AIDS Assignment Week 1:
Tanya Staton
*I included the Part 1 discussion guide and my AIDS notes at the end*
AIDS Synopsis Outline:
I.
Distribution of AIDS
a. Frequency:
1. In summer of 1981 CDC had recorded 100 new cases that mostly appeared in gay
lifestyles.
2. In 1999 1 in 5 South Africans had the disease.
3. In the late 90’s new infections remained stable, but 80% of new cases were among
minorities.
b. Pattern
1. Originally seen in gay men and drug users now in hemophiliacs, women, babies
2. Virus seen in almost every country with South Africa having the most cases
3. 1 confirmed case in 1981 now 40 million cases in 2006
II.
Determinants:
1. Unsure of cause of virus in the beginning
2. When hemophiliacs started getting the disease scientists concluded that it was a virus
because particle was small enough to get through filter.
3. Believed to be a HTLV virus discovered the virus originated from chimpanzees.
III.
Health related states or events
a. Disease States:
1. Low t-helper cell count, pneumocystis, Kaposi sarcoma
b. Conditions associated with health:
1. Sexual activity, drug use, blood transfusion, mother to baby
IV.
Descriptive Epidemiology
a. Person:
1. Gay men, IV drug users, hemophiliacs, mother to baby transmission, heterosexual
couples, Haitians
b. Place:
1. Probably originated in the Congo
2. Seen in larger cities where gay lifestyle thrives and drugs available
3. Bath houses, addiction clinics
4. All over the world: South Africa has most cases
c. Time:
1. First case in 1959
2. Incubation period before symptoms vary: disease can lie dormant
3. 40 million affected can potentially rise to 40 million more
d. Clinical criteria:
1. People becoming sick and dying because no treatment available
2. Ho trying to figure out why the virus lies dormant
V.
Analytical Epidemiology
a. Why
1. Not sure why virus was occurring
b. How
1. Virus believed to have spread from chimpanzees to human more than likely from
meat consumption and unclean sanitation practices when handling the carcass.
2. Virus replicated and RNA changed multiple times before eventually infecting
humans
c. Testing Hypothesis
1. Tried to regrow virus
2. Using clean needles and condoms would prevent spread of virus
3. Tried using AZT to cure, worked for a while but virus adapted
4. Came up with triple cocktail and drugs worked to prolong life
VI.
Other roles of Epidemiology
a. Identifying where greatest risk is
1. Gay & drug users
2. Now South Africa so programs being directed there
3. Uganda was a problem, but leader helped get under control
4. China and Russia
b. Evaluating the effectiveness of preventive programs
1. President Musevini of Uganda started preventive program: started Abstain, be
faithful and use condom (ABC) program. Uganda became first country to get AIDS
under control.
2. Needle exchange program reduced infections in drug users
3. Testing blood and blood products reduced cases in hemophiliacs
c. Assisting in carrying out Public Health Programs
1. Bono backed AIDS and Christin faith: spoke with Helms about providing assistance
2. Clinton tripled funds to help with AIDS research.
3. NIH went to white house to help develop a plan for AIDS
d. Communicating Public health information
1. TASO formed to educate preventive programs
2. Cleave Jones created AIDS quilt to draw national attention
3. Wall Street strike to lower cost of drugs
Positives/Negatives & Strengths/Weakness
There were many negatives and weakness that occurred when AIDS was emerging. The biggest
weakness was the way most political leaders chose to deal with the situation. Instead of protecting
their country they ignored the problem. Reagan actually claimed it “was a disease that scientists could
handle” (pbs.org). He even cut the budget. The way Ryan White and other hemophiliacs were treated is
also a negative. There were many Black American churches that opposed helping with AIDS patients.
They claimed that helping them was “Bad Bible” (pbs.org). A huge negative was how drug companies
kept prices extremely high instead of lowering the cost to save lives (pbs.org).
There were many positives and strengths over the last 25 years in regards to the AIDS pandemic though.
