You are on page 1of 7

HIV/AIDS Dont Die Of Ignorance- AIDS Publicity Campaign, 1987 The Beginning & Patient Zero Gaetan Dugas

-Patient Zero -inapparent carrier of HIV -silent but deadly spread -long latency period beginning of 1984 -United States reported 4,000 cases -by end of the year there were more than 11,000 -CDC estimated 500,000 were infected without knowing it Government Silence -Reagans administration stayed completely mum during outbreak -practiced politics that were ugly, mean, and blind to blatant discrimination -AIDS was marginalized as the gay disease -even when intravenous dug users and Haitians were identified as at risk, the government found no reason to change their ignorance policy -They completely ignored it, with founder of the Moral Majority, Jerry Falwell called AIDS The wrath of God upon homosexuals -CDC estimates caused more than 100,000 people to march at the Democratic National Convention in San Francisco to bring attention to growing epidemic. - Government still failed to respond Rock Hudson - Famous & beloved American actor that announced in July 1985 he was a practicing homosexual and had contracted AIDS. - He was emaciated and a shadow of his former self. - This put a face to the AIDS epidemic and prompted new AIDS activism after his death 3 months later - Change in publics attitude began to occur - Still Reagan refused to speak on the issue and take action - because of that the epidemic spread like wildfire Outbreak and chaos -Early stages of AIDS epidemic was controversial -There were competing hypotheses about the cause of the disease and many groups were victimizing those with AIDS and generating public fear. -There were two outbreaks that started to get peoples attention -Young gay men were contracting Karposis Sarcoma in New York in 1981 -Karposis sarcoma is a rare form of slow growing cancer that is usually seen in the elderly -At about the same time a cluster of Pneumocystis Carinii Pneumonia (PCP) began appearing in Los Angeles and New York among gay men

(PCP EXPLAINED LATER) -What linked these two outbreaks was that they were both opportunistic diseases. Which meant that they were diseases that were only contracted when immune function was compromised -They also were only striking those not considered a mainstream part of society: homosexual men -Contact tracing of cases of PCP in Southern California and New York showed evidence that the diseases underlying cause could be a sexually transmitted infection that had not yet been identified. -Reports in early literature then expanded those at risk to include: -Injection drug users -Haitians -and Hemophiliacs -The disease then appeared in the UK and concerns grew surrounding a pandemic. -At this point the disease did not have a name, the CDC referred to the outbreaks ad Kaposis sarcoma and opportunistic infections (KSOI) -The Lancet called it Gay compromise syndrome -Other groups depending on their stances called it Gay cancer or Gay Related Immune Deficiency (GRID) -Acquired Immune Deficiency Syndrome (AIDS) was finally defined by the CDC on Sept. 24, 1982. Equivalent acronym in French and Spanish is SIDA. Identifying Agents & Risks -Naming the disease still did not identify causative agent nor did it give public knowledge of what the risks were -Due to lack of accurate information, patients with AIDS were stigmatized -they lost their jobs, health insurance, housing, and family and friends. -Public Health officials closed bath houses, sex clubs & put out the message to cease body fluid sharing, limit the number of sex partners, and to always use condoms -The public was offended by the frank talk about sex & rumors began to spread that it could be contracted through toilet seats and mosquitoes. -In response to lack of response, AIDS activists charged the CDC and Reagans administration with racism and homophobia. -Parents demanded that local school boards refuse to let children with AIDS attend public school, even though there were fewer than 400 cases of AIDS in children under 13. -Police depts were issued gloves and masks to deal with people who might have AIDS -School nurses were issued safety equipment, and some doctors and dentists refused to treat patients with the disease. -Surgeons began to double glove and the concept of universal precautions was instituted. C. Everett Koop - U.S. Surgeon General - tried to clarify the situation for the American public

