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Some reflections on the 30th anniversary of AIDS

The June 1981 report could have ended up as just a footnote in history – five gay men in Los Angeles with a rare case of pneumonia. But that CDC report would mark the beginning of an unprecedented epidemic, as these men were suffering from a lethal virus, later characterized and called HIV, which would go on to infect 60 million people worldwide.

As a medical writer, I remember those early days, when this strange disease had no name, and the medical and political world were turned upside down.

One of the many controversies I covered was the decision by the Stanford Blood Center to be the first in the country to test for the virus in donated blood. The move was reviled in the blood banking industry, for it called into question the safety and reliability of the nation’s blood supply. The blood center later would be vindicated, as every other bank would ultimately follow suit and routinely test for HIV. Center Director Ed Engleman, MD, says Stanford’s early initiative saved some 30,000 lives.

In the early 1990s, I went to work at San Francisco General Hospital, the epicenter of the epidemic in this country. SFGH was the site of the first AIDS clinic, known as Ward 86, and I remember spending many hours there, often accompanied by national news crews, visiting patients with rail-thin bodies being drained by the disease. The only anti-AIDS drug available then was AZT, toxic and not very effective. Patients received palliative care, as well as medications to treat their various complications: cancer, eye disease, major skin rashes, fungal infections, diarrheas and so on. It was a grim time.

Then in 1996, at the International AIDS Conference in Vancouver, researchers announced the advent of a three-drug cocktail that could knock down the virus. The landscape in this country would change dramatically, as antiretrovirals would become the mainstay of care, ultimately evolving into a single-pill-a-day treatment for what has become a chronic disease, like heart disease or diabetes. AIDS wasn’t cured, but it could be controlled.

But it would be years before those medications would make it across the ocean to Africa, where two-thirds of the world’s HIV patients – about 22 million people - now live. I would have my first experience in Africa in 2004, and I came away from it feeling absolutely devastated. I have never forgotten the vision of a 34-year-old woman, Susan Andukais, lying on a makeshift wooden bed in her tin shack in Kenya, being nursed by her oldest child, 13-year-old Esther. Esther also had her three brothers to look after; they were all starved for food, comfort and the essentials of life. Susan died for lack of antiretroviral medication – an outrage to me at a time when these drugs were universally available in the West. By my third visit to Africa in 2007, more and more people were receiving medication, as programs sponsored by the U.S. government, private organizations and world bodies like the Global Fund to Fight AIDS, Tuberculosis and Malaria were scaling up. But now, with the world economic crisis, these drug programs are in jeopardy.

So I am both wary and hopeful. I am wary as I know there will be even greater suffering and loss in Africa if there is not continued – and even increased – access to medication and care. At the same time, the science of AIDS has advanced tremendously on so many fronts – from a basic understanding of the immune system to new treatments and new methods of prevention. It was telling indeed that at the last International AIDS Conference in Vienna, researchers even ventured to talk (albeit with many caveats) about the possibility of a cure.

So we can only hope that in the next 30 years, AIDS indeed will be just a footnote in history.

Previously: June marks the 30th anniversary of HIV and AIDS

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