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History of AIDS: 1998-2002

Gugu Dlamini's red ribbon memorialThese are some of the most important events that occurred in the history of AIDS over the period 1998-2002.

1998 History

In Canada there was an outbreak of HIV infection amongst injecting drug users in Vancouver. 1

Glaxo Wellcome cut the price of AZT by 75% after a trial in Thailand showed it was safe and effective at preventing mother-to-child transmission of HIV in developing countries. 2 However, even with this price cut it was expected that the drug would still be far too expensive for use in many developing countries. 3

The Clinton Administration refused to lift a ten-year ban on using federal funds for needle exchange programmes

In some countries HIV positive people were returning to work, having recovered their health as a result of combination antiretroviral drug treatment. However, some people began to be affected by quite severe side effects of the drugs. The emergence of negative reactions - which included a kind of fat redistribution called lipodystrophy - cast doubt on the long term safety of combination therapy. The reasons why lipodystrophy appeared in some people taking anti-HIV drugs were unknown. Some reports linked the syndrome to drug regimens that countained protease inhibitors. 4

"While fat disappears from some areas, for unknown reasons it redistributes to build up in others. The back of the neck resembles a buffalo hump. Breasts enlarge. A woman may have to buy a bra that is two sizes larger that the last one. The abdomen swells producing a sometimes painful pot belly that is dubbed 'a protease paunch'. A woman may look pregnant when she is not. Exercise may not work it off." 5

In April, the Clinton Administration refused to lift a ten-year ban on using federal funds for needle exchange programmes, despite concluding for the first time that such exchanges prevent the spread of HIV and do not encourage drug use. Leaders in the fight against AIDS condemned the unexpected decision, which was announced by Health and Human Services Secretary Donna Shalala. During her speech Shalala quoted NIH director Varmus as saying:

"An exhaustive review of the science indicates that needle exchange programmes can be an effective component of the global effort to end the AIDS epidemic. Recent findings have strengthened the scientific evidence that needle exchange programmes do not encourage the use of illegal drugs."

But, without explanation, Shalala said the administration had "decided that the best course at this time is to have local communities use their own dollars to fund needle exchange programmes". 6

In the UK the London Lighthouse charity closed its residential unit. 7

In June, the company AIDSvax started the first human trial of an AIDS vaccine using 5,000 volunteers from across the USA.

"It opened a new era in AIDS research, and led us toward the human trials. It was like being in a room that was partially lit and getting darker and darker, and suddenly the lights went on and you could see the pathway out." 8

Needle exchange services symbolSan Francisco started a pioneering Post Exposure Prophylaxis (PEP) program giving HIV drugs to people that might have been exposed to HIV through sexual contact or needle sharing during injecting drug use. The HIV drugs were given to people at the earliest possible time after the risk exposure.

"The treatment really is to try, in case they've been exposed to HIV, to stop the replication before it infects the cells and like a brush fire gets out of control." 9

The company AIDSvax started the first human trial of an AIDS vaccine using 5,000 volunteers

A study found that the combination of caesarean delivery and AZT reduced the risk of HIV transmission from a mother to her baby to less than 1%. The study also found that women who took AZT but delivered their babies by natural childbirth had a higher risk (6.6%) of transmitting HIV to their babies. 10

In July, the 12th International AIDS conference was held in Geneva. The challenge of this conference was not only to discuss the advantages available for the treatment of HIV, but also to conquer overwhelming pessimism. The mood of the meeting was in sharp contrast to the euphoria at the previous AIDS meeting in Vancouver two years before.

"A series of reports about new problems with anti-HIV drugs and setbacks in vaccine trials left many participants thinking that their best hope against the epidemic was the strategy they had since it began: prevention." 11

A French court ordered the former French prime minister Laurent Fabius to stand trial on charges of involuntary homicide for allowing HIV-tainted blood to be used in transfusions. 12

The first case of a patient being infected with a strain of HIV resistant to the most powerful new antiretroviral drugs was reported in San Francisco in July. The mutated strain of HIV, seemingly impervious to protease inhibitors and older drugs, was found in a newly infected patient at San Francisco General Hospital.

"We may be seeing an emerging and dangerous edge to the epidemic." - Dr. Frederick Hecht of the University of California at San Francisco 13

The United Nations issued new recommendations advising that HIV positive women in developing countries should be counselled to make their own decisions about how to feed their babies. This was interpreted as a major policy shift towards endorsing the use of infant formula. At the same time the United Nations decided to conduct pilot projects in eleven developing countries to expand access to services to prevent mother-to-child transmission of HIV. 14

Jonathan Mann, the first director of the Global Program on AIDS, died in the crash of Swissair flight 111, along with his wife the AIDS researcher Mary-Lou Clements-Mann.