I think a major positive was the way the CDC, NIH and WHO all worked together to help find a way to
control the virus (pbs.org). There were also people like Graham who considered the crisis as a great
opportunity to spread to Christian faith while helping the infected (pbs.org). Activists proved that
progress can happen if they work together to make their voice heard. The AIDS quilt is a great example
(pbs.org). Blood donation guidelines were set which are still used today. Another strength AIDS
brought was it bonded countries on a global scale. Countries leaned on each other for support for new
drugs, possibility of a cure and for funds.
MPH 510
Age of AIDS – Part One
Discussion Notes
PURPOSES/USES/ROLES/ACTIVITIES OF EPIDEMIOLOGY/EPIDEMIOLOGISTS:
1. Identifying risk factors for disease, injury, and death
 Noticed trend that gay men were dying of pneumocystis and Kaposi Sarcoma
 CDC evaluated the disease more than published first official publication (then called
GRID) in June 1981 edition of MMWR.
2. Describing the natural history of disease
 Discovered the first confirmed death of AIDS from man in Congo in 1959
 Realizing that the transmission event took place from animal to human in the 1930s
probably.
 Discovering the disease was a virus after blood units contaminated: virus can only pass
through filter.
3. Identifying individuals and populations at greatest risk for disease
 First appearing in Gay community so calling the new disease GRID in the U.S.
 Soon noticed increase in IV drug users from needle sharing.
 Hemophiliacs discovered to becoming infected from contaminated blood and blood
products.
4. Identifying where the public health problem is greatest
 Appearing in cities where gay population is prevalent: New York, Los Angeles
 Noticed an increase of HIV infections among Haitian decent in South Florida.
 Bulk of HIV cases are in Africa
5. Monitoring diseases and other health-related events over time
 Epidemiologists realized that the mode of transmission was blood borne.
 Ruling out that casual contact was not a transmission route.
6. Additional activities
 Activists boycotting Wall Street to drive the prices of HIV prescription drugs down.
 Cleave Jones created quilt project to draw national attention and support in 1987.
7. Evaluating the efficacy and effectiveness of prevention and treatment programs
 Condoms distributed to brothels in Thailand: lead to 90% decrease in sex workers over
next decade.
 Programs set up for needle exchange programs in Britain: saw a decrease in cases.
8. Providing information useful in health planning and decision making for establishing health
programs with appropriate priorities

Pamphlets circulated in New York about the importance of safe sex in gay population:
Congress later ruled to ban material in Helms law.
9. Assisting in carrying out public health programs
 Mann at WHO lead global program to work on justice
 Mann helped established AIDS programs in 100 countries
 Elizabeth Taylor convinces president to give speech on AIDS, although he was not very
informed on the subject matter.
10. Being a resource person
 Joe McCormick flying CDC research team to Congo to look for patients with similar
symptoms.
 Beautrice Hann discovering the virus originated from a chimpanzee.
 Dr. Gallea isolating retrovirus from leukemia virus
11. Communicating public health information
 President Uganda preached tolerance: Proved to be one of the first countries that
prevention works and number of cases decline.
 Thailand Prime Minister required HIV broadcasting on the radio every hour
 TASO taught preventive methods on how to avoid infection in 1987 by Dr. Kaleeba.
AIDS Notes Section 1:
Part 1: A Deadly New Disease
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150x smaller than wbc
January 1981- 21 gay man lost 30lbs, fever, lung infection, initial cases mystery, had
pneumocystis.
blood sample had hardly any t-helper cells which means hardly any immune cells
couldn't do much for early cases
CDC- best known for epidemiology,
Jim Current looked back for other cases of pneumocystis
June 1981 MMWR published first official publication
Paul Volberoug, MD – 22 yr old male, Kaposi sarcoma.
