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History of AIDS: 2007-2010

President Yahya Jammeh of The GambiaThese are some of the most important events that occurred in the history of AIDS between 2007 and 2010.

2007 History

A large-scale international microbicide study was halted in January after preliminary results found that the product was not achieving its aims of preventing HIV infection in women. In fact, trials of the drug in some sites found that there was a higher infection rate amongst women who used the cellulose sulphate vaginal gel, compared to the placebo group. 1UNAIDS regarded the news as “a disappointing and unexpected setback” as “[t]he need to continue research to find a user-controlled means of preventing HIV infection in women is urgent.” 2

Also in January came the dramatic announcement by President Jammeh of The Gambia that he had found a cure for AIDS.

“I can treat asthma and HIV/AIDS and the cure is a day’s treatment. Within three days the person should be tested again and I can tell you that he/she will be negative...” 3

Jammeh’s claim was soon revealed to be unfounded. A scientist who conducted the tests rebutted the study’s findings, saying that none of the trial patients “could be described as cured.” 4Despite the negative outcomes of the trial, the president continued in his belief of his treatment plan, which was also endorsed by the Gambian health ministry and administered in state hospitals. The President of the International AIDS Society Dr. Pedro Cahn called the Gambian president’s claims “shocking and irresponsible” 5, not only for providing false hope, but also for risking people’s lives by taking them off potent combination antiretroviral therapy.

Good news came to South Africa in March when the government finally developed an ambitious and comprehensive plan to try and tackle the epidemic after years of inaction. Headed up by the deputy president, Phumzile Mlambo-Ngcuka, and the deputy health minister Nozizwe Madlala-Routledge, the plan aimed to try and reduce the number of new infections by fifty percent, and bring treatment care and support to at least eighty percent of all HIV-positive people and their families. 6The new plan was welcomed by national and international health experts, although it was made clear that in order for the new goals to be realised there needed to be a fast track restructuring of the health care system.

Also that month came the first publication by the World Health Organisation (WHO) and the Joint UN Programme on HIV/AIDS (UNAIDS) regarding recommendations on circumcision and HIV. The guidance came three months after trials in Uganda and Kenya provided conclusive evidence that circumcision reduces the risk of transmission from women to men by around 50-60%. The publication stressed that men should be taught that circumcision provides only partial protection against HIV, to prevent them developing a false sense of security, and should only be provided as part of a comprehensive HIV prevention package. It also stressed that well-trained practitioners working in sanitary conditions should perform the procedure only after obtaining informed consent. 7

In April, it was revealed by the WHO that at the end of 2006 two million HIV-positive people in low- and middle-income countries were accessing antiretroviral treatment. This means that around 28% of those in need of the life-saving drugs were receiving them. The speed of expansion remained too slow to meet the global AIDS treatment targets agreed by the G8 summit. 8

By June the G8 had revised its universal treatment pledge to give every person in need of HIV treatment access by 2010. Instead, it proposed a new weaker target stating that the G8 would, “over the next few years” aim to ensure access for “approximately five million people”. 9The weakening of the original G8 pledge caused anger, as it was felt that a commitment had been broken which had been at the very heart of the fight against AIDS for the past two years. 10Although it was acknowledged that universal treatment by 2010 was more idealistic than feasible, many people believed that having such a demanding target put pressure on country governments to get as many people as possible into treatment programmes and highlighted the scale and urgency of the task.

In July, it was revealed that new methods of sampling led to a massive reduction in the estimated number of people living with HIV in India. Previous estimates had suggested that there were around 5.7 million people living with HIV in India, giving it the largest HIV caseload in the world. The new figures suggested that the actual total was somewhere between 2 and 3.1 million people - around 60% lower than the original estimate - and placed India third after South Africa and Nigeria for countries with the highest HIV infected populations. The previously inflated HIV numbers for India were due to figures being obtained in areas of particularly high HIV prevalence and taken from samples from surveillance sites visited mainly by pregnant women, injecting drug users and prostitutes. 11