"It was always safe for scientists and institutions to think of AIDS as a virus, a transmissible infection… but Dr. Mann structured it as a human rights issue, and a global rights issue. He really was a spiritual leader as well as scientific leader." - Dr. James Curran 15

The FDA gave approval for various new drugs including Sustiva (efavirenz), another drug in the NNRTI group. 16

In South Africa, Gugu Dlamini, an AIDS activist, was beaten to death by her neighbours after revealing her HIV positive status on Zulu television. This happened just a month after Deputy President Thabo Mbeki had called for people to "break the silence about AIDS" in order to defeat the epidemic. 17

"It is a terrible story. We have to treat people who have HIV with care and support, and not as if they have an illness that is evil." - Thabo Mbeki 18

The 1998 World AIDS Campaign 'Young People: Force for Change' was prompted in part by the epidemic's threat to those under 25 years old, for as HIV rates rose in the general population, new infections were increasingly concentrated in the younger age groups. The campaign also had a special representative, Brazilian footballer Ronaldo. 19

UNAIDS estimated that during the year a further 5.8 million people became infected with HIV, half of them being under 25. 20

REGIONEstimated new HIV infections 1998
North America44,000
Latin America160,000
Western Europe30,000
North Africa/Middle East19,000
Sub-Saharan Africa4 million
Eastern Europe/Central Asia80,000
East Asia/Pacific200,000
South Asia/South-East Asia1.2 million
Australia & New Zealand600
Global total5.8 million

Sub-Saharan Africa was home to 70% of people who became infected with HIV during the year. South Africa, which trailed behind some of its neighbouring countries in HIV infection levels at the start of the 1990s was catching up fast. It was estimated that one in seven new HIV infections in Africa were believed to be occurring in South Africa. In Botswana, Namibia, Swaziland and Zimbabwe, the estimates showed that between 20% and 26% of people were living with HIV or AIDS. 21

1999 History

In the United States a doctor who injected his former lover with HIV infected blood was sentenced to 50 years in prison. 22

A group of researchers at the University of Alabama claimed to have discovered that a particular type of chimpanzee, once common in West Central Africa, was the source of HIV. The researchers suggested that HIV-1 was introduced into the human population when hunters became exposed to infected blood. 23

Former South African President, Thabo MbekiReports started to emerge from South Africa of rape cases involving young girls. It was suggested that a popular myth that sex with a virgin could cure AIDS was the root cause of this increase in child rapes. 24 Later on in the year, the South African President Thabo Mbeki claimed that the anti-HIV drug AZT was toxic and could be a danger to health. 25

According to the annual World Health Report, AIDS had become the fourth biggest killer worldwide, only twenty years after the epidemic began. 26

The Ugandan ministry of Health started a voluntary door-to-door HIV screening programme using rapid tests in an effort to reduce the spread of HIV. This effort was intended to make HIV screening services accessible to more people, especially in rural areas where there were neither modern laboratories nor electricity to run standard HIV tests. 27 28 Since 1986 the Ugandan government had implemented a number of successful initiatives, and whereas in 1992 it was estimated that 30% of adults in Kampala were living with HIV, by 1999 the figure had fallen to 12%. 29 However, HIV/AIDS was still a considerable health problem in Uganda. It was estimated that 820,000 adults and children were living with HIV/AIDS as at the end of 1999. 30

In the UK a judge ordered that a five-month-old baby girl should be tested for HIV against her parents' wishes. The baby's parents refused to have their daughter tested, contending that she was perfectly healthy and that they should have the right to decide what was best for her.

"This case is not about the rights of the parents, and if, as the father has suggested, he regards the rights of a tiny baby to be subsumed within the rights of the parents, he is wrong, the judge said." 31

South Africa won the first round in its battle with the United States and multinational pharmaceutical companies to force a cut in drugs prices. The dispute concentrated on South African legislation that enabled local companies to manufacture HIV/AIDS drugs that could be sold at a fraction of the price of similar imported products. The US argued that the South African laws undermined the patent rights of drug manufacturers. 32

Initial findings from a joint Uganda-US study identified a new drug regimen, a single oral dose of the antiretroviral drug nevirapine, as being both affordable and effective in reducing mother to baby transmission of HIV. This research provided real hope that mother to child transmission could be effectively reduced in developing countries. 33

"This extraordinary finding is the most recent in our efforts to bring an end to AIDS, not only in the United States but in countries around the world." - Donna E. Karala, the Health and Human Services Secretary

