Hiv History upto 1983

Up to 1980

We do not know how many people developed AIDS in the 1970s, or indeed in the years before.

"The dominant feature of this first period was silence, for the human immunodeficiency virus (HIV) was unknown and transmission was not accompanied by signs or symptoms salient enough to be noticed. While rare, sporadic case reports of AIDS and sero-archaeological studies have documented human infections with HIV prior to 1970, available data suggest that the current pandemic started in the mid- to late 1970s. By 1980, HIV had spread to at least five continents (North America, South America, Europe, Africa and Australia). During this period of silence, spread was unchecked by awareness or any preventive action and approximately 100,000-300,000 persons may have been infected."Jonathan Mann¹

We also do not know for certain where the AIDS virus HIV originated, but it is now generally accepted that the origin of AIDS can be traced back to Africa.

1981 History

Kaposi's Sarcoma (KS) was a rare form of relatively benign cancer that tended to occur in older people. But by March 1981 at least eight cases of a more aggressive form of KS had occurred amongst young gay men in New York.

At about the same time there was an increase, in both California and New York, in the number of cases of a rare lung infection Pneumocystis carinii pneumonia (PCP).³ In April this increase in PCP was noticed at the Centers for Disease Control (CDC) in Atlanta. A drug technician, Sandra Ford, observed a high number of requests for the drug pentamine, used in the treatment of PCP:

"A doctor was treating a gay man in his 20s who had pneumonia. Two weeks later, he called to ask for a refill of a rare drug that I handled. This was unusual - nobody ever asked for a refill. Patients usually were cured in one 10-day treatment or they died"Sandra Ford for Newsweek

In June, the CDC published a report about the occurrence, without identifiable cause, of PCP in five men in Los Angeles.⁵ This report is sometimes referred to as the "beginning" of AIDS, but it might be more accurate to describe it as the beginning of the general awareness of AIDS in the USA.

A few days later, following these reports of PCP and other rare life-threatening opportunistic infections, the CDC formed a Task Force on Kaposi's Sarcoma and Opportunistic Infections (KSOI).

Dr. Conant and Dr Volverg discussing Kaposi's Sarcoma. Circa 1981

Around this time a number of theories emerged about the possible cause of these opportunistic infections and cancers. Early theories included infection with cytomegalovirus, the use of amyl nitrite or butyl nitrate 'poppers', and 'immune overload'.

Because there was so little known about the transmission of what seemed to be a new disease, there was concern about contagion, and whether the disease could by passed on by people who had no apparent signs or symptoms.¹⁰ Knowledge about the disease was changing so quickly that certain assumptions made at this time were shown to be unfounded just a few months later. For example, in July 1981 Dr Curran of the CDC was reported as follows:

"Dr. Curran said there was no apparent danger to non homosexuals from contagion. 'The best evidence against contagion', he said, 'is that no cases have been reported to date outside the homosexual community or in women'"The New York Times

Just five months later, in December 1981, it was clear that the disease affected other population groups, when the first cases of PCP were reported in injecting drug users. At the same time the first case of AIDS was documented in the UK.

1982 History

As the disease still did not have a name, organisations were referring to it in different ways. The CDC generally referred to it by reference to the diseases that were occurring, for example lymphadenopathy (swollen glands), although on some occasions they referred to it as KSOI, the name already given to the CDC task force.

In contrast some still linked the disease to its initial occurrence in gay men, with a letter in The Lancet calling it "gay compromise syndrome". Others called it GRID (gay-related immune deficiency), AID (acquired immunodeficiency disease), "gay cancer" or "community-acquired immune dysfunction".

In June a report of a group of cases amongst gay men in Southern California suggested that the disease might be caused by an infectious agent that was sexually transmitted.

By the beginning of July a total of 452 cases, from 23 states, had been reported to the CDC.

