In this weakened state, the body finally succumbs to the “invaders” and the result is death.
According to AmfAR (2012), over 60 million people have contracted HIV since the beginning of the epidemic, and nearly 30 million of these have since died. It is estimated that there are currently 34 million people living with HIV or AIDS around the world (USAID 2012). In 2011, 2.5 million people became newly infected with HIV (UNAIDS 2012) and 1.7 million died from AIDS (AmfAR 2012). Each day nearly 7,000 persons contract HIV worldwide (AmfAR 2012) at a time when it is known how to prevent the infection by the virus that causes AIDS. By 1997 AIDS had been reported in over two hundred countries (Frumkin and Leonard 1997:117) and today it would appear that there is not a single nation remaining untouched by the epidemic.27
While these numbers are certainly daunting, recent advances in prevention and treatment are decreasing the infection rate around the globe. According to the latest figures from UNAID (2012), twenty-five countries have seen a 50 percent (or greater) drop in new infections since 2001. The Caribbean region (which ranks second behind sub-Saharan Africa as the most affected region of the world) has seen a 42 percent reduction in infections, and over the past two years, half of all reductions in new HIV infections have been among newborn children, demonstrating that elimination of new infections in children is possible. It would appear that, likely owing to the new ART as a prevention strategy now being employed around the world, globally the epidemic has actually leveled off and is now beginning a decline. According to UNAIDS (2010), the number of new HIV infections peaked globally in 1996 and the number of AIDS-related deaths peaked in 2004.
The latest data from UNAIDS (2012) also suggests, however, that new HIV infections have increased in East and North Africa by 35 percent or more for the same period (since 2001) and that Central Asia and Eastern Europe have also seen increases in HIV infection rates in recent years. This same data elaborates on the worrisome connection between HIV and tuberculosis (TB), concluding that TB remains the leading cause of death among People Living with HIV and AIDS (PLWHA). Furthermore, it concludes that although ART can reduce the risk of contracting TB by PLWHAs by up to 65 percent, fewer than half of those infected with both HIV and TB were receiving ART treatment as of 2011. And as is the case in Nepal (and likely elsewhere as well) there is certainly still a disparity between the availability of and access to ART treatments. So it would appear that the gap between rich and poor nations in regard to AIDS (noted in Beine 2003:56) remains true today, despite the progress noted above.
2.1.1 The history of AIDS
Although the term AIDS was not coined until 1981, and HIV, the virus which causes AIDS, was not “discovered” until 1983 (Frumkin and Leonard 1997:1), recent evidence suggests that HIV was already present in the West as early as the 1950s (Frunkin and Leonard 1997:7), and new evidence suggests that HIV may have had its origin among humans in Africa possibly as early as the period between the 1880s and 1920s (Worobey 2008). There is much controversy and continued debate about the origin of HIV and its subsequent transfer from simians to humans.
By the early 1980s the infection had become widespread enough to gain popular attention. Physicians were seeing multiple patients with strange symptoms. It wasn’t so much that the symptoms were unusual, but the diseases identified were being diagnosed in populations not normally associated with these diseases. By 1981, the Center for Disease Control (CDC) had over one hundred reports of young, healthy, gay men who had contracted diseases such as Kaposi’s sarcoma, a type of cancer that usually affects elderly men of Mediterranean descent, and Pneumocystis carinii pneumonia (PCP), an unusual lung infection in young, otherwise healthy men. When this phenomenon grew large enough, it caught the attention of the CDC, a government-funded agency whose job it is to study such anomalies. On the basis of their findings, scientists at the CDC hypothesized an immunodeficiency syndrome but still hadn’t discovered the causative virus, HIV.28 The link between HIV and AIDS would not be made definitively for another two years.29
Because the first cases noted were mostly in gay men, the disease was first termed gay-related immunodeficiency (GRID) (Flynn and Lound 1995:11). Fed by media reports of the new “gay disease,” the first cultural model of AIDS—as it would later be called—began to emerge, namely that AIDS was a “gay” disease and a “death sentence.”
During the next few years many immigrant Haitians were also found to be infected with GRID, as were hemophiliacs and even newborn infants (AmfAR 1999:370–374). Because the scope of the disease had now moved well beyond the initial community, GRID was renamed AIDS. The new findings began to modify the new cultural model of AIDS that was emerging among the general public. AIDS was still very much considered a “death sentence” but no longer understood as just a “gay” disease.
It has long been suspected that HIV had its origin as a zoonotic disease. Because HIV is so similar to simian immunodeficiency virus (SIV), a virus that causes AIDS-like symptoms in some kinds of monkeys, the link between HIV and SIV was hypothesized (Frumkin and Leonard 1997:13). New research (Gao, Bailes and Robertson 1999) has confirmed this hypothesis, suggesting the common chimpanzee (Pan troglodytes troglodytes) as the origin of HIV-1. Tests carried out on strains of SIV suggest that HIV-1 arose first in this species (as a related SIV). The natural range of this species also corresponds with the areas where HIV-1 is endemic, suggesting that the chimpanzee is the main reservoir for HIV-1. The research also postulates that chimpanzees have been the source of introducing SIV into human populations on at least three separate occasions.
2.1.2 Treatments, treatment as prevention, and “functonal” cure
It would seem we are at a pivotal turning point in the fight against HIV and AIDS. Although there is no true cure for AIDS at this time and no vaccine yet to prevent it, the development of several ART regimens has changed the course of the epidemic (Dieffenbach and Fauci 2011), lowering the death rate of PLWHAs around the world.30 Further, it seems that using these same regimens prophylactically with the non-infected partners of HIV-positive persons (i.e., preventively) can actually decrease the new infection rate (by blocking transfer) dramatically. And it looms hopeful that certain uses of ART might actually provide a functional cure for many in the future.
2.1.2.1 Early ART therapies
Antiretroviral therapies first began to be developed for use against HIV between 1985 and 1990 (Broder 2010). The discoveries led to multi-drug therapies (often referred to as cocktail therapies since they involve the use of various drug combinations), which began to significantly lower the death rate from AIDS in the places where they were being used. With the advent of highly active antiretroviral therapy (HAART), mortality among patients with AIDS who were under ART treatment was nearly half what it was prior to the “HAART era” (Rathbun 2012), and life expectancies for those with HIV rose from months to decades (Dieffenbach and Fauci 2011). Many of these new treatments were successful at reducing the amount of HIV in the blood to an undetectable level. However, these drugs were found to control the virus but not to eradicate it. Once a person stopped treatment, HIV again began to grow in the body. The new treatments began to shift the cultural model to understanding AIDS as a chronic, manageable condition. “Living with AIDS” rather than “dying from AIDS” became the new model.
In the early years of antiretroviral drugs (ARVs) these new medical advances had little impact on the spread of HIV worldwide.31 At that time, 95 percent of HIV infections occurred in the developing world and the developing world also experienced ninety-five percent of all deaths due to AIDS (UNAIDS 1999). There was a large gap between East and West (what I termed “the West and the rest” in the earlier edition) in their ability to access these new treatment possibilities. Many of these treatments at that time cost over one thousand dollars a month per person—an unrealistic hope for an AIDS sufferer, for instance, in Nepal, a country of socialized medicine, where the government then allocated the rupee-equivalent of seven dollars (US) per person per annum to health care and where the underlying trend was an annual decrease in health expenditure (Smith 1996:140). The cost of these treatments made them impossible for developing nations to ever consider. So, while the cultural model began to