The UK Government announced that all pregnant women in Britain would be offered an HIV test in an attempt to reduce the number of babies infected with HIV. The Labour Government set a target of reducing the number of infant infections by 80% by 2002. 34

Health officials rejected attempts to reopen the bath houses in San Francisco, which were closed 15 years previously at the height of the epidemic in 1984. 35 A survey published in August found that growing numbers of gay men in San Francisco were having unprotected sex. 36 The survey results provoked concern and disappointment among public health authorities because, instead of declining, the rate of new HIV infections had remained at about 500 per year. 37

Injecting drug use (IDU) paraphernalia in RussiaNeedle sharing among injecting drug users set off an explosive increase in HIV infections in Russia. In Moscow, three times as many cases were reported in the first nine months of 1999 as in all previous years combined. 38 39

"Russia is broke, and AIDS prevention programs are taking a back seat to problems that appear more pressing, such as mass poverty, crime and Russia's huge foreign debts." 40

In November, China broadcast its first ever television advertisement for condoms in an effort to stop the spread of sexually transmitted diseases and HIV/AIDS. 41 Shortly after the advertisement was seen by hundreds of millions of people, it was banned by the State Administration of Industry and Commerce. 42

'The River', a book by Edward Hooper, was published. There was a lot of debate about the role of polio vaccines in the origin of the AIDS epidemic. 43

T-20, a member of a new class of AIDS drugs called fusion inhibitors, went into clinical trials. 44

The Kenyan President Daniel arap Moi declared AIDS a national disaster and ordered a National AIDS Control Council to be set up immediately.

"AIDS is not just a serious threat to our social and economic development, it is a real threat to our very existence, and every effort must be made to bring the problem under control." - President Moi 45

However the president also said that his government and Kenya's churches would not advocate the use of condoms as a method of prevention because this would encourage young people to have sex.

A research study published in November argued that male circumcision could help to reduce HIV infection rates in Africa and Asia. 46

At the request of countries around the world eager to reach the age group at highest risk, the 1999 World AIDS Day campaign, "Listen, Learn and Live!", continued to focus on people under 25. 47

By the end of 1999, UNAIDS estimated that 33 million people around the world were living with HIV/AIDS and that 2.6 million people worldwide had died of the disease in 1999, more than in any other year since the epidemic began. 48 It was also reported that for the first time more women than men were infected with HIV in Africa. 49

"In 1992, a team headed by the late Dr. Jonathan Mann at the Harvard School of Public Health, published estimates of HIV infections in sub-Saharan Africa ranging from 20.8 million to 33.6 million by 2000. The World Health Organisation criticized Dr. Mann's estimates as excessive. Now academic scientists are criticizing the figures of Dr. Piot's Team. 'When we look at the figures today, they are worse than the scenarios Jonathan had published,' Dr. Piot" 50

The World Bank warned that the effect of AIDS in Asia could be to erase the region's economic gains over the last two decades unless governments maintained funding for social programs. The United Nations estimated that 7 million people in Asia were living with HIV/AIDS. 51

2000 History

In January, the Centers for Disease Control and Prevention (CDC) reported that, for the first time, the rate of AIDS diagnoses among black and Hispanic gay men had overtaken that among white gay men in the U.S. Statistics showed that African Americans comprised 57% of all new HIV infections, even though they made up just 13% of the U.S. population. 52 In order to publicise the importance of HIV testing for African Americans, reverend Jesse Jackson publicly took an oral HIV test. 53

Jesse Jackson publically taking an oral HIV testUK national statistics revealed that 1999 had been the first year in which the number of newly diagnosed HIV infections probably acquired through heterosexual sex was higher than the number probably acquired through sex between men. 54

Preliminary studies presented at the 7th Conference on Retroviruses and Opportunistic Infections showed that, in some cases, temporarily stopping HIV drug therapy might not lead to increased levels of virus or the development of drug resistance. 55 This later became known as the structured treatment interruption or drug holiday.