Later that month the first reports appeared that the disease was occurring in Haitians, as well as haemophiliacs. This news soon led to speculation that the epidemic might have originated in Haiti, and caused some parents to withdraw their children from haemophiliac camps.

The occurrence of the disease in non-homosexuals meant that names such as GRID were redundant. The acronym AIDS was suggested at a meeting in Washington, D.C., in July. By August this name was being used in newspapers and scientific journals.    AIDS (Acquired Immune Deficiency Syndrome) was first properly defined by the CDC in September.

By the beginning of July a total of 452 cases, from 23 states, had been reported to the CDC.

An anagram of AIDS, SIDA, was created for use in French and Spanish. Doctors thought AIDS was an appropriate name because people acquired the condition rather than inherited it; because it resulted in a deficiency within the immune system; and because it was a syndrome, with a number of manifestations, rather than a single disease.

Still very little was known about transmission and public anxiety continued to grow.

"It is frightening because no one knows what's causing it, said a 28-year old law student who went to the St. Mark's Clinic in Greenwich Village last week complaining of swollen glands, thought to be one early symptom of the disease. Every week a new theory comes out about how you're going to spread it."The New York Times 

By 1982 a number of AIDS specific voluntary organisations had been set up in the USA. They included the San Francisco AIDS Foundation (SFAF), AIDS Project Los Angeles (APLA), and Gay Men's Health Crisis (GMHC).In November 1982 the first AIDS organisation, the Terry Higgins Trust (later known as the Terrence Higgins Trust), was formally established in the UK, and by this time a number of AIDS organisations were already producing safer sex advice for gay men.

In December a 20-month old child who had received multiple transfusions of blood and blood products died from infections related to AIDS.³⁴ This case provided clearer evidence that AIDS was caused by an infectious agent, and it also caused additional concerns about the safety of the blood supply. Also in December, the CDC reported the first cases of possible mother to child transmission of AIDS.

By the end of 1982 many more people were taking notice of this new disease, as it was clearer that a much wider group of people was going to be affected.

"When it began turning up in children and transfusion recipients, that was a turning point in terms of public perception. Up until then it was entirely a gay epidemic, and it was easy for the average person to say 'So what?' Now everyone could relate."Harold Jaffe of the CDC for newsweek 

It was also becoming clear that AIDS was not a disease that just occurred in the USA. Throughout 1982 there were separate reports of the disease occurring in a number of European countries.

Meanwhile in Uganda, doctors were seeing the first cases of a new, fatal wasting disease. This illness soon became known locally as 'slim'.

1983 History

In January, reports of AIDS among women with no other risk factors suggested the disease might be passed on through heterosexual.

At about the same time the CDC convened a meeting to consider how the transmission of AIDS could be prevented, and in particular to consider the newly emerged evidence that AIDS might be spread through blood clotting factor and through blood transfusions. As James Curran, the head of the CDC task force, said:

"The sense of urgency is greatest for haemophiliacs. The risk for others [who receive blood products] now appears small, but is unknown.”

The risk for haemophiliacs was so great because the blood concentrate that some haemophiliacs used exposed them to the blood of up to 5,000 individual blood donors.

In March, the CDC stated that,

"persons who may be considered at increased risk of AIDS include those with symptoms and signs suggestive of AIDS; sexual partners of AIDS patients; sexually active homosexual or bisexual men with multiple partners; Haitian entrants to the United States; present or past abusers of IV drugs; patients with haemophilia; and sexual partners of individuals at increased risk for AIDS."

The same report also said,

"each group contains many persons who probably have little risk of acquiring AIDS... Very little is known about risk factors for Haitians with AIDS."

Nevertheless, the inclusion of Haitians as a risk group caused much controversy. Haitian Americans complained of stigmatisation, officials accused the CDC of racism, and Haiti suffered a serious blow to its tourism industry. Before long people were talking colloquially of a "4-H Club" at risk of AIDS: homosexuals, haemophiliacs, heroin addicts and Haitians. Some people substituted 'hookers' for haemophiliacs.

