LECTURE ONE

1. INTRODUCTION AND OVERVIEW OF THE HIV PANDEMIC

This lecture provides a historical perspective to the HIV/AIDS pandemic starting with the first official
report that was published about a hitherto unknown disease. It also gives an overview of how the
pandemic evolved into the most important infectious disease of the last quarter of the Twentieth Century.

1.1 UNIT OBJECTIVES

At the end of this lecture you should be able to:

 Describe the circumstances surrounding the first official report that marked the
emergence of what eventually became the AIDS Pandemic
 Discuss factors that contributed to stigma towards those who were infected with
the HIV Virus.
 Identify factors that led to the gradual and extensive spread of the virus
1.2. The Beginning -First Official Report of HIV/AIDS Infection

American Physician Michael Gottlieb makes the first official AIDS- related reports-1981

Dr Michael Gottlieb- Described the first officially recognised cases of AIDS (Photo by Victor s. on
“Yelp”)

The first official report of the hitherto unknown HIV infection and the advanced stage of the disease in an
infected person referred to as “Acquired Immunodeficiency Syndrome”(AIDS) was made by American
Physician Michael Gottlieb in 1981. At the time Dr Gottlieb who was practicing medicine in San
Franscisco, was attending to a group of five homosexual males (men who have sex with men- “MSMs”)
who were suffering from a type of lung infection (pneumonia) caused by a microorganism known as
Pneumocystis Carinii (later renamed Pneumocystis Jirovecii).This type of pneumonia was known to
occur only in people whose bodies had a very poor ability to fight infection meaning that their immune
systems were impaired such as those given drugs that suppress immunity after organ transplants. The
pneumonia came to be known as Pneumocystis Carinii Pneumonia (PCP).

Gottlieb reported his findings to the Centre for Disease Control (CDC) in Atlanta, Georgia in the USA
and an official report was published in the journal Morbidity and Mortality Weekly on 5thof June,
1981.

Case Definition for AIDS Developed by CDC 1982

The cause of the poor immunity in these patients was at the time unknown but to assist in further
identification of the disease and facilitate research the CDC developed a case definition of the disease that
was emerging in the following year, 1982. A definition of the term case definition is presented next.

Case definition: refers to a set of criteria used to determine whether an individual has a certain disease
or event....includes clinical as well as laboratory characteristics. Source:
www.britanicca.com/science/case-definition.

AIDS Virus is first described and named “Lymphadenopathy Associated Virus”

Researchers involved in trying to establish the cause of the disease were able to make a breakthrough in
1983. French scientist Luc Montaigner and co-worker Francoise Barre- Sinoussi of the Pasteur Institute
Paris, reported having identified viral elements in samples taken from the patients who had shown these
symptoms. They gave the virus the name Lymphadenopathy Associated Virus.

Luc Montaignier who discovered the HIV virus( Credit: Getty images)
Franscoise Barre Sinnousi- co- discoverer of the HIV virus ( credit:
MLA style: Françoise Barré-Sinoussi – Facts. NobelPrize.org. Nobel Media AB 2019. Thu. 15 Aug
2019. <https://www.nobelprize.org/prizes/medicine/2008/barre-sinoussi/facts/>)

“Lympadenopathy” is a medical term referring to swollen lymph nodes and the researchers who
discovered the HIV virus may have called it LAV because people infected with the HIV virus often
have swollen lymph nodes on their body.

The following year American researcher Robert Gallo made reports that corroborated the findings of
Montaigner and co-workers. This confirmed an association between the virus and appearance of
symptoms of a poorly functioning immune system. This disease with devastating, often lethal effects,
came to be called the Acquired Immune Deficiency Syndrome (AIDS), a name derived from the effects
of the virus on the body. The symptoms of this illness will be discussed in a later module.

Other reports appearing around the same time came from researchers in New York and California
describing the occurrence of a severe form of a cancer of the blood vessel (vascular) tissues. This cancer
known as Kaposi’s Sarcoma was appearing in an aggressive form in young, male homosexual patients;
while previously it was usually seen in a slowly- developing form in older patients. This recent
presentation was now being accompanied by other symptoms of a poorly functioning immune system.
The cases would later be confirmed as part of the presentation of AIDS.

1.3 Naming of the HIV Virus

The newly identified virus was initially given different names based on what the researcher observed on
the patient and the behaviour of the virus. These names include:

Lymphadenopathy Associated Virus ( LAV) so called because the virus tended to cause swollen Lymph
nodes in the patients.

