A Brief History of HIV

A Brief History of HIV<script async src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script>
<script> (adsbygoogle = window.adsbygoogle || About 33 million people (of which 2 million are children) live with HIV today. In 2007 about 2.7 million were newly infected and 2 million people died of AIDS. In sub-Saharan Africa about 12 million children under 18 years of age are orphans. Also in 2007 an estimated 370000 children became infected with HIV. How did this happen and where did the virus come from are questions that people ask.

The medical fraternity first became aware of something was wrong in 1981 when unusual lung infections (Pneumocystis jiroveci) were seen in men who have sex with men in the United States

In 1982, after the realisation that these people presented with various manifestations (unusual infections with tumours) that are indicative of a suppressed immune system it was named acquired immunodeficiency e. In 1983 HIV-1 the causal agent named human immunodeficiency virus type 1 was first isolated in a French laboratory

By studying the evolution of HIV in the United States using a molecular clock the indications are that HIV syndrome was introduced into patients in the United States by about 1968. In Africa, the earliest known case of infection was found in a specimen from 1959 of a man living in the former Congo

HIV -1 is closely related to the virus SIVcpz which infects chimpanzees. The virus was most likely transferred during the butchering of chimpanzees for food. It is estimated that HIV-1 could have been transferred to humans in 1940s today HIV-1 is found worldwide.

The second type of HI virus found predominately in West Africa was discovered in 1986. HIV -2 was probably transmitted to humans from Scotty mangabeys, a species of monkeys that is hunted in West Africa.

At the start of the pandemic, no treatment was available was available and the diagnosis of HIV seemed like a death sentence. However, in 1986 clinical trials with AZT for treating HIV-1 showed very promising initial results. In 1987 this drug was approved by FDA (Food and Drug Administration) in the United States for the treatment of AIDS. AZT remained the only available drug until 1991, by when it had fallen into dispute. On its own, it had only temporary benefits, due to people developing resistance to it. The high dose used was also toxic.

This was followed by dual therapy when Didanosine (DDI) became available in 1991. Dual therapy had a longer lasting effect, but after a while resistance also developed. Subsequently, Zalcitabine became available in 1992, Stavudine(D4T) in 1994 and Lamivudine(3TC) in 1995. These medicines are all nucleoside reverse transcriptase inhibitors (NRITIs)

History and Origin of HIV/AIDS in Africa

AIDS in Africa has had a short but devastating history.

“It all started as a rumour… Then we found we were dealing with a disease. Then we realised that it was an epidemic. And, now we have accepted it as a tragedy.” - Chief epidemiologist in Kampala, Uganda

Adult HIV prevalence (%) in Africa between 1988 and 2003

            •           20%-30%

            •           10%-20%

            •           5%-10%

            •           1%-5%

            •           0%-1%

            •           data unavailable

Before the 1960s – African origins of AIDS

There is now conclusive evidence that HIV originated in Africa. A 10-year study completed in 2005 found a strain of Simian Immunodeficiency Virus (SIV) in a number of chimpanzee colonies in south-east Cameroon that was a viral ancestor of the HIV-1 that causes AIDS in humans.

A complex computer model of the evolution of HIV-1 has suggested that the first transfer of SIV to humans occurred around 1930, with HIV-2 transferring from monkeys found in Guinea-Bissau, at some point in the 1940s.

Studies of primates in other continents did not find any trace of SIV, leading to the conclusion that HIV originated in Africa.

The 1960s- Early cases of AIDS

Experts studying the spread of the epidemic suggest that about 2,000 people in Africa may have been infected with HIV by the 1960s. Stored blood samples from an American malaria research project carried out in the Congo in 1959 prove one such example of early HIV infection.

The 1970s – The first AIDS epidemic

It was in Kinshasa in the 1970s that the first epidemic of HIV/AIDS is believed to have occurred. The emerging epidemic in the Congolese capital was signalled by a surge in opportunistic infections, such as cryptococcal meningitis, Kaposi’s sarcoma, tuberculosis and specific forms of pneumonia.

It is speculated that HIV was brought to the city by an infected individual who travelled from Cameroon by river down into the Congo. On arrival in Kinshasa, the virus entered a wide urban sexual network and spread quickly.