Stigma and isolation associated with HIV
Summer CDC had 100 new cases, that mostly appeared in large city center of gay lifestyles
Called GRID 1st (gay related immune deficiency)
Also drug related
Cases seen in South Florida seen in women and men but Haitian descent
Part 2: The Spread Escalates
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Drug users starting to have symptoms not just gays
would rent needles- so blood borne exploded
addiction clinics boomed with patients
fear everywhere within the city
rejection & discrimination starts to set in: support systems get lost
Socially unacceptable: as politician the government became an issue as to what to do with it
Conservatives "against nature, pay the price, violate laws of god"
1981- Children's hospital of San Francisco HIV seen in baby: associated with blood transfusion
Panic within hemophilia community
factor 8 pooled from many donors: multiple lots contaminated
CDC now knew had to be a virus because only particle small enough to get through filter
Blood bankers resistant because no test and would face huge financial risk & screening would
discriminate.
2 more years before safeguards put in place for screening
35000 contaminated from blood products
Part 3: Politics & Tracking
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Epidemic had begun in 1st part of Reagan administration
Margaret Heckler HHS secretary looking to scientists for aids
CDC said budget cuts limited research
Problem scientists could solve
problem: where did disease come from
Joe McCormick flew CDC team to Congo to look for patients with similar symptoms
Alarmed raised when realized that general population could be infected
Epidemic already: Sect of Health Edward Brandt didn't make sense because focus had been on
gays
In Africa realized disease had been circulating for some time
Who took disease out of Congo?
Speculated Haitians did and immigrated after their independence
Porte Prince started first AIDS clinic
Convinced that gay brought to Haiti
Press released Haitians risk group & goods would not be allowed to be sold in the US
Bath house community feeder: come & have multiple partners
Great fear if government closed bath houses what would be next
Bath houses fostering death and disease not liberation
Part 4: Scientific Breakthroughs
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NIH trying to identify viral agent
couldn't see or grow yet
Dr. Robert Gallea: 4 yrs earlier isolated retrovirus for leukemia
Convinced HTLV related to Aids virus
January 1983 biopsy sent to Passer institute: cultured and checked regularly
needed to keep t-cells alive so fed virus with additionally wbc
3 weeks teamed isolated new virus
Summer 1983 French researchers first saw HIV in electron microscope
virus passed on to 70 million people
10 years to discover that it originated from a chimpanzee virus in Africa
Process of hunting encountered blood-blood contact from preparing meat
Virus adapted and evolved
family tree of retroviruses:
1930's speculated the transmission event took place from animal to human
Beautrice Hann: discovered origin in chimpanzee
medical campaigns for pox virus so might have led to transmission and adaption's
1959 first confirmed death of AIDS in Congo
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April 1984: Heckler press conference to help develop blood test
Ashamed that US presented as a US discovery: French US dispute for more than a decade
Thought could develop a vaccine within 2 years
serologic test confirmed that HIV positive but symptom free
mid 1980s number deaths doubling every year
Part 5: A Death gives AIDS a Face
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Government still focusing AIDS as gay problem mainly because activists to fight were gay men
Rock Hudson rumors spreading very sick
Went to Paris to receive treatment because had been doing trials since 1983
denied AIDS rumors
Finally gave permission to announce he had AIDS
90 days he died after Doris day appearance
Frightening that disease happening to a lot of people
A lot of ignorance: denied healthcare, losing apartments, wearing gloves
people afraid to get tested because who will know results
parents forced hemophilia boy to quit school: Ryan White
Family Florida home burned down because hemophilia with AIDS
Nixon should of dispelled the fears
September 1985 Nixon had to dispel fears and told no danger from casual contact
Instead of ensuring not casual he said "medicine has not proved it is safe"
Public Health officials CDC gave pressed briefings to try and calm fears
Government still putting faith in science
Immune parts not reactive because virus hides behind sugar, and proteins that are foreign are
hidden behind this sugar
Part 6: Lessons of Leadership
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2 million affected: majority in Africa
Uganda had highest incidence in mid 1980s
Stigma because sexually transmitted and sex is taboo
WHO in Geneva working on cure
prejudice associated with disease and have to stop
Mann asked to lead global program to work on justice
established AIDS programs in over 100 countries
not just medical disease but also a social disorder
president Uganda preached tolerance
TASO groups offered instruction on how to avoid
positive people and families that exude hope
Uganda one of first countries that prevention could work and numbers could decline
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Thailand prisoners infected because heroin prevalent and many needles shared
Amnesty granted to prisoners so AIDS spread fast
1 in 10 tested positive in military
Thailand prime minister changed where radio broadcaster must have HIV information every
hour on air
condoms distrusted to brothels: "called crash helmet:
90% decline among sex workers next decade
People felt better because of government constant education about aids
helped that churched back the condom "Proved good leadership and great common sense
things can happen"
Part 7: Setbacks
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Nixon and Thacher view of AIDS completely different
Britain mainly iv drug use main transmission
British government trying to establish needle requirements, but does that mean government
supports drugs??