“Today we have a far more reliable estimate of the burden of HIV in India,” said the Indian Health Minister, Anbumani Ramadoss. He did however warn of complacency, as “in terms of human lives affected, the numbers are still large, in fact very large.” 12

Later in July, there were reports of counterfeit antiretroviral drugs (ARVs) flooding the market in Zimbabwe, potentially putting many lives at risk. The adverse economic and political conditions in Zimbabwe meant that supplies of government-funded ARVs dried up in many parts of the country, leaving those with HIV at serious risk of developing AIDS. This left the door open for dealers to sell fake or illegally obtained pills to HIV positive people desperate to maintain their health. A spokesperson for the Medicines Control Authority of Zimbabwe (MCAZ) said “Such medicines may be counterfeited, adulterated and contaminated, thus rendering them ineffective and sometimes dangerous.” 13

As July drew to a close so to did the eight-year ordeal of the six Bulgarian medics facing the death sentence in Libya for allegedly infecting hundreds of children with HIV. They had always denied the claim, saying their confessions were extracted under torture. Expert evidence from various scientists claimed that the infections began long before the medics had arrived in the country, and that they were due to poor hygiene and the reuse of equipment and needles. 14The Libyan authorities finally agreed to release the medics to spend the rest of their sentences in Bulgaria, but on arrival, they were pardoned by the Bulgarian President and returned home to their friends and families. 15

Protest in South Africa against the sacking of the Deputy Health MinisterOptimism regarding South Africa’s response to the AIDS crisis was short lived after it was announced in August that the Deputy Health Minister Nozizwe Madlala-Routledge had been fired. After years of denial and inaction in the country it was felt that Madlala-Routledge was a government member who finally recognised the seriousness of the epidemic and was determined to take effective action. The official reason for Madlala-Routledge’s dismissal was cited as her inappropriate labelling of infant deaths at Frere Hospital as ‘a national emergency’ and accusations of her attendance at an AIDS conference in Spain without the President’s permission. But it was felt that the underlying motive for her dismissal was her ongoing conflict with Tshabalala-Msimang, the Health Minister, and in particular their contrasting opinions on how to confront AIDS. 16

It was revealed that the African nation of Botswana had managed to dramatically reduce rates of mother to child HIV transmission. Botswana, with one of the highest HIV prevalence rates in the world, set up a comprehensive treatment and care programme, to ensure that all women were being tested for HIV in pregnancy and offered appropriate drugs to prevent HIV being passed to their babies. Without intervention, around one in three babies born to HIV positive mothers will become infected with HIV themselves; but by implementing this programme, Botswana successfully cut the mother-to-child transmission rate to under 4%. 17

In August, the U.S. Food and Drug Administration (FDA) granted accelerated approval to the new HIV drugs maraviroc (Selzentry) and raltegravir (Isentress). These two new drugs offered hope to patients infected with virus strains resistant to almost all other classes of drugs designed to fight AIDS.

In October, it was revealed that hundreds of South Africans who had been involved in an AIDS vaccine trial might have an increased risk of HIV infection as a result. The trial, which was being conducted by the Merck pharmaceutical company, had been halted in the previous month after initial results showed the vaccine to be ineffective, an outcome that was described by leading vaccine researcher Dr. Gary Nabel as “a big blow to the field.” 18It was revealed that the infection rate was higher among people who received the vaccine than among those given a placebo. Experts said the vaccine itself could not have caused HIV infection, but it may have increased the risk of transmission by affecting immune responses. 19

The biographer of Thabo Mbeki revealed in November that the South African President remained unconvinced that HIV caused AIDS. Mbeki had previously stepped back from the AIDS debate in South Africa in 2000 after causing much controversy. 20

2008 History

At the beginning of 2008 the Swiss Federal Commission for HIV/AIDS published the findings of four studies, showing that people living with HIV who take effective antiretroviral therapy cannot pass on the virus through unprotected sex, as long as they adhere to the drugs, have an undetectable viral load for at least six months, and have no other sexually transmitted infections. It was not possible to prove conclusively that transmission is impossible, however the commission reported that scientific evidence showed the risk to be “negligibly small”. 21

