Thirty years of AIDS
Physician reflects on sex, drugs and a loss of innocence
By David May
As it turned out, it all started long before 1981 but then (as now) few people outside the continent care much about what happens in Africa.
Thirty years ago the world was a very different place. Ronald Reagan and his "Iron Lady" UK equivalent Margaret Thatcher were sowing the seeds of a corporate-led right-wing revolution whose harvest we are reaping today. The cold war was still hot and as London medical students we virtuously attended protests against the Americans basing medium range nuclear weapons on "aircraft carrier Britain."
We amused ourselves by going to Bob Marley and Supertramp concerts. We also amused ourselves in other ways. We were probably the last generation of naive sexual innocents.
Meanwhile at the Centre for Disease Control (CDC) in Atlanta alarm bells were ringing. A new wasting disease was on the loose that left previously fit and healthy young people vulnerable to fatal and, until then, rare infections and cancers.
Some wag at the CDC called it the 4H disease based on the first letter of groups it affected. The first H was homosexuals or, more specifically, the "free loving" gay population of western California.
The second H was for heroin addicts, which later got broadened to any IV drug abuser.
The third H was (inexplicably) Haitians.
And the final H was Hemophiliacs. Hemophilia is a genetic disease involving a lack of a product (factor VIII) in the blood, which enables it to clot. Untreated sufferers are vulnerable to disabling and sometimes fatal hemorrhages.
One of the mainstays of treatment is to transfuse factor VIII into sufferers. Factor VIII was produced by pooling blood from multiple donors, a significant proportion of whom were drug addicts who used the donation fee to get their next fix. In the U.K. in 1980 the supply of factor VIII came from the U.S.
The fourth H became personal for us one cold winter's afternoon in 1983 as we lined up to donate blood. By then the probable cause of the disease-HIV (or HTLVIII as it was then called) had been isolated. Our blood donation on that day was part of a premature attempt to develop an artificial factor VIII free from the virus. One of the senior medical students had hemophilia and had asked us all to come. Unbeknown to any of us at the time, Tim had already contracted HIV. He never graduated and died at home two years later.
It's hard to remember the paranoia that surrounded those early years.
The religious right labelled AIDS as an avenging plague sent by God and a clear indication that end of the world was near.
AIDS was at that time 100% fatal and sufferers were treated like lepers. It wasn't until 1987 that there was a sea change in attitudes in the UK when Princess Diana was seen to hold the hand of an AIDS patient, shaming the general public into a less xenophobic attitude.
By the next year I was a senior resident on a respirology ward and treating AIDS victims on a regular basis. The pandemic was already global.
Since then the reality of AIDS has predominantly changed our lives. There have been a few light moments. I recall the fits of giggles from my children as I discussed safe sex and demonstrated correct condom technique on a bunch of bananas. (They refused point blank to eat the fruit at the end of the show.)
The cold, hard facts, however, are daunting. Approximately 30 million people have died of the disease since 1981 and about 0.6% of the total world population is now infected with HIV. In the developed world these statistics are now largely disarmed by the huge advances that have been made in management and treatment. With the shameful exception of Vancouver's downtown East side, those infected with the virus in the "developed" world can look forward to a life expectancy about the same or better than those who have other chronic illnesses.
And then there is Africa.
Sixty-four per cent of all those infected with HIV globally live in sub-Saharan Africa and most are without access to optimum treatments. This has resulted in a generation of orphans brought up by their grandparents in ghost villages.
Worse still, the kids end up on the street, turning to drugs and prostitution and renewing the cycle.
AIDS has influenced several of the continent's wars and the child soldiers that fight them; leading to what one CEO termed an "unfavourable business environment throughout much of the continent." Organizations like the UN and the Gates Foundation are making some things better but meanwhile 'big pharma' is bickering over patent rights and access to newer, better drugs.
As Bono said: "History will judge us on how we respond to the AIDS emergency in Africa... whether we stand around with watering cans and watch while a whole continent bursts into flames... or not."
Some 30th birthdays are better off not being celebrated.
Approximately 30 million people have died of the disease since 1981.