In May 1983, doctors at the Institute Pasteur in France reported that they had isolated a new virus, which they suggested might be the cause of AIDS.

In the UK there were public concerns about the blood supply with references in newspapers to "killer blood". The media more generally started to take notice of AIDS, with the screening of a TV Horizon programme, "The Killer in the Village", and a number of newspaper articles on the subject of the "gay plague".

In May 1983, doctors at the Institute Pasteur in France reported that they had isolated a new virus, which they suggested might be the cause of AIDS. Little notice was taken of this announcement at the time, but a sample of the virus was sent to the CDC. A few months later the virus was named lymphadenopathy-associated virus or LAV, patents were applied for, and a sample of LAV was sent to the National Cancer Institute.

But whilst progress was being made by scientists there was increasing concern about transmission, and not just in relation to the blood supply. A report of AIDS occurring in children suggested quite incorrectly the possibility of casual household transmission.

AIDS transmission became a major issue in San Francisco, where the Police Department equipped patrol officers with special masks and gloves for use when dealing with what the police called "a suspected AIDS patient"
.

"The officers were concerned that they could bring the bug home and their whole family could get AIDS."The New York Times

And in New York:

"landlords have evicted individuals with AIDS" and "the Social Security Administration is interviewing patients by phone rather than face to face."Dr David Spencer, Commisioner of Health, New York City

There was considerable fear about AIDS in many other countries as well:

"In many parts of the world there is anxiety, bafflement, a sense that something has to be done - although no one knows what."The New York Times

As anxiety continued, the CDC tried to provide reassurance that children with AIDS had probably acquired it from their mothers and that casual transmission did not occur:

"The cause of AIDS is unknown, but it seems most likely to be caused by an agent transmitted by intimate sexual contact, through contaminated needles, or, less commonly, by percutaneous inoculation of infectious blood or blood products. No evidence suggests transmission of AIDS by airborne spread. The failure to identify cases among friends relatives, and co-workers of AIDS patients provides further evidence that casual contact offers little or no risk [...] the occurrence in young infants suggests transmission from an affected mother to a susceptible infant before, during, or shortly after birth."

Reports from Europe suggested that two rather separate AIDS epidemics were occurring. In the UK, West Germany and Denmark, the majority of people with AIDS were homosexual, and many had a history of sex with American nationals. However in France and Belgium AIDS was occurring mainly in people from Central Africa or those with links to the area.

Examples of this second epidemic included a number of previously healthy African patients who were hospitalised in Belgium with opportunistic infections (such as PCP and cryptosporidosis), Kaposi's sarcoma, or other AIDS-like illnesses. All of these Africans had immune deficiency similar to that of American AIDS patients. However they had no history of blood transfusion, homosexuality, or intravenous drug use. In light of such reports, European and American scientists set out to discover more about the occurrence of AIDS in Central Africa.

By this time, doctors working in parts of Zambia and Zaire had already noticed the emergence of a very aggressive form of Kaposi's sarcoma. This cancer was endemic in Central Africa, but previously it had progressed very slowly and responded well to treatment, whereas the new cases looked very different and were often fatal.

In September the CDC published their first set of recommended precautions for health-care workers and allied professionals designed to prevent "AIDS transmission". In the UK, people who might be particularly susceptible to AIDS were asked not to donate blood.

In October, the first European World Health Organisation (WHO) meeting was held in Denmark. At the meeting it was reported that there had been 2,803 AIDS cases in the USA.

That meeting was followed in November by the first meeting to assess the global AIDS situation. This was the start of global surveillance by the WHO and it was reported that AIDS was present in the U.S.A., Canada, fifteen European countries, Haiti and Zaire as well as in seven Latin American countries. There were also cases reported from Australia and two suspected cases in Japan.

By the end of the year the number of AIDS cases in the USA had risen to 3,064 and of these 1,292 had died.