The Swiss statement was met by immediate controversy, with questions over the reliability of its conclusions coming from HIV/AIDS advocacy groups as well as scientists. Concerns focused on the fact that the research was based solely on heterosexual couples and therefore neglected to include anal sex 22. UNAIDS and the WHO quickly issued a statement stressing that consistent use of condoms was still the safest protection against HIV. 23

Michel Sidibé, the Executive Director of UNAIDSIn April, the Executive Director of UNAIDS, Peter Piot, announced that he would be stepping down at the end of the year. An editorial in The Lancet praised Piot for having “raised the profile of HIV/AIDS so successfully that the epidemic has remained a high priority on health, political and security agendas". 24Later in the year it was announced that Michel Sidibé would be Piot’s successor. 25

In June, a team of scientists in South Africa were tried and found guilty by a South African court for conducting unauthorised medical trials and selling unregistered vitamin supplements as a treatment for AIDS. One of the supervisors of the illegal trials, Matthias Rath, was already widely criticised for his promotion of vitamins as a substitute for antiretroviral drugs. The South African court halted the medical trials and banned Rath from advertising his natural AIDS remedies. It also highlighted the responsibility of the South African government and its failure in not preventing Rath from distributing his products. 26

The American PEPFAR funding program was renewed on 30th July, committing $48 billion to HIV/AIDS, malaria and tuberculosis for fiscal years 2009-2013. 27This was triple the amount of money that the fund had distributed in its initial five years, and was commended by international HIV/AIDS activists and organisations. However, they stressed that the bill only authorised the expenditure and the money would still need to be appropriated each year. 28

The Reauthorization Act 29also repealed a policy that had received substantial criticism: the requirement that one third of funding be spent exclusively on the promotion of sexual abstinence. However, it was replaced with a ‘reporting requirement’ for recipients who spend less than 50 percent of prevention funds on abstinence-only programmes. It was argued that this perpetuated bias in PEPFAR spending.

The political and economic climate in Zimbabwe worsened dramatically in 2008, exacerbating an already severe AIDS epidemic. A cholera outbreak that began in August was so critical that by December, UK Prime Minister Gordon Brown was describing the crisis as an “international emergency”. 30The effect of the outbreak on people living with HIV and AIDS was compounded by the collapse of the health system, the government’s block on foreign aid, and widespread malnutrition, leading to an equally devastating AIDS crisis. 31 32

Medicines Sans Frontiers (MSF) estimated that in Bulawayo (the second largest city in Zimbabwe) there were 2,500 patients still waiting to receive antiretroviral drugs by the end of 2008. Even those who were able to access drugs were put at risk by the widespread lack of food, with 2008 producing the worst harvest Zimbabwe had experienced since the country gained independence in 1980. 33The government’s decision to ban most international aid groups, which was imposed at the beginning of June and lasted throughout July and August, exacerbated food and drug shortages farther. MSF called for an urgent increase in the humanitarian response to the crisis, and stressed the importance of HIV and AIDS being a prominent part of this response 34

The seventeenth International AIDS Conference took place in Mexico City in August. For the first time in the history of the Conference, 2008 saw the use of ‘conference hubs’: a network of locations around the world where conference sessions were screened and accompanied by moderated discussion. The ‘hubs’ were considered very successful in widening the reach of the conference. 35

In the same month, UNAIDS published its 2008 report on the global AIDS epidemic. The report warned that with 2010 only two years away, the target of universal access by 2010 would be unattainable unless the global response to HIV was substantially strengthened and accelerated. However it also emphasised that signs of major progress in the HIV response were being seen for the first time in 2008.