programs to set up needle exchanges to prevent transmission
US activists ran into trouble about clean needles
40% HIV infections are drug related
no needle exchange will receive public funding
Conservatives upset with promotion and pushed ban to eliminate material to educate gays
Helms law to ban still in affect: Politics driving force in spread of disease
AZT started to help patients re-build immune system
AZT developed with public money
charged highest pharmaceutical ever 10k a year
Burroughs Welcome: act up activist group went o protest
Activists boycott wall street to finally drive price down
FDA greatest demonstration: 1k almost all with HIV "seize control" to help develop new
medications
Wanted access to new drugs biggest concern
AZT not cure it seemed to be because as long it could replicate resistance developed
Part 8: At the Brink
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1987 AIDS quilt on display: 40,000 already died
Cleave Jones created quilt project to draw national attention
Reagan spoke at AIDS research benefit: Elizabeth Taylor invited
realized how "clueless" Regan really was
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White house staff 2nd guessing a medical doctor
education is critical to clearing up fears
demonstration inside because claimed immigrants needed to tested
did not talk about condoms/abstinence
August 1990 finally governed research funding: Called Ryan White care act
CIA predicted AIDS time bomb for global: predicted 45 million infections by year 2000
250 employees working on AIDs at height now down to 4
Section 2
Part 1: Political Indifference
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Before first case 250,000 Americans already had it
Because of stigma/shame world leaders un-willing to accept fact that HIV is real issue
South Africa largely been free from AIDS but foreign come to work mines
Live in Hostel and mine workers come to have sex with women: no clue about AIDS so no
condom use
1990 Mandela released from prison and 1% already HIV +
Heterosexual African epidemic
Activists met resistance because outsiders coming in and trying to tell how to behave (especially
whites)
Mostly women dying who were infected by husbands who worked in mines
New government having challenges so HIV not really focused on
Babies being infected childbirth/breast feeding
Discriminated on HIV status so people being turned away from treatment to allow for better
prognosis cases
May 1994 activists hoped he would make time for AIDS
Deputy took on AIDS effort, but activists tried to get Mandela involved.
In 5 years South African president he barely mentioned AIDS
South Africa epidemic becoming World’s largest
Part 2: A radical new treatment
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Clinton said he would help AIDs when ran from presidency
“virus do not discriminate” –Clinton
AIDS already killed 200,000 another 1.5 million infected
One world one hope campaign started
Triple funds for research
David Ho trying to figure out why did the virus lie dormant
Discovered never was, but replicated by billions every day and mutated
HIV developed drug resistance if given one at time so tried to use multiple drugs
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3 drugs being used: protease inhibitors was one of them
Dodge a clinical trial patient: given anti-viral therapy that were incredibly toxic
Very toxic but viral load un-detectable
1996 researchers announced results to world: called triple cocktail
New drug allowed HIV to longer be a death
16000 a year for drug cost
South Africa could definitely not afford drugs
1996 20 million infected with HIV
United Nations agency developed to fight epidemic
Part 3: Struggle to Get the Drugs
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Insurance patients could get triple cocktail
Emergency funds available for treatment but long delays and not everyone would get the
treatment
Prince worked AIDS clinic in Alabama: still in dark about AIDs “not happening in their part”
DE Brito: can you fight for human drugs and rights (lived in Brazil)
Brazil guaranteed health care for everyone, but did not allow triple cocktail because drugs too
expensive
Sued government and judged ruled to approve drugs
Dialog between government and society also strengthen institution of state to respond
Brazil 1st country to guarantee anti-viral to its citizens
South Africa Mandela presidency ended MBeki promised AIDS solution
Linda gray proved that AZT could block transmission to babies
Banned drugs because they claimed it was to toxic for the poor people
1999 1:5 South African s had virus
Part 4: The Relentless Spread
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Minority still spreading in U.S.
