Today is World AIDS Day.
Since 1988, it has been the 1st December that the World Health Organisation has marked World AIDS Day as one of its global public health campaigns. World AIDS Day was the first ever global health day.
AIDS has killed over 35 million people worldwide. It’s estimated that around the world there are currently over 37 million people living with HIV.
Here’s four things you should know:
- HIV is a virus that attacks the body’s immune system - the body’s defence against diseases.
- A person is considered to have developed AIDS when the immune system is so weak it can no longer fight off a range of diseases with which it would normally cope.
- HIV can be passed on through infected blood, semen, vaginal fluids, or breast milk.
The most common ways HIV is passed on are – sex without a condom with someone living with HIV, sharing infected needles, syringes or other injecting drug equipment, and from a mother to her child during pregnancy, childbirth, or breastfeeding.
The virus was first clinically observed in 1981. As time passes, there’s an increasing number of us who have only ever known a world in which HIV was a reality.
After devastating generations, the availability of improved medication in recent years has meant that HIV has now become a manageable condition. If you have HIV and are taking medication, then your viral load can be reduced to undetectable levels and you will not be able to pass the virus onto others. This is often referred to as U=U. Additionally, the availability of PrEP is an effective tool to prevent new infections. The combined forces of U=U and PrEP have been a real game-changer, and it’s changing the way that LGBTQ people perceive HIV.
A recent survey by UK charity GMFA revealed that four out ten respondents reported that the majority of the sex that they had was unprotected – without using a condom. Dig into that a bit more and the study shows that of the HIV-negative men who mostly have sex without condoms, 42 percent reported that they’re not worried about HIV.
It seems that we’ve almost accepted that the HIV virus is part of life for gay men. Whether you’ve got the virus or not, it’s part of our lives, here to stay.
On this World AIDS Day, it’s worth reflecting on where things began.
It’s 37 years ago that the beginnings of the HIV pandemic were first reported. On 5 June 1981, the Centers for Disease Control and Prevention in the US reported that in the period October 1980–May 1981, five young men – all “active homosexuals” – were treated for biopsy-confirmed Pneumocystis carinii pneumonia at hospitals in California.
These are the patient records that were documented by the CDC’s report.
Patient 1: A previously healthy 33-year-old man developed P. carinii pneumonia and oral mucosal candidiasis in March 1981 after a 2-month history of fever associated with elevated liver enzymes, leukopenia, and CMV viruria. The serum complement-fixation CMV titer in October 1980 was 256; in may 1981 it was 32. The patient’s condition deteriorated despite courses of treatment with trimethoprim-sulfamethoxazole (TMP/SMX), pentamidine, and acyclovir. He died May 3, and postmortem examination showed residual P. carinii and CMV pneumonia, but no evidence of neoplasia.
Patient 2: A previously healthy 30-year-old man developed p. carinii pneumonia in April 1981 after a 5-month history of fever each day and of elevated liver-function tests, CMV viruria, and documented seroconversion to CMV, i.e., an acute-phase titer of 16 and a convalescent-phase titer of 28 in anticomplement immunofluorescence tests. Other features of his illness included leukopenia and mucosal candidiasis. His pneumonia responded to a course of intravenous TMP/.SMX, but, as of the latest reports, he continues to have a fever each day.
Patient 3: A 30-year-old man was well until January 1981 when he developed esophageal and oral candidiasis that responded to Amphotericin B treatment. He was hospitalized in February 1981 for P. carinii pneumonia that responded to TMP/SMX. His esophageal candidiasis recurred after the pneumonia was diagnosed, and he was again given Amphotericin B. The CMV complement-fixation titer in March 1981 was 8. Material from an esophageal biopsy was positive for CMV.
Patient 4: A 29-year-old man developed P. carinii pneumonia in February 1981. He had had Hodgkins disease 3 years earlier, but had been successfully treated with radiation therapy alone. He did not improve after being given intravenous TMP/SMX and corticosteroids and died in March. Postmortem examination showed no evidence of Hodgkins disease, but P. carinii and CMV were found in lung tissue.
Patient 5: A previously healthy 36-year-old man with clinically diagnosed CMV infection in September 1980 was seen in April 1981 because of a 4-month history of fever, dyspnea, and cough. On admission he was found to have P. carinii pneumonia, oral candidiasis, and CMV retinitis. A complement-fixation CMV titer in April 1981 was 128. The patient has been treated with 2 short courses of TMP/SMX that have been limited because of a sulfa-induced neutropenia. He is being treated for candidiasis with topical nystatin.
The summary of the diagnoses: The diagnosis of Pneumocystis pneumonia was confirmed for all five patients antemortem by closed or open lung biopsy. The patients did not know each other and had no known common contacts or knowledge of sexual partners who had had similar illnesses. Two of the five reported having frequent homosexual contacts with various partners.
The conclusion: All the above observations suggest the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections such as pneumocystosis and candidiasis. Although the role of CMV infection in the pathogenesis of pneumocystosis remains unknown, the possibility of P. carinii infection must be carefully considered in a differential diagnosis for previously healthy homosexual males with dyspnea and pneumonia.
That “possibility of a cellular-immune dysfunction” that was leading to the illness of “previously healthy homosexual males” quickly became the reality of HIV and its aftermath.
Thirty-seven years on and we don’t yet have a cure for HIV. People around the world are still contracting HIV, and people around the world are still dying of AIDS. The devastation of the pandemic continues.
Today is World AIDS Day.