“The 2008 Report on the global AIDS epidemic confirms that the world is, at last, making some real progress in its response to AIDS.”Peter Piot, Executive Director of UNAIDS

Describing a "stabilization of the global epidemic", the report estimated that by the end of 2007 there were 33 million people living with HIV worldwide (down from the 39.5 million estimate made at the end of 2006). Although much of the reduction was attributed to better surveillance techniques in many countries, it also reflected the drop in HIV prevalence in certain areas, including sub-Saharan Africa. The report estimated that the annual number of AIDS deaths had declined from 2.2 million in 2005 to 2 million in 2007, reflecting an increase in the number of people receiving antiretroviral drugs. 36 Dr. Robert Gallo

In September, the resignation of president Thabo Mbeki was welcomed as a potential turning point in the controversial history of HIV and AIDS in South Africa. A Harvard study published shortly after asserted that more than 330,000 lives were lost between 2000 and 2005 as a direct result of the South African government’s failures in the provision of antiretroviral drugs. 37The decision of interim president Kgalema Motlanthe to immediately appoint a new health minister, Barbara Hogan, was celebrated by AIDS activists as a sign of a new commitment to the AIDS response. 38 39

An old controversy was revived in October with the announcement of the winners of the Nobel Prize for medicine. The prize was split between Françoise Barré-Sinoussi and Luc Montagnier of the Pasteur Institute in Paris for their discovery of HIV, and a third scientist for his work on a separate disease. The decision not to credit American researcher Robert Gallo for his contribution to early work on AIDS resurrected a bitter dispute over who claimed rights to the discovery. In awarding the prize, the chair of the Nobel committee, Professor Bertil Fredholm, stated:

"I think it is really well established that the initial discovery of the virus was in the Institute Pasteur." 40

In November, German haematologist Gero Huetter announced that he had cured a man of HIV through a bone marrow transplant from a donor who had a genetic resistance to the virus. Huetter spoke at a press conference in Berlin stating that the patient, who was taken off antiretroviral drugs after the transplant two years before, continued to show no traces of the virus, leading doctors to declare him “functionally cured”. 41However, it was generally accepted that the operation did not present a viable HIV cure. Researchers cautioned that further testing was needed to ensure that the virus had been completely eradicated and not just suppressed to very low levels or become latent. 42

Also in November, Barack Obama was elected President of the United States of America. As part of his election campaign, Obama released a plan to combat global HIV and AIDS promising a move away from ideology and a greater focus on “best practice” in America’s HIV/AIDS strategy. 43At home, Obama committed to implementing a comprehensive national strategy on HIV and AIDS in America in his first year, and to signing universal health care legislation by the end of his first term. In terms of America’s response to HIV and AIDS overseas, Obama pledged that he would substantially increase funding to both PEPFAR and the Global Fund. 44However, commentators questioned the likelihood of this pledge being followed through in the context of an unfolding international financial crisis.

Obama also openly supported lifting the ban on states using federal funding for needle exchange programmes 45and pledged to overturn the controversial policy banning funding to international organisations that perform or promote abortion (known as the global gag rule). As the year drew to a close, HIV/AIDS advocacy groups and commentators expressed high expectations for the future of America's response to the AIDS epidemic under Obama. However there was emphasis on the need to maintain pressure to ensure that campaign promises are followed through. 46

2009 History

In January the long standing UNAIDS Executive Director, Peter Piot, stood down from his post to be replaced by Michel Sidibé. Sidibé began with the promise...

“I will do everything in my power to bring around an AIDS reversal – where less people become infected than are put on treatment.” 47

The beginning of the year also saw the HIV/AIDS crisis worsen in Zimbabwe with 400 people dying a day from AIDS, 48the closure of two of the largest hospitals in Harare, 49and a black market for ARVs springing up. 50Later in the year Zimbabwe was granted $37.9 million by the Global Fund for its fight against HIV/AIDS, TB and Malaria, to be administered by the UN. 51

In January, newly elected President Obama took the opportunity to announce the reversion of the global gag rule, legislation first brought under Ronald Reagan that had impeded funds from going to organisations which provide services linked with abortion. 52This accompanied a promise to lift the U.S’ travel ban, which had, for 22 years, prevented people with HIV/AIDS from entering the U.S. The lifting of the ban was finally announced in October when Obama formally declared it would take effect after a routine 60-day waiting period. 53