The world’s first heterosexually-spread HIV epidemic had begun.

The 1980s – Spread and reaction

Although HIV was probably carried into Eastern Africa (Uganda, Rwanda, Burundi, Tanzania and Kenya) in the 1970s from its western equatorial origin, it did not reach epidemic levels in the region until the early 1980s.

Once HIV was established rapid transmission rates in the eastern region made the epidemic far more devastating than in West Africa, particularly in areas bordering Lake Victoria. The accelerated spread in the region was due to a combination of widespread labour migration, high ratio of men in the urban populations, low status of women, lack of circumcision, and prevalence of sexually transmitted diseases . It is thought that sex workers played a large part in the accelerated transmission rate in East Africa; in Nairobi for example, 85 percent of sex workers were infected with HIV by 1986.

Uganda was hit very hard by the AIDS epidemic in the 1980s. At the beginning of the decade, doctors were confronted by a surge in cases of a severe wasting disease known locally as ‘slim disease’, alongside a large number of fatal opportunistic infections such as Kaposi's sarcoma. By this time doctors were aware of AIDS cases with similar symptoms in the United States:

‘But we just could not connect a disease in white, homosexual males in San Francisco to the thing that we were staring at…’ David Serwadda, former medical resident at the Uganda Cancer Institute in Kampala.

After the initial clinical recognition of the link between ‘slim disease’ and AIDS, research was initiated to discover transmission patterns, risk factors, and the prevalence of HIV in Uganda. By the end of the decade HIV prevalence amongst pregnant women in Uganda’s capital had peaked at over 30 percent.

The early 1980s also saw HIV spread further into Western Equatorial Africa and Western African nations. In the Western Equatorial countries of Gabon, Congo- Brazzaville and Cameroon the virus did not cause large epidemics. The long distances between cities, the difficulty of travel, and violence and insecurity meant that there were not the sexual networks that would allow the spread of HIV to epidemic proportions.

West Africa had generally high levels of infection of both HIV-1 and HIV-2, although nowhere near the proportions of East Africa. The HIV-1 epidemic spread across the region beginning with reported cases in Côte d'Ivoire (probably due to rapid urbanisation and immigration). By the end of the decade HIV infection had been identified in all of the West African states. Sex work was also a major driver of early infection in West Africa; in Abidjan the former capital of Côte d'Ivoire, the HIV prevalence amongst sex workers was already 38% by 1986.

In the mid-1980s the Western African nation of Guinea-Bissau had the world’s highest level of HIV-2, with 26% of paid blood donors, 8.6% of pregnant women and 36.7% of sex workers testing positive. The virus spread into rural areas of southern Senegal and the Gambia but HIV-2 was not infectious enough to generate an epidemic beyond this region.

Truck drivers – alongside other migrants such as soldiers, traders and miners - have been identified as a group which facilitated the initial rapid spread of HIV-1, as they engaged with sex workers and spread HIV outwards on the transport and trade routes. In the 1980s, 35 percent of tested Ugandan truck drivers were HIV positive, as were 30 percent of military personnel from General Amin’s Ugandan army.

In 1988 the second highest prevalence rate of HIV in all of Africa was found on the Tanzam road linking Tanzania and Zambia .

As the decade progressed so too did the epidemic, moving south through Malawi, Zambia, Mozambique, Zimbabwe and Botswana.

Although the virus arrived comparatively late in this region it spurred a devastating epidemic in the general population. By the end of the 1980s the southern African countries of Malawi, Zambia, Zimbabwe and Botswana were on the verge of overtaking East Africa as the focus of the global HIV epidemic.

It is thought that the first case of HIV in South Africa was in a white, homosexual air steward from the USA who died of pneumonia (PCP) in 1982. Blood specimens showed a 16 percent infection rate among tested gay men in Johannesburg in 1983. The small-scale epidemic was largely confined to white gay men and remained virtually unheard of in the general population in the mid 1980s. The homosexual epidemic had stopped growing by the end of the decade.