In February, the trial started of Bulgarian health workers charged in Libya with deliberately infecting children with HIV. The Bulgarian medics - five nurses and an anaesthetist - were detained in 1998 after almost 400 children were given infected blood at a hospital in Benghazi, Libya's second largest city. Eight Libyans and a Palestinian were also charged. 56 57

A more definitive study was published about the risk of transmitting HIV through oral sex. Although earlier studies had identified oral sex as a means of transmitting HIV, the new study was designed to find out the extent of HIV transmission through oral sex among men who have sex with men. The research suggested that oral sex accounted for about 7% of cases. 58

"I think it reinforces what we've said already - which is that condoms should be used for whatever type of sex you have." - Dr. Robert Janssen, Director of the Division of HIV/AIDS prevention at the CDC 59

Early in the year the South African government made a decision to invite a panel of experts to pursue debate on questions relating to HIV/AIDS. 60 In March it was reported that South African President Thabo Mbeki had consulted two American 'dissident' researchers to discuss their claim that HIV was not the cause of AIDS. 61

Israel lost one of its most successful singers, Ofra Haza, from what was believed to be an AIDS-related complication. Following her death there was a considerable increase in demand for helplines and anonymous HIV testing.

"Nevertheless, her death has brought the whole issue of AIDS out into the open in Israel. This can only be a good thing for a country which has seven openly HIV positive people - including myself - out of an estimated 10,000." - Aviram Germanovitch, Director of the Israeli AIDS Task Force 62 63

In April, President Mbeki sent a letter to world leaders explaining his views on HIV/AIDS. In this letter Mbeki argued, amongst other things, that since HIV is spread mostly through heterosexual contact in Africa, the continent's problems are unique.

"Accordingly, as Africans, we have to deal with this uniquely African catastrophe... It is obvious that whatever lessons we have to and may draw from the West about the grave issue of HIV-AIDS, a simple superimposition of Western experience on African reality would be absurd and illogical." 64 65

In Botswana, as many as one in four adults and four of every ten pregnant women were estimated to be infected with HIV. 66 The president of Botswana, Festus Mogae, announced that new contributions from donors including $50 million donated by the Bill and Melinda Gates Foundation would allow his country to provide antiretroviral therapy to all HIV-infected pregnant women and children born with the virus. 67

The Clinton Administration formally declared HIV/AIDS to be a threat to U.S national security. The United States government believed that the global spread of AIDS was reaching catastrophic dimensions that could topple foreign governments, spark ethnic wars and undo decades of work building free-market democracies abroad. It was the first time the National Security Council was involved in fighting an infectious disease. 68 69

"We shouldn't pretend that we can give injections and work our way out of this. We have to change behaviour, attitudes, and it has to be done in an organized, disciplined, systematic way." - Bill Clinton 70

Later in the year, the U.S. Institute of Medicine released a report that sharply criticised the Clinton Administration for failure to develop a comprehensive and effective plan to combat the disease in the United States. 71

In May, at the opening of the first meeting of the presidential advisory panel on AIDS in South Africa, President Mbeki offered his first detailed explanation of why he had consulted the two American 'dissident' AIDS researchers. He also explained why the 33-member presidential AIDS advisory panel contained people who believed that HIV caused AIDS and others who did not.

"We were looking for answers because all the information that has been communicated points to the reality that we are faced with a catastrophe, and you can't respond to a catastrophe merely by saying I will do what is routine." 72

Five pharmaceutical companies offered to negotiate steep reductions in the prices of AIDS drugs for Africa and other poor regions. 73 A couple of months later the United States offered sub-Saharan African nations loans to finance the purchase of AIDS drugs and medical services. 74 The offer was not seen as very helpful and was rejected by many African nations. 75

"Making drugs affordable is the solution rather than offering loans that have interest." 76

According to the latest UNAIDS report, there were 34.3 million people infected with HIV worldwide, of whom 1.3 million were children under the age of 15. 77 It was predicted that AIDS would cause early death in as many as half of the teenagers living in the hardest hit countries of southern Africa, causing population imbalances. In particular, it was predicted that two thirds of 15 year-old children in Botswana would die of AIDS before they reached 50. 78

Almost four million people were estimated to be living with HIV in India. This meant that the country had the second largest HIV population in the world: only South Africa had more people living with HIV. 79

In July, the 13th International AIDS Conference was held in Durban, South Africa. This was the first time that such a conference was held in a developing country or in Africa. 80 Nkosi Johnson, an eleven year old HIV-positive boy, gave a speech in the opening ceremony of the conference and called for the government to give AZT to pregnant HIV-positive women. 81 82

Mbeki used his opening address at the conference to stress the role of poverty in explaining the problems faced by Africa and compared the campaign against AIDS with the struggle against apartheid. 83

"As I listened and heard the whole story told about our own country, it seemed to me you could not blame everything on a single virus." 84

An HIV-positive woman marching at the Durban AIDS Conference, South AfricaTo counter the comments made by president Mbeki, over 5,000 scientists around the world signed the 'Durban Declaration' affirming that HIV is the cause of AIDS. 85 86

Nelson Mandela, South Africa's former president, closed the AIDS conference with a call for action to combine efforts and save people. 87

"History will judge us harshly if we fail to do so now, and right now."