February brought the news that a microbicide trial had not proved as effective as hoped, with the results from the PRO 2000 trial shown to be not statistically significant. 54 55

Barack ObamaIn March a report from the Washington DC Health Department revealed that Washington DC had a higher rate of HIV than West Africa with 3 percent prevalence - enough to describe it as a ‘severe and generalised epidemic.’ 56

Also in March the Pope warned against condom use, stating that condoms actually ‘increase’ the problem of AIDS. He called the HIV/AIDS epidemic...

"A tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which even aggravates the problems". 57

The Pope’s comments elicited criticism from several EU states and the World Health Organization who responded that such a message was not only incorrect but dangerous. The Dutch Development Minister said it was "extremely harmful and very serious" that the Pope was "forbidding people from protecting themselves". 58

Anti-discrimination legislation received a boost in India in July as the high court overturned section 377 of India's Penal Code which had banned homosexuality. 59This 150-year-old law had stigmatised a marginalised group in Indian society, making it difficult for men who have sex with men to access HIV prevention, treatment and care.

In August researchers in North Carolina announced that they had mapped the entire genome of HIV-1. One of the researchers stated, “We are beginning to understand tricks the genome uses to help the virus escape detection by human host.” 60

September saw renewed, but short-lived hope that an ‘ AIDS vaccine’ may not be far off. The United States military, in partnership with researchers in Thailand released results from a trial which tested a combination of two vaccines dubbed ‘RV144’. The trial, with 16,000 participants, was the largest ever conducted. 61The preliminary analysis of the results claimed to provide a 33% chance of protection against HIV. However, closer investigation of the data revealed that the supposed effectiveness was actually lower (26%) and could have been due to chance. 62The leaders of the study were criticised for not revealing both sets of data at the same time and therefore misleading the general public and scientific community.

Also in September, a report from UNAIDS and the WHO showed an increase in those receiving HIV treatment, with a 36% increase in access to ARVs for those living with HIV in just one year. The most progress was seen in sub-Saharan Africa. In addition, the report showed that in 2009 ‘approximately 45% of HIV positive pregnant women are receiving ARVS when only 35% had access in 2007.’ 63However the report also contained a note of caution. In particular, it highlighted the possibility that an increased funding gap as a result of the recession in 2009 could jeopardise access to life-prolonging drugs.

In November, UNAIDS published its annual Epidemic Update stating that the decade had seen a significant decline in new HIV infections. The number of new infections had dropped by 17% since 2001, and thanks to the increased availability of HIV drugs, deaths had declined by 10% over the past five years. Some of the most encouraging signs came from sub-Saharan Africa where 400,000 fewer people were infected in 2008 than at the start of the decade. East Asia also saw a dramatic 25% decrease in annual infections between 2001 and 2008. 64

The UNAIDS report coincided with a publication by Médecins Sans Frontières, which praised the scale up of treatment and prevention worldwide and the achievements of the recent past, but cautioned that the ‘crisis is not over.’ 65 The report pointed to ‘worrying sings of waning international support.’ In particular, it highlighted the Global Fund’s struggle to keep up funding, with Executive Director Michel Kazatchkine saying ‘for the first time, the demand for funds in 2009 has exceeded the funds we have available’. 66

In December, the Ugandan Parliament were debating a much-publicised bill that aimed to criminalise homosexuality with the possibility of the death sentence for some offences committed by homosexuals, including having sex with a person below the age of 18, with a disabled or HIV positive person. 67

2010 History

The New Year coincided with a significant event in the United States of America’s HIV and AIDS history. From January 4th, HIV positive individuals travelling to the country would no longer be denied entry based on their status – legislation that had been in place since 1987. 68Following the commitment to remove the ban, it was decided that the 2012 International AIDS Conference would be held in Washington, D.C. 69The year 2010 would be a progressive one for the removal of travel bans, as South Korea, China and Namibia all lifted their restrictions. 70 71 72

Speaking at two conferences in February, Professor Brian Williams from the South African Centre for Epidemiological Modelling and Analysis suggested that using antiretroviral treatment to stop HIV transmission could “eliminate HIV transmission in five to ten years and HIV infection in 40 years.” 73 His presentations were reported across the world and the idea of using HIV treatment as prevention gained momentum as the year progressed.