AIDS- Associated Retrovirus (ARV)-Because the virus was in the group of viruses known as retroviruses
and resulted in the illness called AIDS.

Human T- cell Lymphotropic Virus- (HTLV) because the virus infected and thrived on T- Lymphocytes.

Finally in 1986 the World Health Organization (WHO) adopted the name Human Immunodeficiency
Virus (HIV) as the official name for the virus following a consultative meeting.

1.4 The Spread of the Virus Globally

The initial assumption that HIV was a problem of certain groups of people such as those with a
homosexual orientation, would rapidly be replaced by a realization that the infection had a much
wider reach and would eventually become a worldwide problem.

Pratt, 2003 has described the spread of HIV in two waves the first wave occurring from the mid 70’s
up to the late eighties. In this wave North America, Western Europe and Australasia, and the, were
affected in a pattern where mostly Homosexual and Bisexual Men, intravenous drug users and some
recipients of contaminated blood were the most affected. Heterosexual transmission also occurred
but this was minimal as was Mother to Child Transmission.

The second pattern was observed in the Sub-Saharan Africa, Latin America and the Caribbean. Here
most transmission was heterosexual with groups such as Commercial Sex Workers getting infected
early and in turn infecting their clients who on their part would carry the infection to their sexual
partners (wives and girlfriends). Where many females got infected, mother- to- child transmission
that caused infections in babies became an important reality.

Pratt further notes that in the 1990’s countries that did not show many infections in the first wave
such as Asia, Eastern Europe, North and South Africa, the Middle East and the Pacific region got
sucked into the Pandemic where there was accelerated transmission. This was the second wave of
the Pandemic.

1.5 The first case in Kenya was reported in 1984.

By the year 2003 an estimated 62 million people would have become infected by the HIV virus with
20 million deaths occurring as a result of these infections. (Pratt 2008)

Factors that Led to the Spread of HIV in the early days of the pandemic

The following factors contributed to the early spread of HIV infection in one way or the
other:

 International travel
 The use of intravenous drugs of abuse such as heroine often using contaminated needles
 The Blood industry where treatments using blood and blood products became more
common
 The changing sexual norms in communities such as increased acceptance of gay lifestyles,
and more freedom regarding sexual choices such as having multiple partners and engaging
in commercial sex work.
 Stigma towards the disease and the misconception that it was a disease of certain types of
people
 Inadequate understanding about risk factors for contracting HIV.

1.6 Early Perceptions and Foundation for Stigma

The fact that the first cases of HIV infections were reported in homosexual patients (“ gays”)
created an impression that this was a problem of individuals with what was regarded as a deviant
lifestyle. In the early days of the Pandemic terms such as “Gay- Related Immunodeficiency Disease -
GRID” were used in some quarters. Other inordinately affected groups were the intravenous drug
users, “Heroine injectors”, “Haitians immigrants” “ Haemophilia Patients” and of course the
“Homosexuals” so another stigmatising perception was of HIV as the “Four ‘H’ disease”.
Commercial Sex Workers would also emerge as the other main group at high risk of contracting the
HIV virus. These observations and the devastating, eventually lethal effects of what was clearly a
communicable disease laid the foundation for a fearful and heavily stigmatizing perception of the
new disease.

Note: A communicable disease is a disease caused by a living organism such as a virus, a

bacteria, or parasite that can be passed from one person to another.

1.7. Other Important milestones.

First Laboratory Test

Having identified the HIV Virus as the cause of the new disease it was necessary to develop tests
that could be used widely in clinical settings to detect the presence of the virus in the affected
patient. The first Laboratory test that could detect the presence of the virus and be used widely was
developed and deployed in 1985. Subsequently it became possible to screen people for HIV
infection.
  The first Laboratory method introduced to test for the HIV virus in health facilities
was given the name “ Enzyme-Linked Immuno-sorbent Assay in short “ELISA”.

Early treatments for HIV Infection focused on managing the many infections that developed in
those people whose immune system had failed. These infections came to be called” Opportunistic
Diseases’ because they took advantage of a weakened body to attack. These treatments only
afforded patients temporary relief as those with advanced disease inevitably progressed on a
downhill path with an average life expectancy of 1.3 years.