At the conference, preliminary findings were reported from nonoxynol-9 studies in Africa and Thailand. Scientists had hoped that nonxynol-9 would prove to be the first effective 'microbicide' that could reduce the risk of HIV transmission during sex, but the findings were quite the opposite. Women at high risk of HIV infection were warned not to use the spermicide nonoxynol-9 because the studies suggested it might increase the risk of transmission. 88

"If you use nonoxynol-9, you are either wasting your money or possibly wasting your life." - Dr. Joseph Perriens 89

For some people these were not surprising findings, since the toxic effects of nonoxynol-9 had been reported since 1989. 90

There were few other noteworthy scientific findings reported at the conference.

In September, the first phase of a new vaccine trial was launched in Oxford. The trials were sponsored by the International AIDS Vaccine Initiative. 91 The research into an AIDS vaccine was criticised by the World Bank for focusing on a vaccine that could be marketed in western countries, despite the fact that more than 90% of HIV infections were in the developing world. 92

It was reported that the number of people living with HIV in Brazil was less than half that once predicted by health experts, and the number of AIDS deaths had plummeted by as much as fifty per cent since the introduction of combination antiretroviral therapy in 1996. The country's HIV prevention and treatment programmes were seen as a model for other resource-poor countries to emulate.

"It makes a lot of sense to look at what Brazil is doing... Something they're doing is working." - Mbulelo Rakwena, South Africa's ambassador to Brazil - 93

Treatment provision remained non-existent in South Africa, and President Mbeki stated in an interview with the Time Magazine that he did not think that HIV alone caused AIDS.

"Clearly there is such a thing as acquired immune deficiency. The question you have to ask is what produces this deficiency. A whole variety of things can cause the immune system to collapse… But the notion that immune deficiency is only acquired from a single virus cannot be sustained. Once you say immune deficiency is acquired from that virus your response will be antiviral drugs. But if you accept that there can be a variety of reasons, including poverty and the many diseases that afflict Africans, then you can have a more comprehensive treatment response." 94

In October, President Mbeki announced his withdrawal from the scientific and public debate on the causes of AIDS after admitting that he had created confusion in South Africa. 95

There has been a lot of confusion about what Mbeki said and did not say during the year. 96 It is clear that over a period of some months, particularly in April and in September, Mbeki led many people to think that either 1) he does not believe that HIV causes AIDS or 2) he does not believe that HIV causes AIDS on its own.

It would seem that Mbeki may have believed that immune deficiency is caused by a collection of factors such as poverty, nutrition and contaminated water as well as HIV, rather than just HIV on its own:

"You cannot attribute immune deficiency solely and exclusively to a virus." 97

It is true that poverty related factors such as malnutrition will hasten the onset of AIDS in people who are HIV-positive. Therefore, it is also true that provision of food will slow down the progression of HIV. However improved nutrition is not enough in itself to permanently keep people healthy. History provides evidence of this. 98

2001 History

After years of denial, China finally admitted that HIV/AIDS threatened its public health and economic security. China's most senior AIDS researcher stated that China could soon have one of the world's largest populations of people living with HIV. Infections were predicted to grow from about 600,000 to 6 million by 2005. 99 It was believed that nearly 75% of people living with HIV in China had acquired the virus through injecting drug use or transfusion with contaminated blood. 100

The Indian drug company Cipla offered to make AIDS drugs available at reduced prices to the international aid organisation Medecins Sans Frontieres (MSF). Cipla's offer to produce drugs at a price less than $1 per day put further pressure on multinational drug companies. 101

The U.S. Government threatened Brazil with legal action over its production of generic HIV drugs. 102 The complaint was dropped later in the year and Brazil promised to give the USA advance warning before changing its patent law for drugs. 103

Thirty-nine pharmaceutical companies withdrew their case against the South African government's efforts to lower drug prices. This victory was, however, overshadowed by a statement by the health minister Manto Tshabalala-Msimang, who said that the government already offered adequate treatment to AIDS patients and that proposals to buy antiretroviral drugs were still being considered. 104 The South African government released its annual HIV/AIDS figures estimating that 4.7 million people were infected with HIV/AIDS and that 24.5% of pregnant women were HIV-positive in 2000. 105

According to a CDC study of six large U.S. cities, 30% of young gay black men were infected with HIV. 106

"When people think 'gay', they think 'white'. But the people still at the greatest risk are sexually active gay men, and that cuts across all races." - Helene Gayle of the CDC 107

The CDC also reported that the rate of new HIV infections was increasing twice as fast among people aged over 50 as among younger age groups.