25% black men in New York infected
Black American churches resistance disease: not heir problem “bad bible”
Late 90s new infections remained stable only 40k: 80% among minorities new cases
No new intervention between public health perspective
Clinton under pressure to fund needle exchange program
Republicans cast AIDS “why handing out free utensils for drug users”
Politically country was not ready
In Russia some drug users pay for habit with sex
Moscow did almost nothing to prevent spread
Did not want to talk about it: embarrassed or denial
United Nations calling AIDS a security problem
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Pandemic running course with hardly any intervention from rich world
Durbin meeting in 2000 Aids conference held in Africa: put face onto problem
MBeki repeated denials claim that caused by Poverty and not HIV
Part 5: Financing the Battle
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Activists in America picked up cause to help Africa
Industry argued high prices paid for future research
Companies finally dropped prices to 400 a year, but still problem for poor countries
Working on way to buy drugs at cost and give to for free
Bush just taken office: funds needed from America but republicans against aids for years
3 billion wanted to rural Africa
Difficult to reach anti-viral in Africa because how to distribute because no clinics doctors nurses
Helms still opposed because still thought gay virus: result of sin so does not concern
Graham gave out Christian response: framed AIDS has a missionary opportunity
Bono backing AIDS: Christian faith
Bono went to meet Helms to try and convince backing
Helms became advocate for finding finally
NIH sent to white house to help develop plan for aids
Want to hear it can be feasible for African communities
January 2003 plan still behind closed doors, war in Iraq wondering if AIDS being put on back
burner
State of Union addressed Bush talked about AIDS first instead of Iraq: proposed money devoted
to Africa
Only 1 billion went to Global Fund: trying to cover 130 countries
Bush plan only targeted 15
3 months Bush speech China & Russia started to realize have AIDS problem because no U.S.
money going there
Part 6: New Challenges
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SARS shook China leadership: turned leaders to health problems for first time
Aids made priority out of office Clinton
Birth control preached for 1 child 1 family now also about AIDS prevention
Sex workers got free aids test & learned how to use female condoms
Drug users got council and free methadone
Only 6 drugs available in china- 24 available in America
Discovered could suppress virus but never eradicate it
Ethiopia had 2000 docs for 70 million people
Amount of free drugs available is limited
Prevention made up 20% Bush aids plan: visited Uganda
Washington uncomfortable how open Uganda sex prevention, wanted to be quiet on condom
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Billion dollars sent aside to teach abstinence
Brazil sent forth aids campaign, but strings attached for money especially regarding prostitutes
Part 7: 40m Infections + 40m to Come
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Trying to focus on science of AIDs
South Africa biggest but Mbeki banned triple cocktail so activist sued
Government finally began to corporate with drugs from U.S.
40k on treatment, but more than 5 million HIV +
Debrito in Brazil realized that the 3 cocktail was allowing extra 8 years
Now spends 1/5 of healthcare on aids
2008 bush plan runs out of $ so will no longer get drugs
95% all new infections in poor countries
Treatment programs will never keep pace so 40 million to come
India’s challenge is to get ahead of disease
2000 Clinton gave money to teach safe sex to truckers in India
2006 study showed that programs like this reduce infections by 1/3
Researchers developing gel to kill virus on contact
Core used for women to protect themselves
5 microbicides now in advanced clinical trials
Increase 5 million per year: working on vaccine but hard because replicates so fast
Can’t win but can mitigate disaster
References:
Frontline the Age of AIDS. (2006). 25 years of AIDS. Retrieved from
http://www.pbs.org/wgbh/pages/frontline/aids/cron/
Cran, W. (Producer & Director). (May 30, 2006). The Age of AIDS. United States: Public Broadcasting
System.