The first small-scale needle and syringe exchange project was started in the year 1984 in Amsterdam, the Netherlands but more similar projects were also started in the year 1985 as a result of growing apprehensions about HIV.

In the month of April more than 2000 people attended the first international Conference on AIDS held in Atlanta where the three major topics of discussion were the new HTLV-III/LAV test, the global situation with regard to AIDS and the extent of heterosexual transmission. The World Health Organization (WHO) organized another international meeting immediately after the conference was over, to contemplate the AIDS deadly disease and also to initiate an intensive global action against it. Meanwhile in many other countries there developed an outbreak of fear and prejudice apart from this spread of HIV and AIDS infection. In the UK tabloid press, many headlines were related to AIDS alone which further caused fright and raised terror among the public at large. In some of the newspapers, the prejudice was obvious since the hemophiliacs were regarded as the innocent victims of AIDS while the gay people & the drug-users were seen as being responsible to source the disease upon themselves. The fear of AIDS caused firemen to ban the kiss of life, and caused holidaymakers to cut their holiday short for fear of contracting AIDS from an HIV-positive passenger on the Queen Elisabeth 2. A 9-year old HTLV-III positive hemophiliac was allowed to attend the local school, however some of the pupils where kept home by the anxious parents.

In the USA, a general fear arose, that, drinking communion wine from a common cup could transmit AIDS, and Ryan White, a 13-year old hemophiliac with AIDS was barred from school to take preventive and precautionary measures against the further spread of this disease. On 17th September, President Reagan mentioned AIDS publicly for the very first time, when he was questioned about AIDS funding at a press conference and at the same press conference he was also raised a query whether he would send his children to school with a child who has AIDS, if they were not young enough. Drugs such as ribavirin, thought to be active against HIV, were being smuggled from Mexico into the USA. The actor Rock Hudson also died of AIDS on 3rd October, 1985 who was the first major publicly known figure to have passed away because of AIDS. All blood transfusion centers in UK began routine HIV testing of all blood donations in October. For the Global Surveillance of AIDS, the WHO had in the initial & crucial days used the definition of AIDS as developed in the USA in 1982 but this definition was all the difficult to be used in the developing countries which lacked of modern and sophisticated laboratory tests, therefore, in order to help with the surveillance of AIDS, particularly in Africa, a new WHO definition was adopted in October when this definition of AIDS became known as the Bangui definition. Towards the year end, scientists in the west became much more responsive to the "slim disease" that had become alarmingly & increasingly common in South West Uganda since 1982. Founding’s of the studies conducted in this regard displayed that most of the cases noticed and reported so far, were among those heterosexuals who had multiple sexual partners, and the majority of them tested positive for antibodies to HTLV-III. The site and timing of the first reported cases suggested that the disease arose in neighboring Tanzania. Some of the scientists who had studied “slim disease” concluded that, though slim disease resembled AIDS in many ways, it seemed to be a new entity. However, many other scientists thought otherwise and suggested that slim disease could not be differentiated from AIDS and ARC [AIDS related complex] by extreme weight loss and diarrhea, therefore, slim disease may not be a new syndrome but simply identical with AIDS as seen in Africa. In December 1985, the Pasteur Institute filed a lawsuit against the National Cancer Institute to claim a share of the royalties from the NCI's patented AIDS test. During the year, knowledge of transmission routes was to change again, when the first report appeared of the transmission of the virus from mother to child through breast feeding. The first case of AIDS was also reported in China, and AIDS had as a result been reported in every region in the world. By the end of 1985, 20,303 cases of AIDS had been reported to the World Health Organisation. In the USA 15,948 cases of AIDS had been reported, and in the UK 275 cases.

The first UK needle exchange scheme started in Dundee in the month of February after which the government launched, in March, the first public information campaign on AIDS, with the slogan "Don't Aid AIDS". There were a series of advertisements in national newspapers but still there existed disagreement about the name of the virus at this time after which in the month of May 1986, the International Committee on the Taxonomy of Viruses made a ruling that both names should be shunned and the dispute be resolved by a new name given to this virus to be now called as HIV (Human Immunodeficiency Virus). At the opening speech of the International Conference in Paris, held from June 23-25 1986, Dr H Mahler, the Director of WHO, announced that as many as 10 million people world wide could already be infected with HIV. In August, the USA Federal Government accused an employer of illegal discrimination against a person with AIDS for the first time because a hospital had dismissed a nurse and refused to offer him an alternative job and this was observed as a violation of his civil rights. In September there was a spectacular progress in the provision of medical treatment for AIDS, when early results of clinical tests showed that a drug called azidothymidine (AZT) which was first synthesised in 1964 as a possible anticancer drug but it proved ineffective at that time, now AZT slowed down the attack of the AIDS virus. The AZT clinical trial divided patients into two groups; one that received AZT and the others placebo, or dummy drugs and it was observed that, at the end of six months, only one patient in the AZT group died, whereas there were 19 deaths reported among the placebo group. This clinical trial was stopped soon, because there was a contemplation which recognized this as unethical and unjustified to deny the patients of the placebo groups a better chance of survival thus considered this as a violation of the human rights. In the United States, the Surgeon General's Report on AIDS was published which was the Government's first major statement on what the nation should do to prevent the spread of AIDS. The 'unusually explicit' report urged parents and schools to start 'frank, open discussions' about AIDS. By this time, scientists had accumulated enough evidence to form an overview of AIDS in Africa. Studies of medical records showed there had been marked increases in a number of AIDS-related conditions during the late 1970s and early 1980s. In particular:

• Slim disease in Kinshasa, Zaire (late 1970s)

• Slim disease in Uganda and Tanzania (early 1980s)

• Esophagel candidiasis in Rwanda (from 1983)

• Aggressive Kaposi's sarcoma in Kinshasa, Zaire (early 1980s)

• Aggressive Kaposi's sarcoma in Zambia and Uganda (from 1982 and 1983)

• Crypotococcal meningitis in Kinshasa, Zaire (late 1970s to early 1980s).

To conclude, it would be appropriate to state that, these studies suggested that while isolated cases of AIDS may have occurred in Africa earlier, it was probably rare until the late 1970's and early 1980's, a pattern similar to that in the United States and Haiti came into limelight. As in the case of the developed countries, AIDS in Africa too was found to primarily affect young and middle-aged people, especially those who were unmarried. The sex and age distributions were seen to reflect other sexually transmitted diseases, and the major transmission routes had already been identified and the available data suggest that heterosexual activity, blood transfusions, vertical transmission from mother to infant, and probably frequent exposure to non-sterilized needles account for the spread of HIV infection and AIDS in Africa. By the end of the year, 85 countries had reported 38,401 cases of AIDS to the World Health Organisation. By region these were: Africa 2,323, Americas 31,741, Asia 84, Europe 3,858, and Oceania 395.