The history of HIV and AIDS in Kenya

Between 1983 and 1985, 26 cases of AIDS were reported in Kenya. Sex workers were the first group affected – a study from 1985 reported an HIV prevalence of 59 percent amongst a group of sex workers in Nairobi.

Towards the end of 1986 there was an average of four new AIDS cases being reported to the World Health Organization each month. This totalled 286 cases by the beginning of 1987, 38 of which had been fatal.

One of the Kenyan government’s first responses was to publish informative articles in the press and to launch a poster campaign urging people to use condoms and avoid indiscriminate sex. A year later in 1987, the Minister of Health announced a year-long health and education programme, funded by a £2 million donation from Western countries.

By 1987 HIV appeared to be spreading rapidly among the population – an estimated 1-2 percent of adults in Nairobi were infected with the virus, and HIV prevalence among pregnant women in the capital had increased from 6.5 percent to a staggering 13 percent between 1989 and 1991.

The government was criticised for not responding aggressively to the emerging epidemic, unlike governments in its neighbouring countries, such as Uganda. The government was also accused of playing down the threat of AIDS because of the damage it could do to Kenya’s tourism industry.

By 1994 an estimated 100,000 people had already died from AIDS and around 1 in 10 adults were infected with HIV.

In a speech at an AIDS awareness symposium in 1999, Kenyan President Daniel Arap Moi declared the AIDS epidemic a national disaster and announced that a National AIDS Control Council would be established imminently. Critics argued that in the speech the President failed to promote the use of condoms as a preventative measure and a way forward for tackling the epidemic. However, at the end of 1999 President Moi broke his silence surrounding condoms and declared in a speech to students at the University of Nairobi:

“The threat of AIDS has reached alarming proportions and must not be treated casually; in today’s world, condoms are a must.”

In 2000 plans were drawn up to build a condom factory in Nairobi, with the aim of producing 100 million condoms a year. However, by 2001 the company planning the build moved its project to South Africa, apparently due to excessive government regulations and a lack of responsiveness.

HIV prevalence began to decline from its peak of 13.4 percent in 2000 and continued to decrease steadily to 6.9 percent in 2006. The decrease in prevalence coincided with the rapid expansion of preventative interventions since 2000, which resulted in a change in sexual behaviour and the increased use of condoms. The decline has also been attributed to the large number of people dying from AIDS in Kenya, which totalled 150,000 in 2003 alone.

The current situation in Kenya

Kenya’s HIV epidemic has been categorized as generalized – meaning that HIV affects all sectors of the population, although HIV prevalence tends to differ according to location, gender and age. Nearly half of all new infections in 2008 were transmitted during heterosexual sex whilst in a relationship and 20 percent during casual heterosexual sex.

Various studies have revealed a high HIV prevalence amongst a number of key affected groups, including sex workers, injecting drug users (IDUs), men who have sex with men (MSM), truck drivers and cross-border mobile populations. Some of these groups are marginalized within society – for example, homosexuality is illegal in Kenya and punishable by up to 14 years in prison. Therefore these groups are difficult to reach with HIV prevention, treatment and care, and the extent to which HIV is affecting these groups has not been fully explored.

In 2008, an estimated 3.8 percent of new HIV infections were among IDUs and in the capital, Nairobi, 5.8 percent of new infections were among IDUs. HIV infections are easily prevented in healthcare settings, nevertheless, 2.5 percent of new HIV infections occurred in health facilities during 2008 in Kenya.

Women are disproportionally affected by HIV. In 2008/09 HIV prevalence among women was twice as high as that for men at 8 percent and 4.3 percent respectively. This disparity is even greater in young women aged 15-24 who are four times more likely to become infected with HIV than men of the same age. Kenyan women experience high rates of violent sexual contact, which is thought to contribute to the higher prevalence of HIV. In a 2003 nationwide survey, almost half of women reported having experienced violence and a quarter of women aged between 12 and 24 had lost their virginity by force.

Adult HIV prevalence is greater in urban areas (8.4 percent) than rural areas (6.7 percent) of Kenya. However, as around 75 percent of people in Kenya live in rural areas, the total number of people living with HIV is higher in rural settings (1 million adults) than urban settings (0.4 million adults).

References

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