"Officials have speculated that a more open society, people entering the dating scene after the monogamy of marriage and the absence of a fear of pregnancy is causing the alarming rise in sexually transmitted infections." 108

Zimbabwe's government announced that it would dissolve the board of the National AIDS Council, after allegations of inappropriate political support and mismanagement of funds. Zimbabwe had one of the highest HIV infection rates in Africa. It was estimated in 2001 that AIDS had orphaned 1 million children and 25% of Zimbabwe's 12 million population were HIV positive. 109

In April 2001, it was reported that the year 2000 saw by the far the largest number of new HIV cases yet recorded in the UK. The Public Health Laboratory Service (PHLS) recorded 3,435 new diagnoses in 2000. 110

"Many of those being diagnosed are people infected some years ago, but who are now coming forward for testing. This is good news because once people are diagnosed they can seek treatment." - Barry Evans 111

In April, at the African Summit in Nigeria, United Nations Secretary-General Kofi Annan called for spending on AIDS to be increased tenfold in developing countries. 112 He suggested 'a war chest' of $7-10 billion to be spent annually on a global campaign against AIDS - a massive increase on the $1 billion per year that was then being spent. 113 A few weeks after, it was announced that a new Global AIDS and Health Fund would not only target AIDS (as had at first been suggested) but would also address tuberculosis and malaria. 114

"In this effort, there is no us and them, no developed and developing countries, no rich and poor - only a common enemy that knows no frontiers and threatens all people." - Kofi Annan at the G8 summit in Genoa 115

There were some concerns about how this new initiative was going to be governed and implemented, and the U.S. government was criticised for contributing only $200 million to the fund. Later on in the year, it was officially named as The Global Fund to Fight AIDS, Tuberculosis and Malaria. 116 The amount of money donated to the Fund was a disappointingly low $1.6 billion 117much less than the $10 billion that Kofi Annan had called for.

Newspapers all over the world marked the 20th anniversary of the first published report on the disease that came to be known as AIDS.

"At the time, I read the report with great interest, but I never imagined I was looking at the first sign of an epidemic, that in just 20 years would have infected 60 million people, killed 22 million and achieved the status of the most devastating epidemic in human history." - Peter Piot recalling the first mention of AIDS 118

Ugandan president Yoweri Museveni opened a regional centre for treatment of HIV-positive patients in Kampala. One of the main aims of the centre was to train health workers from all over Africa.

"Our hope is that the hundreds trained here will train thousands who will treat millions." 119

Kofi Annan appointed the Canadian Stephen Lewis as his 'Special Envoy for AIDS in Africa'. 120

Kofi Annan opened the UN General Assembly Special Session (UNGASS) on HIV/AIDS in New York. This was the first ever UN meeting devoted to a public health issue. 121

During the UNGASS, representatives of all 189 members of the UN signed a Declaration of Commitment on HIV and AIDS. This document contained many significant pledges, including one to reduce HIV prevalence among young people (aged 15 to 24) by 25% in the most affected countries by 2005, and to reduce it by 25% globally by 2010. 122

There was a sudden explosion in HIV cases among injecting drug users in Dublin, Ireland. It was reported that diagnoses jumped fivefold between January 1999 and June 2000. Diagnoses fell to a low of 12 in 1998, but in the next 18 months 96 people tested positive. Doctors blamed this on a sudden tightening of regulations around the supply of the heroin substitute methadone, which caused more people to start injecting street heroin. 123

Stephen Kelly was found guilty at Glasgow High Court of 'culpable and reckless conduct' for having unprotected sex despite knowing that he had HIV. He infected his girlfriend in 1994. Kelly was the first person to be tried under Scottish law for this type of offence. It was feared that the threat of legal action would make people more reluctant to be tested for HIV. 124

President George Bush appointed an openly gay man, Scott Evertz, as Director of the Office of National AIDS Policy, but did not find any extra money in his 2002 budget for AIDS prevention or treatment. 125

The US Food and Drug Administration (FDA) issued a warning letter to manufacturers of HIV/AIDS drugs, cautioning them to tone down the optimistic tone of their antiretroviral drug advertisements. 126

"Examples of such images range from robust individuals engaged in strenuous physical activity to healthy-looking individuals giving testimonials of a specific drug's benefit. However, not all individuals have a response to ARV therapy; in fact, some patients will still have disease progression despite ARV therapy." 127

A former Japanese Health Ministry official was found guilty of negligence for failing to stop the sale of untreated blood products. Over 1,800 haemophiliacs had contracted HIV in Japan since the early 1980s from untreated blood and more than 500 had died. 128