- Released Surgeon Generals Report on Acquired Immune Deficiency Syndrome in October 1986. - In it he described symptoms of the disease and its modes of transmission. - sexual intercourse, sharing of contaminated needles, from mother to child during pregnancy or birth, and through contaminated blood or blood transfusions.. - He reassured everyone that AIDS could not be contracted through casual contact. - Koop outlined a realistic approach to AIDS prevention: early sex education in schools, increased use of condoms and voluntary testing. - Conservatives were outraged & his actions contrasted that of the silent Reagan administration - They felt Koops plan would encourage promiscuity. - Conservatives pushed for mandatory testing, which was feared because it could push those who were infected underground out of fear and would not help protect the publics health at all - AIDS activists, however were in favor of Koops report & hoped it would open discussion of U.S. AIDS policy. - The debate continued with little compromise - However, Koop was successful in proving to the public that AIDS was a preventable disease and did not require social and physical isolation of those who were infected. The Search For the Cause -The discovery of HIV as the cause of AIDS begins with Robert C. Gallo and his team at the NIH who were investigating links between viruses and leukemia. -They developed new methods for isolating human retorviruses in the 1970s. - In 1980 they isolated the human T-cell lymphotrophic virus type 1 (HTLV-1) and linked it to adult T-cell leukemia in 1982 - They also managed to isolate HTLV-II, but could not link it to any malignancies - At the Institute Pasteur in France, Francois Barre-Sinoussi and colleagues reported that they hd isolated a new human retrovirus called lymphadenopathy virus (LAV) in 1983. - They isolated this virus from a patient with persistent swelling of the lymph nodes, which was a condition that was present in the early stages of AIDS. - They used the same protocol as Gallos team for identifying and isolating LAV - Some questioned whether LAV was the same as HTLV-1 or HTLV- II. - In April, 1984, Luc Montagnier contended that LAV was morphologically different than HTLV 1 and II and could be one, if not the only, etiological agent for AIDS. - In May 1984, Gallos team isolated HTLV-III, which was harvested from pre-AIDS cases with Lymphadenopathy, from children and adults with AIDS and a homosexual blood donor who later developed AIDS. - They became able to detect the presence of HTLV-III through a screening test: the enzyme-linked immunosorbent assay (ELISA) and a confirmatory test, the Western electrophoretic blotting technique (Western blot). - This meant that blood supply could be screened for the presence of a potential etiologic agent for AIDS for the first time. - NIH filed for a patent and it was granted quickly

- This was a hop, skip and jump for the ability to understand AIDS epidemic Epidemiologic Spread - The spread of the HIV epidemic is being studied right using genetic sequencing. - Results show that the epidemic most likely began as a zoonosis, with two different simian viruses jumping the species barrier to infect humans in Africa, possibly as early as the 1930s. - The genome of the virus shows it has two different types: HIV-1 and HIV-2 - They can be divided into groups, and many of those can be divided into subgroups. - HIV-1 seems to have moved from Africa into North America, either through immigration or tourism, maybe even through Haiti. - It then moved into Europe, Australia, and Asia. - The HIV-1 subtype typically found in homosexuals differs from that one found in injection drug users, and the footprint of the virus found in heterosexuals is similar to the one found in injection drug users. - This shows that HIV is not one single epidemic but rather two separate ones and could possibly be more. - Because of the multi-epidemic arising at the same time among different risk groups, confusion about the disease led to inaction and flat out denial of risk. - In African nations, the ABC policy was implemented which was - A- Abstinence - B- Being loyal to your partner - C- Condom use - Under George W. Bush this policy was amended to only promote abstinence, which most likely furthered the spread of the disease. - Response to HIV also varied among different African nations. - In Uganda, they had a relative success due to an aggressive comprehension campaign beginning in the early 90s. - Places like South Africa just refused to acknowledge the disease. - At the beginning of the 21st century, the prevalence of HIV in Uganda was only 6% of the adult population, while in South Africa it was 20%. - Neighboring Botswana, Lesotho, and Swaziland were dealing with at least 1/4 of their populations being infected. Treatment - Once HIV was confirmed as the cause of AIDS, scientists at Burroughs-Wellcome Company began looking at azidothymidine (AZT) to treat the HIV retrovirus. - AZT was previously found to be effective against a mouse retrovirus. - They filed for a patent in 1985 after a phase 1 trial was conducted with the NCI showed that AZT increased CD4 cell counts. - AZT was then approved as a treatment and later a preventative for HIV by the FDA in 1987 after a placebo controlled, randomized clinical trial showed that AZT could prolong the life of AIDS patients. - High doses of the drugs had to be administered every four hours around the clock - Treatment was expensive and side effects were toxic.

