Michael ODriscoll
Age of AIDS
Frontline PBS: The Age of AIDS
PURPOSES/USES/ROLES/ACTIVITIES OF EPIDEMIOLOGY/EPIDEMIOLOGISTS:
1. Identifying risk factors for disease, injury, and death
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Sharing (renting) needles for intravenous drug use
Multiple sexual partners
Hemophiliacs who use donated blood products
Sexual promiscuity- heterosexual and homosexual
Infected mothers giving it to their new born babies
2. Describing the natural history of disease
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1930’s:
 Suspect transmission of a similar simian virus to humans possibly by a hunter coming in
contact with the virus while preparing chimpanzee meat from a successful hunt.
1959:
 First death of AIDS in the Congo region of Africa was not confirmed until decades later.
1960’s:
 People in Central African towns were dying of a wasting disease we now know to be
AIDS.
Late 1970’s – early 1980’s:
 Haiti: local doctors were witnessing large numbers of men, women, and children who
contracted what they called the “wasting disease.”
1980’s:
 Many African men traveled to South Africa to work in the mines; many of the workers
were already infected and they hired prostitutes. Increasingly, the wives of these men
were becoming infected and dying.
1981:
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United States: a homosexual male was diagnosed with rare and fatal pneumocystis
pneumonia
CDC reports over 100 cases of disease (most are seen in open gay men with active drug
use and high number of sexual partners).
Paris: seven new patients diagnosed with disease – 3 were gay men, 3 were women, and 1
Portuguese heterosexual man
Belgium: both men and women of Central Africa were being diagnosed with similar
symptoms.
New York City: 3 heterosexual men were diagnosed who shared needles during
intravenous drug use.
San Francisco: a baby was diagnosed after having multiple blood transfusions.
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United States: hemophiliac population was observed to have a significant rise in positive
diagnoses.
1982:
 CDC releases first MMWR describing etiology of AIDS and suggesting disease may be
caused by an infectious agent transmitted sexually or through blood exposure to blood or
blood products.
1983:
 French researchers were the first to isolate the HIV virus and take an electron microscope
picture.
 French researchers identified AIDS caused by a retrovirus.
 Two cases of infected, heterosexual women were reported who had sex with infected
males.
1984:
 Blood test was developed by U.S. researchers to screen for virus in an individual.
 U.S. researchers found that a person could be HIV positive, but symptom free for a long
period of time and be at risk of infecting others.
 U.S. Health and Human Secretary, Margaret Heckler holds a press conference crediting
Dr. Gallo for discovering the virus and announcing a vaccine will be found in two years.
1985:
 500,000 Americans infected with virus.
 Over two million people around the world infected.
 Actor Rock Hudson authorizes his physicians to publicly confirm AIDS diagnosis prior
to death late in the year.
1986:
 World Health Organization begins global AIDS program headed up by Dr. Mann.
1987:
 AIDS activist, Cleve Jones organizes first memorial quilt march and display on
Washington, D.C.
1988:
 Noreen Kaleeba founded The AIDS Support Organization (TASO) in Uganda after her
husband died from becoming infected following a blood transfusion.
1990:
 Estimated one million Americans infected with disease.
 Nelson Mandela was released from prison; by then nearly 1% of S. African population
was HIV positive.
1992:
 U.S. President, Bill Clinton, tripled funds for AIDS research and doubled fund for care.
1994:
 Nelson Mandela became president and did not become involved in AIDS. Deaths from
disease accelerated in S. Africa, especially in the poor townships. Infections were
doubling every year in S. Africa.
1995:
 Dr. David Ho discovered virus is never dormant and developed a multiple drug program
to fight the virus and avoid drug resistance. Called triple cocktail, trails began on a test
subject.
1996:
 Startling results from the trails on the triple cocktail were presented to the Global AIDS
conference. However, drugs cost $16,000 per year for one patient.
 20 million people in Africa were infected with HIV.
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Brazilian AIDS activist, Nair Soars de Brito, sues government to provide medication free
to its citizens. Judge rules in her favor and the government began providing drugs to
infected citizens.
Liberal Brazilian Catholic priests started demanding action to help those infected.
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1999:
 1 in 5 S. African adults were HIV positive.
 Thabo Mbeki, Successor to Nelson Mandela becomes president of S. Africa and banned
access to AZT and the cocktail citing information given to him by HIV deniers.
 AIDS has killed over 20 million people by this time.
 U.S. rates of infection ran steady at 40,000/year with 80% of those infected being
minorities. Stigma and denial ran deep in the minority population across the U.S.
2000:
 AIDS researchers held biannual meeting in S. Africa. President Mbeki repeated the
denier’s claims that AIDS was caused by poverty and not HIV. President Mbeki refused
to help his people.
2002:
 Citing bible verses, Evangelist Franklin Graham called on all religious people to assist
with the HIV epidemic with compassion and action.