In July the World Health Organization (WHO) released its revised editions of the antiretroviral treatment guidelines for adults and adolescents and the treatment guidelines for preventing mother-to-child transmission of HIV. 74 75 A key change in the guidelines for adults and adolescents was the earlier initiation of antiretroviral therapy for people living with HIV. The previous version of the guidelines (2006) recommended treatment initiation at a CD4 count of 200 cells/mm3, whereas the updated guidelines recommended treatment initiation at ≤350 cells/mm3 (or those with WHO clinical stage 3 or 4 if CD4 testing was unavailable). The recommendation was based on evidence that showed starting treatment earlier slowed disease progression and reduced the risk of HIV transmission. The new guidelines would significantly increase the global number of people in need of antiretroviral treatment.

Red ribbon on the Parliament building in Vienna, AustriaThe biannual International AIDS Conference was held in Vienna in July. The theme of the conference, ‘Rights Here, Rights Now’, highlighted the need for the protection of human rights for an effective response to the global AIDS epidemic.

Results from CAPRISA 004, a microbicide trial, were hailed as the highlight of the conference. The Phase IIb trial assessed the safety and effectiveness of an antiretroviral-based gel in 900 HIV-negative, sexually active women in South Africa. The results were statistically significant, with the gel reducing the risk of HIV acquisition by almost 40 percent overall. 76

“This is an astonishing scientific achievement and a great boost to the microbicide field. At the same time, the results are complicated, and we will need to work hard to make sure that women and their partners understand what these results do and do not mean for the immediate future and in the long-term” Mitchell Warren, AVAC Executive Director 77

In September WHO, UNAIDS and UNICEF published the annual Universal Access report for low- and middle-income countries, which showed an estimated 5.25 million people were receiving antiretroviral therapy in 2009. 78 An estimated 1.2 million people started treatment in 2009, the largest increase in one year. 79 80However, due to WHO’s revised treatment threshold of 350 cells/mm3, the number of people needing treatment increased from 10 million to an estimated 15 million. 81

UNAIDS reported a continued decline in new HIV infections and AIDS-related deaths in their biannual report on the global AIDS epidemic, published in November. 82According to the report, since the spread of HIV had finally been halted and reversed, the challenge was to see how quickly the global response could end the epidemic.

“This new fourth decade of the epidemic should be one of moving towards efficient, focused and scaled-up programmes to accelerate progress for Results. Results. Results.” Michel Sidibé, UNAIDS Executive Director 83

In November Pope Benedict spoke about condom use, more than a year after his previous controversial comments about HIV and condoms. In a book based on a series of interviews, the Pope said condoms could be used in certain circumstances where there is a real risk to the lives of others. The Pope's comments were the subject of considerable interpretation. The Vatican was quick to clarify the Pope’s remarks, stating, “…the Holy Father was talking neither about conjugal morality nor about the moral norm concerning contraception”, but “…those involved in prostitution who are HIV positive and who seek to diminish the risk of contagion by the use of a condom”. 84The statement also reiterated the Catholic Church’s stance on prostitution: “The practice of prostitution should be shunned, and it is the duty of the agencies of the Church, of civil society and of the State to do all they can to liberate those involved from this practice”.

The year ended with another success story in HIV prevention. Researchers from a large-scale Phase III pre-exposure prophylaxis (PrEP) trial revealed there had been a 44 percent reduction in HIV infection risk among HIV-negative participants taking a daily dose of antiretroviral drugs compared to those taking a placebo. 85The iPrEX trial, which recruited men who have sex with men in six countries, was the first to prove the concept of PrEP for HIV infection could work.


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