- AIDS activists complained that the government was catering more to big pharma rather than the needs of those suffering with AIDS - They claimed the treatment was price gouged and unethical and that treatment was mediocre and toxic. - Over time research discovered that protease inhibitors interrupted the replication of HIV and allowed CD4 cell counts to rise - Doctors could now monitor viral loads and adjust dosage to suppress HIV so that they could reduce the toxicity - Highly Active Antiretroviral Therapy (HAART or Triple drug therapy) evolved in the 1990s and completely changed the epidemic. - Drug cocktails containing a protease inhibitor, a nucleoside analog reverse transcriptase inhibitor and a non-nucleoside reverse -transcriptase inhibitor kept HIV from developing into AIDS - This changed the disease from being deadly to just a chronic illness. - Unfortunately, when it came to the epidemic in sub-saharan Africa, HAART was not the answer because it was an expensive treatment and not a preventative measure - In the US AZT was being used to prevent perinatal transmission of HIV from mother to child, but it also was extremely expensive. - Intense research began to focus on finding a vaccine or less expensive drug regimen to prevent the transmission from mother to child. - Even though the NIH and UN AIDS Program launched several clinical trails in developing nations, there were a lot of outcries about them being unethical and many were shut down - This was because in the US subjects in those trials all had access to antiretroviral treatments while those in the developing countries did not. - International standards for bioethics have yet to be determine - Time and improved lab technology give us a better understanding of HIV/AIDS that we did not have back in the 80s. - Unfortunately, this has yet to effectively spread to all the countries involved in the pandemic. - Sub-Saharan African nations especially face challenges in providing health care and support because such large amounts of their populations suffer with the disease. 1981 Study of Pneumocystis Pneumonia in Los Angeles - October 1980 - May 1981 - 5 young active homosexual men were treated for biopsy confirmed PCP at 3 different hospitals in Los Angeles, California. - 2 patients died - All five had confirmed previous or current cases of cytomegalovirus (CMV) infection and candidal mucosal infection Patient 1 - 33 years old and previously healthy - developed PCP and oral mucosal candidiasis in March of 1981

- Had a 2 month history of fever associated with elevated liver enzymes, leukopenia, and CMV viruria. - This patients condition deteriorated despite treatment - Died May 3rd, 1981. Patient 2 - 30 years old, previously healthy - Developed PCP in April 1981 - Had a 5 month history of fever every day, elevated liver function tests, CMV viruria, leukopenia, and mucosal candidiasis - His pneumonia was responsive to treatment, but continued to have fevers each day Patient 3 - 30 years old, previously healthy - Developed esophageal and oral candidiasis in January 198, but responded well to treatment - Hospitalized in Feb. 1981 for PCP - esophageal candidiasis recurred after PCP diagnosis - Was given same treatment and alter biopsy tested positive for CMV Patient 4 - 29 years old, had Hodgkins disease 3 years prior to PCP diagnosis and was successfully treated with radiation therapy - Developed PCP in February 1981 - Did not improve with treatment - Died in March 1981 Patient 5 - 36 years old, previously healthy - Clinically diagnosed with CMV infection in September 1980 - Seen in April 1981 because of 4 month history of fever, dyspnea and cough. - When admitted he was found to have PCP, oral candidiasis, and CMV retinitis - Responded to treatment What they all had in common - Diagnosis of PCP was confirmed for all 5 patients ante-mortem by open or closed lung biopsy - Patients did not know each other, had no mutual contacts or knowledge of sexual partners with similar illnesses. - None had comparable histories of STDs. - 4 had evidence of past Hepatitis B infection, but no current infection. - 2 of the 5 reported having frequent homosexual contacts with various partners - All 5 reported using inhalant drugs, and 1 reported parenteral drug abuse Notes About PCP - PCP in the US is almost exclusively limited to severely immunosuppressed patients.

- The occurrence of PCP in these 5 patients without clinically apparent underlying immunodeficiency was strange - The fact that they all were homosexual suggested a link between that lifestyle and a disease acquired through sexual contact and PCP. - All of those observations suggested the possibility of a cellular immune dysfunction related to a common exposure that predisposes people to opportunistic infections Cluster of Cases of the Acquired Immune Deficiency Syndrome: Patients Linked By Sexual Contact - The possibility that homosexual men with AIDS had been sexual partners of each other was studied. - Of the first 19 reported from Southern California, names of partners were obtained from 13 - 9 of the 13 had sexual contact with one or more AIDS patients within 5 years of the onset of symptoms - 4 of the patients had contact with a non-California AIDS patient, who was also the sexual partner of 4 AIDS patients from NYC. - 40 patients throughout 10 different cities were linked by sexual contact - A mean latency period of 10.5 months between sexual contact and onset of symptoms was determined. - The finding of the link of sexual contact backed up the hypothesis that AIDS is caused by some infectious agent.