First Antiretroviral Medication Introduced

Efforts to develop specific treatment against the virus bore some fruit when the first antiretroviral
Zidovudine (AZT) was introduced. However, the benefit obtained from the use of AZT proved to be
limited as initial improvement would eventually be replaced by deterioration. The virus would
gradually develop resistance towards the medication so that the patient started worsening after a
brief period (six months or so) of improvement. The use of Zidovudine was found to improve life
expectancy for those on it for about 20 months.

Note:

 Viral Resistance means that the virus that was being destroyed by some medicine
being taken by a patient stop being affected by that same medicine. So the virus will
multiply in the body of the person and gradually cause worsening of the patient’s
condition.

Highly Active Antiretroviral Medicines ( HAART)

A partial solution to this problem was found when combinations of antiretroviral medicines were
developed and became the preferred treatment option in the 1990’S and after. These so called
Highly Active Antiretroviral Medicines ( HAART) produced dramatic improvement in the patients
and also delayed the onset of viral resistance to the treatment. However, these medicines are not a
cure for the virus and have a potential to cause side effects in the patient. Nevertheless, they
represent great advancement in the treatment of HIV infection that significantly improve life
expectancy as well as quality of life for people living with the HIV Virus. Now having entered its
fourth decade(at the time of writing) since the first official report, HIV remains an incurable disease
and prevention through the many available measures remain the only real hope for eventually
bringing the pandemic under control.

AIDS Vaccine -Unrealised hopes

The hope of developing a vaccine against the HIV virus, though still alive has not translated into a
practical solution in preventing infections and any future role for this option remains to be seen.

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SUMMARY

This lecture highlights the circumstances surrounding the first official report made on
the infection that would come to be known as HIV/AIDS and the discovery in 1983 that
this was a viral infection. It also looks at how the seeds of stigma were sowed in those
early stages of the Pandemic and how the infection eventually spread in a way that
debunked those early perceptions. The chapter also looks at other important
developments such as the introduction of the first HIV test and the first Antiretroviral
drug Zidovudine.
NOTE

 The occurrence of a rare type of pneumonia caused by a usually harmless type of

protozoa microorganism Pneumocystis Carinii pneumonia is the first finding that
alerted Physician Michael Gottlieb that an unknown medical condition may have
emerged.
 The work of virologist Luc Montaigner and Franscoise Barre- Sinnousi was
Instrumental to the identification of the HIV virus as the cause of AIDS. They were
awarded the 2008 Nobel Prize in Medicine for their achievement. Robert Gallo
corroborated their findings.
 The first effective Antiretroviral Medicine Zidovudine (AZT) was introduced in 1987
and is still in use to date.

Place an important point you want to emphasize here in your unit topics
or subtopics.
ACTIVITIES

 Access the internet through the Google search engine and type the Theories of Origin
of the HIV virus in the search bar. From the various sources availed identify at least
five of the various theories presented.
 Access the internet through the Google , Yahoo or other search engine and read about
the following personalities: Rock Hudson, Arthur Ashe and Philly Lutaaya. What was
the contribution of each to the early response to the AIDS Pandemic
 Place here the unit activities, forming the body of this module.
SELF-TEST QUESTIONS

1. Discuss the circumstances surrounding the first official report of what came to be known
as HIV/AIDS infection.

2. Discuss the role of: i) Michael Gottlieb, ii) Luc Montaignier and Francoise Barre- Sinnousi
in the early stages of the HIV Pandemic.

1.9 FURTHER READINGS

1 Pratt J Robert 2003.HIV/AIDS. A Foundation for Nursing and Healthcare Practice London.
Bookpower.

2.Maranga, R.O., Muya S.M., Ogila K.O., 2008 Fundamentals of HIV/AIDS Education.
Nairobi. Fragrancia.

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GLOSSARY

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together with their meanings. This is an optional but necessary tool to accelerate the learning
process.

ANSWERS TO SELF-TEST QUESTIONS

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REFERENCES

1.Maranga, R.O., Muya S.M., Ogila K.O., 2008 Fundamentals of HIV/AIDS Education.
Nairobi. Fragrancia.

2. Ministry of Health(NASCOP, KENYA),2005.National Training Curriculum ART Comprehensive

HIV/AIDS Care. Nairobi.

3.Pratt.,R.,J. 5th Ed.2003 HIV and AIDS- A Foundation for nursing and health care practice. London.
Bookpower
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