Publicity for the UN special session on HIV/AIDS in 2001In August, AIDS activists took legal action against the South African health ministry over its continuing refusal to supply antiretrovirals to prevent mother-to-child transmission (MTCT) of HIV. 129 In December, it was ruled that the South African government should give pregnant women free access to the drug nevirapine. The judge ordered the government to set up a nationwide MTCT programme with a deadline for an implementation report to be handed back to the court by March 2002. 130

Ministers meeting at the World Trade Organisation conference in Doha, Qatar, agreed a new declaration on intellectual property rights. This made it easier for developing country governments to license the production of drugs against AIDS and other diseases without having to get permission from patent holders. It was hoped that the new rules would help improve access to antiretrovirals. 131

It was reported that some Asian countries had reduced the transmission of HIV through widespread condom use. In Thailand, the rate of new infections had plummeted from 143,000 in 1991 to 20,000 in 2000. 132 Meanwhile HIV was spreading fastest in Eastern Europe and Russia. 133

A senior Iranian health official warned that the number of AIDS cases in the country had risen dramatically. In the past, Iranian officials estimated the number of HIV-positive people to be around 2,000, but the Deputy Health Minister said that the real figure was more than 15,000. 134

2002 History

Ukraine became the first nation in Europe to have 1% of its adult population infected with HIV. 135

Botswana became the first African country to begin providing antiretroviral treatment through the public sector. It was estimated the programme would cost $24.5 million in its first year and would reach 19,000 people. 136

The US Secretary of State Colin Powell strongly advocated condom use to prevent the spread of AIDS and other sexually transmitted diseases, setting himself apart from President Bush's views on sex education in an MTV broadcast:

"In my own judgement, condoms are a way to prevent infection… Therefore, I not only support their use, I encourage their use among people who are sexually active and need to protect themselves." 137

A new line of condoms carrying the logos of most important Brazilian football teams went on sale. The campaign was helped by a TV advertisement in which supporters wore caps with their team colours in the shape of a condom.

"The level of success was more than we had expected… We are selling the condoms in places not normally associated with this sort of product, such as news stands and bakeries." 138

Later in the year, for the first time ever in Brazil, an HIV prevention campaign was being aimed at male homosexuals. 139

A study showed that approximately 50% of Americans still believed they could acquire HIV through everyday contact, and most supported the mandatory testing of groups at highest risk of HIV infection. 140

The Chinese Government announced a 17% jump in AIDS cases. The government estimated that the number of people with full-blown AIDS was as high as 200,000, of whom more than half were presumed already dead. It also estimated that up to 850,000 people were infected with HIV by the end of 2001. These figures were still far below the estimates by experts at the UN and the WHO, who said that as many as 1.5 million people could have been infected in China. 141

The National Statistics Institute in Lisbon announced that there were 104.2 HIV cases per one million Portuguese residents in 2000, compared with 88.3 cases in 1999. This was the highest rate of HIV infection in the European Union. The European average was just under 25 cases per million residents. Injecting drug use was thought to be the main source of HIV infection in Portugal. 142

The board of directors of the Global Fund to Fight AIDS, Tuberculosis and Malaria selected Richard Feachem to be its first leader. 143 In the first funding round the Fund received applications for more than six times the amount they had anticipated. During the year the Global Fund announced their first round of payments of $600 million over a two-year period; the first $1 million was given out in December. 144

The WHO published guidelines for providing antiretroviral drugs for treating HIV infection in resource poor countries. They also released a list of 12 essential AIDS drugs. These two moves were seen as "vital steps in the battle against the AIDS pandemic [that] should encourage both industrialised and developing country governments to make HIV treatment more widely available." 145

In April, the South African government promised to start providing nevirapine to HIV-positive pregnant women and their babies to reduce the risk of HIV transmission. It was also going to be possible to offer AZT as post-exposure prophylaxis (PEP) to women who had been raped. 146

A World Bank report said that HIV was spreading so rapidly in parts of Africa that it was killing teachers faster than the nations could train them. The report noted that for example in parts of Uganda and Malawi, nearly a third of all teachers were HIV-positive. 147

"With more than 113 million children not in school in the poorest countries already presents a major challenge. However, HIV/AIDS makes this much greater in those countries where the education system is already struggling to grow, teachers are dying, or are too sick to teach. And every year more children are losing their parents and the support that allows them to go to school. Achieving education for all in a world of AIDS presents an unprecedented challenge to the world education community." - World Bank President James D. Wolfensohn 148