 Singer Bono meets with Senator Jessie Helms who was opposing legislation funding HIV
research and AIDS treatment and changes his mind.
2003:
 U.S. President, George W. Bush, announced at the state of union speech the government
will provide 15 billion dollars in aid to address global locations with high HIV infections
rates; Africa and the Caribbean were targeted. The U.S. plan drew from current religious
and government health services in place in those areas.
 Former U.S. President, Bill Clinton, attends a conference on AIDS in China and invites
an HIV positive individual on stage to meet the government officials. China quickly
implements a prevention and treatment program.
2005:
 Brazil publicly turned down U.S. funds to assist their AIDS prevention programs because
the U.S. attached certain moral mandates for any government accepting the aid. In this
case, Brazil was forbidden to advocate the legalization of prostitution.
3. Identifying individuals and populations at greatest risk for disease
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Gay men who were very active in their community who had high numbers of sexual partners.
Hemophiliacs who used blood supplies that were contaminated with the virus.
Any patient needing a blood transfusion.
Intravenous drug users who “rented” or shared needles.
Poor countries with high poverty, low education levels, and almost no access to health care.
4. Identifying where the public health problem is greatest (alphabetical order)
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Britain:
 Intravenous drug (heroin) users who shared needles.
Central Africa:
 Men and women with multiple sex partners.
 Gay men – due to cultural perceptions, this population was not recognized as existing.
Haiti:
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All stages of population due to high poverty, low education levels, and lack of health
care.
Thailand:
 Prisoners who use intravenous drugs supplied by the guards and share needles.
 Sex industry workers.
 Hemophiliacs.
United States:
 Young gay men in larger cities.
 Hemophiliacs.
China:
 At all levels of the population
Russia
 Intravenous drug users (cheap heroin)
 Selling sex to pay for drugs
S. Africa
 Mine workers
 Women
 Children
 Hemophiliacs
 Homosexual population
5. Monitoring diseases and other health-related events over time
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Initially, the CDC was monitoring the disease and first reported on the disease in a 1981
published Morbidity & Mortality Weekly Report (MMWR).
Since 1985 the CDC has funded HIV testing at health care and non-health care sites (CDC,
2013).
Currently, UNAIDS collects reports on national statistics with its members. These reports are
used in the preparation of global progress reports.
AIDS has been identified in every country on the planet.
Currently, 95% of all new infections are in poor countries.
40 million of HIV worldwide
30 million died from AIDS
Russia – government did almost nothing for dealing with the disease and it spread through
Eastern Europe to S. E. Asia to India to China.
6. Evaluating the efficacy and effectiveness of prevention and treatment programs
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Thailand was able to see a reduction of 90% HIV infection rate in their sex worker trade
professionals by introducing a mandatory advertising education program and making condoms
available for free.
Uganda showed a dramatic decrease in HIV infected people after the president went across the
country talking to the people about AIDS and tolerance. Having the government directly
involved brought credibility of message to the people of Uganda.
Once blood supply testing was introduced, infection rates for hemophiliac population
dramatically declined.
San Francisco bathhouses were shut down by the health department in 1984, but were reopened
by a judge two months later. This action was not effective because this action targeted only the
gay population and created a high level of distrust between the government and homosexual
population.
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Once the blood supply was tested, the number of hemophiliacs becoming infected declined.
Ethiopia received money from U.S. but insisted on control of the prevention program for the
medicine. Was mostly ineffective because the government was ineffective in administering the
program.
Brazil provided treatment medication free to all HIV citizens. Program was very effective. In
addition, the government leveraged their ownership of the drug manufacturing plants to negotiate
a better price on the medications. First country to guarantee drugs to all citizens. Subsequent
studies show live span of HIV positive individuals lived 8 years longer.
China began encouraging condoms use through their existing birth control program, provided
free AIDS testing for sex workers, and counseling for heroin addicts.
India made education a priority. In 2000, the government began teaching truck drivers about safe
sex. Infection rates dropped by 1/3 by 2006. In addition, the Bill Gates foundation hired ex-sex
workers to go into that population to educate the workers.
U.S. authorized funds for treatment however; long delays and medication shortages marked this
program.
7. Providing information useful in health planning and decision making for establishing health programs
with appropriate priorities
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French and United States researchers were providing key information about the virus to assist
public health professionals in creating public health programs.
Uganda and Thailand implemented health programs based on current data showing which
populations were at risk, however, each country had a unique culture which created two very
different programs, each showed a level of success.
In 1984 Ronald Reagan was to hold a press conference to ease growing concerns of the citizens
about HIV. At the last minute he received legal advice to tone down his message and the result
was more confusion and fear in the American people. This was not useful.
