Discovery and Spread of AIDS: A Historical Perspective, Study notes of World History

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History 285, History of Modern Science Lecture 30, Page 1 For use by students enrolled in History 285 - May note be quoted or duplicated without permission Lecture 30 AIDS Discovery: 1979-1981 • Los Angeles physician, Joel Weisman • symptoms 4 mononucleosis-like syndrome, fever, weight loss, swollen lymph nodes 4 oral and anal infestations, called thrush (yeast infection) 4 reduced population of lymphocytes in blood, cause by the disappearance of helper T cells 4 rare bronchial pneumonia, Pneumocystis carinii pneumonia (PCP) • five patients, all homosexuals Cause? • All had cytomegalovirus (CMV) • Possible association with Epstein-Barr virus NY City • More hospitals, cases spread around • Noticed requests for pentamidine, drug used to treat drug resistant cases of PCP • 9 requests in early 1981 raised concern • Also Kaposi's sarcoma, relatively rare skin cancer/disorder Announcement of the disease: • March 1981, first patient died • June 5, 1981, CDC described five Los Angeles cases in weekly bulletin, the Morbidity and Mortality Weekly • conclusion: "all the above observations suggest the possibility of a cellular- immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections...." Early stories • July, 4 1981, second CDC article, linked to Kaposi's sarcoma • July 3, 1981, first public notice in New York Times, very brief article on an inside page • November 1981, had over 150 cases • early 1982, passed 200 and climbing History 285, History of Modern Science Lecture 30, Page 2 For use by students enrolled in History 285 - May note be quoted or duplicated without permission Response? • Clarify the situation • If a new disease, find out what is causing it • Find ways to prevent • Did not even have terminology • Called gay disease, gay syndrome, gay plague, etc. Centers for Disease Control • Founded 1942, to track malaria • 1946, Communicable Diseases Center • 1951, Epidemic Intelligence Service (EIS) • 1961 began Morbidity and Morality Weekly Report (MMWR) • 1976, Swine flu Patient zero, 1981-1983 • Looked intensively at first 250 cases reported • Two foci, Los Angeles and New York • Identified one patient in New York • Initial information Naming and further clarification • 1982, AIDS, for Acquired Immune Deficiency Syndrome • French used SIDA, Syndrome d'Immuno-Deficience Acquise • ARC, AIDS-related complex • LAS, Lymphadenopathy Syndrome • 1983, AIDS entered in Cumulated Index Medicus as "acquired immunodeficiency syndrome" Tracking the spread ofAIDS, 1982-1984 • major locations, New York, Los Angeles, San Francisco, in that order • sexually transmitted, how not yet certain • Hemophiliacs, 1982 • March 1981, AIDS spread during caesarian section, given blood transfusions • June, 1983, wife of hemophiliac diagnosed with AIDS By end of 1983 200 end of 1981 History 285, History of Modern Science Lecture 30, Page 5 For use by students enrolled in History 285 - May note be quoted or duplicated without permission • 93% in developing countries • More women than men infected in sub-Saharan Africa • 68% of new cases in sub-Saharan Africa 1997 • Improved treatment using “drug cocktails” • Death rate drops • Mortality rates • Actual number of deaths 1994 42,114 (15.4/100K) 1995 42,500 (15.4?100K) 1996 36,865 1997 16,865 AIDS 2001 • ~ 40 million people worldwide infected with HIV virus • ~ 20 million have died from AIDS • 2001, 5 million newly infected, 3 million died • 1/3rd living with HIV/AIDS are 15-24 • 70% of infected live in sub-Saharan Africa • 38% of adults in Botswana are infected • AIDS pandemic orphaned 14M, 92% Africa • 7 m in Asia & Pacific living with HIV/AIDS • Women account for 50% percent HIV/AIDS-infected adults Future? • US Infection rate constant (40,000/year) African-Americans & women disproportionately affected • World situation 90% of all cases in developing countries Major burden, sub-Saharan Africa Growing problem in Asia • Treatment Drugs suppress, do not cure Supply falls short of demand (10x or more) History 285, History of Modern Science Lecture 30, Page 6 For use by students enrolled in History 285 - May note be quoted or duplicated without permission Hemorrhagic fevers • Soul Hantaan (Hantaan fever) • 1962-64, Bolivian Hemorrhagic Fever • Late 1960s, Lassa Fever, Nigeria • Mid 1970s, Ebola Fever, Zaire Other “New” Diseases • 1986, Mad Cow Disease • 1999, West Nile Virus (human encephalitis) • 2002, SARS Major policy questions: • Basic science vs. clinical/applied • Priorities US health World health Prevention vs. cure Basic treatment for all vs. high end of insured • How much can we afford to spend on health care? US health costs = 13.9 % GDP,( $4,887/ person). US lags behind in key indicators of health. AIDS Death by country 1. India 310,000 (1999 est.) 2. South Africa 300,000 (2000 est.) 3. Ethiopia 280,000 (1999 est.) 4. Nigeria 250,000 (1999 est.) 5. Kenya 180,000 (1999 est.) 6. Zimbabwe 160,000 (1999 est.) 7. Tanzania 140,000 (1999 est.) 8. Mozambique 114,111 (2001 est.) 9. Uganda 110,000 (1999 est.) 10. Zambia 99,000 (1999 est.) 11. Congo, Democratic Republic of the 95,000 (1999 est.) 12. Cote d'Ivoire 72,000 (1999 est.) 13. Malawi 70,000 (1999 est.) 14. Thailand 66,000 (1999 est.) 15. Cameroon 52,000 (1999 est.) 16. Burma 48,000 (1999 est.) 17. Burkina Faso 43,000 (1999 est.) 18. Rwanda 40,000 (1999 est.) 19. Burundi 39,000 (1999 est.) 20. Benin 37,000 (2002) 21. Ghana 33,000 (1999 est.) 22. Botswana 24,000 (1999 est.) 23. Central African Republic 23,000 (1999 est.) 24. Haiti 23,000 (1999 est.) 25. United States 20,000 (1999 est.) History 285, History of Modern Science Lecture 30, Page 7 For use by students enrolled in History 285 - May note be quoted or duplicated without permission