A report warned that Papua New Guinea was on the brink of an HIV/AIDS epidemic and the country could face losing 13-38% of its working population by 2020. It was estimated that Papua New Guinea had between 10,000 to 15,000 people infected with HIV. In comparison, Australia with a population almost 5 times that of Papua New Guinea had less than 12,000 HIV positive people. It was feared that HIV/AIDS could spread rapidly since 90% of infections were transmitted through heterosexual sex. 149

A major Spanish study found that over 19,000 instances of unprotected oral sex did not lead to a single case of HIV transmission among 135 HIV-negative heterosexuals in a sexual relationship with a person with HIV. 150

The WHO warned that HIV could spread rapidly throughout Afghanistan due to high levels of injecting drug use and unsafe blood transfusions. It also said that refugees were especially vulnerable to HIV infection because of sexual abuse, violence and lack of information and education. To learn more about this problem, the WHO was funding the first survey of HIV/AIDS in Afghanistan. 151

Treatment activists at the International AIDS Conference 2002, SpainIn July, the 14th World AIDS Conference was held in Barcelona, Spain. Issues around providing HIV treatment for resource-poor countries dominated the mood and agendas of the conference.

"If we can get cold Coca Cola and beer to every remote corner of Africa, it should not be impossible to do the same with drugs." - Joep Lange, the President of the International AIDS Society speaking at the closing ceremony 152

At the Barcelona conference, there were encouraging results from trials of T-20, an injectable drug from a new class of treatments called fusion inhibitors. The results provided good news for people who had become resistant to existing drugs; the fusion inhibitors were called 'the most exciting advance since protease inhibitors were introduced'. 153

The number of children orphaned by HIV/AIDS had risen three-fold in six years to reach an all time high of 13.4 million. It was estimated that India had the largest number of AIDS orphans of any country in the world, with an estimated at 1.2 million in 2001; this was predicted to rise to 2 million in five years and 2.7 million in ten years. 154

"Children are taking the role of adults in many places affected by HIV because a generation has disappeared. They can't go through normal development. They have to work 40 hours a week. The very fabric of society is disappearing, with family structures crumbling." - Peter Piot

Indonesia, the world's fourth most populous country, demonstrated how suddenly HIV/AIDS epidemics could emerge. After more than a decade of low HIV prevalence, the country was seeing rates increasing rapidly among injecting drug users and sex workers, with as many as 40% of people in drug treatment centres in Jakarta testing positive. 155

Swiss researchers reported the first fully documented case of HIV-positive man who was additionally infected with a second strain of HIV through unprotected sex more than two years after he was first infected. 156

Kami, a fluffy, mustard-coloured, HIV-positive character joined the cast of the South African version of Sesame Street. Kami's name was derived from the Tswana word for 'acceptance'. 157

In the U.S., the Food and Drug Administration for the first time approved a rapid HIV test. It was hoped that this test, which could provide results in as little as 20 minutes, would counter the problem of people not returning to collect test results, and would also be useful for diagnosing pregnant women during labour. 158

It emerged that several batches of cut priced drugs destined for Africa had been illegally sold at full European prices in the Netherlands and Germany. The drugs were supposed to be exported to Africa for 10% of the European price. 159

"The face of HIV/AIDS has become that of a young African woman - seven of 10 people living with the disease are in sub-Saharan Africa, and 58% of infected Africans are female. Of the 38.6 million adults living with the disease worldwide, 19.2 million are women." 160

A study controversially suggested that more people in Africa may have been infected with HIV through medical injections and treatments than was previously thought. 161

"Our observations raise the serious possibility that an important portion of HIV transmission in Africa may occur through unsafe injections and other unsterile medical procedures." 162

In December the US Agency for International Development (USAID) announced it was adopting a new approach to preventing sexual transmission of HIV around the world, which would be known as "ABC" (Abstinence, Being faithful and Condom use). USAID said its ABC approach was based on the strategies adopted in Uganda, which it credited with reducing HIV prevalence in that country. The decision to adopt the ABC approach came three months after USAID hosted an experts technical meeting on behaviour change approaches to HIV prevention. 163

The UN Secretary General, Kofi Annan, used World AIDS Day as a platform to speak out against HIV-related stigma and discrimination. He said that, 'the impact of stigma can be as detrimental as the virus itself,' and he urged people to replace 'fear with hope, silence with solidarity'. He went on to say that, 'the fear of stigma leads to silence and when it comes to fighting AIDS, silence is death'. The use of phrase 'silence is death' was interesting, as it had been used around the world for many years by AIDS activists, initially by the group ACT UP. 164


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