Thailand government changed regulations on advertising requiring all radio and TV stations to
have 30 seconds of AIDS education for every hour of broadcast. In addition, the government
implemented a free condom program with great success. However, one of Thailand’s most
susceptible populations, intravenous drug users, were not included in any health program
initiative.
South African presidents Mandela and Umbeki used unhelpful decision making decisions to deal
with the AIDS epidemic.
8. Assisting in carrying out public health programs
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The World Health Organization became a leader in assisting other countries implementing public
health programs targeting high risk populations. Dr. Mann, with many financial resources
available to him helped dozens of countries implement HIV/AIDS public health programs.
Dr. Robertson, a British physician proved transmission of HIV was high in drug users who
shared needles recommended a needle exchange program which the government approved.
In 1990, the United States House of Representatives passed the Ryan White Care Act providing
funded treatment and education to HIV/AIDS patients.
UN created a new agency in 1996 to fight the global epidemic.
AIDS activists across the globe were carrying out public health promotion and education
programs.
Scientists played a large role in directing public health programs based on their findings. For
example, discovering the virus was passed through the blood supply brought about a change in
the public health programs for the nation’s blood supply.
9. Being a resource person
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Noreen Kaleeba became Uganda’s spokesperson and resource expert on HIV after her husband
died from AIDS after receiving a blood transfusion (unknowingly) from his brother who was
infected.
Dr. Mann from the World Health Organization became the world’s expert on HIV/AIDS and
created a worldwide network for education and prevention. His staff grew to 250 when he
abruptly left WHO amidst reports of internal political strife. In a short period of time, the
HIV/AIDS staff went from 250 to four.
CDC and the WHO became the experts for medical and health information about HIV/AIDS.
Former U.S. President Bill Clinton became a spokesperson and advocate for AIDS worldwide.
10. Communicating public health information
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An example of poor communication was President Ronald Reagan’s lack of concern over
HIV/AIDS and his inability to commit any resources or communicate helpful health information
to the American people.
Gay activists became the voice behind communicating to the American people about HIV/AIDS.
Musician Bono joined the campaign to educate the world about HIV/AIDS.
Activist Cleave Jones in 1987 creates the AIDS Memorial Quilt bringing national awareness to
the disease.
Continuing to publish medical reports through the CDC.
President Clinton became a very good communicator and advocate for AIDS information.
President Umbeki became a poor communicator for AIDS and caused many infections to occur
due to his refusal to adapt to the changing public health landscape.
Throughout the presentation the standard measure of mortality and morbidity for HIV would have changed.
Limitations in research data and reporting mechanisms at the beginning of the epidemic lead to underreporting
and imprecise indicator values. As information became more available and disseminated, changes in the
reporting mechanism and estimation methods occurred and a worldwide spike in the morbidity of the virus was
observed. As the epidemic exploded across the globe, these measuring standards changed again.
The number of people living with HIV is usually referred to as prevalence; the number of new infections as the
incidence; and, mortality is defined as the number of people who died from AIDS. In these presentations, the
data collected must have been difficult for the epidemiologist to sort through for many reasons including: 1)
infections/deaths are usually collected by local government agencies, 2) resources in the poorer countries were
inadequate, 3) lack of trained personnel, 4) definitions of reporting varied, 5) poor compliance, and 6) laws
would have varied by country. Information provided to us during this presentation were estimates based on the
reporting mechanisms in place at the time. However, I would like to point out that even with difficulties in
obtaining accurate data, as the epidemic spread and grew, the data coming in to the CDC and WHO
substantiated the quick and efficient spread of HIV.
Throughout the presentation, hot spots (clustering) of the epidemic included areas with a thriving sex trade
industry and intravenous drug users; mostly heroin.
Public health prevention programs were very slow to be created and implemented for HIV/AIDS. I believe this
occurred because people and politicians applied a moral component to any response which only served to take
focus off of the virus and the science behind transmission. Once prevention programs began to focus on the
causes of transmission a level of success was obtained. For instance, Uganda introduced a successful
nationwide program communicating how to prevent anyone from getting the virus rather than focusing in on
one or two high risk populations. Politicians and citizens each played an important part in the success of the
Uganda program and the number of newly infected people declined. India was proactive and implemented a
prevention program in their highest risk populations (sex trade and truckers) instead of waiting until the
epidemic swept through their population unchecked. President Bush provided prevention and treatment program
money to selected countries with moral strings attached to the funding which proved to be more ineffective than
effective. In my opinion, public health programs solely operated by a government or activist group had little
effect on reducing the infection rate. However, the programs which involved a combination of government and
citizenry focusing on the etiology of the virus were highly successful in preventing the spread of the disease.
Brazil appears to be the exception in many ways in dealing with the epidemic by providing treatment to HIV
individuals free of charge; but, let’s not forget that it took a lawsuit by one citizen and favorable ruling by a
court of law to propel the government into action.
Michael ODriscoll