Understanding AIDS

In 1981, the first cases of patients with the disease that was to become known as AIDS, were identified in hospitals in New York and San Francisco. By late 1983, the cause of AIDS — the human immunodeficiency virus (HIV) had been identified. Significant numbers of cases had been reported from central Africa. In southern Africa, where I lived and worked, we had seen only sporadic occurrences — mainly among gay white men. However by 1987, HIV-infected men were identified in the workforce serving the mines industries and farms of South Africa. Armed with knowledge of labour migration and the potential for the spread of this disease, I wrote and presented my first (highly speculative) paper on AIDS at the first ‘Global Impact of AIDS’ conference held in the Barbican Centre in London.

By 1994, it was clear that the southern African epidemic was going to be horrendous. In Swaziland, the prevalence among anti-natal clinic attenders, who were a bellwether for infections, rose from 3.9% in 1992 to 16.1% in 1994. This peaked to an unbelievable 42.6% in 2004. Similar patterns were seen across the region. The prevalence was highest among younger people, who aged between 25 and 39.

I quickly realised the task for academics was to understand the causes and consequences of this disease. In particular, we needed to warn of its potential social, political, and economic impacts. Because of the long term nature of the disease, it was clear that academics had to ‘cry wolf’ long and loud. AIDS generally only emerges after a prolonged period during which a person’s immune system battles the virus. It is, like climate change, a long wave event. Those who understood this had to reach policymakers, politicians, and persuade them to take action. The tools we had to do this were, and continue to be, limited. Research and writing; talking to whatever audience will have us; and educating and influencing students.

I deployed all these strategies to the best of my ability. From 1992, I co-ran short courses on ‘Planning for the Impact of AIDS’ in countries from the Philippines to the United Kingdom via South Africa, Ukraine, and other locations. I set up and raised money for research projects, and brought in students and research assistants. I published widely. Books and articles flowed. Did they make any difference? I believe so, but it is hard to measure.

In 2005 while preparing an article which asked ‘Is AIDS a Darwinian event’, I came across the Very Short Introductions (VSI) series. I decided I had to write a VSI on HIV and AIDS. Following their acceptance of the proposal, there was the painfully slow writing process, peer review of an early version, and meticulous editing and production. Ultimately, the first edition of the HIV and AIDS VSI appeared in 2008. By 2015, it was apparent that a second edition of the HIV and AIDS VSI was needed.

We can’t ignore the most serious epidemic of the past 100 years, and if nothing else, we should learn from it.

AIDS is a fast moving epidemic and some of the data and assertions were immediately out of date. For example, the book failed to foresee the massive expansion in treatment. In 2008, there were 28.9 million people living with HIV, and a mere 770 000 were receiving anti-retroviral drugs. By 2015, there were 36.7 million people infected with HIV, but 17 million were on treatment. Of course, the current thinking is that everyone who is infected should be on treatment. Unfortunately, there is a long way to go for this to become a reality. The level of funding that the disease has received, especially from international donors, was exceptionally generous.

The election of Donald Trump in the United States and the vote where 52% of Britons said they should leave the European Union in the Brexit poll, will have consequences for the epidemic. These countries are the main international donors and have led the fight against the epidemic. It is unclear if global support will continue.

AIDS is no longer at the top of the global agenda; not even for health, where two outbreaks — Ebola and Zika, have caught the attention of the world. Environmental challenges and inequality are going to be high on the international agendas. Who is to say this is wrong, because ultimately these challenges have created fertile ground for the spread of HIV and other diseases. Despite this, we can’t ignore the most serious epidemic of the past 100 years, and if nothing else, we should learn from it.

Featured image credit: microscope slide research by PublicDomainPictures. Public domain via Pixabay. 

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